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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

事实上,他希望通过无痛分娩的推广,产科麻醉的发展,开展成为了世界围产医学主流的团队医学,全面提升母婴安全。

分娩过程蕴含着许多无法预期的风险,常见的,譬如胎儿宫内窘迫或是产妇的大出血,《国际妇产科学期刊》在一篇评论中曾指出,分娩急救是「安全孕产拱门上的拱心石」。在美国的麻醉学界,硬膜外镇痛管被认为是「预见性医疗」的一个范例——全身麻醉下做剖宫产的产妇死亡可能性大,而如果预先放置这根「保命管」,产妇的安全性也就有了更多的保障。

在紧急情况下,尽快将胎儿娩出的即刻剖宫产,高危病人(例如二胎瘢痕子宫阴道试产)没有麻醉医生的保驾护航,有需要尽量避免剖宫产简直难以想象。美国的保险公司甚至强行规定,产妇必须在有麻醉医生24小时驻守的产房,才并需要分娩镇痛,才允许进行(剖宫产后)瘢痕子宫阴道试产。

源于分娩镇痛,致力于母婴安全的产科麻醉,始于对女性的关怀,最终让母婴安全提高到全新的水平。

如果仅仅将产科麻醉定位于分娩镇痛,仅仅着眼于降低无医学指征的剖宫产率,这是远远不够的。

在中国,这一点尤其有现实意义。这里昔年曾有46.2%的剖宫产率,二胎政策后,那批女性又一次成了孕产妇的一个重要组成部分,发展产科麻醉,开展团队医疗,普及现代产房对二胎全面开放的今天,尤其有现实意义。

5,减少女性的痛苦不划算?

对于大部分中国产妇而言,「无痛」还往往是可遇而不可求的稀罕事儿。目前的中国,「无痛分娩」通常被作为一种「奢侈品」而非基本医疗需求,只有极少数的地区,比如珠三角,把这项技术列入了医保范围,在某些地区,无痛分娩甚至尚未列入收费目录。

而对医院而言,它需要增加对麻醉医生和产房的投入,可又不在国家发改委的定价标准里,于是,从医院财务角度来看,分娩镇痛似乎成了一项不划算的投入。

「产妇对分娩最大的担心便是疼痛,作为一个管理者,如果从患者的角度来看,你就不会觉得不划算了。」上海市第一妇婴保健院的前院长段涛这样回答。

美国的妇产科学院发布于2004年的一份共识文件中写道:「分娩造成了大多数产妇剧烈的疼痛,在我们医生的眼皮底下让产妇经历如此剧烈的疼痛而不给予已被证实是安全有效的镇痛治疗是不人道的」。

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