Calderini E, Tuveri L E, Seveso M, Salvo I
Ospedale Maggiore Polyclinic Foundation, Mangiagalli and Regina Elena, Milan, Italy.
Minerva Anestesiol. 2009 Mar;75(3):103-7. Epub 2008 Jan 24.
Since January 2005 the Regional Government of Lombardia, a large Italian region with over 1/5 of all Italian births, allocated public funds for 3 consecutive years to help provide epidural analgesia (EA) for women in labor. The aim of the present study was to evaluate the trend of diffusion of EA in the triennium 2005-2007.
Data obtained from regional Obstetric Departments, recognized by the National Health Care System, were elaborated by the Epidemiological Service of Regione Lombardia. The software looked for specific codes for vaginal deliveries, with or without EA, and Cesarean sections included in the administrative patient records.
A substantial increase in epidurals administered in comparison to total vaginal deliveries was recorded after assignment of regional financing: from 8.2% in 2005, to 10.4% in 2006 and 12.9% in 2007 (P<0.0001). More than 60% of epidurals were performed in 8 hospitals with >2 000 births per year. The rate of EAs in these hospitals was 18% in 2005, 22% in 2006 and 24.9% in 2007. In the 69 hospitals with <2000 births per year, the rate of EAs was markedly lower: 4% in 2005, 5.5% in 2006 and 7.8% in 2007. In both cases, the increase was statistically significant (P<0.0001). At the three-year time-point, the rate of Cesarean sections did not change.
The continuous increase of EA for labor after regional financings suggests that the low rate of pain relief procedures in Lombardia was mainly due to economic and organizational issues, rather than to cultural and psychological factors.
自2005年1月起，意大利伦巴第大区政府（该大区人口超过意大利总人口的1/5，意大利超过1/5的新生儿在此出生）连续三年划拨公共资金，以帮助为分娩妇女提供硬膜外镇痛（EA）。本研究旨在评估2005 - 2007三年间EA的普及趋势。
由伦巴第大区流行病学服务部门对从国家医疗保健系统认可的地区产科部门获取的数据进行整理。该软件在行政患者记录中查找阴道分娩（无论有无EA）及剖宫产的特定代码。
在获得地区资金支持后，与总阴道分娩量相比，硬膜外镇痛的实施量大幅增加：从2005年的8.2%增至2006年的10.4%以及2007年的12.9%（P<0.0001）。超过60%的硬膜外镇痛在每年分娩量超过2000例的8家医院进行。这些医院的EA实施率在2005年为18%，2006年为22%，2007年为24.9%。在每年分娩量少于2000例的69家医院中，EA实施率明显较低：2005年为4%，2006年为5.5%，2007年为7.8%。在这两种情况下，增长均具有统计学意义（P<0.0001）。在三年时间节点上，剖宫产率未发生变化。
地区资金投入后，分娩时EA的持续增加表明，伦巴第大区疼痛缓解程序使用率低主要是由于经济和组织问题，而非文化和心理因素。
