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欧美国家无痛分娩比例高达80%以上 国内比例不足10%

2017-09-09 17:56:35   央广网

央广网北京9月9日消息(记者车丽)据中国之声《新闻晚高峰》报道,最近榆林产妇坠楼事件引发公众对“无痛分娩”的高度关注。分娩时的疼痛被认为是人类所经历的最强疼痛之一。有医学疼痛指数表明,产痛仅次于烧灼伤痛位居第二。但在我国推行了20年的“无痛分娩”却没有广泛普及。

事实上,“无痛分娩”技术有着近百年的历史,在欧美国家无痛分娩的比例高达80%以上,但在国内这个比例却不到10%。无痛分娩在我国为何难以普及,生育文明进程还有多远?

俗称的“无痛分娩”在医学上称为“分娩镇痛”,是使用各种方法使分娩时的疼痛减轻。通行的做法是由有经验的麻醉医师进行椎管内分娩镇痛,这可以让准妈妈们不再经历疼痛的折磨,减少分娩时的恐惧和产后的疲倦。北京和睦家医院麻醉科副主任杨路表示,这项技术有着近百年的历史,对母婴健康都是安全的。“我们用特别低浓度的局部麻醉药,基本对于产程的进展影响不大。我们担心药物对胎儿的影响,如果对胎儿有影响一定是吸收入血,但通过椎管内麻醉后,药物的作用点在神经,吸收入血的成分很低,药物再通过胎盘进入孩子体内更是微乎其微。从大样本回馈来看,对母亲和孩子都没有特别负面的影响。”

分娩疼痛是人类可感疼痛的最高值,然而长期以来分娩疼痛被认为是产妇理所应当经历的疼痛。“无痛分娩”技术则可以解决这一难题。那么,无痛分娩是否意味着“一点不疼”?杨路表示“分娩镇痛”是希望把严重的疼痛降到轻度至中度的疼痛,并非绝对无痛。“有个别病人觉得全程都不疼,但对于大部分人来说有疼痛的感觉,但可以耐受。对于绝大多数人分娩时是9分10分严重的疼痛,希望通过镇痛技术把疼痛降到4分3分以下,病人会觉得舒服很多。”

公开资料显示,在欧美国家无痛分娩的比例高达80%以上,但在我国这个比例却不到10%。中华医学会麻醉学分会产科麻醉学组副组长、南京市妇幼保健院麻醉科主任沈晓凤表示,近几年这个比例正在逐年增长,现在一些大型三甲医院、专科妇产医院的无痛分娩率已经达到50%左右,南京部分医院“分娩镇痛”率甚至高达95%,但是中西部基层医院的比例确实较低。“这个项目没有收费(标准),打的时候有的算自费、药品费或者耗材费,但管理中这个成本是零收费。如果在全国大面积开展,目前没有专项收费标准。在加上麻醉医生队伍本身很紧缺,不是说医务人员不愿做这件事,是耗人耗时耗精力又没有收费,大面积推广难在这里。”

目前全国有麻醉医生8.5万多名,缺口大约有30万人。目前我国很多综合医院承担的任务是普遍医疗救助,还没有提升到舒适医疗的水平。河南省妇幼保健医院暨郑州大学第三附属医院妇产科主任许雅娟说,分娩镇痛需要麻醉师24小时看护,麻醉科医生不足,也阻挡了这项技术广泛推广。“一是麻醉工作人员相对比较少,都集中在手术室可能就达不到产科需求时到位。二是技术的掌握的问题,不可能麻醉医师一下子就能够在全国性完全到位。”

分娩镇痛是减轻产妇分娩疼痛的重要手段,近年来逐步得到更多推广应用。中华医学会麻醉学分会产科麻醉学组副组长沈晓凤表示,推广镇痛分娩适宜技术,能使更多产妇收益,也将推动生育文明的进程。“最重要的第一步应该有分娩镇痛的专项收费,可能会有激励政策。媒体也要多宣传,有的合并症并发症与无痛分娩没有关系,但有的医生会担心会被人说‘看吧,是无痛做的’,再有医院管理层要加以重视。我相信,未来我们医疗行业会把这件事做好,让我们享受分娩得子的快乐。”

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