坐式体位对产妇镇痛分娩的影响

目的探讨坐式体位对产妇镇痛分娩的影响。方法在获得研究对象知情同意后,便利抽样法选取2013年3-7月在绍兴市妇幼保健院住院实施硬膜外镇痛分娩的99例产妇作为研究对象,按随机数字表法将其分为观察组(n=52)和对照组(n=47)。观察组产妇采用坐式体位进行分娩,对照组产妇采用传统的仰卧位进行分娩,观察两组产妇分娩方式、第二产程、产妇舒适度、下肢酸胀麻木及会阴切开等指标。结果观察组产妇自然分娩率为98.08%,明显高于对照组的85.11%,差异有统计学意义(χ2=3.982,P=0.046);第二产程所用时间明显少于对照组,差异有统计学意义(t=2.310,P=0.024);产妇分娩舒适度总体好于对照组,差异有统计学意义(Z=-2.049,P=0.040);产妇发生下肢酸胀麻木和会阴切开的比例均低于对照组,差异均有统计学意义(均P0.05)。结论坐式体位分娩可提高产妇自然分娩率、缩短第二产程时间和提高产妇分娩舒适度。     

应用分娩球纠正产程进展缓慢的效果观察

目的 探讨应用分娩球纠正产程进展缓慢的效果.方法 选择进入产程后出现产程进展缓慢的初产妇300例,分为观察组和对照组各150例,对照组给予静脉滴注催产素,并采用舒适体位、平卧位、交替左右侧卧位等体位,观察组在宫缩间歇期采取最舒适的姿势,如骑坐、跪伏、趴在分娩球上,宫缩时随身体重心做前、后、左、右、转圈运动,直至宫口开全.观察两组产程进展、分娩方式、新生儿窒息和产后出血量.结果 观察组产程进展顺利,剖宫产率、产后出血量低于对照组,差异均有统计学意义(P=0.000).新生儿窒息率两组差异无统计学意义(P=0.176).结论 应用分娩球能纠正产程异常,促进自然分娩,减少产后出血量,保障母婴安全.     

导乐陪伴分娩联合无创分娩镇痛的应用研究

目的:探讨导乐陪伴分娩联合无创分娩镇痛的临床效果。方法:选择2012年5月—2013年7月在江苏省镇江市妇幼保健院待产的初产妇260例,将其随机分为干预组和对照组,每组130例;2组产妇在年龄、文化程度、职业、孕周等方面的差异无统计学意义(P0.05)。对照组产妇在宫口开至2 cm时入产房,由家属陪伴,仅采用常规的呼吸减痛分娩法待产,至产后2 h;干预组产妇在宫口开至2 cm时入产房,由家属陪伴,同时由导乐师进行一对一导乐陪伴并应用分娩镇痛仪镇痛待产,至产后2 h。比较2组产妇的焦虑程度、各产程时间、活跃期时间、产后出血量、镇痛效果、生理分娩率、满意度。结果:干预组产妇焦虑程度、活跃期时间、产后出血量明显低于或少于对照组(P0.05);干预组产妇镇痛效果、生理分娩率、满意率均明显优于对照组(P0.05)。2组产妇的第二产程时间、第三产程时间差异均无统计学意义(P0.05)。结论:导乐陪伴分娩配合分娩镇痛仪的应用能有效降低产妇的焦虑与疼痛程度,缩短活跃期时间,促进自然分娩,减少产后出血量,值得推广。     

Nasal Drug Delivery

The Nasal Drug Delivery Conference was held at the Institute of Directors in London, England. The meeting was organised by the Management Forum Ltd and chaired by P Seeney (PA Consulting, UK) and Professor F Merkus (Leiden University, The Netherlands; Innoscience Technology, Belgium). The conference covered a wide range of topics including aspects of nasal physiology, formulation, new nasal products, nasal vaccines, nose to brain transport and pain management via nasal sprays.     

Drug Delivery Systems

Abstract:   Intrathecal drug delivery (IDD) is a proven and effective treatment alternative in carefully selected patients with chronic pain that cannot be controlled by a well-tailored drug regime and/or spinal cord stimulation (SCS), and may be specifically trialed in patients who fail to respond to SCS. While the lack of randomized controlled trials is often perceived as a limitation of IDD, many studies attest to the efficacy of this therapy, and a number are large-scale and with follow-up periods of up to five years. Good to excellent pain relief is achieved in many patients who have failed more conservative therapies, and there is often a reduced need for analgesia. The advent of patient-controlled analgesia allows flexibility of dosing according to the patient's needs. Consequently, quality of life improves in many patients and the majority express satisfaction with treatment. Some patients are able to return to work. The benefits of IDD (including a potent analgesic response with a more stable therapeutic drug level, decreased latency, increased duration of action, and decreased pharmacological complications) mean that side effects such as nausea, vomiting, sedation, and constipation are reduced. In addition, IDD demonstrates long-term cost-effectiveness when compared to conventional pain therapies, addressing a concern that affects many physicians in clinical practice today.     

Aptamer-targeted Antigen Delivery

Effective therapeutic vaccines often require activation of T cell-mediated immunity. Robust T cell activation, including CD8 T cell responses, can be achieved using antibodies or antibody fragments to direct antigens of interest to professional antigen presenting cells. This approach represents an important advance in enhancing vaccine efficacy. Nucleic acid aptamers present a promising alternative to protein-based targeting approaches. We have selected aptamers that specifically bind the murine receptor, DEC205, a C-type lectin expressed predominantly on the surface of CD8α⁺ dendritic cells (DCs) that has been shown to be efficient at facilitating antigen crosspresentation and subsequent CD8⁺ T cell activation. Using a minimized aptamer conjugated to the model antigen ovalbumin (OVA), DEC205-targeted antigen crosspresentation was verified in vitro and in vivo by proliferation and cytokine production by primary murine CD8⁺ T cells expressing a T cell receptor specific for the major histocompatibility complex (MHC) I-restricted OVA_257–264 peptide SIINFEKL. Compared with a nonspecific ribonucleic acid (RNA) of similar length, DEC205 aptamer-OVA-mediated antigen delivery stimulated strong proliferation and production of interferon (IFN)-γ and interleukin (IL)-2. The immune responses elicited by aptamer-OVA conjugates were sufficient to inhibit the growth of established OVA-expressing B16 tumor cells. Our results demonstrate a new application of aptamer technology for the development of effective T cell-mediated vaccines.     

分娩镇痛配合缩宫素在催产中应用的效果

目的观察分娩镇痛配合使用缩宫素催产的效果。方法对238例要求分娩镇痛的初产妇,按分娩先后顺序分为观察组和对照组两组。观察组119例初产妇在常规镇痛开始1h后配合使用缩宫素催产,对照组119例初产妇实行常规分娩镇痛。观察2组孕妇分娩结局及母婴情况。结果观察组产程时间与对照组比较差异有统计学意义（P〈0．05）。分娩结局、新生儿窒息情况及产后2h出血量与对照组比较差异无统计学意义。结论分娩镇痛配合缩宫素静脉滴注能有效缩短产程,对母儿无不良影响。     

拉美滋减痛分娩法对产妇分娩方式及结局的影响

目的观察拉美滋减痛分娩法对产妇分娩方式及结局的影响。方法将400例孕39～42周、正常单胎头位且无明显头盆不称及产道异常的初产妇随机分为拉美滋组（n=200）和对照组（n=200）,比较两组产妇的分娩方式、产后出血量、产程时间2、4 h初乳分泌率、新生儿出生体重及Apgar评分。结果经拉美滋减痛分娩指导后,产妇的自然分娩率2、4 h初乳分泌率较对照组显著提高（P〈0.05或P〈0.01）,而产程时间、手术产率和产后出血量明显降低（P〈0.05或P〈0.01）;两组新生儿体重及Apgar评分差异无统计学意义（P〉0.05）。结论拉美滋减痛分娩法能显著提高产妇正常分娩率、降低手术产率,且可缩短总产程和减少产后出血率,值得临床推广应用。     

Delivery of enteral nutrition

There is increasing evidence that enteral feeding is superior to parenteral nutrition with regard to maintaining gut structure and function. Selection of the enteral access route depends on the type and anticipated duration of nutrient delivery. At present, enteral feeding devices can be divided into two major categories: those entering the gastrointestinal tract through the oral or nasal cavity (oroenteric or nasoenteric tubes) and those entering through the abdominal wall including gastrostomy, duodenostomy, or jejunostomy tubes. This article provides a review of methods to insert and confirm gastric and intestinal feeding tube placement. Care of the patient with an enteric tube will be described.     

循证护理在分娩室内助产士陪伴分娩中的应用

目的观察与探讨循证护理在分娩室内助产士陪伴分娩中的应用。方法本文选择了2009年10月～2010年10月我院收治的孕妇100例,年龄23～36岁,妊娠37～40w。依照循证护理的方式提出问题,并且寻求实证,将其与临床实际相结合,将所选孕妇分为两组,观察组与对照组各50例,对照组孕妇接受出传统健康教育的护理,观察组孕妇接受循证护理的方法。比较两组孕妇的产程、剖宫产率以及产后出血情况等。结果经比较,观察组孕妇的产程较对照组短,剖宫产率及产后出血率低于对照组,差异具有统计学意义(P<0.05)。结论采取循证护理的模式对孕妇实行产前健康教育,这种方式有助于孕妇产前自我保健意识的提高以及维护母婴健康。