剖宫产术后镇痛对母乳喂养影响的研究

目的:探讨剖宫产后使用不同镇痛方法,对母乳喂养的影响。方法:将无妊娠合并症及母乳喂养禁忌症的剖宫产产妇分为两组,选取自愿应用自控镇痛泵(PCA)的剖宫产产妇80例,作为观察组,同期行剖宫产采用传统方法镇痛,肌肉注射哌替啶的产妇80例作为对照组。观察两组术后镇痛的效果,术后3天乳汁是否充足,母乳喂养次数,母乳喂养知识的掌握情况。结果:观察组12h、24h的镇痛效果显著高于对照组(P<0.01),母乳喂养次数、母乳喂养知识的掌握观察组明显高于对照组(P<0.05);两组有显著差异,有统计学意义。结论:剖宫产术后使用自控镇痛泵(PCA),能有效地镇痛,使产妇尽快适应母亲角色,掌握母乳喂养方法,提高母乳喂养率。     

剖宫产术后硬膜外镇痛对母乳喂养的影响

通过对40例剖宫产术后硬膜外腔镇痛产妇母乳喂养的观察，结果显示：术后镇痛组新生儿出生后24小时内排便次数、排便量较对照组明显增多，产妇初乳量及哺乳次数较对照组明显增加，结论：提示剖宫产术后硬膜外腔镇痛较非镇痛性剖宫产更有利于和促进母乳喂养。     

自控镇痛对剖宫产术后母乳喂养的影响

<正>母乳是新生儿的最佳食物,产后早泌乳和多泌乳是保障母乳喂养的关键。然而,剖宫产术后疼痛导致的焦虑、交感神经兴奋引起的血浆儿茶酚胺增高抑制了母乳的产生。剖宫产术后病人硬膜外自控     

剖宫产术后硬膜外镇痛对母乳喂养的影响

通过对40例剖宫产术后硬膜外腔镇痛产妇母乳喂养的观察,结果显示:术后镇痛组新生儿出生后24小时内排便次数、排便量较对照组明显增多,产妇初乳量及哺乳次数较对照组明显增加,结论:提示剖宫产术后硬膜外腔镇痛较非镇痛性剖宫产更有利于和促进母乳喂养.     

镇痛泵对剖宫产术后患者的镇痛效果

镇痛泵通过持续的机械泵将药物按规定的浓度和速度匀速注入患体内。当患意识到疼痛发生和加剧时可按压控制按钮，将事先设定的药物注入体内。此法镇痛药物总量小，用药个体化、血药浓度稳定、镇痛确切，易被患接受。     

剖宫产术后硬膜外持续镇痛对母乳喂养的影响

目的探讨剖宫产术后硬膜外持续镇痛(PCEA)对母乳喂养的影响。方法对2005年1月至2005年6月在本院住院分娩的产妇,根据患者要求剖宫产术后予PCEA50例,观察对母乳喂养的影响并与剖宫产术后未予PCEA及自然分娩的各50例进行对照分析。结果PCEA组及自然分娩组与术后非镇痛组,开始泌乳时间、乳胀出现时间、24h母乳喂养次数、新生儿体重下降、术后肛门排气时间均有显著差异(P<0.05)。结论剖宫产术后PCEA提高了母乳喂养成功率。     

麻醉护理干预对剖宫产产妇术后镇痛及母乳喂养的效果观察

[目的]观察麻醉护理干预对剖宫产产妇术后镇痛及母乳喂养的效果。[方法]将200例剖宫产术后使用镇痛泵的足月初产妇随机分为观察组和对照组各100例,观察组给予以麻醉护士为基础、麻醉医生为督导的术后疼痛管理模式,对照组为传统的麻醉医生负责组。术后采用VAS法进行疼痛评分,观察两组术后8h、12h、24h、48h时间点VAS评分,比较两组泌乳功能、术后镇痛效果满意度评分。[结果]观察组产妇术后8h、12h、24h、48h时间点VAS评分低于对照组,术后初次泌乳时间早于对照组,24h哺乳次数多于对照组,乳汁充足率高于对照组,术后镇痛满意度高于对照组(P0.05)。[结论]麻醉护士参与术后镇痛管理可以提高术后镇痛效果及镇痛满意度,提高母乳喂养成功率。     

硬膜外镇痛用于剖宫产术后的观察

探讨剖宫产术后采用硬膜外镇痛的镇痛效果,对产妇及新生儿呼吸、循环的影响及其副反应,以便采取相应的护理措施。随机选择107例产妇作为实验组,于剖宫产结束时留置硬膜外导管,连接注有生理盐水100ml,吗啡5mg,氟呱啶5mg,布比卡因45mg的自控镇痛泵。101例产妇作为对照组,术后予曲马多塞肛。结果显示,实验组术后1级镇痛达76．6％。与对照组比较,P＜0．01,有显著意义。对产妇及新生儿呼吸,循环比较P＞0．05。     

剖宫产术后硬膜外自控镇痛对母乳喂养的影响

目的：探讨剖宫产术后硬膜外自控镇痛对母乳喂养的影响。方法：120例行剖宫产术的初产妇根据经济状况不同分为两组：实验组和对照组，每组60例。实验组采用镇痛泵（所用药物为0．75％布比卡因15mL＋吗啡5mg＋0．9％氯化钠注射液至100mL）进行镇痛；对照组在主诉剧痛时给予杜冷丁50mg，肌肉注射1次。观察两组产妇术后活动、功能恢复、早吸吮、奶胀及术后第7天母乳喂养和新生儿体重变化情况。结果：实验组的镇痛效果优于对照组（P〈0．05）；实验组术后48h床上活动及72h肛门通气均优于对照组（P均〈0．05）；实验组72h下床活动和72h自解小便与对照组之间差异均无统计学意义（P均〉0．05）；实验组早吸吮、纯母乳喂养率均优于对照组（P均〈0．05），实验组新生儿体重回复率优于对照组（P〈0．05）。结论：剖宫产术后采用硬膜外自控镇痛效果好，有利于提高母乳喂养成功率和新生儿体重回复率。     

品质圈活动对提高孕产妇母乳喂养率的影响

目的 探讨品质圈活动对提高孕产妇母乳喂养率的影响.方法 将品质圈活动应用于124例住院孕产妇和家属母乳喂养知识的提高,并与124例未应用者比较.结果 参加活动者对母乳喂养相关知识的了解程度显著高于未参加者.结论 品质圈活动能明显提高住院孕产妇及其家属对母乳喂养知识的了解程度,以提高母乳喂养成功率.     

The effects of volume loading during epidural analgesia

We have determined the effects of volume loading on the cardiovascular changes during epidural analgesia in 37 patients, who underwent various kinds of surgery. The patients were placed in 4 groups, depending upon the level of analgesia and utilization of volume loading with colloidal solutions. If the analgesia extended above Th4 we grouped them as "high epidural" and lower than Th5 level they were grouped as "low epidural". The cardiac output was measured through a Swan-Ganz catheter with thermo-dilution methods and cardiovascular variables were calculated by standard formulas. Under epidural block the most significant changes were a fall in blood pressure with decrease in cardiac output which were more pronounced during high epidural analgesia. Volume loading during the induction period with colloidal solutions would prevent the marked fall of blood pressure in half of cases studied, but in the other half the infusion was not effective for the prevention of fall in blood pressure. On every occasion over-loading effects on the right side of the heart were observed with the infusion of colloidal solutions. Also, a marked fall in systemic vascular resistance was observed with the infusion. In consequence the volume loading did not prevent the fall in arterial pressure. To manage the latter which was observed during epidural block, some sympathomimetic agents would be necessary with the volume loading. This approach would be much more important in patients with dehydration and high level of epidural analgesia.     

When breastfeeding is unsuccessful – mothers' experiences after giving up breastfeeding

Some mothers have to give up breastfeeding even though they want to breastfeed. To give up breastfeeding can be a sensitive issue in a time when breastfeeding is promoted as the healthiest for mother and child. The aim of this study was to describe mothers' experiences after they gave up breastfeeding even though they intended to breastfeed. A qualitative social constructive approach was used to describe mothers' experiences after giving up breastfeeding. Danish first‐time mothers who had expected and wanted to breastfeed were interviewed 4 months after birth. The interviews were analysed by meaning condensation. The mothers experienced that giving up breastfeeding was a crucial but necessary decision for the child's health and well‐being. They tried to ‘be on the side of the angels’ by caring for and bonding with the child. The mothers were divided between expressing milk or formula feeding and initially felt especially insecure about which method to choose when not breastfeeding. It was difficult for them to face the world with a bottle, but they did not ask for help. The mothers found it hard to explain the difficulty they had experienced breastfeeding and they were concerned about what to do the next time around. The mothers always tried to do what they perceived was best for their child, but they were in a vulnerable position and not always supported and understood by the surroundings. Therefore, health professionals who focus on making new mothers feel successful need to be aware that mothers who have to give up breastfeeding need special attention and support.     

Focused hypnotic analgesia: local and remote effects

Suggestion for hypnotic analgesia aimed at a specific body area is termed "focused hypnotic analgesia". It is not clear, however, whether this analgesia is limited to a specific body location or spread all over the body. Focused hypnotic analgesia was studied, in response to ascending electrical stimuli, when analgesia and stimulation were applied to the same area (local), and when analgesia was applied to one location and stimulation was delivered to a different area (remote). The face or leg served alternately as the local or remote areas, and the effect was tested in 12 high-hypnotizable (HH) and 13 low-hypnotizable (LH) subjects. Hypnotic analgesia in the local site produced a significant pain reduction compared to the remote site in HH subjects (P<0.0001) but not in LH subjects (P=0.68). As stimuli increased in intensity the reduction in pain as a result of hypnosis was larger both in HH and LH subjects (P<0.0001). Nevertheless, significant analgesia occurred in the 3 highest intensities in the local and remote location of HH subjects, but only in 2 highest intensities in the local and 1 in the remote of LH subjects. We conclude that in HH subjects focused hypnotic analgesia is mostly confined to the area aimed at, but some spread of analgesia to remote areas cannot be dismissed all together. Alternatively, this "spread" of analgesia could be due to a placebo effect in the remote area. Focused hypnotic analgesia requires increased attention to the body area aimed at, unlike analgesia achieved by distraction of attention.     

腰硬联合阻滞后硬膜外自控镇痛在分娩镇痛中的应用

目的：探讨腰硬联合阻滞后硬膜外自控镇痛（CSEA＋PCEA）对分娩方式的影响。方法：将60例A SAⅠ-Ⅱ级单胎头位、无明显头盆不称、自愿接受分娩镇痛的足月初产妇随机分为两组：镇痛组（A组）和对照组（B组）。A组（n=30）待宫口开至2-3 cm时行L2-3间隙穿刺,向蛛网膜下隙注入0.2%舒芬太尼3-5μg（1.75 mL）,硬膜外腔头向置管4 cm,10 m in后连接硬膜外自控镇痛泵,PCEA输注0.1%罗哌卡因与舒芬太尼1.5μg/mL,单次剂量4 mL,锁定时间15 m in,背景剂量4 mL/h。B组（n=30）常规分娩处理,未实施分娩镇痛。观察镇痛效果、运动神经阻滞情况、产程进展及分娩方式、新生儿出生后A pgar评分情况及不良反应。结果：两组镇痛效果比较差异有统计学意义（P〈0.01）;两组活跃期和第二产程时间比较差异有统计学意义（P〈0.05）;两组缩宫素使用量及剖宫产率差异有统计学意义（P〈0.05）;两组新生儿出生后1,5 m in的A pgar评分无统计学意义。结论：CSEA＋PCEA镇痛效果明显,无运动阻滞,不良反应较少,对产程有一定抑制,但对分娩结局无明显影响。     

不同健康教育形式对剖宫产产妇行自控镇痛的影响

目的探讨不同健康教育形式对剖宫产产妇行自控镇痛的应用效果。方法选取60例剖宫产产妇,随机分为对照组和实验组各30例。对照组术前1d由麻醉师进行术前教育,介绍自控镇痛泵的使用方法,术后由当班护士口头自控镇痛宣教;实验组术前1d由研究者进行系统化口头自控镇痛宣教,并发放书面的健康教育资料,术后再接受研究者的个别指导。评价并比较2组术后6,24,36,48h的疼痛强度。结果术后6,24,36,48h,对照组疼痛评分均显著高于实验组,差异有统计学意义。结论系统化口头宣教及书面的健康教育资料能有效提高自控镇痛的健康教育效果,降低产后疼痛,对提高产妇的生活质量有着十分重要意义。     

自控镇痛泵用于剖宫产术后镇痛效果观察及护理

目的：探讨自控镇痛泵用于剖宫产术后镇痛的效果及护理方法。方法：选择剖宫产患者200例，按自愿原则分为观察组和对照组．每组100例。观察组术后应用自控镇痛泵镇痛，对照组应用度冷丁镇痛，观察两组术后24h内的镇痛效果及睡眠状态。结果：观察组术后24h内镇痛效果及睡眠状态明显优于对照组（P〈0．01），且肠蠕动恢复及肛门排气时间较对照组明显提前（P〈0．01）。结论：自控镇痛泵用于剖宫产术后镇痛效果明显，是一种值得推广的有效、快速、持续的术后镇痛方法。     

超声引导下腰方肌后阻滞和连续硬膜外镇痛对剖宫产术后镇痛效果的比较

目的 比较腰方肌阻滞(QLB)和连续硬膜外镇痛在剖宫产术后的镇痛效果。方法 前瞻性选取2019年4~10月首都医科大学附属北京友谊医院收治的行剖宫产的产妇60例,采用随机数字表法将其分为三组:腰方肌阻滞组(QLB组)、连续硬膜外镇痛组(PECA组)和腰方肌阻滞+连续硬膜外镇痛组(QLB+PCEA组),每组各20例。于剖宫产术后,给予PCEA组和QLB+PCEA组产妇连接硬膜外镇痛泵,镇痛泵配方为150 mg罗哌卡因、50μg舒芬太尼用生理盐水配至250 ml。给予QLB组和QLB+PCEA组产妇行超声引导下双侧腰方肌阻滞,采用腰方肌后阻滞,给予0.375%的罗哌卡因两侧各25 ml。记录以下指标:①三组产妇术后6 h、12 h、24 h、48 h产妇的静态疼痛VAS评分;②PCEA组和PCEA+QLB组产妇术后24 h、48 h内镇痛泵的按压次数和舒芬太尼用量;③PCEA组和QLB组产妇在镇痛期间不良反应发生情况。结果 QLB组和PCEA组产妇术后6 h、12 h、24 h、48 h静息时疼痛评分比较,差异均无统计学意义(P> 0. 05)。PCEA+QLB组产妇的术后6 h静态疼痛VAS评分(1. 75±0. 50分)、以及12 h静态疼痛VAS评分(1. 00±0. 0分)分别较PCEA组产妇术后6 h(3. 19±1. 11分)和12 h(2. 31±0. 79分)更低,差异具有统计学意义(P <0. 05);24 h、48 h的静息疼痛评分无显著差异;但24 h、48 h内的镇痛泵按压次数明显减少,PCEA组24 h(9. 79±8. 41次)、48 h(11. 68±9. 63次),PCEA+QLB组24 h(3. 11±2. 22次)、48 h(5. 96±4. 57次),差异均具有统计学意义(P <0. 05)。PCEA+QLB组产妇较PCEA组产妇,24 h内使用的舒芬太尼量差异无统计学意义(P> 0. 05);但48 h内使用的舒芬太尼量减少,PCEA组(46. 13±2. 42μg),PCEA+QLB组(9. 71±1. 48μg),差异具有统计学意义(P=0. 039)。QLB组产妇麻醉不良反应发生率为0,PCEA组为20. 0%,显著高于QLB组,差异具有统计学意义(P=0. 035)。结论与连续硬膜外镇痛相比,超声引导下腰方肌后阻滞用于剖宫产术后镇痛,可减少围手术期舒芬太尼用量和麻醉不良反应的发生。