Department of Anesthesiology, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., Petach Tikvah, Israe.
Anesth Analg. 2012 Mar;114(3):654-60. doi: 10.1213/ANE.0b013e318241f4f3. Epub 2012 Jan 16.
Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain.
Healthy, nulliparous women who were accompanied by their partners and requested neuraxial analgesia were enrolled into the study. The study took place in the Labor and Delivery Unit of a large tertiary hospital in Israel. Upon request for epidural analgesia, both partners were assessed for baseline anxiety (numerical rating scale, 0 to 10), systolic blood pressure, heart rate, estimated contraction pain of parturient (verbal rating scale for pain, 0 to 10), and salivary amylase. After measurements, couples were randomized into 1 of 2 groups: "partner in" and "partner out." Immediately after epidural catheter insertion, anxiety, arterial blood pressure, heart rate, and salivary amylase were measured again in both partners. Both partners were asked to complete the State Anxiety Inventory questionnaire measuring current anxiety. The parturient was asked to rate the pain of epidural catheter insertion. The primary outcome measurement was parturient and partner anxiety as assessed by the numerical rating scale.
Eighty-four couples were randomized (partner in 41, partner out 42, protocol violation 1). At baseline there was no difference in self-reported anxiety of parturients between the partner-in and partner-out groups (median interquartile range 7.5 [6.0 to 9.0] versus 7.0 [3.5 to 8.5]; P = 0.26, difference in medians = -1.0; 95% confidence interval [CI] of difference -2.0 to 1.0). After epidural catheter insertion, parturients in the partner-in group had a higher level of anxiety than those in the partner-out group (8.0 [7.0 to 10.0] versus 7.0 [5.0 to 9.0]; P = 0.03, difference in medians -1.0; 95% CI of difference -2.0 to 0.0). Pain scores during epidural catheter placement were higher in partner-in than in partner-out groups (7.0 [4.0 to 8.0] versus 4.0 [3.0 to 6.0]; P = 0.004, difference in medians = -2.0; 95% CI of difference -3.0 to -1.0).
Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.
硬膜外镇痛可减轻分娩时的疼痛和焦虑。在这项随机对照试验中，我们旨在确定在硬膜外镇痛开始时伴侣的陪伴是否会降低母亲和她的伴侣的压力，以及他们对母亲疼痛的感知。
我们招募了健康的初产妇，她们在伴侣的陪同下要求接受脊神经阻滞镇痛。研究在以色列一家大型三级医院的产房进行。在要求硬膜外镇痛时，对两位伴侣进行基线焦虑评估（数字评分量表，0-10）、收缩压、心率、产妇估计宫缩疼痛（疼痛言语评分量表，0-10）和唾液淀粉酶。测量后，夫妇被随机分为 2 组之一：“伴侣在”和“伴侣出”。在硬膜外导管插入后，立即再次测量两位伴侣的焦虑、动脉血压、心率和唾液淀粉酶。两位伴侣都被要求完成测量当前焦虑的状态焦虑量表问卷。产妇被要求对硬膜外导管插入的疼痛进行评分。主要结局测量是产妇和伴侣的焦虑程度，用数字评分量表评估。
84 对夫妇被随机分配（伴侣在组 41 对，伴侣出组 42 对，方案违反 1 对）。在基线时，伴侣在组和伴侣出组的产妇自我报告的焦虑程度没有差异（中位数四分位距为 7.5 [6.0 至 9.0] 与 7.0 [3.5 至 8.5]；P=0.26，中位数差异= -1.0；95%置信区间[CI]的差异为-2.0 至 1.0）。在硬膜外导管插入后，伴侣在组的产妇焦虑程度高于伴侣出组（8.0 [7.0 至 10.0] 与 7.0 [5.0 至 9.0]；P=0.03，中位数差异为-1.0；95%CI 的差异为-2.0 至 0.0）。硬膜外导管置入期间的疼痛评分在伴侣在组高于伴侣出组（7.0 [4.0 至 8.0] 与 4.0 [3.0 至 6.0]；P=0.004，中位数差异为-2.0；95%CI 的差异为-3.0 至-1.0）。
在进行分娩镇痛的硬膜外导管插入时伴侣的陪伴并没有降低焦虑水平。相反，如果伴侣留在房间里，硬膜外导管插入的焦虑和疼痛会更大。
