Pain, Anxiety, and Fatigue During Labor: A Prospective, Repeated Measures Study

生產過程的疼痛、焦慮與疲憊：一項前瞻性、重覆量測研究

10.1097/jnr.0000000000000165

曾雅玲(Ya-Ling Tzeng)；楊雅玲(Ya-Ling Yang)；郭碧照(Pi-Chao Kuo)；林雅娟(Ya-Chuan Lin)；陳淑齡(Shu-Ling Chen)

pain ； anxiety ； fatigue ； epidural anesthesia ； labor ； 產痛 ； 焦慮 ； 疲憊 ； 減痛分娩 ； 生產

The Journal of Nursing Research

25卷1期（2017 / 02 / 01）

59 - 67

英文

Background: Pain, anxiety, and fatigue are known to significantly influence labor; however, the interacting relationships among the three symptoms have not been empirically shown. Purpose: The aim of this study was to investigate the interrelationships among intrapartum pain, anxiety, and fatigue relative to the mode of delivery, with or without epidural analgesia (EDA). Methods: A prospective, repeated measures design was adopted, and women with uncomplicated pregnancies at term (N = 186) were enrolled. Self-reported visual analog scales were used to assess pain, anxiety, and fatigue during the four phases of labor, as determined by cervical dilation (e.g., Phase 1 = 2-4 cm, Phase 2 = 4-6 cm, Phase 3 =10 cm, and Phase 4 = immediately after delivery of the placenta). Of the 186 participants, 48 received EDA when their cervical dilation was 3-4 cm. Results: Throughout the process of labor, pain, anxiety, and fatigue were significantly correlated, no matter whether participants had received EDA, especially during Phases 1 and 3. For the participants undergoing EDA, the level of fatigue decreased more slowly than the levels of pain and anxiety. The participants who received EDA had significantly greater pain and fatigue in Phase 1 of labor than those who did not receive EDA. Mode of delivery was correlated with age, parity, and pain level in Phase 2 of labor and anxiety level in Phase 2 of labor. Conclusions/Implications for Practice: Intrapartum pain, anxiety, and fatigue were strongly interrelated. Intrapartum pain management (EDA) led to a significant decline in anxiety and fatigue. Furthermore, fatigue accumulated during the course of labor and was not easily diminished. These findings provide a reference for maternity nurses to develop strategies for managing multiple symptoms.

背景　疼痛、焦慮、疲憊顯著影響生產過程，然而此三種症狀的相互關係仍有待進一步驗證。目的　探討減痛分娩對生產過程疼痛、焦慮、疲憊相互關係的影響，及其與生產方式的關係。方法　採前瞻性重複測量設計，共186位無孕期合併症的產婦參與本研究。以視覺量表依子宮頸口擴張（第一期2-4公分；第二期4-6公分；第三期10公分；第四期為胎盤娩出後）分別測量疼痛、焦慮、疲憊程度，有48位產婦於宮口擴張3-4公分接受減痛分娩。結果　無論有無接受減痛分娩，疼痛、焦慮、疲憊程度皆顯著相關，尤其是在第一期和第三期。縱使接受減痛分娩，疲憊感下降程度仍比產痛和焦慮感來得緩慢，且接受減痛分娩婦女第一期的產痛和疲憊感顯著較未接受者高。生產方式與年齡、產次、第二期的疼痛與焦慮有相關性。結論／實務應用　產時疼痛、焦慮和疲憊密切關聯。疼痛處置能使焦慮和疲憊顯著下降，惟疲憊感易累積且較不易緩解。本研究結果可作為發展處理多種症狀策略時之參考。

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