College of Nursing, University of Colorado, Aurora, Colorado.
Nurse-Midwifery Program, Vanderbilt University School of Nursing, Nashville, Tennessee.
J Midwifery Womens Health. 2020 May;65(3):335-341. doi: 10.1111/jmwh.13124. Epub 2020 May 26.
Women desire safe and effective choices for pain management during labor. Currently, neuraxial and opioid analgesia are the most common methods used in the United States. The purpose of this study was to investigate demographic characteristics, safety, and satisfaction in a cohort of parturients who used inhaled nitrous oxide (N O) analgesia and to determine predictors of conversion from N O to neuraxial analgesia.
This was a prospective chart review study. Individuals aged at least 18 years who used inhaled N O during the first or second stage of labor between March 1, 2016, and July 23, 2017, on the labor and delivery unit of one academic medical center (N = 463) and their neonates were included. Data describing maternal and neonatal factors are reported. Logistic regression and chi-square tests were used to model the effects of oxytocin augmentation, labor induction, parity, prior cesarean birth, pre-N O cervical dilatation, and post-N O cervical dilatation on the odds of conversion from N O to neuraxial analgesia.
In this cohort, 31% who chose N O for analgesia did not convert to any other analgesic method. Significant positive predictors for conversion from N O to neuraxial analgesia included labor induction (odds ratio [OR], 2.9; 95% CI, 1.7-5.0), oxytocin augmentation (OR, 3.1; 95% CI, 1.6-6.0), and labor after cesarean (OR, 6.4; 95% CI, 2.5-16.5). Multiparity (OR, 0.4; 95% CI, 0.2-0.6) and post-N O cervical dilatation (OR, 0.8; 95% CI, 0.7-0.9) were negative predictors. Adverse effects related to N O use during labor were rare (8%) and were not a significant reason for conversion to neuraxial analgesia. Parturients had moderately high satisfaction with N O for pain management (11-point scale, mean [SD], 7.4 [2.9]). Five-minute Apgar scores were 7 or greater in 97.8% of the newborns.
Understanding predictors of conversion from inhaled N O to neuraxial analgesia may assist perinatal care providers in their discussions with women about analgesia options during labor. N O is a useful, safe option for labor analgesia in the United States.
女性希望在分娩过程中安全有效地缓解疼痛。目前，在美国，椎管内和阿片类药物镇痛是最常用的方法。本研究旨在调查使用吸入一氧化二氮（N O）镇痛的产妇队列的人口统计学特征、安全性和满意度，并确定从 N O 转为椎管内镇痛的预测因素。
这是一项前瞻性图表回顾研究。2016 年 3 月 1 日至 2017 年 7 月 23 日期间，至少 18 岁的个体在一家学术医疗中心的分娩和分娩单位使用吸入 N O 进行第一或第二产程时（N=463），并包括其新生儿。报告描述了产妇和新生儿因素的数据。使用逻辑回归和卡方检验来模拟催产素增强、引产、产次、既往剖宫产、N O 前宫颈扩张和 N O 后宫颈扩张对从 N O 转为椎管内镇痛的可能性的影响。
在该队列中，31%选择 N O 进行镇痛的产妇没有转为任何其他镇痛方法。从 N O 转为椎管内镇痛的显著正预测因素包括引产（优势比[OR]，2.9；95%置信区间[CI]，1.7-5.0）、催产素增强（OR，3.1；95% CI，1.6-6.0）和剖宫产术后分娩（OR，6.4；95% CI，2.5-16.5）。多产（OR，0.4；95% CI，0.2-0.6）和 N O 后宫颈扩张（OR，0.8；95% CI，0.7-0.9）是负预测因素。与分娩期间使用 N O 相关的不良反应很少见（8%），也不是转为椎管内镇痛的重要原因。产妇对 N O 用于疼痛管理的满意度较高（11 分制，平均[SD]，7.4[2.9]）。新生儿的 5 分钟 Apgar 评分为 7 分或更高，占 97.8%。
了解从吸入 N O 转为椎管内镇痛的预测因素可能有助于围产期护理提供者与产妇讨论分娩时的镇痛选择。N O 是美国分娩镇痛的一种有用、安全的选择。
