Pattee C, Ballantyne M, Milne B
Department of Anaesthesia, Queen's University, Kingston General Hospital, Ontario.
Can J Anaesth. 1997 Sep;44(9):918-23. doi: 10.1007/BF03011961.
Many anaesthetists believe that informed consent for epidural analgesia during labour is inadequate. Patients are perceived to be poorly informed and unable to cope with the information given during labour for informed consent. We reviewed these two hypotheses: A) to define complications for which patients want clear information: B) to quantify the influence of pain, anxiety, opioid premedication, and the importance of level of education, on a patient's level of satisfaction with regard to the consent process: and C) to assess how satisfactory epidural pain relief correlates with satisfaction with the consent process.
Sixty patients were surveyed during the first two months after vaginal delivery by two interviewers. Questions related to demographics, severity of labour pain, level of satisfaction with the epidural anaesthetic, risk of complications and satisfaction with information received were either categorical or scored on a scale from 0 to 10.
All epidural related complications were considered important to disclose (8.4/10). The level of satisfaction with the consent process was 8.1/10. Patient satisfaction was not affected by opioid premedication, anxiety, pain score, education group or level of pain relief.
Patients indicated they should be informed of all possible complications associated with epidural analgesia, regardless of severity or risk. In contrast to reports in the literature, non disclosure of serious risks during labour was not acceptable to parturients.
许多麻醉医生认为，分娩期间硬膜外镇痛的知情同意做得不够充分。患者被认为了解不足，且在分娩时无法理解为获取知情同意而提供的信息。我们对以下两个假设进行了研究：A）确定患者希望得到明确信息的并发症；B）量化疼痛、焦虑、阿片类药物术前用药以及教育水平的重要性对患者在同意过程中的满意度的影响；C）评估硬膜外镇痛的满意度与同意过程的满意度之间的相关性。
在阴道分娩后的头两个月，由两名访谈者对60名患者进行了调查。与人口统计学、分娩疼痛严重程度、对硬膜外麻醉的满意度、并发症风险以及对所获信息的满意度相关的问题，要么是分类问题，要么是按0至10分进行评分。
所有与硬膜外相关的并发症都被认为有必要披露（8.4/10）。同意过程的满意度为8.1/10。患者满意度不受阿片类药物术前用药、焦虑、疼痛评分、教育程度分组或疼痛缓解程度的影响。
患者表示，无论并发症的严重程度或风险如何，都应告知他们与硬膜外镇痛相关的所有可能并发症。与文献报道相反，产妇不能接受在分娩期间不披露严重风险。
