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1.
目的 探讨预先电刺激内关穴预防蛛网膜下腔阻滞剖宫产术中低血压的效果.方法 选择择期在蛛网膜下腔阻滞下行剖宫产术的单胎足月妊娠产妇90例,年龄18~35岁,ASAⅡ或Ⅲ级,孕37~42周.随机分为三组:A组、B组和C组,每组30例.A组不给予电刺激;B组在蛛网膜下腔阻滞前20 min(摆左侧卧位)开始接受电刺激(连续波、...  相似文献   

2.
目的 观察新型可充气抗休克裤预防蛛网膜下腔阻滞(腰麻)下剖宫产术中低血压的效果.方法 选择择期在腰麻下行剖宫产术的单胎足月妊娠产妇97例,年龄18~35岁,ASAⅡ或Ⅲ级,孕期>37周.采用随机数字表将产妇分为两组:对照组(n=48)和观察组(n=49).观察组腰麻后立即穿戴新型可充气抗休克裤,对照组不使用.腰麻后2~...  相似文献   

3.
200例剖宫产患者麻醉期间护理的分析   总被引:1,自引:0,他引:1  
目的 探讨剖宫产术后患者麻醉期间的护理方法,完善促进母婴健康的产科护理模式.方法 选取2007年~2008年我院收治的血压、脉搏、呼吸、体温均正常的需行剖宫产术的产妇200例,按完全随机法分两组,对照组(n=100)接受常规护理,观察组(n=100)在对照组的护理基础上,根据剖宫产术麻醉手术的特点,有针对性地运用麻醉护理配合.两组患者入手术室后进行体征监护及相关项目的观察及记录,进行对比研究,旨在反映观察组产妇的护理效果.结果 观察组产妇的手术时间缩短[(24±6)min vs(18±3)min],术中出血、疼痛、新生儿窒息等明显低于对照组,患者满意度高于对照组(99%vs 85%)(P<0.05).结论 对剖宫产产妇术中实施麻醉护理增进产妇舒适度和满意度,减少副作用的发生,保证手术顺利进行.  相似文献   

4.
目的 评价吗啡对电刺激坐骨神经诱发大鼠脊髓背角突触长时程增强(LTP)的影响.方法 雄性SD大鼠27只,日龄60~90 d,体重180~200 g,随机分为4组:对照组(C组,n=7)、吗啡组(M组,n=7)、纳洛酮组(N组,n=6),纳洛酮+吗啡组(MN组,n=7).麻醉下分离左侧坐骨神经,记录电极插入左侧T13~L1脊髓背角,刺激电极刺激左侧坐骨神经,给予15 V、0.5 ms、1/60 Hz单个方波电刺激30 min以诱发场电位,抽取生理盐水10 μl、吗啡10 μl(15 μg/μl)、纳洛酮10 μl(2.5 μg/μl)、纳洛酮(2.5 μg/μl)和吗啡(15 μg/μl)各5 μl的混合液,在脊髓上方3~5 mm,经2 min内缓慢滴注,给药后5 min时,给予4串高频高强度强直电刺激后,再给予15 V、0.5 ms、1/60 Hz单个方波电刺激210 min,记录强直刺激前30 min、强直刺激后即刻~30 min、35~60 min、65~120 min、125~210 min时段平均场电位幅值及潜伏期.结果 与C组比较,M组和MN组平均场电位幅值降低,潜伏期延长(P<0.05或0.01),N组上述指标差异无统计学意义(P>0.05).与M组比较,MN组平均场电位幅值升高,潜伏期缩短(P<0.05或0.01).与强直刺激前30 min比较,C组和N组在强直刺激后各时段平均场电位幅值升高,潜伏期缩短,M组在强直刺激后各时段平均场电位幅值降低,潜伏期延长,MN组在强直刺激后即刻~30 min和35~60 min时段平均场电位幅值升高,强直刺激后即刻~30 min时段潜伏期缩短,65~120 min和125~210 min时段平均场电位幅值降低,潜伏期延长(P<0.05或0.01).结论 吗啡可抑制电刺激坐骨神经诱发大鼠脊髓背角突触LTP,可能是其抑制中枢敏化的机制之一.  相似文献   

5.
李杰  段光友  曾义  李洪 《临床麻醉学杂志》2019,35(11):1070-1074
目的通过回顾性病例数据分析,探讨围术期患者因素和麻醉方式对再次剖宫产术中出血风险的影响。方法通过检索医院电子病历系统,搜集我院2015年10月至2017年10月再次剖宫产产妇2 442例的临床病历资料,年龄20~45岁,BMI 18~40 kg/m~2,ASAⅠ—Ⅳ级。剖宫产常规采用椎管内麻醉,全麻仅用于患者强烈要求、椎管内麻醉禁忌或失败等情况。根据术中出血标准分为明显出血组(MH组,n=494)和非明显出血组(NMH组,n=1948)。记录产妇的术前、术中和术后的资料。应用Logistic回归分析筛选术中出血的危险因素。采用倾向性匹配分析比较全麻组(GA组,n=141)与非全麻组(NGA组,n=141)术中明显出血发生率、新生儿窒息和住院时间。结果 MH组的术中出血量明显大于NMH组(P0.05)。Logistic回归结果显示再次剖宫产术中出血的危险因素包括:前置胎盘(OR=38.269,95%CI 15.970~91.706,P0.001),宫缩乏力(OR=10.047,95%CI6.155~16.399,P0.001),胎盘粘连(OR=5.045,95%CI 3.146~8.089,P0.001),全麻(OR=2.922,95%CI 1.521~5.614,参考组:非全麻,P0.001)等。倾向性匹配结果显示,GA组术中明显出血发生率明显高于NGA组(P0.05), 1 min新生儿窒息率明显明显高于NGA组(P0.05),住院时间明显长于NGA组(P0.05)。结论再次剖宫产术中出血的风险因素包括前置胎盘、宫缩乏力、胎盘粘连、全麻等。全麻与非全麻比较,可增加术中出血风险和新生儿窒息发生率,延长住院时间。  相似文献   

6.
目的观察地佐辛用于剖宫产产妇寒颤反应治疗的安全性和有效性。方法 50例剖宫产手术产妇(均为腰硬联合麻醉,ASAⅠ~Ⅱ)随机分为2组(n=25),经静脉给药,观察产妇术中寒颤情况。实验组(Ⅰ组)用地佐辛,对照组(Ⅱ组)不用地佐辛,分别记录用药前及用药后5 min寒颤的评分和不良反应。结果Ⅰ组产妇于用药后5 min寒颤停止,Ⅰ组与Ⅱ组比较,2组差异有统计学意义(P<0.05)。Ⅰ组嗜睡发生率较高,差异有统计学意义。结论地佐辛能有效的治疗剖宫产产妇术中寒颤反应。  相似文献   

7.
目的探讨阴道产钳助产对剖宫产率及母婴结局的影响。方法随机选取2016年5月至2017年5月本院收治的产妇80例,依据治疗方法将这些产妇分为阴道产钳助产组(n=40)和剖宫产手术组(n=40)两组,剖宫产手术组产妇分娩困难时直接进行剖宫产手术,阴道产钳助产组产妇分娩困难时优先考虑阴道产钳助产,然后对两组产妇的分娩方式、操作时间、母婴结局进行统计分析。结果阴道产钳助产组产妇的顺产率72.5%(29/40)显著高于剖宫产手术组35.0%(11/40)(P0.05),剖宫产率27.5%(14/40)显著低于剖宫产手术组65.0%(26/40)(P0.05),操作时间显著短于剖宫产手术组(P0.05),术后切口感染率、新生儿面部创伤率12.5%(5/40)、22.5%(9/40)均显著高于剖宫产手术组2.5%(1/40)、0(P0.05),新生儿头皮水肿率显著低于剖宫产手术组20.0%(8/40)(P0.05)。结论阴道产钳助产能够有效降低产妇剖宫产率,改善母婴结局。  相似文献   

8.
目的 研究晶体或胶体预充液对O型与非O型血剖宫产产妇血栓弹力图(TEG)的影响.方法 择期单胎足月剖宫产产妇60例,ASA Ⅰ或Ⅱ级,根据血型和预充液随机分为四组:O型血复方氯化钠组(A1组,n=15),非O型血氯化钠组(A2组,n=14),O型血6%羟乙基淀粉130/0.4组(B1组,n=15),非O型血6%羟乙基淀粉130/0.4组(B2组,n=16).分别在麻醉前和预扩容完成时抽血测定TEG和血常规.结果 预扩容完成时A1、B1组Hb、Plt、最大振幅(MA)明显降低(P<0.05),B1组反应时间(R),凝固时间(K)明显延长,α角减小,达MA 30 min后血凝块溶解率(CL30)、凝血指数(CI)降低(P<0.05),B2组MA、α减小,CI降低(P<0.05).6%羟乙基淀粉130/0.4和O型血存在交互作用(P<0.05).结论 6%羟乙基淀粉130/0.4和O型血对剖宫产产妇TEG指标存在相加作用,但是凝血功能无明显改变.  相似文献   

9.
目的探讨改良式剖宫产术在前置胎盘治疗中的有效应用。方法随机选取2016年3月至2018年3月收治的前置胎盘产妇80例,依据治疗方法将这些产妇分为两组,即改良式剖宫产术组(改良式组,n=40)和子宫下段剖宫产术组(子宫下段组,n=40)。子宫下段组产妇接受子宫下段剖宫产术治疗;改良式组产妇接受改良式剖宫产术治疗。然后统计分析两组产妇的术中术后指标。结果改良式组产妇开始手术到娩出胎儿时间、手术时间均显著短于子宫下段组(P0.05),术中出血量显著少于子宫下段组(P0.05),术后1天排气比例40.0%(16/40)显著高于子宫下段组17.5%(7/40)(P0.05),并发症发生率、疼痛发生率5.0%(2/40)、12.5%(5/40)均显著低于子宫下段组25.0%(10/40)、37.5%(15/40)(P0.05)。结论改良式剖宫产术较子宫下段剖宫产术在前置胎盘治疗中的应用效果好,更能有效缩短产妇开始手术到娩出胎儿时间、手术时间,减少产妇术中出血量,促进产妇术后早日排气,减少产妇并发症,减轻产妇疼痛。  相似文献   

10.
目的分析顺产与剖宫产分娩方式对初产妇产后近期盆底肌力的影响及电刺激联合生物反馈等盆底肌康复治疗的效果。方法选取2017-12—2018-06间在黄河中心医院分娩的80例初产妇。根据分娩方式分为顺产组和剖宫产组,每组40例。产后6周应用PHENIX USB2检测仪量化评估盆底肌力后,对初筛结果盆底肌力下降(≤Ⅲ级)的初产妇均采用电刺激联合生物反馈等盆底肌康复治疗后再次检测产妇盆底肌力。结果剖宫产组产后42 d后盆底肌力下降率低于顺产组,差异有统计学意义(P0.05)。剖宫产组中肌力下降的初产妇治疗后有效率(盆底肌力Ⅲ级)高于顺产组,但差异无统计学意义(P0.05)。结论剖宫产初产妇产后盆底肌力下降率低于顺产产妇,但不能成为避免盆底肌肉受损程度而选择分娩方式的依据。无论何种分娩方式,术后出现盆底肌力受损的初产妇通过电刺激联合生物反馈治疗,可有效改善盆底功能障碍。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

13.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

16.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

17.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

18.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

19.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

20.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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