孕妇分娩疼痛和镇痛认知度的调查及对策

目的 了解孕妇对分娩疼痛与镇痛的认知程度。方法 采用自行设计的调查表，对310位孕妇进行问卷调查。结果 100％孕妇认为分娩会痛，其中63．87％认为分娩疼痛是难以忍受的，并有恐惧心理；85．16％孕妇认为分娩疼痛对母儿无不良影响；69．68％孕妇认为分娩镇痛对胎儿及新生儿无不良影响；92．90％孕妇要求分娩镇痛，其中孕2次及以上的孕妇100％要求分娩镇痛。结论 孕妇的分娩疼痛及镇痛认知存在问题，必须给予分娩疼痛及镇痛的知识宣教。     

硬膜外自控分娩镇痛对产妇焦虑的影响

目的：观察硬膜外自控分娩镇痛对产妇焦虑的影响。方法：选择50例实施分娩镇痛的产妇为镇痛组，42例未实施分娩镇痛者为对照组。在宫口开至2～3cm时和产后24～48h采用焦虑自评量表（SAS）问卷评定焦虑程度。结果：镇痛组产妇在硬膜外自控分娩镇痛前焦虑程度、疼痛程度明显高于对照组，在实施镇痛后焦虑程度和疼痛程度明显低于对照组。结论：硬膜外自控分娩镇痛可减轻产妇产后焦虑。     

自控硬膜外镇痛与笑气分娩镇痛的比较及护理观察

目的观察比较自控硬膜外镇痛与笑气分娩镇痛的临床效果,加强分娩镇痛的护理。方法选择无产科及麻醉禁忌症拟阴道分娩初产妇90例,随机分为3组,罗哌卡因+芬太尼硬膜外自控镇痛组30例(A组);50%笑气(N2O)吸入组30例(B组);未行分娩镇痛组30例为对照组(C组)以自然方式分娩。比较3组产妇的疼痛程度、产程、分娩方式及新生儿情况。结果90例产妇分娩期生命体征平稳,VAS评分A、B组较对照组明显降低(p<0.01),A组较B组亦有统计学意义(p<0.05);器械助产率及剖宫产率,A、B组较对照组低(p<0.05),A组较B组无显著意义的降低(p>0.05)。结论自控硬膜外镇痛和笑气均可用于分娩镇痛,对产妇、新生儿均无影响,是较理想的分娩镇痛方法;自控硬膜外镇痛效果较50%笑气吸入镇痛效果佳。     

0．1％罗哌卡因与布比卡因用于分娩镇痛对分娩方式和新生儿的影响

硬膜外腔输注0.1%罗哌卡因或布比卡因用于分娩镇痛,很多文献肯定了它们的镇痛效果.本文旨在研究低浓度的罗哌卡因和布比卡因用于硬膜外腔自控镇痛对产妇的分娩方式和新生儿是否会造成影响,报道如下.     

全产程陪伴加硬膜外分娩镇痛用于催产素静脉滴注引产孕妇的临床观察

目的探讨全产程陪伴加硬膜外分娩镇痛应用于催产素静脉滴注引产孕妇中的有效性和安全性。方法收集催产素静脉滴注引产孕妇147例,根据孕妇的意愿,分为全产程陪伴加硬膜外分娩镇痛组(观察组)68例和对照组79例。对观察组孕妇实施全程陪伴,并在出现规律有效的宫缩后,由麻醉师经L2-3穿刺成功后行硬膜外置管,通过注药泵给予0.125%罗哌卡因 2μg/ml芬太尼混合液持续加自控给药进行分娩镇痛,至宫口近开全停药。对照组按产科实施常规护理。比较2组的镇痛效果、产程、分娩方式、产后出血、新生儿窒息率、产后尿潴留情况。结果观察组0～1级镇痛效果达到95.59%,较对照组第一产程明显缩短,阴道分娩率明显提高,P<0.01;2组的第二、三产程时间,产后出血、产后尿潴留、新生儿窒息率比较,差异无统计学意义(P>0.05)。结论全产程陪伴加硬膜外分娩镇痛用于催产素静脉滴注引产的孕妇,可提高阴道分娩率,达到真正"无痛分娩"的目的,有效缩短产程,保障了母儿安全,值得推广应用。     

分娩镇痛临床应用率偏低的原因分析

[目的]探讨分娩镇痛临床应用率偏低的原因。[方法]采用问卷调查法对248例孕妇进行调查,了解孕妇对硬膜外麻醉分娩镇痛基本知识的了解情况及应用意愿等;并对26例不愿使用分娩镇痛的孕妇进行半结构式深度访谈,运用Colaizzi资料分析原则进行整理分析,提炼主题。[结果]9. 68%的孕妇表示对硬膜外麻醉分娩镇痛很清楚;78. 63%的孕妇不愿意使用硬膜外麻醉分娩镇痛,原因是担心对母儿有不良影响(57. 95%)、对其不了解(31. 28%)及担心费用高(4. 62%)等。质性访谈结果显示:大部分孕妇对硬膜外镇痛的副作用较为担心且目前宣传广度、深度不够,无法获取有效的信息。[结论]孕妇对分娩镇痛相关知识缺乏了解,担心其不良反应而不愿使用该方法。应加强分娩镇痛宣教,使孕妇做到充分知情,推进分娩镇痛临床应用。     

自控硬膜外镇痛分娩180例临床观察

目的 探讨自控硬膜外镇痛(PCEA)对产妇及新生儿的影响.方法 采用回顾性分析方法,选择180例行硬膜外分娩镇痛、健康、单胎头位、足月临产初产妇为镇痛组.另选择同期180例条件相似,未行任何镇痛措施的自然临产产妇为对照组.比较两组产程、疼痛程度、分娩方式、缩宫素使用情况、产后出血、新生儿窒息等的差异.结果 ①镇痛组活跃期较对照组缩短,剖宫产率较对照组低;镇痛组疼痛程度和焦虑情绪比对照组明显减轻,产妇满意度高,共差异有统计学意义.②两组的缩宫素使用、产后出血、新生儿窒息差异无统计学意义.结论 自控硬膜外分娩镇痛能明显缩短产程,降低剖宫产率,减轻产痛及产妇焦虑程度,对母婴影响小,是目前较理想的分娩镇痛方法,值得临床推广应用.     

自控硬膜外分娩镇痛对分娩方式、产程的影响分析

目的研究在分娩中实施自控硬膜外分娩镇痛对产妇产程以及分娩方式的影响。方法选取2017年1月～2019年1月来我院分娩的产妇200例,随机分为对照组和观察组各100例。对照组未接受自控硬膜外分娩镇痛,观察组接受自控硬膜外分娩镇痛,比较两组产程、分娩方式、分娩结局。结果观察组产程潜伏期、活跃期、第二产程、第三产程时的VAS疼痛评分均低于对照组,差异有统计学意义(P0.05);观察组产程潜伏期、活跃期、第二产程、第三产程时间及总产程时间均短于对照组,差异有统计学意义(P0.05);观察组阴道分娩率为75%,剖宫产率为8%,优于对照组60%和17%,差异有统计学意义(P0.05);观察组产后出血量、胎儿窘迫发生率、新生儿1min Apgar评分与对照组比较差异无统计学意义(P0.05)。结论自控硬膜外分娩镇痛的实施能够提升阴道分娩率,减少剖宫产,缩短产程时间,有良好应用价值。     

舒芬太尼联合罗哌卡因硬膜外分娩镇痛对母儿的影响

目的:了解舒芬太尼加罗哌卡因分娩镇痛对产程及母婴安全的影响。方法:采用硬膜外连续自控镇痛,对60例孕妇产程、产后2h出血量进行观察,并对其新生儿出生1minApgar评分、脐血血气分析进行观察、检测。结果:镇痛组较非镇痛组活跃期至宫口开全时间明显缩短,差异有显著性;第二产程时间及产后2h出血量两组比较差异无显著性;新生儿血气分析,镇痛组pH值高于非镇痛组,差异有显著性,PCO2低于非镇痛组,差异有显著性,PO2高于非镇痛组,差异有显著性。结论:舒芬太尼联合罗哌卡因硬膜外分娩镇痛效果确切,利于产程进展,对母儿是安全的。     

3种不同镇痛方法用于产妇分娩的效果比较

目的：探讨产妇自控硬膜外镇痛、笑气吸入镇痛和药物镇痛不同分娩镇痛方法的镇痛效果和对产妇及新生儿的影响。方法：选择120例产妇分为产妇自控硬膜外镇痛组（自控组）、笑气吸入镇痛组（笑气组）、药物镇痛组（药物组）和对照组各30例。自控组于产程活跃期给予硬膜外麻醉,接自控镇痛泵联合注入罗哌卡因和芬太尼;笑气组于活跃期给予吸入含50%氧化亚氮和50%氧气的混合气体;药物组于潜伏期给予度冷丁100mg肌内注射,于活跃期给予地西泮10mg静脉推注;对照组未给予任何镇痛措施。分别观察4组产妇的镇痛效果、产程时间、分娩方式、血氧饱和度及新生儿脐动脉血的血气分析、新生儿窒息情况。结果：在镇痛效果方面,自控组镇痛分级0级为23例,Ⅰ级为5例;笑气组Ⅰ级为15例,Ⅱ级为11例;药物组Ⅰ级为4例,Ⅱ级为20例;对照组Ⅱ级为17例,Ⅲ级为13例;4组比较有显著性差异（P〈0.05）。产程时间、分娩方式、新生儿窒息率、血气分析结果比较均无显著性差异（P〉0.05）。结论：产妇自控硬膜外镇痛用于分娩镇痛效果满意,对产妇及新生儿无明显副作用,可作为分娩镇痛的首选方法;笑气吸入和药物镇痛效果虽仅次于产妇自控硬膜外镇痛组,但方便简单,安全可靠,值得临床推广使用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.