阴道分娩后有无硬膜外镇痛的身体和心理恢复：一项前瞻性队列研究。
Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study.
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
Department of Anesthesia, St. Luke's International Hospital, Tokyo, Japan.
出版信息
PLoS One. 2023 Oct 5;18(10):e0292393. doi: 10.1371/journal.pone.0292393. eCollection 2023.
BACKGROUND
Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown.
METHODS
Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (FitbitTM Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3rd trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization.
RESULTS
Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as >3500 steps between 48 and 72 hours postpartum).
CONCLUSION
The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization.
TRIAL REGISTRATION
UMIN-CTR, #UMIN000039343, registered on January 31, 2020.
背景
强化康复是现代围手术期管理的金标准，包括剖宫产。然而，关于阴道分娩后女性身体和心理康复的定性和定量数据有限。椎管内分娩镇痛是否会影响产后康复尚不清楚。
方法
本研究纳入了 2020 年 1 月至 2021 年 5 月期间预期阴道分娩的初产妇。排除患有主要合并症或产后并发症以及行剖宫产的女性。使用腕戴活动追踪器（FitbitTM Inspire HR）测量阴道分娩后 120 小时的每日步数。在产前 3 个月就诊时、产后第 1 天和第 3 天以及产后 1 个月就诊时，使用多维疲劳量表（MFI）和 EuroQol 5 维度 5 级（EQ-5D-5L）评估主观疲劳水平和健康相关生活质量。参与者在产后住院期间记录休息和动态疼痛评分以及疼痛部位。
结果
在 300 名接受产前登记的女性中，95 名和 116 名分别接受了无（NCB 组）和有（EPL 组）硬膜外镇痛的阴道分娩。两组的 24 小时每小时步数均逐日增加，且两组之间无显著差异。产后疼痛总体较轻，两组的休息和动态疼痛评分中位数均小于 4。两组在产后第 1 天的 MFI 和 EQ-5D-5L 评分最差，并在产后 1 个月就诊时逐渐恢复至产前水平。两组中，产后第 1 天 MFI 评分较高与无法实现足够的产后活动（定义为 48 至 72 小时内步数>3500）的可能性较低有关，但与使用硬膜外镇痛无关。
结论
使用硬膜外镇痛与产后住院期间的康复结局较差无关。
试验注册
UMIN-CTR，#UMIN000039343，于 2020 年 1 月 31 日注册。
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