西班牙产科镇痛临床实践全国调查。

L Hernández González, N Brogly, S Manrique Muñoz, C Suárez Castaño, G Yerga Pozo, M Raynard Ortiz, E Guasch Arévalo
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引用次数: 0

摘要

导言:为了了解产科镇痛临床实践中的差异,并就西班牙未来的最佳护理达成共识,我们在全国产科医院中开展了一项全国性调查:西班牙产科麻醉学专家按照德尔菲程序设计了一项关于分娩期间产科镇痛实践的调查。调查于 2022 年 4 月至 9 月间通过谷歌表格发送至 195 家西班牙产科医院。对调查结果进行了描述性研究:108家中心(55.4%)做出了回复,其中88家(83.8%)为公立医院。最常用的技术是硬膜外镇痛,有 97 家(92.4%)。9个中心(8.6%)使用脊髓-硬膜外联合镇痛(CSE)技术,5个中心(4.8%)使用脊髓镇痛,3个中心(2.9%)使用硬膜外穿刺镇痛(DPE)。在82家(78.1%)中心中,最常用的局麻药是0.1-0.25%的左旋布比卡因。96家(91.4%)中心在局麻药中添加了芬太尼或舒芬太尼。64家(60.9%)和33家(30.5%)中心分别采用连续硬膜外输注(CEI)+患者自控硬膜外镇痛(PCEA)或程序化间歇硬膜外栓剂(PIEB)+PCEA进行硬膜外维持。15个(14.3%)中心缺乏硬膜外镇痛的替代技术,25个(23.8%)中心未遵循产科镇痛方案:尽管西班牙产科镇痛的临床实践存在差异,但绝大多数中心都遵循了该领域的建议。但仍有改进的余地,这应被视为迈向卓越的基本策略。
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National survey on clinical practice in obstetric analgesia in Spain.

Introduction: A national survey was conducted among maternity hospitals nationwide to understand the variability in clinical practice for obstetric analgesia and to reach a consensus on optimal care in the future in Spain.

Materials and methods: Spanish experts in obstetric anesthesiology designed a survey on the practice of obstetric analgesia during childbirth, following a Delphi process. The survey was sent to 195 Spanish maternity hospitals between April and September 2022 using Google Forms. A descriptive study of the results was performed.

Results: Responses were obtained from 108 centres (55.4%), of which 88 (83.8%) were public hospitals. The most commonly used technique was epidural analgesia in 97 (92.4%) centres. Nine (8.6%) centres used the combined spinal-epidural (CSE) technique, 5 (4.8%) used spinal analgesia, and 3 (2.9%) used dural puncture epidural (DPE) analgesia. The most commonly used local anaesthetic was levobupivacaine 0.1-0.25% in 82 (78.1%) centres. Fentanyl or sufentanil were added to the local anaesthetic in 96 (91.4%) centres. Epidural maintenance was performed with continuous epidural infusion (CEI) + patient-controlled epidural analgesia (PCEA) or programmed intermittent epidural bolus (PIEB) + PCEA in 64 (60.9%) and 33 (30.5%) centres, respectively. Fifteen (14.3%) centres lacked alternative techniques to epidural analgesia and 25 (23.8%) did not follow obstetric analgesia protocols.

Conclusion: Despite the variability in clinical practice for obstetric analgesia in Spain, the vast majority of centres follow recommendations in this field. There is room for improvement, which should be considered a fundamental strategy for progressing towards excellence.

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