Application report of NBAS-APS mode nursing combined with exclusive midwifery to improve pain free delivery experience
NBAS-APS模式护理联合专属助产对改善无痛分娩体验的应用报告

摘要

目的 探讨以麻醉护士主导，以麻醉医师为督导的疼痛管理模式（NBAS-APS）联合专属助产士对无痛分娩体验改善的应用价值。方法 选择我院采用无痛分娩的初产妇144例，按照随机原则分为观察组78例和对照组各66例，两组基线资料一致。对照组予以病区护士联合专属助产士为基础的常规急性疼痛的护理模式，观察组采用由麻醉护士主导参与的，以麻醉医生为督导的急性疼痛服务护理模式（NBAS-APS）。对比分析两组不同时间段产妇疼痛程度、分娩体验、焦虑抑郁水平及产后恢复情况。结果 观察组的分娩体验评分显著高于对照组，除麻醉门诊外其它时段的疼痛程度显著低于对照组，产后恢复情况显著优于对照组，观察组分娩体验问卷（CEQ）总分显著高于对照组（95.24±6.95 vs 82.96±5.17，P<0.001）。观察组在宫口开大3 cm、宫口全开及胎儿娩出时的疼痛评分（VAS）均显著低于对照组（P<0.001）。在宫口开大3 cm及产后2 h，观察组的汉密尔顿焦虑（HAMA）及抑郁（HAMD）量表评分亦显著低于对照组（P<0.001）。此外，观察组产后2 h出血量更少，首次下床、排尿及哺乳时间均显著短于对照组（P<0.05）。结论 通过麻醉护士主导，麻醉师督导协助的NBAS-APS模式联合专属助产的多学科协作可以显著改善无痛分娩产妇的分娩体验，有效提升产妇对分娩过程的控制感和满意度，促进产后快速康复，值得推广。

Abstract

Objective To explore the application value of the pain management model led by anesthesia nurses and supervised by anesthesiologists (NBAS-APS) combined with dedicated midwives in improving the experience of painless delivery.
Methods 144 primiparous women who underwent painless delivery in our hospital were randomly divided into an observation group of 78 cases and a control group of 66 cases each. The baseline data of the two groups were consistent. The control group received routine acute pain nursing based on ward nurses and dedicated midwives, while the observation group received acute pain service nursing led by anesthesia nurses and supervised by anesthesiologists (NBAS APS). Compare and analyze the pain level, delivery experience, anxiety and depression levels, and postpartum recovery of two groups of parturients at different time periods.
Results The delivery experience score of the observation group was significantly higher than that of the control group, and the pain level during other periods except for anesthesia clinic was significantly lower than that of the control group. The postpartum recovery was significantly better than that of the control group. The total score of the delivery experience questionnaire (CEQ) in the observation group was significantly higher than that of the control group (95.24 ± 6.95 vs 82.96 ± 5.17, P<0.001). The pain scores (VAS) of the observation group were significantly lower than those of the control group when the cervix was widened by 3 cm, fully opened, and the fetus was delivered (P<0.001). The Hamilton Anxiety Scale (HAMA) and Depression Scale (HAMD) scores in the observation group were significantly lower than those in the control group when the cervix was dilated by 3 cm and 2 hours postpartum (P<0.001). In addition, the observation group had less bleeding after 2 hours postpartum, and the first time getting out of bed, urinating, and breastfeeding were significantly shorter than the control group (P<0.05).
Conclusion   The NBAS-APS model, led by anesthesia nurses and assisted by anesthesiologists, combined with specialized midwifery, can significantly improve the delivery experience of painless mothers, effectively enhance their sense of control and satisfaction with the delivery process, promote rapid postpartum recovery, and is worthy of promotion.