Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise: a randomised controlled study

BackgroundNorepinephrine is as effective as phenylephrine for management of spinal anaesthesia-induced hypotension. Most of the studies comparing these vasopressors have been conducted in healthy pregnant women undergoing elective caesarean section. In the current study, we tested the null hypothesis that there is no difference in neonatal outcome when phenylephrine or norepinephrine is used to treat spinal anaesthesia-induced hypotension in women undergoing emergency caesarean section for fetal compromise.MethodsPatients undergoing caesarean section for fetal compromise who developed spinal anaesthesia-induced hypotension were randomised to receive phenylephrine 100 μg or norepinephrine 8 μg for treatment of each hypotensive episode, defined as systolic blood pressure <100 mmHg. Umbilical cord arterial and venous blood samples were obtained for blood gas analysis. The primary outcome measure was umbilical artery pH.ResultsOne hundred patients (50 in each group) were studied. There was no significant difference in umbilical artery pH between the two groups (mean difference 0.001; 95% CI −0.032 to 0.034). The number of hypotensive episodes, vasopressor boluses required, the incidence of bradycardia, heart rate and blood pressure trends following vasopressor administration, and the incidence of nausea/vomiting were not significantly different between groups.ConclusionPhenylephrine 100 μg and norepinephrine 8 μg were not significantly different in terms of neonatal outcome when administered as intravenous boluses for treatment of spinal anaesthesia-induced hypotension in parturients undergoing emergency caesarean sections for fetal compromise.     

评价健康信念模式指导下的孕期护理干预对剖宫产率的影响

目的：：评估在孕妇孕期护理干预服务中运用健康信念模式指导对剖宫产率影响情况。方法：随机选择2015年3月-2016年3月进入本院接受产检及相应护理的117例孕妇，将其划分为研究、对照两组，研究组59例于妊娠期内施行基于健康信念模式的系统化护理干预服务，对照组58例于妊娠期内施行基础性的相关护理干预服务，探究产妇剖宫产率情况，对比两种护理法的效果。结果：研究组干预护理前、后选择破宫产的孕妇例数减少，占比下降显著，有统计学方面的意义（P＜0.05）。对照组干预护理前、后孕妇选取生产方式的占比情况没有较大变化，差异不具统计学方面的意义(P＞0.05)。结论：产科护理服务当中引入以健康信念为导向的干预模式，可降低剖宫产率，效果较好。     

顺产与剖宫产对母婴健康影响的比较分析

目的通过分析顺产与剖宫产对母亲产后出血、泌乳时间以及围生儿体质量影响,为正确选择分娩方式提供依据。方法回顾我院进行生产的产妇资料142例作为观察组,按照1:1对照的原则,以同期阴道顺产分娩的初产妇资料作为对照组,比较两组产妇与新生儿情况。结果两组产妇在产后出血量、泌乳不足情况、24小时宫高、下床情况及住院时间均具有统计学意义,P0.05;两组新生儿体质量、胆红素指数及新生儿肺炎情况差异均具有显著性,P0.05。结论顺产是一个自然的生理过程,与剖宫产分娩方式相比,更有利于母婴健康。     

Ⅱ型剖宫产瘢痕妊娠的腹腔镜处理

目的探讨腹腔镜下子宫动脉阻断、病灶切除及子宫修补术治疗Ⅱ型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的应用价值。方法回顾性分析2009年9月~2013年12月31例Ⅱ型CSP的临床资料,均在腹腔镜下游离出双侧子宫动脉并以3-0可吸收线结扎,然后行妊娠病灶切除及子宫修补术,5例有生育要求者松解子宫动脉的结扎线。术后随访血β-h CG、月经恢复的情况。结果 31例手术均获成功,无中转开腹,无严重手术并发症。手术时间50~100 min,(70.4±12.3)min。术中出血量50~200 ml,(123.6±36.8)ml。术后血β-h CG降至正常时间10~25 d,(19.8±8.1)d,月经周期均恢复正常。结论腹腔镜下子宫动脉阻断、病灶切除及子宫修补术具备微创、安全、疗效确切等优点,是Ⅱ型CSP的有效治疗方法。     

一对一全程陪伴剖宫产模式对产妇负性情绪及产后恢复的影响

目的观察产妇引入一对一全程陪伴剖宫产模式对其负性情绪及产后恢复的影响。方法应用随机数字表将84例剖宫产产妇分为观察组和对照组,各42例。对照组开展常规护理干预,观察组实施一对一全程陪伴剖宫产模式。记录两组孕产妇在入院当天及产后2h的焦虑自评量表和抑郁自评量表评分,并且比较两组产妇产后恢复情况和成本。结果两组入院当天焦虑自评量表和抑郁自评量表评分差异无统计学意义(P0.05);观察组产后2h的焦虑自评量表和抑郁自评量表评分均低于对照组(P0.05)。产后观察组阴道流血量少于对照组,子宫恢复正常大小时间、产后首次进食及初乳分泌时间均早于对照组,产后6h尿潴留发生率低于对照组,差异均有统计学意义(P0.05)。观察组护理人力成本及实际护理总成本要高于对照组,且差异有统计学意义(P0.05)。两组间在材料成本、设备折旧费、作业费、行政管理费及教育研究费方面差异无统计学意义(P0.05)。结论一对一全程陪伴剖宫产模式能有效改善产妇消极情绪,且能促进产后机体恢复。     

1例剖宫产合并肠破裂患者的护理

剖宫产出现诸多并发症，我院曾出现1例因剖宫产合并肠破裂病例，在连续硬膜外麻醉下行子宫下段剖宫产术，术中见肠管与腹膜粘连，钝性分离肠管时肠管破裂，取出胎儿后，行肠管切除肠吻合手术，通过医护人员精心治疗与护理，该患者通过针对性的护理措施和积极护理干预，经过12d治疗，治愈出院。医护人员密切配合，针对患者的特点制定引流管护理及产后护理方案，密切观察病情变化，早期处理，未造成严重并发症发生。     

Abordagem perioperatória de grávida com angioedema hereditário submetida a cesariana: relato de caso

Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C‐section.     

盐酸羟考酮复合右美托咪定在子痫前期患者剖宫产术后镇痛、镇静中的临床观察

目的:探讨不同剂量的盐酸羟考酮和右美托咪定复合用于子痫前期患者剖宫产术后镇痛、镇静的有效性和安全性。方法:120例子痫前期患者随机分为A、B、C 3组,各组40例。术后入重症监护病房(ICU)时连接盐酸羟考酮注射液和右美托咪定持续泵注镇痛、镇静治疗。A组采用低剂量盐酸羟考酮每小时0.5 mg+右美托咪定每小时0.3μg/kg持续泵注;B组采用中剂量盐酸羟考酮每小时0.75 mg+右美托咪定每小时0.3μg/kg持续泵注;C组采用高剂量盐酸羟考酮每小时1 mg+右美托咪定每小时0.3μg/kg持续泵注。记录3组患者术毕入ICU时(T0)、入ICU后2小时(T1)、4小时(T2)、6小时(T3)、8小时(T4)、12小时(T5)、24小时(T6)、48小时(T7)静息及按压宫底时的数字疼痛评分法(NRS)评分、按压宫底前后平均血压(MAP)、心率(HR),各时点静息时镇静满意者比例及恶心、呕吐、瘙痒、呼吸抑制、头晕痛等不良反应和子痫、脑出血、心力衰竭等并发症情况。结果:A组中静息NRS评分在T2~T7高于T1(P<0.05);在T2~T5时静息和按压时差异有统计学意义(P<0.05)。A组MAP、HR在T2~T5时点按压前后相比,差异有统计学意义(P<0.05)。B、C两组患者静息、按压NRS评分在T2~T7各时点低于A组(P<0.05);B、C两组间MAP、HR在按压前后各时点比较差异均无统计学意义(P>0.05)。B、C两组镇静满意者例数在T1~T7时点所占比例高于A组(P<0.05)。3组间恶心、呕吐、呼吸抑制发生率差异无统计学意义(P>0.05)。无子痫、脑出血、心力衰竭等并发症发生。结论:盐酸羟考酮每小时0.75mg+右美托咪定每小时0.3μg/kg持续静脉泵注用于子痫前期患者剖宫产术后48小时内镇痛、镇静,安全有效。