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我痛得快要死了,谁能帮帮我?

2017-09-07 14:10:41   瞭望智库

「我们只能尽可能的去个性化,但大多数可能做不到。」在这间产房,大约有60%~70%的产妇可以享受到无痛的服务,「除了禁忌症、产程进展过快,以及一些特殊的个人原因,基本上,只要有要求,我们就会给她们上」。

在黄绍强的办公室,我看到了那套被很多产妇形容为让人「从地狱到天堂」的硬膜外设备。

一个女士坤包似的小盒子,负责均匀地向产妇体内泵入麻药,一根细线连着一支可以按压的控制器,刚好握在手心,产妇在镇痛效果不足时按压便可额外泵入麻醉药物,增强麻醉效果,还有穿刺用的针管、透明的软管。操作时,产妇身体蜷成虾状,穿刺针穿过产妇腰部的脊椎孔,将一根细小的导管导入硬膜外腔——那是脊髓腔外的一个充满神经根的潜在腔隙。

白天,红房子医院的产房不是很繁忙——前一天的夜里,那里出生了5个婴儿。整个上午,待产床上只有零星几个产妇,安安静静的。这安静得益于无痛分娩的采用。

产房护士长的毛丽萍这样告诉我。这里的医护人员口袋里都揣着一张「疼痛程度数字估量表」,如果产妇达到了上面「中度疼痛,轻度影响睡眠」的3分以上,就可以进行分娩镇痛了。

无痛分娩会不会拉长产程,导致不得不转剖?红房子医院产房主任徐常恩的回答是并没有发现这一点。他反倒觉得上无痛可能让产妇宫口开得更快,「有时候,肚子一疼,人就容易无意识地往下用力气,力气用早了,宫颈血液回流就容易受阻,宫颈肿胀,开宫口就更难了。

打了无痛之后,放松了,宫口反倒会开得更快。目前,红房子医院的剖宫产率大约有35%,「剖宫产率的降低有各种原因,但如果没有无痛分娩,剖宫率想达到低于40%还是很难想象的」,徐常恩这样说。

在一项涉及不同国家、多家医院和37,000名产妇的调查中发现,有些医院的硬膜外镇痛率在短期内发生了5~10倍的增长率,但剖宫产率并没有随之增加。

另一项基于石家庄20,000余例和温州15,000余例两个大型产妇数据的研究发现,使用镇痛后,产钳的使用率没有发生变化,剖宫产率却是下降的。无痛分娩并没有增加产伤,反而由于母亲侧切率的急剧下降而减少了母亲的产伤。

除了镇痛,为每间产房配置一个24小时的麻醉医生,还是为了保障安全。胡灵群认为,产科里的麻醉医生就像ICU里的监护医生,产科医生负责与孕产相关的事宜,而麻醉医生负责管理产妇的疼痛,以及监护产妇的各项生命体征。

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