间苯三酚静脉注射配合徒手扩张宫颈缩短产程的研究

目的 探讨间苯三酚静脉注射配合徒手扩张宫颈缩短产程的效果.方法 将240例初产妇随机分为3组各80例.分娩过程中待宫口开大3 cm时,观察组采用间苯三酚80 mg静脉注射配合徒手扩张宫颈口;对照1组用地西泮10mg缓慢静脉注射,不扩张宫颈口;对照2组用间苯三酚80 mg静脉注射,不扩张宫颈口.比较三组产妇分娩时总产程时间、产后出血量、新生儿窒息及剖宫产率.结果 观察组产妇总产程时间、新生儿窒息与对照1组及对照2组比较,差异有显著性意义(P＜0.05,P＜0.01);剖宫产率较对照1、2组显著下降(P＜0.05,P＜0.01);3组产后出血量比较,差异无显著性意义(均P＞0.05),对照1组药物不良反应发生率显著高于观察组及对照2组(均P＜0.01).结论 静脉注射间苯三酚配合徒手扩张宫颈能加速产妇宫颈口扩张,缩短产程,而且对母婴安全无显著不良影响.     

间苯三酚联合缩宫素静滴促宫颈成熟及产程进展的临床疗效分析

目的探讨间苯三酚联合缩宫素静滴促宫颈成熟及产程进展的临床疗效。方法选择足月妊娠单胎头位104例需引产初产妇,采用单盲法随机分为两组各52例。研究组予间苯三酚120 mg加入5%葡萄糖250 ml静脉滴注,继而缩宫素2.5 U加入5%葡萄糖500 ml静脉滴注;对照组单纯予缩宫素2.5 U加入5%葡萄糖500 ml静脉滴注。记录并比较两组宫颈成熟度、产程进展、阴道分娩率、新生儿Apgar评分、产后阴道出血量及用药后母婴不良反应。结果研究组宫颈成熟度Bishop评分改善程度明显优于对照组,总产程时间明显短于对照组,阴道分娩率明显高于对照组,差异均有统计学意义(P0.05)。两组产后阴道出血量、新生儿Apgar评分比较差异均无统计学意义(P0.05),用药后母婴均无明显不良反应出现。结论间苯三酚联合缩宫素能促进宫颈成熟,加速产程进展,提高阴道分娩率,且对母婴无不良影响。     

间苯三酚对产程进展的影响

目的观察间苯三酚对产程进展的作用及其安全性。方法选择宫口开大3～4cm后出现活跃期延缓及停滞的初产妇189例,随机分为两组,观察组89例应用间苯三酚80mg静注,对照组100例应用地西泮10mg静注,观察两组产妇的产程进展时间、分娩方式、新生儿Apgar评分、产后出血量。结果观察组子宫颈口从用药至开全的时间明显短于对照组（P〈0.05）,阴道分娩率明显高于对照组（P〈0.05）,两组第2产程时间、胎儿窘迫、新生儿窒息及产后2h出血量比较差异无统计学意义（P〉0.05）。结论间苯三酚能明显改善宫颈条件,治疗活跃期延缓、停滞效果显著,能明显缩短活跃期产程,对母体和新生儿有较好的安全性,使用方便,为临床医生的理想选择。     

间苯三酚联合氧化亚氮用于第一产程疗效观察

目的 观察间苯三酚与氧化亚氯联合应用于第一产程活跃期的效果。方法 将120例初产妇随机分为间苯三酚与氧化亚氯联合应用组（观察1组，40例），单用间苯三酚组（观察2组。40例）和不用药物组（对照组，40例）。结果 间苯三酚可显著缩短活跃期时间（P〈0．01）．间苯三酚与氧化亚氟联合应用既可明显缩短活跃期时间．还可达到良好的分娩镇痛疗效（P〈0．01）。应用间苯三酚和氧化亚氯后产后2小时出血量、新生儿评分无正著改变（均P〉0．05）。结论 间苯三酚与氧化亚氯联合应用于第一产程活跃期有明显的缩短产程和镇痛作用。     

间苯三酚联合氧化亚氮用于第一产程疗效观察

目的观察间苯三酚与氧化亚氮联合应用于第一产程活跃期的效果.方法将120例初产妇随机分为间苯三酚与氧化亚氮联合应用组(观察1组,40例),单用间苯三酚组(观察2组,40例)和不用药物组(对照组,40例).结果间苯三酚可显著缩短活跃期时间(P＜0.01),间苯三酚与氧化亚氮联合应用既可明显缩短活跃期时间,还可达到良好的分娩镇痛疗效(P＜0.01).应用间苯三酚和氧化亚氮后产后2小时出血量、新生儿评分无显著改变(均P＞0.05).结论间苯三酚与氧化亚氮联合应用于第一产程活跃期有明显的缩短产程和镇痛作用.     

间苯三酚在绝经期患者宫腔镜手术中的应用

目的探讨间苯三酚在绝经期患者宫腔镜手术中应用的可行性及安全性。方法 2016年6月～2018年6月选取首都医科大学附属北京妇产医院妇科微创中心和航天中心医院妇产科176例绝经期患者,根据宫腔镜手术前宫颈预处理的方法分为间苯三酚组(n=84)和Foley尿管组(n=92),比较2组扩张宫颈时间、4.5 mm宫腔检查镜的镜体直接通过宫颈管的例数、术前并发症等。结果宫腔镜手术中无须扩宫,间苯三酚组54例,Foley尿管组60例,2组比较差异无显著性(χ~2=0.017,P=0.897)。间苯三酚组扩张宫颈管时间(20.6±7.5) s,Foley尿管组(21.8±8.0) s,2组比较差异无显著性(t=-1.024,P=0.307)。间苯三酚组术前均无腹痛、心率增快和(或)血压升高,Foley尿管组12例腹痛(P=0.000)、5例心率增快(P=0.037)和6例血压升高(P=0.019)。2组均无经尿道前列腺电切综合征、子宫穿孔、子宫出血、感染及静脉血栓等并发症发生。结论在充分评估患者手术风险的基础上,间苯三酚应用于绝经期患者宫腔镜手术前的宫颈预处理,疗效肯定,安全可行。     

活跃期应用间苯三酚并配合自由体位分娩的临床应用效果

目的探讨产妇活跃期应用间苯三酚配合自由体位分娩的临床效果。方法选取2014年2月至2015年5月在我院待产的产妇380例,根据处理方式不同分为观察组(190例)与对照组(190例),观察组产妇实施间苯三酚联合自由体位分娩,对照组产妇实施传统分娩(不给予间苯三酚)。比较两组产妇的产程进展、分娩结局、产妇并发症及新生儿结局等。结果与对照组比较,观察组中活跃期至胎儿分娩出时间4h产妇数量明显升高(63.16%vs.41.05%),活跃期时间也显著缩短[(2.9±0.3)h vs.(4.2±0.4)h],宫颈水肿消退率显著升高(92.11%vs.77.34%)(P均0.05);与对照组比较,观察组中产妇自然分娩率显著增加(85.79%vs.60.53%),剖宫产率显著降低(14.21%vs.37.89%),并发症发生率显著降低(22.11%vs.50.53%)(P均0.05);与对照组比较,观察组新生儿Apgar评分整体升高,颅内出血发生率降低(0.53%vs.3.68%)(P0.05)。结论产妇分娩活跃期应用间苯三酚配合自由体位分娩能显著改善产妇分娩结局及新生儿结局,并能降低并发症的发生,临床效果显著,值得推广应用。     

间苯三酚在宫腔镜手术中的应用

目的探讨间苯三酚在宫腔镜手术中进行宫颈预处理的可行性。方法将2009年12月~2010年7月在我科行宫腔镜手术、符合条件的患者98例分成2组：间苯三酚组50例,于宫腔镜术前10~15 min静点间苯三酚80 mg;米索组48例,术前12 h阴道放置米索前列醇0.4 mg。观察2组宫颈软化程度（测量用药后宫颈扩张程度、扩宫时间、扩宫难易程度）,观察药物副作用。结果 （1）用药后宫颈无阻力可通过的扩宫器：间苯三酚组5.0~8.0（中位数6.5）mm,米索组4.5~9.5（中位数6.75）mm;开始扩张宫颈至扩张至9.5号扩宫器的时间：间苯三酚组15~1080（中位数60）s,米索组0~1800（中位数60）s;扩张宫颈难易程度：间苯三酚组容易43例,较困难4例,困难3例,米索组容易34例,较困难11例,困难3例。以上指标2组均无显著差异（P〉0.05）。（2）间苯三酚组用药前后宫颈情况比较：间苯三酚组无阻力可通过的扩宫器用药前为3.0~7.5（中位数5.0）mm,用药后为5.0~8.0（中位数6.5）mm,用药后开大0~3.0（中位数1.0）mm。用药前后比较差异显著（Z=-6.221,P=0.000）。（3）药物副作用：米索组用药后20例（41.7%）阴道出血,14例（29.2%）下腹痛,9例（18.8%）发热;间苯三酚组用药后均无不适主诉。结论间苯三酚能有效软化、扩张宫颈,而且无毒副作用,应用简便,是一种安全、简便、有效的宫腔镜手术中进行宫颈预处理的药物。     

间苯三酚用于中期妊娠引产的疗效观察

目的总结间苯三酚在中期妊娠引产中的疗效。方法选择中期妊娠引产孕妇122例,分为间苯三酚组(62例)和对照组(60例)。间苯三酚组予以常规利凡诺引产,于出现规律宫缩后予间苯三酚80mg静脉注射。对照组为单纯用利凡诺引产,观察引产时间、患者的痛苦程度、宫颈水肿、宫颈裂伤情况,记录引产后的出血量,应用统计学进行分析。结果孕妇引产时间间苯三酚组明显短于对照组(P<0.05),孕妇痛苦程度、宫颈水肿及宫颈裂伤发生率间苯三酚组明显低于对照组,产后出血量比较差异无统计学意义(P>0.05)。结论间苯三酚用于利凡诺中期妊娠引产的辅助用药可以明显缩短引产时间、减轻孕妇痛苦、降低宫颈裂伤及宫颈水肿的发生率。     

Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen

Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen’s undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.     

经输液泵输入缩宫素引产初始滴速设置的研究

目的合理设置经输液泵输入缩宫素引产的初始滴速,为临床安全有效地输入缩宫素提供参考。方法将80例孕妇随机分为A组(24例)、B组(28例)与C组(28例),使用输液泵输入0.5%缩宫素液,三组分别以1、2、3 gtt/m in为初始滴速,此后根据宫缩每15分钟调整1次滴速,观察出现规律宫缩时所用的时间和滴速。结果静脉输注缩宫素后15 m in内A、B组无1例出现规律宫缩,C组有2例出现规律宫缩。22.5%孕妇在滴速续加至3~7 gtt/m in时出现规律宫缩。三组出现规律宫缩所用时间比较,差异有显著性意义(P<0.01),其中C组所用时间显著短于A、B组(P<0.01,P<0.05),B组显著短于A组(P<0.01)。结论从安全和时效的角度考虑,使用输液泵输注0.5%缩宫素初始滴速以3 gtt/m in(12 m l/h)为宜。     

经输液泵输入缩宫素引产初始滴速设置的研究

目的合理设置经输液泵输入缩宫素引产的初始滴速，为临床安全有效地输入缩宫素提供参考。方法将80例孕妇随机分为A组（24例）、B组（28例）与C组（28例），使用输液泵输入0．5％缩宫素液，三组分别以1、2、3gtt／min为初始滴速，此后根据宫缩每15分钟调整1次滴速，观察出现规律宫缩时所用的时间和滴速。结果静脉输注缩宫素后15min内A、B组无1例出现规律宫缩，C组有2例出现规律宫缩。22．5％孕妇在滴速续加至3～7gtt／min时出现规律宫缩。三组出现规律宫缩所用时间比较，差异有显著性意义（P＜0．01），其中C组所用时间显著短于A、B组（P〈0．01，P〈0．05），B组显著短于A组（P〈0．01）。结论从安全和时效的角度考虑，使用输液泵输注0．5％缩宫素初始滴速以3gtt／min（12ml／h）为宜。     

Compartment Syndrome of the Hand Induced by Peripherally Extravasated Phenylephrine

Background: Compartment syndrome of the hand is a rare and devastating complication of peripheral intravenous extravasation. With changes in critical care research, vasoactive medications are now more frequently administered through peripheral lines in the acute setting. Methods: We present the case of a patient diagnosed with compartment syndrome of the hand secondary to phenylephrine extravasation in the setting of hypovolemic shock. Results: The use of fasciotomy compartment release and intraoperative phentolamine resulted in significant improvement in tissue perfusion postoperatively. Conclusion: With incraesed incidence of peripherally administered vasoactive medications, the hand surgeon should be aware of potential complications and treatment of compartment syndrome with urgent fasciotomy and phentolamine administration.     

Self-Reported Use of an Implanted FES Hand System by Adolescents with Tetraplegia

Abstract

The Freehand System®, an eight-channel functional electrical stimulation (FES) system, was implanted in five adolescents with C-5 or C-6 tetraplegia to provide stimulated lateral pinch and palmar grasp. Following completion of inpatient training on how to use the Freehand System for predefined and self-selected activities of daily living (ADL), the adolescents were discharged to use their Freehand systems at home and school. A telephone survey was administered on a weekly basis to obtain information on the type of ADL performed with the Freehand System, reasons for not using the Freehand System, and perceived barriers and motivators to FES use. Twenty surveys were obtained on each adolescent, resulting in a total of 100 surveys. The most common type of activity performed with the Freehand System was self-care, which included tasks such as eating, grooming, and brushing teeth. The Freehand System was also used for productivity activities defined as writing, socialization, and manipulation of school and household objects. Motivators to Freehand System use included perceived need and importance to perform an ADL in an independent fashion, physical ease of using the Freehand System, and availability of social supports that facilitated Freehand System use. While there were several reported barriers to Freehand System use, incompatibility with multiple transfers to and from the wheelchair and lack of physical assistance during morning care to don the system were perceived as two of the more common reasons for nonuse.