Christiansen Pia, Klostergaard Kate Meedom, Terp Mette Rohde, Poulsen Claus, Agger Anders Ole, Rasmussen Kjeld Leisgård
Herning Sygehus, gynaekologisk-obstetrisk afdeling.
Ugeskr Laeger. 2002 Oct 14;164(42):4927-9.
The aim of the study was to investigate the stability of labour pain recall 14-21 months after delivery, and to relate it to events during labour.
One hundred and fifteen primipara completed a visual analogue scale (VAS) on the second day after delivery, and a similar VAS 14-21 months later. Women who were delivered before completing 37 gestational weeks, had a multiple pregnancy, needed epidural analgesia, or whose infant was transferred to the neonatal care unit were excluded. Data were analysed by three different methods to minimise bias. By method 1, the proportion of VAS 2 > VAS 1 was calculated. By method 2, the accuracy of recall was defined from the equation -1 < or = VAS 2--VAS 1 < or = 1. By method 3, the VAS used was regarded as an unlimited scale, but with all observations shortened to the interval, 0 to 10 cm. Pain scores were related to obstetrical data: instrument delivery, fetal weight, duration of second stage of labour, use of pethidine and use of pudendal analgesia.
Thirteen of 20 women (65%) who had received pethidine during labour reported a higher VAS 2 than VAS 1, compared to 27 of 95 (28%) women who had not received pethidine (p = 0.003). According to method 2, 35% of the pethidine-treated women overestimated labour pain on recall, compared to 13% in the non-pethidine-treated group (p < 0.05). According to method 3, women who were not treated with pethidine showed a decrease of 0.81 cm on the recalled VAS, compared to an increase of 1.13 cm in the pethidine-treated group (p < 0.01). None of the other investigated events during labour were related to pain recall.
In general, labour pain recall fades over time or tends to be stable, but to a significantly higher number of women receiving pethidine, pain seems to intensify on recall. If further investigations show that this is an effect of pethidine itself, opioids should be used with caution during labour.
本研究的目的是调查分娩后14 - 21个月时分娩疼痛回忆的稳定性，并将其与分娩期间的事件相关联。
115名初产妇在分娩后第二天完成了视觉模拟评分法（VAS），并在14 - 21个月后完成了类似的VAS评分。孕周未满37周分娩、多胎妊娠、需要硬膜外镇痛或其婴儿被转入新生儿重症监护病房的妇女被排除。数据采用三种不同方法进行分析以尽量减少偏差。方法1：计算VAS 2 > VAS 1的比例。方法2：回忆的准确性由等式 -1 ≤ VAS 2 - VAS 1 ≤ 1定义。方法3：使用的VAS被视为无限制量表，但所有观察值缩短至0至10厘米的区间。疼痛评分与产科数据相关：器械助产、胎儿体重、第二产程持续时间、哌替啶使用情况和阴部神经阻滞镇痛使用情况。
分娩期间接受哌替啶治疗的20名妇女中有13名（65%）报告VAS 2高于VAS 1，而未接受哌替啶治疗的95名妇女中有27名（28%）是这样（p = 0.003）。根据方法2，接受哌替啶治疗组中有35%的妇女在回忆时高估了分娩疼痛，而未接受哌替啶治疗组中这一比例为13%（p < 0.05）。根据方法3，未接受哌替啶治疗的妇女回忆的VAS下降了0.81厘米，而接受哌替啶治疗组上升了1.13厘米（p < 0.01）。分娩期间调查的其他事件均与疼痛回忆无关。
一般来说，分娩疼痛回忆会随时间消退或趋于稳定，但对于接受哌替啶治疗的妇女，疼痛在回忆时似乎会加剧。如果进一步的研究表明这是哌替啶本身的作用，那么在分娩期间使用阿片类药物应谨慎。
