剖宫产术后自控镇痛对母婴的影响

目的　观察剖宫产术后产妇自控镇痛对母婴的影响。方法　 2 0 0 2年 1月至 2 0 0 3年 1月首都医科大学附属复兴医院将剖宫产产妇 2 16例分为观察组和对照组 ,两组均为连续硬膜外麻醉 ,手术结束时 ,观察组将自控镇痛泵接在硬膜外管上。术后分别取产妇肘静脉血、初乳、尿及新生儿尿 ,测定吗啡含量 ;观察镇痛效果及副反应。结果　与对照组比较观察组镇痛效果明显 (P <0 0 5 )。观察组血吗啡质量浓度 5 0～ 12 6 0 μg/L ,初乳吗啡质量浓度 5 0～ 33 6 μg/L ,91 8%的产妇尿吗啡呈阳性 ,12 7%的新生儿尿吗啡呈阳性。随访 1年两组婴儿的体格及发育商比较 ,P >0 0 5。结论　剖宫产术后硬膜外腔应用吗啡镇痛 ,对产妇及新生儿是安全可行的     

剖宫产术后硬膜外镇痛产妇血及初乳中吗啡含量的监测

目的　监测剖宫产术后硬膜外镇痛产妇血及初乳中的吗啡含量 ,探讨微量吗啡对新生儿的影响。　方法　选择剖宫产术的产妇 10 0例 ,分为实验组和对照组各 5 0例 ,两组均为连续硬膜外麻醉 ,穿刺点选择 L1 ～ L3,麻醉药为 2 %利多卡因 15～ 2 0 m l,在手术结束时 ,实验组将吗啡缓慢注入硬膜外管 2 mg然后拔管。于术后 1h取产妇的静脉血 3m l,采集产妇术后 3、6 h尿样及术毕 6～ 12 h采集新生儿尿样 3m l;在产后 4 8h内收集产妇的初乳 3～ 5 m l。　结果　观察组 96 % (48/ 5 0 )的镇痛效果较对照 16 % (8/ 5 0 )明显 ,差异有显著性 (P<0 .0 5 ) ,观察组血吗啡浓度 <5～ 118μg/ m l,初乳吗啡浓度 <5～ 30 .4μg/ L ,产妇尿 92 %呈阳性 ,新生儿尿 13.3%呈阳性。两组产妇和新生儿的生命体征比较差异无显著性。　结论　剖宫产术后硬膜外腔应用吗啡镇痛 ,产妇哺乳对新生儿没有影响 ,是安全可行的。     

剖宫产术后镇痛对泌乳素的影响

目的 :观察剖宫产术后产妇静脉自控镇痛 (PCIA)和硬膜外自控镇痛 (PCEA)对血浆泌乳素 (PRL)浓度的影响。方法 :选择足月妊娠拟行剖宫产孕妇 6 0 0例 ,随机分为PCIA组、PCEA组和对照组 ,各 2 0 0例。采用视觉模拟评分法(VAS)和Ramsay评分法测评产妇镇痛、镇静程度 ,用放射免疫分析法测定术前、术后 2 4小时及 48小时血浆PRL浓度。结果 :两镇痛组术后 2 4小时、48小时血浆PRL水平显著较对照组高。结论 :术后静脉和硬膜外镇痛能促进泌乳素的分泌。     

阴道分娩与剖宫产的正常足月新生儿脐动脉血乳酸值的比较

目的 :探讨阴道分娩与剖宫产的足月正常新生儿脐动脉血乳酸值间的差异 ,及阴道分娩新生儿脐动脉血乳酸值与产妇第二产程时间的相关性。方法 :5 6例阴道分娩和 6 2例剖宫产的足月正常新生儿出生后立即取 2ml脐动脉血行乳酸检测。并对阴道分娩新生儿脐动脉血乳酸值与第二产程时间长短的相关性进行分析。结果 :阴道分娩组的脐动脉血乳酸水平明显高于剖宫产组 (P <0 0 1) ;但阴道分娩中第二产程≤ 45分钟 (10例 ) ,脐动脉血乳酸水平低于剖宫产组 (P <0 0 5 ) ;第二产程≤ 1小时 (2 8例 ) ,乳酸水平与剖宫产组比较 ,差异无显著性 (P >0 0 5 ) ;而第二产程 >1小时 (2 8例 ) ,乳酸水平高于剖宫产组 (P <0 0 5 )。阴道分娩新生儿乳酸水平与第二产程时间呈密切正相关 (P <0 0 1)。结论 :阴道分娩第二产程 <1小时与剖宫产比较新生儿乳酸值无差异 ;而当第二产程 >1小时 ,则使新生儿乳酸值增高。故对第二产程长应重视 ,并予积极处理。     

剖宫产术后硬膜外与静脉镇痛效果的观察

目的：观察剖宫产术后硬膜外与静脉镇痛的效果,为剖宫产术后镇痛提供参考。方法：从2009年1月至2010年12月间在我院进行剖宫产的产妇中随机筛选出61例采用硬膜外镇痛（即PCEA组）,在术后采用硬膜外持续微量注射;61例采用是静脉镇痛（即PCIA组）,在术后采用静脉自控微量注射。结果：PCEA组发生不良反应：恶心呕吐18例（占29.5%）,头痛头晕10例（占16.39%）,皮肤瘙痒4例（占6.56%）,合计32例;PCIA组发生不良反应：恶心呕吐10例（占16.39%）,头痛头晕5例（占8.20%）,皮肤瘙痒1例（占1.64%）,合计16例。结论：硬膜外与静脉镇痛各有优略,具体选择何种镇痛方式,要根据患者具体状况和意愿来定。     

剖宫产术后再次妊娠阴道分娩产程的初步分析

目的:研究无阴道分娩史的剖宫产术后再次妊娠孕妇阴道分娩的产程特点。方法:回顾性分析2017年7月1日至2018年6月30日在深圳市妇幼保健院产科住院阴道分娩的无新生儿窒息孕妇资料。选取单胎头位、自然临产、既往无阴道分娩史的346例剖宫产术后阴道分娩(VBAC)产妇作为病例组,选取同期住院自然临产阴道分娩、单胎头位的350例正常初产妇作为对照组,比较两组产妇的产程特点。结果:病例组和对照组孕妇的年龄、分娩孕周、新生儿出生体质量、产后出血量、新生儿转科率差异无统计学意义(P0.05)。两组产妇第一产程、第二产程、第三产程及总产程比较,差异无统计学意义(中位数分别为7.00 vs 6.5小时、0.33 vs 0.42小时、0.17 vs 0.15小时和7.45 vs 7.28小时;P0.05)。结论:对于无阴道分娩史的剖宫产术后阴道试产(TOLAC)孕妇的产程观察与处理可与初产妇相同标准,子宫瘢痕不影响产程。     

罗比卡因和布比卡因用于自控硬膜外分娩镇痛的临床效果对比研究

目的 :比较罗比卡因和布比卡因联合芬太尼用于自控硬膜外分娩镇痛 (PCEA)的效果及运动神经阻滞情况。方法 :将 6 0例健康、单胎、足月的初产妇随机分为两组 ,接受 0 .1%罗比卡因加 1μg/ml芬太尼 (RF组 )或 0 .0 75 %布比卡因加 1μg/ml芬太尼 (BF组 )自控硬膜外分娩镇痛。两组进行视觉模拟镇痛评分 (VAS)和下肢运动神经阻滞评分(MBS)。记录两组产程时间、分娩方式、阴道流血量及新生儿Apgar评分。结果 :两组产妇均有较可靠的镇痛效果 ,差异无显著性 (P >0 .0 5 ) ;RF组可下床活动者为 96 .6 7% ,而BF组为 33.33% ,两组差异有显著性 (P <0 .0 5 ) ;两组产程时间和分娩方式差异无显著性 (P >0 .0 5 ) ;两组新生儿Apgar评分差异无显著性 (P >0 .0 5 )。结论 :低浓度罗比卡因或布比卡因联合小剂量芬太尼用于PCEA均可产生可靠的镇痛效果。产程中罗比卡因极少引起运动阻滞 ,产妇有下床活动能力 ,其效果优于布比卡因     

蛛网膜下腔-硬膜外联合阻滞麻醉用于分娩镇痛206例分析

目的　探讨分娩镇痛的效果及对产程、母婴状况的影响。方法　采用蛛网膜下腔 -硬膜外联合阻滞(CSEA)用于分娩镇痛的产妇 2 0 6例作为观察组 ,将未采用任何分娩镇痛药物而进入产程的产妇 2 0 6例作为对照组 ,分别观察产程时间、分娩方式、产后出血、胎儿窘迫及新生儿窒息情况。结果　两组产程活跃期比较 ,有极显著性差异 (P <0 0 1) ;两组分娩方式比较有显著性差异 (P <0 0 5 ) ;两组胎儿窘迫、新生儿窒息及产后出血发生率比较 ,无显著性差异 (P >0 0 5 )。结论　CSEA用于分娩镇痛 ,疼痛阻滞完善 ,加速了产程活跃期及第二产程的进展 ,降低了剖宫产及阴道难产率 ,对母婴均无不良影响     

"新生儿游泳"在产科临床应用的探讨

目的　探讨在住院期间新生儿“游泳”后部分指标变化的临床意义。　方法　将 377例正常新生儿按分娩顺序分为观察组 (游泳组 ) 2 2 3例 ,其中阴道分娩 12 7例 ,剖宫产 96例 ;对照组 (单纯沐浴组 ) 15 4例 ,其中阴道分娩 10 9例、剖宫产 4 5例。测定两组新生儿的出生体重、出院时体重、胎便初排时间、胎便转黄时间。　结果　两组阴道分娩、剖宫产新生儿出生时体重无明显差异 (P >0 .0 5 ) ,观察组新生儿出院时阴道分娩者平均体重 (32 90± 35 0 ) g,剖宫产者平均体重 (35 10± 4 0 0 ) g;对照组新生儿出院时体重阴道分娩者平均 (30 90± 380 ) g,剖宫产者平均 (3170± 4 80 ) g,两组比较差异有显著性 (P<0 .0 1)。观察组胎便转黄时间 ,阴道分娩者平均 (39.2± 15 .9) h,剖宫产者平均 (39.0± 13.6 ) h,对照组胎便转黄时间 ,阴道分娩平均 (4 8.0± 19.4 ) h,剖宫产平均 (5 5 .7± 2 5 .1) h,两组比较差异有显著性 (P<0 .0 1)。两组胎便初排时间差异亦有显著性 (P<0 .0 5 )。　结论　新生儿游泳有助于新生儿的生长发育。     

椎管内阻滞麻醉与笑气吸入用于分娩镇痛的效果比较

目的　比较椎管内阻滞麻醉和笑气吸入两种方法的分娩镇痛效果和对产妇及新生儿的影响。方法　随机选取 30 0例产妇分为笑气组、椎管内阻滞组和对照组 ,每组各 10 0例。在分娩过程中 ,笑气组给予吸入含 5 0 %笑气与 5 0 %氧气的混合气体 ;椎管内阻滞组给予蛛网膜下腔 +硬膜外腔联合注入芬太尼和布比卡因 ;对照组未给予镇痛药物。并分别观察 3组产妇的镇痛效果、产程时间、分娩方式、产后出血量、产妇桡动脉血及新生儿脐血的血气分析以及新生儿窒息情况。结果　 (1)镇痛效果比较 :椎管内阻滞组镇痛分级 0级为 88例 ,笑气组为 12例 ,对照组为 0例。 3组之间比较 ,差异有极显著性 (P <0 0 1)。 (2 )产程时间比较 :第一产程和总产程时间 ,椎管内阻滞组短于对照组和笑气组 (P <0 0 5 ) ,笑气组与对照组比较 ,差异无显著性 (P >0 0 5 ) ;第二产程时间椎管内阻滞组长于对照组和笑气组 ,但差异无显著性 (P >0 0 5 )。 (3)剖宫产术后出血量比较 :笑气组为 (373± 77)ml,椎管内阻滞组为 (2 5 9± 78)ml,对照组为 (2 39± 89)ml,笑气组与其他两组比较 ,差异有极显著性 (P<0 0 1)。(4)血气分析结果比较 :3组产妇桡动脉血及新生儿脐血血气分析结果各组之间比较 ,差异均无显著性 (P >0 0 5 )。 (5 )分娩方式比较     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

Prostacyclin and thromboxane in gynecology and obstetrics

The gynecologic and obstetric implications of the smooth muscle-relaxing, antiaggregatory prostacyclin and its endogenous antagonist, thromboxane A2, are reviewed. In addition to the vascular wall and circulating platelets, which are primary sources for prostacyclin and thromboxane A2, respectively, reproductive tissues produce great amounts of these prostanoids, evidently for the regulation of the vascular tone and/or vascular platelet interaction. Several gynecologic and obstetric disorders are characterized by abnormalities in prostacyclin and/or thromboxane A2. In primary menorrhagia the uterine release of prostacyclin is increased, and consequently menstrual blood loss can be reduced with various prostaglandin synthesis inhibitors. Prostacyclin relaxes the nonpregnant myometrium in vitro and may also do so in vivo, although intravenous infusion of prostacyclin has no effect upon the uterine contractility in nonpregnant or pregnant subjects. Patients with pelvic endometriosis may have increased levels of prostacyclin and thromboxane A2 metabolites in the peritoneal fluid. The prostacyclin/thromboxane A2 balance shifts to thromboxane A2 dominance in patients with gynecologic cancer. During pregnancy the production of prostacyclin and thromboxane A2 increases in the mother and fetoplacental tissue. Preeclampsia and other chronic placental insufficiency syndromes are accompanied by prostacyclin deficiency in the mother and in fetomaternal tissues and by an overproduction of thromboxane A2, at least in the placenta. These changes may account for the vasoconstriction and platelet hyperactivity, which are pathognomonic for hypertensive pregnancies. By directing the prostacyclin/thromboxane A2 balance to prostacyclin dominance (by dietary manipulation, administration of prostacyclin and/or its analogues, drugs with prostacyclin-stimulating and/or thromboxane A2-inhibiting action), it may be possible to prevent and/or treat hypertensive pregnancy complications in the future.     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.