Yoezer Tenzin, Gyeltshen Dawa, Tshering Jampel
Tsirang District Hospital Ministry of Health, Royal Government of Bhutan Tsirang Bhutan.
Department of Adult Intensive Care Unit Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan.
Public Health Chall. 2023 Mar 7;2(1):e73. doi: 10.1002/puh2.73. eCollection 2023 Mar.
The practice of neuraxial labor analgesia (NLA) as a mode of pain relief was introduced in Bhutan in 2016 despite it being in practice for more than five decades. There is a lack of data on NLA in Bhutan. Therefore, this study describes the use of NLA and its outcome over 4 years in Bhutan.
A retrospective descriptive study was conducted from 1 January 2018 to 31 December 2021. The data were obtained from the Anesthesia Department, medical records, admission forms, and birth-registers. A total of 524 women were included. Data were recorded using 2021 Microsoft Excel version 16.57 (22011101) and analyzed using Epi Info 7.2.5.0. Categorical data were summarized using frequencies and percentages. Continuous data were summarized using mean and standard deviation.
The incidence of NLA usage was 3.5% (524/15,119). Most women were between 21 and 30 years (67.2%). Modes of delivery following NLA were spontaneous vaginal delivery, cesarean section, and assisted vaginal delivery 63.4%, 18.4%, and 18.3%, respectively. Non-reassuring fetal status (37.5%) and failed progression of labor (36.5%) were the leading indications of cesarean section. The primary reason for assisted vaginal delivery was poor maternal effort (55.2%). Neonates of the mother who received neuraxial analgesia had neonatal jaundice in 8%, neonatal intensive care unit admission in 0.76%, and Apgar score less than 7 in 5.1% and 0.2% at 1 and 5-min, respectively, after birth.
Although NLA is safe for both mothers and babies, its use is low in Bhutan. The probable reason for the low incidence could be a shortage of anesthesiologists, cultural beliefs, and lack of awareness. The Ministry of Health and the Department of Anesthesia should work together to improve the service.
尽管神经轴索分娩镇痛（NLA）作为一种疼痛缓解方式已应用了五十多年，但不丹直到2016年才引入该技术。不丹缺乏关于NLA的数据。因此，本研究描述了不丹4年来NLA的使用情况及其结果。
进行一项回顾性描述性研究，时间跨度为2018年1月1日至2021年12月31日。数据来自麻醉科、病历、入院表格和出生登记册。共纳入524名女性。使用2021版Microsoft Excel 16.57（22011101）记录数据，并使用Epi Info 7.2.5.0进行分析。分类数据用频率和百分比进行汇总。连续数据用均值和标准差进行汇总。
NLA的使用率为3.5%（524/15119）。大多数女性年龄在21至30岁之间（67.2%）。NLA后的分娩方式分别为自然阴道分娩、剖宫产和辅助阴道分娩，比例分别为63.4%、18.4%和18.3%。胎儿状况不佳（37.5%）和产程进展失败（36.5%）是剖宫产的主要指征。辅助阴道分娩的主要原因是产妇用力不足（55.2%）。接受神经轴索镇痛的母亲所生新生儿中，8%出现新生儿黄疸，0.76%入住新生儿重症监护病房，出生后1分钟和5分钟时Apgar评分低于7分的比例分别为5.1%和0.2%。
尽管NLA对母亲和婴儿都安全，但在不丹其使用率较低。发生率低的可能原因是麻醉医生短缺、文化信仰和缺乏认识。卫生部和麻醉科应共同努力改善这项服务。
