SECOND STAGE LABOR NURSING CARE WITH EPIDURAL ANESTHESIA

硬膜外麻醉第二产程护理

• 批准号: 6199115
• 负责人: LINDA J MAYBERRY
• 金额: $ 5.51万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-30 至 2000-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6199115
• 关键词: birth; clinical research; embryo /fetus hypoxia; embryo /fetus monitoring; epidural anesthesia; fatigue; female; heart rate; human pregnant subject; labor complications; neuropsychological tests; newborn human (0-6 weeks); nursing care evaluation; obstetric nursing; outcomes research; oximetry; patient care management; postpartum; pregnancy; satisfaction; women's health

The use of epidural anesthesia for pain control in labor and delivery is widely accepted throughout the U.S. with prevalence rates reported for many hospitals as high as 98 percent. However, a paucity of research has been reported on how standards for second stage labor care that are based on the common management guidelines used for non-anesthetized women, should be adapted in relation to interventions such as assistance with bearing-down or pushing efforts, positioning, and resting time intervals for women receiving epidural anesthesia. Since the trend toward use of epidural anesthesia during the intrapartum is predicted to continue, interdisciplinary nursing and medical research is necessary to provide data to use in developing care guidelines for the second stage of labor that: 1) define acceptable parameters for length and progress; 2) reduce the risk for adverse fetal/neonatal outcomes; 3) minimize maternal fatigue and perineal trauma; 4) reduce the incidence of failure to progress , maternal fatigue/exhaustion and fetal distress as indications for instrumental/assisted or cesarean deliveries; and 5) promote maternal satisfaction with the childbirth experience. The study aims are to determine if there is a difference in maternal, fetal and neonatal outcomes based on the use of a rest and descend nursing care protocol for second stage labor versus a "standard" nursing care protocol. In addition, data on the relationship of anesthesia outset and duration, maternal positions, and pushing/rest patterns to the designated maternal and fetal/neonatal outcomes will be obtained. A randomized, controlled experimental design will be used to study the research aims in two labor and delivery units. Based on power analysis calculations, a total sample of 630 nulliparous women will be recruited and randomized into either the control group (n=315) or experimental group (n=315). Analysis procedures for testing statistically significant group differences will include a combination of Frequentist/Bayesian, Chi-square, multiple regression, logistic regression and loglinear analysis procedures.

硬膜外麻醉在分娩镇痛中的应用 在美国被广泛接受， 在很多医院，这个比例高达98%。然而，缺乏研究 已经报道了第二阶段劳动护理的标准， 根据用于非麻醉的常见管理指南， 妇女，应调整与干预措施， 用下压力或推动力、定位和休息时间 接受硬膜外麻醉的妇女的间隔。 由于趋势 预计在分娩期间使用硬膜外麻醉 为了继续下去，跨学科的护理和医学研究是必要的 提供数据，用于制定第二次 分娩阶段：1）定义长度的可接受参数， 进展; 2）降低不良胎儿/新生儿结局的风险; 3） 减少产妇疲劳和会阴创伤; 4）降低发病率 进展失败、母体疲劳/衰竭和胎儿 作为器械/辅助或剖宫产指征的窘迫 5）提高产妇对分娩的满意度 体验.这项研究的目的是确定是否有差异， 产妇、胎儿和新生儿的结果，基于使用休息和 降低第二产程护理方案与 “标准”护理方案。 此外，数据显示， 麻醉开始和持续时间、产妇体位和推/休息 指定的孕产妇和胎儿/新生儿结局的模式将是 得到了 将采用随机对照实验设计， 在两个产程和分娩单元中研究研究目的。 基于功率 分析计算，共630名未经产妇女的样本将被 招募并随机分为对照组（n=315）或 实验组（n=315）。 检测分析程序 具有统计学显著性的组间差异将包括 频率论/贝叶斯，卡方，多元回归，logistic 回归和对数线性分析程序。