The performance of neck circumference and other airway assessment tests for the prediction of difficult intubation in obese parturients undergoing cesarean delivery

BackgroundPregnancy and obesity each increase the chance of difficult tracheal intubation. This study assessed the performance of the neck circumference and other bedside tests in predicting difficult intubation, and aimed to identify the optimal cutoff point of the test(s) with the highest performance.MethodsParturients with a body mass index ≥30 kg/m², undergoing a cesarean delivery employing conventional tracheal intubation, were enrolled. Preoperative neck circumference, sternomental distance and modified Mallampati test were examined. Difficult intubation was defined as intubation difficulty scale score ≥5.ResultsFive hundred and seventy parturients of mean body mass index 34.1 (± SD 3.8) kg/m² were recruited. The incidence of difficult intubation was 3.5%. The performance of the neck circumference test, conducted with the patient sitting or supine, and using the area under the receiver operating characteristic (ROC) curves, was 0.6 (95% CI 0.5 to 0.7) and 0.6 (95% CI 0.4 to 0.7) respectively. The area under the ROC for the modified Mallampati test was 0.6 (95% CI 0.5 to 0.7) and for the sternomental distance test was 0.7 (95% CI 0.6 to 0.8). A sternomental distance less than 14.5 cm, and a ratio of neck circumference in the sitting position to sternomental distance of greater than or equal to 2.7, were optimal cutoff points to identify difficult intubation.ConclusionThe neck circumference, the sternomental distance, the modified Mallampati test and the ratio of neck circumference to the sternomental distance show limited performance as screening tests to predict difficult intubation among obese parturients.     

自控腰硬联合分娩镇痛不同的停泵时机对产程和分娩结局的影响

目的探讨自控腰硬联合分娩镇痛麻醉下,初产妇分娩过程中不同的停泵时机对产程、分娩结局和产妇满意度的影响。方法选择2013年4月-2013年12月间符合条件的初产妇120例,按先后顺序分到A、B、C三组,每完成10个另起一组,每组40例,腰硬联合麻醉分娩镇痛,A组宫口开全停泵,不再开泵;B组宫口开全停泵,胎儿娩出后立即开泵;C组一、二、三产程持续镇痛,三组均于第三产程结束,会阴缝合术毕结束镇痛并拔硬外镇痛管。观察比较产妇基本情况、镇痛效果（VAS）评分、第1、2、3产程时间、产后2h内出血量、缩宫素使用、剖宫产率、钳产率、羊水性质、产妇满意度,新生儿Apgar评分。结果三组间产后2h出血、新生儿Apgar评分、第三产程时间差异无统计学意义;A、B组产妇分娩痛比例较c组增加,会阴缝合痛或不适者较C组多,C组产妇满意度较A、B组增加,差异有统计学意义,A、B组间各项指标间差异无统计学意义。结论不同的停泵时机不增加第二产程,不影响新生儿Aparg评分,不增加产后出血,持续用药组增加缩宫素使用率,差异有统计学意义（P〈0．05）,可能增加剖宫产趋势,但可提高产妇满意度。     

Pain perception among parturients at a University Teaching Hospital,South-Western Nigeria

Introduction:

Labour pain is a universal experience. Relief of labour pains and companionship in labour are important aspects of quality of care in labour.

Objectives:

To evaluate perception of labour pains among parturients, their knowledge and awareness of pain relief during labour, the types of obstetric analgesia available and the outcome of their labour at the Ekiti State University Teaching Hospital, Ado-Ekiti.

Materials and Methods:

A cross-sectional study using questionnaire administered to pregnant women between 37 and 42 weeks gestational age in labour ward of the hospital.

Results:

The study revealed that 75.2% of the parturients experienced severe labour pains and 35.3% of them received analgesia in labour with Pentazocine injection being the only analgesic used. Only 18.3% had maximum relief of their pains. Parturients with increasing parity, higher social class and educational attainment and who had antenatal education on labour pains were associated with severe perception of labour pains with P values of 0.03, 0.03, 0.02 and 0.01, respectively. Parturients who were given Pentazocine injection for pains and had relief in labour had more spontaneous vaginal deliveries, P = 0.030 and better outcome for their babies, P = 0.028. Majority of the women reported that the practice of companionship and back rubbing in labour helped them to cope better with the labour process.

Conclusion:

Most women desire relief of pains of labour but the practice is still suboptimal in this centre. Efforts should be made towards developing the practice of obstetric analgesia and companionship in labour in this environment.     

产妇产后心绪不良发生情况及其影响因素分析

目的探讨产妇产后心绪不良的发病情况及其影响因素。方法对480例初产妇分别于分娩后1周逐一进行一般状况问卷调查,并采用抑郁自评量表(SDS)调查产妇产后心绪不良的发生率,然后采用Logistic回归分析产妇产后心绪不良发生的影响因素。结果480例产妇产后1周发生产后心绪不良167例,发生率为34.8%;产妇文化程度、经济状况、分娩方式、新生儿性别、产后出血、合并妊娠高血压综合征、新生儿呼吸衰竭、家庭支持系统等是其发生的主要影响因素。结论对有上述高危因素作用的产妇,应加强围产期的精神卫生保健和心理援助。     

高危产妇产后出血的防治

目的:探讨不同药物用于预防和治疗产后出血的临床疗效和安全性。方法:选取2006年6月～2011年6月因多胎妊娠、巨大胎儿、前置胎盘、胎盘早剥、羊水过多等有高危因素的产妇,计划剖宫产者1 380例随机分为3组,A组:胎儿娩出后宫体注入缩宫素20U,若有出血倾向者,加大缩宫素剂量,最大剂量80U;B组:胎儿娩出后宫体注入缩宫素20U,并于剖宫产术中胎盘娩出后擦拭宫腔后将米索前列醇片200μg置放宫腔底部,若有出血倾向者,给予嚼服或直肠给予米索前列醇片,最大剂量600μg;C组:胎儿娩出后宫体注入缩宫素20U+欣母沛250μg,若有出血倾向者,加大欣母沛剂量,最大剂量750μg,对3组资料进行回顾性分析。结果:预防性用药C组比A组、B组术后2h及术后24h出血量显著减少(P<0.01)。治疗性用药产后出血发生率明显低于A组、B组(P<0.05),治疗有效率明显高于A、B两组(P<0.05)。结论:欣母沛能很好预防高危产妇的产后出血发生率,治疗宫缩乏力性产后出血的效果明显,大大减少了切除子宫的危险,值得临床推广应用。     

Schnider模型用于全麻剖宫产诱导时丙泊酚的效应室靶浓度

目的:探讨在Schnider模型下进行剖宫产全麻诱导时,能提供足够麻醉深度的丙泊酚效应室靶浓度(effect-site propofol concentration,ECe)。方法:选择72例ASAⅠ～Ⅱ级择期全麻行接受剖宫产的产妇,按照不同的丙泊酚ECe(4.0、4.5、5.0、5.5、6.0、6.5μg/mL)分为6组,每组12例。采用Schnider模型进行丙泊酚靶控输注,意识消失后1min,脑电双频指数(BIS)值60且丙泊酚达到ECe时,行气管插管。采用Probit回归分析计算产妇全麻诱导时的丙泊酚ECe50和ECe95。记录产妇平均动脉压(MAP)、心率(HR)、BIS、Apgar评分、新生儿脐动脉血气分析结果和分娩时间。结果:各组间产妇的一般情况差异无统计学意义。产妇全麻诱导的丙泊酚ECe50和ECe95分别为5.14μg/mL(95%CI 4.90～5.38)和6.07μg/mL(95%CI 5.72～6.96)。各组间产妇MAP、HR,新生儿Apgar评分,新生儿脐动脉血气结果和娩出时间差异无统计学意义。结论:Schnider模型下产妇进行择期剖宫产全麻诱导时,丙泊酚的ECe50和ECe95分别为5.14μg/mL和6.07μg/mL。     

以相对头盆不称为指征的剖宫产100例分析

对我院１９９３年６月至１９９５年６月间，诊断为相对头盆不称而施行剖宫产手术者１００例进行回顾性分析，结果：６６例处理正确，诊断正确率为６６％；另外３４例中，过早诊断相对头盆不称者１４例；在产程中因观察处理不当诊断相对头盆不称者２０例。提示：在产程中及时正确地诊断相对头盆不称，并允许其进行充分的试产，在观察产程中予以正确的处理，是降低剖宫产率，提高产科质量的关键。     

孕产期保健保偿制三级管理的做法

本文阐述了张家口市在完善保健保偿制的基础上,于1990年对孕产期保健保偿制实行三级管理和三级质量控制的做法。一级是市孕保办对县(区)孕保办的管理和质量控制:二级是县(区)孕保办对辖区内地段保健、医疗单位及乡(镇)卫生院的管理和质量控制;三级是地段保健、医疗单位对本单位有关科室,乡(镇)卫生院对责任乡村医生和接生员的管理和质量控制。通过实践,收到了较好的效果。     

肥胖产妇剖宫产术59例麻醉分析

目的探讨肥胖产妇剖宫产术的麻醉处理方法及效果。方法选择在该院行剖宫产的59例肥胖产妇,常规监测血氧浓度、心率、血压、呼吸,并行硬腰联合麻醉。结果 36例产妇穿刺顺利,脑脊液回流通畅,麻醉效果优;19例产妇脑脊液回流不通畅改用硬膜外麻醉完成手术;4例产妇穿刺困难改用气管插管全麻。所有婴儿1分钟Apgar评分均为7～10分,产妇产后恢复良好。结论椎管内麻醉为肥胖产妇剖宫产术的较好的麻醉方式,其次为硬膜外麻醉方式,麻醉过程中均应特别重视气道和循环的管理。     

基于微信平台延续性护理服务对剖宫产肥胖产妇伤口愈合及外观满意度影响

目的 分析对剖宫产肥胖产妇实施基于微信平台延续性护理服务的效果及对伤口愈合、外观美观度 的影响。方法 选择2022年1月-2023年4月于我院实施剖宫产手术的60例肥胖产妇为研究对象,随机分为对照 组和观察组,每组30例。对照组实施常规围术期护理,观察组在对照组的基础上实施基于微信平台的延续 性护理服务,比较两组瘢痕宽度及厚度、伤口愈合情况、外观满意度。结果 观察组瘢痕宽度、厚度均小于 对照组（P ＜0.05）;观察组伤口甲级、乙级愈合占比高于对照组,丙级愈合占比低于对照组（P＜0.05）; 观察组外观满意度为93.33%,高于对照组的73.33%（P ＜0.05）。结论 对剖宫产肥胖产妇实施基于微信平 台延续性护理服务的效果良好,可促进伤口愈合,减轻瘢痕情况,对于提高外观满意度具有积极意义。