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国际护理学研究

International Journal of Nursing Research

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International Journal of Nursing Research. 2025; 7: (1) ; 10.12208/j.ijnr.20250008 .

Research progress on the application of non-pharmacological labor analgesia in obstetrics wards
非药物性分娩镇痛在产科病房的应用进展

作者: 何建珍, 张德华, 梁秋霞 *, 邓永芳

广州医科大学附属妇女儿童医疗中心 广州广东

*通讯作者: 梁秋霞,单位:广州医科大学附属妇女儿童医疗中心 广州广东;

引用本文: 何建珍, 张德华, 梁秋霞, 邓永芳 非药物性分娩镇痛在产科病房的应用进展[J]. 国际护理学研究, 2025; 7: (1) : 23-29.
Published: 2025/1/24 10:59:22

摘要

本综述研究综合评估了非药物性分娩镇痛在产科病房的应用进展,重点介绍了多种非药物性分娩镇痛方法,并探讨了它们在减轻产妇分娩疼痛、提升分娩体验方面的有效性。研究结果表明,非药物性分娩镇痛方法不仅能有效缓解产妇的疼痛,还能提高产妇的满意度和分娩体验,减少医疗干预,降低剖宫产率。本研究为产科病房在早期实施疼痛管理,开展非药物镇痛服务提供了参考,并指出了未来研究方向,如多模式联合镇痛、个性化镇痛方案、技术革新、规范化管理以及健康教育等。

关键词: 分娩疼痛;非药物性分娩镇痛;中医适宜技术;疼痛管理;综述文献

Abstract

This review study comprehensively evaluated the application progress of non-drug labor analgesia in obstetric wards, focusing on a variety of non-drug labor analgesia methods, and explored their effectiveness in reducing maternal labor pain and improving labor experience. The results showed that non-drug labor analgesia methods can not only effectively relieve maternal pain, but also improve maternal satisfaction and labor experience, reduce medical intervention, and reduce cesarean section rates. This study provides a reference for the early implementation of pain management and non-drug analgesia services in obstetric wards, and points out future research directions, such as multimodal combined analgesia, personalized analgesia plans, technological innovation, standardized management, and health education.

Key words: Labor pain; Non-drug labor analgesia; Appropriate Chinese medicine technology; Pain management; Review literature

参考文献 References

[1] Czech I, Fuchs P, Fuchs A, et al. Pharmacological and Non-Pharmacological Methods of Labour Pain  Relief-Establishment of Effectiveness and Comparison[J]. Int J Environ Res Public Health, 2018,15(12).

[2] Junge C, von Soest T, Weidner K, et al. Labor pain in women with and without severe fear of childbirth: A  population-based, longitudinal study[J]. Birth, 2018,45(4):469-477.

[3] 樊雪梅, 蒲丛珊, 张爱霞, 等. 孕产妇分娩心理创伤的研究进展[J]. 中华护理杂志, 2022,57(10):1256-1262.

[4] 戚芳, 黄绍强, 丁焱. 中国分娩镇痛服务的现状调查与分析[J]. 中国妇幼保健, 2019,34(09):1937-1941.

[5] 史明春, 樊雪梅, 侯静静, 等. 中医适宜技术在产妇分娩疼痛管理中的应用进展[J]. 护理学杂志, 2024,39(12):20-24.

[6] Chao A S, Chao A, Wang T H, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on  acupuncture points during the first stage of labor: a randomized double-blind  placebo-controlled trial[J]. Pain, 2007,127(3):214-220.

[7] UK N G A. Addendum to intrapartum care: care for healthy women and babies[M]. London: National Institute for Health and Care Excellence (NICE), 2017.

[8] Trout K K. The neuromatrix theory of pain: implications for selected nonpharmacologic  methods of pain relief for labor[J]. J Midwifery Womens Health, 2004,49(6):482-488.

[9] ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and  Birth[J]. Obstet Gynecol, 2019,133(2):e164-e173.

[10] Roberts L, Gulliver B, Fisher J, et al. The coping with labor algorithm: an alternate pain assessment tool for the  laboring woman[J]. J Midwifery Womens Health, 2010,55(2):107-116.

[11] 王晓娇, 顾春怡, 张铮, 等. 非药物性分娩镇痛在阴道试产产妇产程管理中的证据总结[J]. 中华护理杂志, 2021,56(07):1086-1092.

[12] Gagnon A J, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both[J]. Cochrane Database Syst Rev, 2007,2007(3):CD002869.

[13] Klein M C, Kaczorowski J, Hall W A, et al. The attitudes of Canadian maternity care practitioners towards labour and birth:  many differences but important similarities[J]. J Obstet Gynaecol Can, 2009,31(9):827-840.

[14] 黄悦, 钟月华, 陈乔珠, 等. 非药物镇痛降低阴道分娩产妇潜伏期分娩疼痛的循证实践[J]. 军事护理, 2022,39(08): 17-20.

[15] Klein M C, Kaczorowski J, Hearps S, et al. Birth technology and maternal roles in birth: knowledge and attitudes of canadian  women approaching childbirth for the first time[J]. J Obstet Gynaecol Can, 2011,33(6):598-608.

[16] Aaron B, Ellen T. Nonpharmacologic approaches to management of labor pain[EB/OL]. (2023-07-14)[2024-07-22]. https://www.uptodate.com/contents/nonpharmacologic-approaches-to-management-of-labor-pain?search=Nonpharmacologic+approaches+to+management+of+labor+pain&source=search_result&selectedTitle=1%7E150&display_rank=1.

[17] Hodnett E, Downe S, Walsh D. Alternative versus conventional institutional settings for birth.[J]. Cochrane Database Syst Rev, 2012:CD000012.

[18] Caughey A B, Cahill A G, Guise J M, et al. Safe prevention of the primary cesarean delivery[J]. Am J Obstet Gynecol, 2014,210(3):179-193.

[19] Simon R M, Johnson K M, Liddell J. Amount, Source, and Quality of Support as Predictors of Women's Birth  Evaluations[J]. Birth, 2016,43(3):226-232.

[20] Hodnett E D. Pain and women's satisfaction with the experience of childbirth: a systematic  review[J]. Am J Obstet Gynecol, 2002,186(5 Suppl Nature):S160-S172.

[21] Bonapace J, Chaillet N, Gaumond I, et al. Evaluation of the Bonapace Method: a specific educational intervention to reduce  pain during childbirth[J]. J Pain Res, 2013,6:653-661.

[22] Chang C Y, Gau M L, Huang C J, et al. Effects of non-pharmacological coping strategies for reducing labor pain: A  systematic review and network meta-analysis[J]. PLoS One, 2022,17(1):e0261493.

[23] Campbell D A, Lake M F, Falk M, et al. A randomized control trial of continuous support in labor by a lay doula[J]. J Obstet Gynecol Neonatal Nurs, 2006,35(4):456-464.

[24] 张敏, 刘立荣. 导乐分娩的应用现状与研究进展[J]. 实用妇科内分泌电子杂志, 2024,11(10):35-37.

[25] 吴萍, 周科秀, 李涛. 导乐陪伴分娩应用现状调查及其影响因素分析[J]. 中国医药导报, 2024,21(14):47-49.

[26] Lawrence A, Lewis L, Hofmeyr G J, et al. Maternal positions and mobility during first stage labour[J]. Cochrane Database Syst Rev, 2013(8):CD003934.

[27] Bloom S L, McIntire D D, Kelly M A, et al. Lack of effect of walking on labor and delivery[J]. N Engl J Med, 1998,339(2): 76-79.

[28] Lawrence A, Lewis L, Hofmeyr G J, et al. Maternal positions and mobility during first stage labour[J]. Cochrane Database Syst Rev, 2013(10):CD003934.

[29] Michel S C, Rake A, Treiber K, et al. MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions[J]. AJR Am J Roentgenol, 2002,179(4):1063-1067.

[30] Declercq E R, Sakala C, Corry M P, et al. Major Survey Findings of Listening to Mothers(SM) III: Pregnancy and Birth:  Report of the Third National U.S. Survey of Women's Childbearing Experiences[J]. J Perinat Educ, 2014,23(1):9-16.

[31] Smith C A, Levett K M, Collins C T, et al. Massage, reflexology and other manual methods for pain management in labour[J]. Cochrane Database Syst Rev, 2018,3(3): CD009290.

[32] 申家美. 三线放松法对初产妇产前分娩恐惧和妊娠结局的影响[J]. 中国实用护理杂志, 2020,36(10):741-746.

[33] Smith C A, Levett K M, Collins C T, et al. Massage, reflexology and other manual methods for pain management in labour[J]. Cochrane Database Syst Rev, 2018,3(3): CD009290.

[34] Simkin P P, O'Hara M. Nonpharmacologic relief of pain during labor: systematic reviews of five methods[J]. Am J Obstet Gynecol, 2002,186(5 Suppl Nature):S131-S159.

[35] Janssen P, Shroff F, Jaspar P. Massage therapy and labor outcomes: a randomized controlled trial[J]. Int J Ther Massage Bodywork, 2012,5(4):15-20.

[36] Smith C A, Levett K M, Collins C T, et al. Massage, reflexology and other manual methods for pain management in labour[J]. Cochrane Database Syst Rev, 2012(2): CD009290.

[37] Menon V, Levitin D J. The rewards of music listening: response and physiological connectivity of the  mesolimbic system[J]. Neuroimage, 2005,28(1):175-184.

[38] Browning C A. Using music during childbirth[J]. Birth, 2000, 27(4):272-276.

[39] 沈丽丹. 不同镇痛方法在足月初产妇产程中的应用分析比较[D]. 苏州大学, 2018.

[40] Ganji Z, Shirvani M A, Rezaei-Abhari F, et al. The effect of intermittent local heat and cold on labor pain and child birth  outcome[J]. Iran J Nurs Midwifery Res, 2013,18(4):298-303.

[41] 郑晶晶, 麻彬彬, 杨素娟. 穴位按摩联合艾盐包腰骶部热敷在第一产程产痛中的应用研究[J]. 中国妇幼保健, 2023, 38(22):4325-4329.

[42] Smith C A, Collins C T, Crowther C A, et al. Acupuncture or acupressure for pain management in labour[J]. Cochrane Database Syst Rev, 2011(7):CD009232.

[43] 李茂军, 王键, 未彬秀, 等. 潜伏期电针镇痛在硬膜外分娩镇痛中的作用与安全性研究[J]. 针刺研究, 2020,45(04): 325-329.

[44] 陈伟业, 李宗存, 席四平, 等. 经皮穴位电刺激对硬膜外分娩镇痛相关产时发热的影响[J]. 针刺研究, 2021, 46(07):586-591.

[45] 祝丽娟, 谢珠, 叶春媚. 揿针疗法用于分娩镇痛疗效观察[J]. 上海针灸杂志, 2018,37(04):382-385.

[46] 曹雅军, 严霞. 中药穴位贴敷联合硬膜外阻滞对初产分娩疼痛的影响[J]. 实用中医药杂志, 2023,39(09):1811-1813.

[47] 付东英, 王必超. 耳穴压豆在分娩潜伏期镇痛中的应用[J]. 中华护理教育, 2018,15(05):373-375.

[48] Derry S, Straube S, Moore R A, et al. Intracutaneous or subcutaneous sterile water injection compared with blinded  controls for pain management in labour[J]. Cochrane Database Syst Rev, 2012,1:CD009107.

[49] Lee N, Gao Y, Collins S L, et al. Caesarean delivery rates and analgesia effectiveness following injections of  sterile water for back pain in labour: A multicentre, randomised placebo  controlled trial[J]. EClinicalMedicine, 2020,25:100447.

[50] Bahasadri S, Ahmadi-Abhari S, Dehghani-Nik M, et al. Subcutaneous sterile water injection for labour pain: a randomised controlled  trial[J]. Aust N Z J Obstet Gynaecol, 2006,46(2):102-106.

[51] Hutton E K, Kasperink M, Rutten M, et al. Sterile water injection for labour pain: a systematic review and meta-analysis of  randomised controlled trials[J]. BJOG, 2009, 116(9): 1158-1166.

[52] 仲文莉, 明雨, 楼鹏飞, 等. 中药热奄包源流探析[J]. 现代中医临床, 2023,30(02):90-96.

[53] Dunbar R, Pearce E, Tarr B, et al. Cochlear SGN neurons elevate pain thresholds in response to music[J]. Sci Rep, 2021,11(1):14547.

[54] 蒋秋燕, 王梦莹, 唐乾利, 等. 五行音乐配合电针对分娩疼痛的镇痛效应及作用机制[J]. 中华中医药杂志, 2019, 34(09):4417-4422.

[55] Stark M A. Therapeutic showering in labor[J]. Clin Nurs Res, 2013,22(3):359-374.

[56] Lee S L, Liu C Y, Lu Y Y, et al. Efficacy of warm showers on labor pain and birth experiences during the first  labor stage[J]. J Obstet Gynecol Neonatal Nurs, 2013,42(1):19-28.

[57] Cluett E R, Burns E, Cuthbert A. Immersion in water during labour and birth[J]. Cochrane Database Syst Rev, 2018,5(5): CD000111.

[58] Committee Opinion No. 679: Immersion in Water During Labor and Delivery[J]. Obstet Gynecol, 2016,128(5):e231-e236.