腰-硬联合麻醉在剖宫产手术中的应用及护理

[目的]探讨腰-硬联合麻醉在剖宫产手术中的应用效果及配合所采取的护理措施。[方法]通过对600例剖宫产进行回顾性总结,在麻醉前、中、后期实施了一系列有效的护理措施。[结果]由于护理得当,麻醉效果满意率达98%,所有手术均顺利完成,确保了母婴的安全。[结论]针对腰-硬联合麻醉的特点,重点做好心理护理,预防低血压的护理,有效预防仰卧位低血压综合征是保证手术顺利进行的关键。     

腰硬联合麻醉下剖宫产术中并发症的预防和护理

目的:探讨腰硬联合麻醉下剖宫产术中并发症的预防和护理方法。方法:对486例在腰硬联合麻醉下实行剖宫产术中发生并发症的患者采取预防和护理措施,观察其效果。结果:发生低血压452例,恶心、呕吐115例,寒战89例,经术中采取预防和护理措施均手术顺利。结论:产妇在腰硬联合麻醉下实行剖宫产术中采取有效预防和护理措施,可以减轻术中并发症程度,降低术后并发症发生。     

剖宫产术腰硬联合麻醉低血压的原因分析及护理

总结了102例剖宫产术腰硬联合麻醉发生低血压的原因及护理经验。原因有妊娠期母体血液动力学改变,腰硬联合麻醉后血液的重新分布等。针对性的措施包括加强体位护理及生命体征监测、心理护理等。认为精心的护理是预防剖宫产术腰硬联合麻醉低血压的重要措施。     

剖宫产腰-硬联合麻醉下仰卧位低血压综合征的预防及护理

探讨剖宫产腰-硬联合麻醉下仰卧位低血压综合征的预防和护理方法.通过对82例剖宫产病人腰-硬联合麻醉下仰卧位低血压综合征的原因分析,认为要做好充分的术前准备,术中密切观察病情,采取适当的护理措施,可预防或减少腰-硬联合麻醉下仰卧位低血压综合征的发生.     

剖宫产腰硬联合麻醉下仰卧位低血压综合征的预防护理

探讨剖宫产腰硬联合麻醉下仰卧位低血压综合征的预防和护理方法。通过对52例剖宫产患者腰硬联合麻醉下仰卧位低血压综合征的原因分析,认为要做好充分的术前准备,术中密切观察病情,采取适当的护理措施,可预防或减少腰硬联合麻醉下仰卧位低血压综合征的发生。     

两种不同麻醉方法对剖宫产术中血压的影响

目的探讨两种不同麻醉方法对剖宫产术中血压的影响,并提出针对性的预防及护理措施。方法选择择期的ASA Ⅰ期实行腰-硬联合麻醉和单纯硬膜外麻醉的剖宫产产妇各50例,对两种麻醉方法在麻醉手术期间引起的低血压进行比较分析。结果麻醉后腰-硬联合麻醉组,血压下降34例(34／50 68％),且在给药后血压即开始下降,3-5 min下降最低,15-20 min恢复到术前水平,收缩压最低者低于8.00kPa;硬膜外麻醉组,血压下降12例(12／50 24％),在给药后15-20 min血压下降最显著;麻醉后血压下降,腰-硬联合麻醉组比硬膜外麻醉组显著增多(P<0.01)。结论两种麻醉方法均可导致血压下降,但腰-硬联合麻醉组明显多于单纯硬膜外麻醉组,因此应重视术前探视、随时准备急救用物和急救药物,常规鼻导管吸氧,早期开放静脉通道,密切观察病情,麻醉后采用左侧倾斜30的体位,使产妇能顺利度过麻醉手术期间的低血压这一关。     

腰硬联合麻醉下剖宫产低血压原因分析

目的：分析腰硬联合麻醉下剖宫产低血压的原因。方法收集2012年1月到2013年9月武汉市第十一医院收治的580例腰硬联合麻醉下进行剖宫产手术患者的临床资料进行回顾性分析,分析手术原因、麻醉平面的变化及术中出血量对低血压发生的影响。结果术中发生低血压症状患者87例,发生率为15．00％,妊娠高血压综合征、孕妇羊水过多、巨大胎等可能是引发低血压的重要因素;T4以下麻醉平面低血压发生率最高（37．50％）,其次是T4～6（18．09％）;此外,手术中出血量在600mL以上的患者低血压发生率最大（50．00％）;对上述低血压患者采取及时的对症治疗与护理措施后,血压平均升高达基础压的30．00％,手术成功率为100．00％。结论妊娠高血压综合征、孕妇羊水过多、巨大胎、麻醉平面的变化及术中出血量等可能是腰硬联合麻醉下剖宫产术中引发低血压症状的重要原因。全面落实术前准备,针对病因给予强化后术中患者病情转化的监控,实施科学合理的护理对策,可降低腰硬联合麻醉时剖宫产孕妇低血压的发生率,确保母婴安全。     

腰-硬联合麻醉用于剖宫产的护理

目的:探讨腰-硬联合麻醉(CSEA)在剖宫产术中护理配合的方法,减少麻醉并发症的发生。方法:根据腰-硬联合麻醉特点,对60例剖宫产患者做好麻醉护理配合、生理、心理护理及术后镇痛。结果:产妇在术中生命体征稳定,有效地预防了并发症的发生。结论:CSEA起效快、效果确切、安全简便,具有重要的临床价值,为剖宫产术的首选麻醉方法之一。     

三种不同体位在腰硬联合麻醉下剖宫产术中的应用比较

在剖宫产麻醉选择方面,腰硬联合麻醉具有操作简便、起效迅速、麻醉效果确切等优势,但产妇麻醉后低血压的发生率较高且程度严重,临床上通常采用向左推移子宫、改变体位、容量补充以及预防和治疗性使用血管收缩药物等措施进行处理。但快速补液或使用升压药存在一定顾虑。为此笔者在腰硬联合麻醉剖宫产术中采用左倾斜中凹体位,探讨其在剖宫产手术中的临床应用效果。     

斜曲卧位预防剖宫产时引起的仰卧位低血压综合征疗效分析

目的 探讨斜曲卧位是否能有效预防硬-腰联合麻醉下剖宫产时仰卧位低血压的发生.方法 将120例拟在硬-腰联合麻醉下行剖宫产手术患者随机分为两组,每组60例,Ⅰ组为斜曲卧位组,Ⅱ组为对照组.监测两组麻醉后仰卧位低血压综合征发生情况.结果 Ⅰ组(斜曲卧位)组有2例发生仰卧位低血压综合征,Ⅱ组(对照组)有11例发生仰卧位低血压综合征.两组比较差异有统计学意义(P<0.05).结论 采用斜曲卧位可有效预防硬-腰联合麻醉下剖宫产时仰卧位低血压的发生.     

Regional anesthesia: combined spinal epidural anesthesia

The review deals with the promising method of regional anesthesia--combined epidural anesthesia. It gives indications for anesthesia, the specific features of its technical performance, and possible complications.     

循证麻醉访视在局部麻醉患者术前的应用研究

目的研究循证术前麻醉访视在局部麻醉患者中的应用效果。方法将240例局部麻醉患者采用随机数字表分为观察组和对照组,各120例,对照组采用常规术前访视,观察组采用循证麻醉访视,比较2组的手术应激情况以及功能恢复情况。结果观察组术中的恐惧评分低于对照组,收缩压、舒张压以及心率低于对照组,差异有统计学意义(P0.05)。观察组术后的躯体功能、认知功能、情感功能评分均高于对照组,差异有统计学意义(P0.05)。结论循证麻醉访视能够减轻局部麻醉患者的恐惧情绪,提高麻醉效果,有利于患者术后躯体功能的恢复。     

Principles of office anesthesia: part II. Topical anesthesia

The development of topical anesthetics has provided the family physician with multiple options in anesthetizing open and intact skin. The combination of tetracaine, adrenaline (epinephrine), and cocaine, better known as TAC, was the first topical agent available for analgesia of lacerations to the face and scalp. Cocaine has been replaced with lidocaine in a newer formulation called LET (lidocaine, epinephrine, and tetracaine). For analgesia to nonintact skin, LET gel is generally preferred over TAC because of its superior safety record and cost-effectiveness. EMLA (eutectic mixture of local anesthetics) is perhaps the most well-known topical anesthetic for use on intact skin. EMLA can be used to anesthetize the skin before intramuscular injections, venipuncture, and simple skin procedures such as curettage or biopsy. To be fully effective, EMLA should be applied at least 90 minutes before the procedure. ELA-Max is a new, rapidly acting topical agent for intact skin that works by way of a liposomal delivery system and is available over the counter. Other delivery vehicles for topical anesthesia currently in development, including iontophoresis and anesthetic patches, may one day give patients and physicians even more flexibility.     

Principles of office anesthesia: part I. Infiltrative anesthesia

The use of effective analgesia is vital for any office procedure in which pain may be inflicted. The ideal anesthetic achieves 100 percent analgesia in a short period of time, works on intact or nonintact skin without systemic side effects, and invokes neither pain nor toxicity. Because no single agent meets all of these criteria, the physician must choose from the available armamentarium based on the anesthetic properties that are most desired. Infiltrative anesthetics are frequently chosen because of their proven safety record, low cost, ease of storage, widespread availability, and rapid onset of action. Allergy to local injectable anesthetics is rare, and when it occurs it is often secondary to the preservative in multidose vials. Anesthesia can be prolonged with the addition of epinephrine or the use of longer-acting agents. Buffering the local anesthetic with bicarbonate, warming the solution, and injecting slowly can minimize the pain of anesthetic injection. Complications are rare but include central nervous system and cardiovascular toxicity, or extreme vasoconstriction in an end organ, if epinephrine is used.