一项关于神经轴索分娩镇痛需求和疼痛缓解方面种族差异的前瞻性观察研究。
A prospective observational study of ethnic and racial differences in neuraxial labor analgesia request and pain relief.
作者信息
Wilson Sylvia H, Elliott Matthew P, Wolf Bethany J, Hebbar Latha
机构信息
From the Departments of Anesthesia and Perioperative Medicine, and Public Health Service, Medical University of South Carolina, Charleston, South Carolina.
出版信息
Anesth Analg. 2014 Jul;119(1):105-109. doi: 10.1213/ANE.0000000000000260.
BACKGROUND
As ethnic and racial diversity increases, it is important that anesthesia providers understand the expectations and concerns of this changing population regarding labor analgesia. Our objective was to evaluate ethnic/racial differences in labor analgesia characteristics with regard to the timing of request for neuraxial analgesia.
METHODS
Three hundred ninety-seven parturients were enrolled in this prospective observational cohort study. Term laboring parturients who planned vaginal delivery and requested neuraxial labor analgesia were eligible for inclusion. Data collected included cervical dilation at the time of neuraxial analgesia request, self-identified ethnicity/race, parity, education, insurance status, pain score before and after the initiation of neuraxial analgesia, and mode of delivery. The primary outcome was cervical dilation at the time of neuraxial analgesia request. Ethnicity/race classification was determined by asking the patient, "How would you define your ethnicity?" Patients were categorized into the ethnic/racial groups of non-Hispanic White, African American, Hispanic, or other. Univariate associations between cervical dilation and categorical variables were examined. Multivariate analysis was performed for the primary outcome of cervical dilation at the time of initiation of neuraxial analgesia.
RESULTS
At the time of neuraxial analgesia placement, the mean difference in cervical dilation of Hispanic parturients was 0.8 cm compared to non-Hispanic Whites (95% confidence interval [CI], 0.1-1.4; P = 0.047). After controlling for education, reason for placement, labor augmentation, and mode of delivery in a multivariate model, Hispanic parturients had 0.5 cm greater cervical dilation compared to non-Hispanic Whites, which was not significant (95% confidence interval, -0.1 to 1.1; P = 0.089).
CONCLUSIONS
Our data indicate that ethnicity/race plays a small role in acceptance and request for neuraxial labor analgesia.
背景
随着种族和民族多样性的增加，麻醉医生了解这一不断变化的人群对分娩镇痛的期望和担忧非常重要。我们的目的是评估在硬膜外镇痛请求时间方面分娩镇痛特征的种族差异。
方法
397名产妇纳入了这项前瞻性观察队列研究。计划经阴道分娩并请求硬膜外分娩镇痛的足月分娩产妇符合纳入标准。收集的数据包括请求硬膜外镇痛时的宫颈扩张情况、自我认定的种族、产次、教育程度、保险状况、硬膜外镇痛开始前后的疼痛评分以及分娩方式。主要结局是请求硬膜外镇痛时的宫颈扩张情况。种族分类通过询问患者“你如何定义自己的种族？”来确定。患者被分为非西班牙裔白人、非裔美国人、西班牙裔或其他种族/民族组。检查宫颈扩张与分类变量之间的单变量关联。对硬膜外镇痛开始时宫颈扩张的主要结局进行多变量分析。
结果
在放置硬膜外镇痛时，西班牙裔产妇与非西班牙裔白人相比，宫颈扩张的平均差异为0.8厘米（95%置信区间[CI]，0.1 - 1.4；P = 0.047）。在多变量模型中控制教育程度、放置原因、引产和分娩方式后，西班牙裔产妇与非西班牙裔白人相比，宫颈扩张大0.5厘米，差异无统计学意义（95%置信区间，-0.1至1.1；P = 0.089）。
结论
我们的数据表明，种族在接受和请求硬膜外分娩镇痛方面作用较小。
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