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无痛分娩因“产妇坠楼”再受关注 国内谁在“阻碍”它?

2017-09-14 13:06:23   中国青年网

截至2017年9月9日,该项目已在中国80家医院开展活动,其中77%的医院椎管内分娩镇痛率达到50%以上,南京市妇幼保健院甚至高达95%。

无痛分娩,在医学上被称为“分娩镇痛”,主要包括非药物性和药物性分娩镇痛法两大类。“非药物镇痛方式如拉玛泽呼吸法,药物镇痛方式如肌肉注射杜冷丁、吸入笑气以及腰硬联合麻醉法和硬膜外麻醉法。”北京和睦家医院麻醉科主任刘薇医生说,腰硬联合和硬膜外麻醉法是效果最确切、使用最广泛的方法,它的原理是通过在产妇后背的硬膜外腔进行麻药输注,短暂地部分阻断了疼痛的神经传导,镇痛有效率达95%以上。

“有些人完全无痛,有些人还是有痛感,这与个人体质差异、麻醉师技术水平都有关系。”知名产科医生、上海市第一妇婴保健院段涛教授补充道。

在网络上,能发现大量关于“无痛分娩是不是骗人的”“中国的无痛分娩和国外的是一样的吗”等提问,而一些产妇还可能遭遇了“假无痛分娩”。

家在重庆的小琳被医院推销自费1700元购买了一种分娩止痛仪,但事实上对减轻产痛毫无效果。还有一些产妇产程过半才使用椎管麻醉,只能“减轻一半的疼痛感”。

尽管很多人至今不了解这一技术,但我国无痛分娩的历史可追溯到半个多世纪之前。

胡灵群告诉南方周末记者,早在1952年,山东省就成立了“无痛分娩法推行委员会”。此后几十年间,业界多有研究。而大量临床应用则始于1990年代后期。1997年10月,北京协和医院麻醉科叶铁虎医师,帮助当时中美合资的和睦家医院开展了分娩镇痛。之后,南京、上海、广州等地陆续开展临床试验,“取得了不错的效果,但大多半途而废”。

一个被广泛传播的数据是:85%的美国产妇分娩时做到分娩镇痛,英国更高达98%。中国的数据是多少,这个数字在既有公开材料里说法不一。

早在2002年北京大学第一医院曲元医生等的论文中,就提到“我国的分娩镇痛率不足1%”,媒体报道沿用这一数据,多年未有更新。2015年,国家卫计委在“快乐产房,舒适分娩”项目启动会上提到,我国无痛分娩率尚不足10%。

“为什么1964年就能做的、无需高昂设备的、产妇急需的医疗服务,在中国发展不了呢?”胡灵群问。

产痛“天经地义”?

胡灵群发现,无痛分娩在欧美推广无阻的同时,中国产妇的分娩疼痛却直接加剧了她们提出剖宫产的诉求。根据国家卫计委统计,2013年中国剖宫产率为46%,2014年为34.9%,仍处于偏高水平,远超世卫组织推荐的15%。

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