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处理分娩镇痛的非药物性方法

Authors
Penny Simkin, PT
Michael C Klein, MD, CCFP, FAAP, FCFP, ABFP
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
刘西茹, 副主任医师

引言

分娩镇痛的管理是产时护理的一个主要目标。镇痛方法一般有两种：药物性镇痛和非药物性镇痛。药物性镇痛旨在消除分娩痛的躯体感觉，而非药物性镇痛主要旨在预防心理痛苦。心理痛苦可定义为如下任何心理因素：感知到对身体和/或心理的威胁、无助和失控、苦恼、应对苦恼状况的资源不足、害怕自己或新生儿死亡[1]。虽然躯体疼痛和心理痛苦经常同时出现，但人们可能遭受心理痛苦而无躯体疼痛，或遭受躯体疼痛而无心理痛苦。

多数女性采用非药物性方法缓解分娩疼痛，伴或不伴药物性方法[2]。非药物性镇痛方法包括多种技术，这些方法不仅可降低躯体的疼痛感，还可通过强化对心理-情绪和精神方面的治疗尝试预防心理痛苦。在这种方法中，将疼痛认为是多数分娩时的一种正常伴随现象。照料者、分娩教育者和支持者可对产妇进行教育和帮助，使其主动做出决定并采用自我安慰的方法和非药物性方法缓解疼痛。照料者和支持者也可通过安慰、引导、鼓励及无条件地接受产妇应对疼痛的方式进行帮助。通过主动做出决定并接受恰当的支持，产妇更可能忍受疼痛，并有掌握、控制和幸福的感觉，这些因素与产妇应对分娩的能力有关[1]。

一项系统评价纳入了有关产妇对分娩疼痛、疼痛缓解的预期和经验及其参与决策过程的研究，结果发现，产妇的预期与实际经历之间存在差距[3]。产妇对分娩疼痛的事实没有充分准备，不能做出有关疼痛缓解的知情选择。为缩小该差距，产妇需在产前了解药物性和非药物性镇痛方法的风险和益处，并有机会练习非药物性镇痛方法。

本专题将探讨多种产时镇痛的非药物性方法及其有效性的证据。多数分娩机构至少可提供其中某些技术；然而，诸如针刺治疗等操作通常需要相关证书，并非在所有分娩机构均可使用。一项有关分娩镇痛的系统评价的概述认为，某些证据表明水中浸泡、放松、针刺和按摩有效，但目前并不清楚如下技术是否有效：催眠、生物反馈、无菌水注射、芳香疗法及经皮神经电刺激(transcutaneous electrical nerve stimulation, TENS)[4]。

产时镇痛的药物性方法见其他专题。 (参见“临产和分娩过程中疼痛的药物治疗”)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-27.
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