使用活动追踪器量化产后活动：区域麻醉和镇痛干预后活动的前瞻性观察研究。

Using Activity Trackers to Quantify Postpartum Ambulation: A Prospective Observational Study of Ambulation after Regional Anesthesia and Analgesia Interventions.

机构信息

From the Department of Obstetrics and Gynecology (J.M., M.P.G.) and the Department of Anesthesia (R.M., B.C., M.G., J.G.L., F.W.A.), University of Toronto, Toronto, Ontario, Canada; and the Department of Obstetrics and Gynecology (J.M., M.P.G.) and the Department of Anesthesia (R.M., B.C., M.G., J.G.L., F.W.A.), St. Michael's Hospital, Toronto, Ontario, Canada; the Department of Obstetrics and Gynecology, Dalla Lana School of Public Health (J.M.), Toronto, Ontario, Canada; the Department of Anesthesia, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada (J.G.L., F.W.A.); the Department of Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland (J.G.L.); and the Department of Anesthesiology and Pain Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.).

出版信息

Anesthesiology. 2018 Mar;128(3):598-608. doi: 10.1097/ALN.0000000000001979.

DOI:10.1097/ALN.0000000000001979

PMID:29135475

Abstract

BACKGROUND

Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery.

METHODS

Parturients having first/second cesarean delivery under spinal anesthesia or first/second vaginal delivery under epidural analgesia between July 2015 and December 2016 were recruited. Patients with significant comorbidities or postpartum complications were excluded, and participants received standard multimodal analgesia. Mothers were fitted with wrist-worn activity trackers immediately postdelivery, and the trackers were recollected 24 h later. Rest and dynamic postpartum pain scores at 2, 6, 12, 18, and 24 h and quality of recovery (QoR-15) at 12 and 24 h were assessed.

RESULTS

The study analyzed 173 patients (cesarean delivery: 76; vaginal delivery: 97). Vaginal delivery was associated with greater postpartum ambulation (44%) compared to cesarean delivery, with means ± SD of 1,205 ± 422 and 835 ± 381 steps, respectively, and mean difference (95% CI) of 370 steps (250, 490; P < 0.0001). Although both groups had similar pain scores and opioid consumption (less than 1.0 mg of morphine), vaginal delivery was associated with superior QoR-15 scores, with 9.2 (0.6, 17.8; P = 0.02) and 8.2 (0.1, 16.3; P = 0.045) differences at 12 and 24 h, respectively.

CONCLUSIONS

This study objectively demonstrates that vaginal delivery is associated with greater early ambulation and functional recovery compared to cesarean delivery. It also establishes the feasibility of using activity trackers to evaluate early postoperative ambulation after neuraxial anesthesia and analgesia.

摘要

背景

早期术后活动与功能恢复增强有关，尤其是在产后人群中，但活动问卷受回忆偏倚的限制。本观察性研究旨在通过活动追踪技术客观地量化椎管内麻醉和镇痛后剖宫产和阴道分娩后的活动量。假设是与剖宫产相比，阴道分娩在分娩后 24 小时内的活动量更大。

方法

招募了 2015 年 7 月至 2016 年 12 月间接受脊髓麻醉下首次/二次剖宫产或硬膜外镇痛下首次/二次阴道分娩的产妇。排除有显著合并症或产后并发症的患者，并为参与者提供标准的多模式镇痛。产妇在分娩后立即佩戴腕戴式活动追踪器，并在 24 小时后再次收集追踪器。评估产后 2、6、12、18 和 24 小时的静息和动态产后疼痛评分，以及 12 和 24 小时的恢复质量（QoR-15）评分。

结果

该研究分析了 173 名患者（剖宫产：76 例；阴道分娩：97 例）。与剖宫产相比，阴道分娩后的产后活动量更大（44%），分别为平均（±SD）1205±422 步和 835±381 步，平均差异（95%CI）为 370 步（250，490；P＜0.0001）。虽然两组的疼痛评分和阿片类药物用量（少于 1.0mg 吗啡）相似，但阴道分娩与更好的 QoR-15 评分相关，分别为 12 小时时 9.2（0.6，17.8；P=0.02）和 24 小时时 8.2（0.1，16.3；P=0.045）。