头部按摩对初产妇心理及分娩方式的影响

目的 观察头部按摩对初产妇心理和分娩方式的影响.方法 将200例初产妇随机分为对照组与观察组各100例,对照组采用一对一陪伴分娩服务模式,观察组在此基础上施行头部按摩.比较两组产妇的焦虑、抑郁状态及剖宫产率.结果 观察组第二产程开始时焦虑、抑郁评分及剖宫产率显著低于对照组(P＜0.05、P＜0.01).结论 在分娩过程中对产妇进行头部按摩可有效缓解产妇的焦虑、抑郁情绪,降低剖宫产率.     

拉玛泽分娩法对初产妇分娩方式的影响

目的:探讨拉玛泽分娩法对初产妇各产程、分娩方式等的影响.方法:选择阴道试产的初产妇90例,采用随机和自愿原则分成无痛分娩组、对照组、拉玛泽组,每组30例.观察各产程的时间、分娩方式、产后2小时内阴道出血量,记录孕妇在各产程中对疼痛的耐受情况.结果:拉玛泽组能显著缓解产时疼痛、缩短产程、减少出血量,阴道自然分娩率增高,P＜0.05.无痛分娩组与对照组比较,显著减轻产时疼痛,延长产程,增加阴道出血量,P＜0.05.结论:拉玛泽分娩法显著降低分娩过程中的疼痛,减少产后2小时内阴道出血量,提高阴道自然分娩率.     

头部按摩对初产妇心理及分娩方式的影响

目的探讨自制大便失禁引流装置的护理成本及应用效果。方法将40例大便失禁患者随机分为对照组和观察组各20例。对照组按常规随时清理溢出大便、清洗肛周皮肤、涂鞣酸软膏等方法护理患者。观察组使用自行研制的大便失禁引流装置引流大便,每日常规清洗肛周2次。比较两组护理成本和肛周皮肤炎性反应情况。结果对照组每日护理材料消耗为（80.87±10.72）元、每日护理工时为（10.60±2.32）h,观察组分别为（50.99±4.56）元、（2.75±1.57）h,两组比较,差异有显著性意义（均P〈0.01）。观察组肛周皮肤炎性反应发生率显著低于对照组（均P〈0.01）。结论应用自制大便失禁引流装置引流大便,可降低护理成本,减少患者肛周皮肤炎性反应的发生。     

长强穴按摩对初产妇第二产程和分娩结局的影响

目的缩短初产妇第二产程,减少缩宫素使用率,促进阴道分娩。方法将200例初产妇随机分为观察组和对照组各100例,对照组给予常规陪伴分娩,观察组产妇进入第二产程后按摩长强穴。结果观察组第二产程时间较对照组显著缩短,缩宫素使用率、剖宫产率较对照组降低(P<0.05,P<0.01)。结论在初产妇进入第二产程后给予长强穴按摩,操作方法简单,安全有效,能进一步提高产科护理质量。     

上海市初产妇分娩意向及方式影响因素调查

目的了解无剖宫产指征的初产妇分娩意向及分娩方式,并分析其影响因素。方法采用非概率抽样方法对336例无剖宫产指征的初产妇进行问卷调查。结果336例无剖宫产指征的初产妇中,256例分娩意向为自然分娩,80例为剖宫产;276例初产妇选择了自然分娩,60例选择了剖宫产。分娩意向和分娩方式呈高度相关(r=0.809,P<0.01)。户籍、是否有医疗保险、分娩方式相关知识、丈夫文化程度、丈夫对分娩态度及朋友的分娩情况对初产妇的分娩意向产生影响,影响程度为43.2%;而年龄、待产时间、产前的分娩意向、与分娩方式相关的知识及丈夫态度对初产妇的实际分娩方式产生影响,影响程度为53.4%。结论初产妇对分娩方式的选择受到年龄、待产时间、产前的分娩意向、与分娩相关的知识及丈夫态度的影响。因此,应将家属纳入到产前的健康教育中、提高社会对自然分娩的正确认识和信心,并且提供更加人性化的分娩服务,以降低剖宫产率。     

个体化产程管理对初产妇配合度及分娩方式的影响

目的探究个体化产程管理对初产妇配合度及分娩方式的影响。方法将120例初产妇按时间段分为对照组和观察组各60例。对照组行常规产程管理;观察组行个体化产程管理,包括待产姿势、产程活动管理,宫缩管理,促进自然分娩和情绪管理。结果观察组分娩配合度、分娩方式显著优于对照组,自然分娩产妇产程显著短于对照组(P<0.05,P<0.01)。结论对初产妇实施个体化产程管理可提高其分娩配合度和自然分娩率,优化分娩方式,缩短产程。     

护理干预对初产妇分娩过程的影响

目的:探讨护理干预对初产妇分娩过程的影响.方法:对128例初产妇采用SDS进行抑郁状态评分,将评分≥51分定为抑郁组,＜51分为正常组,对两组初产妇的分娩方式、总产程、产后出血量进行比较.结果:抑郁组剖宫产率及产后出血率均高于正常组,总产程也长于正常组.结论:针对孕产妇不同阶段实施不同的护理干预,可提高初产妇的顺产率,缩短产程,减少产后出血量.     

剖宫产初产妇术后早期乳房按摩对泌乳的影响

目的探索早期乳房按摩对剖宫产初产妇术后泌乳始动时间、泌乳量及乳头状况的影响。方法将200例剖宫产初产妇随机分为观察组和对照组各100例。对照组产妇仅接受常规产后护理，观察组产妇在此基础上于术后4～6h施行乳房按摩3d。观察两组产妇泌乳始动时间，泌乳量及乳头平坦、凹陷的改善情况。结果观察组与对照组比较，产妇泌乳时间明显提前、泌乳量明显增加、乳头状况显著改善（P〈0．01，P〈0．05）。结论早期乳房按摩可使剖宫产初产妇术后乳汁分泌始动时间提前、泌乳量增加，还能缓解产后乳房胀痛，纠正乳头状况，保证母乳喂养。     

全程导乐陪伴分娩对初产妇心理状态及妊娠结局的影响

目的探讨全程导乐陪伴分娩在初产妇护理中的应用效果。方法根据护理方式不同将92例初产妇分为2组,各46例。对照组予以常规护理,观察组采用全程导乐陪伴分娩模式。比较2组的产妇心理状态、疼痛程度及妊娠结局。结果产后2组SAS、SDS、VAS评分均有所降低,且观察组低于对照组,差异有统计学意义(P<0.05);观察组产后出血、胎儿窘迫、尿潴留等围产期并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论对初产妇实施全程导乐陪伴分娩模式,可有效帮助其缓解内心压力、减轻疼痛,进一步改善妊娠结局,从而确保母婴安全。     

分娩预演结合3D技术对初产妇分娩的影响

目的 探索分娩预演结合3D技术对初产妇分娩的影响。方法 按照住院日期将在产科门诊产检的200例初产妇分为对照组与观察组各100例。对照组按常规进行产前教育,观察组在对照组基础上于孕32周时对初产妇进行临产征兆、住院流程、自然分娩的分娩预演结合3D技术的产前教育。对两组产妇分娩恐惧、自我效能、分娩方式意愿选择及分娩方式进行比较。结果 教育后观察组分娩恐惧、分娩自我效能评分显著优于对照组(均P＜0.01);观察组自然分娩意向、自然分娩率显著高于对照组（均P＜0.01）。结论 对初产妇进行分娩预演结合3D技术的产前教育,可以降低初产妇分娩恐惧,提升其分娩自我效能,进而提高其自然分娩意愿,降低剖宫产率。     

Effect of Massage on the Efficacy of the Mental and Incisive Nerve Block

The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.Key Words: Dental pulp anesthesia, Lidocaine, Mental and incisive nerve blockMandibular teeth are more susceptible to failed anesthesia than maxillary teeth as a result of difficulties in blocking the inferior alveolar nerve and collateral innervations.^1–6 A number of alternative and supplementary techniques have been described to overcome failure of the conventional inferior alveolar nerve block (IANB) injection, including infiltration anesthesia, intraligamentary anesthesia, intraosseous anesthesia, and mental and incisive nerve block (MINB).^7–12 Few objective data have been published on the efficacy of the MINB as a supplemental or even alternative technique to IANB for lower anterior and premolar teeth. The reported failure rate of MINB is very low for pulp anesthesia in premolars.⁸ It may, however, be less effective for other teeth; Nist et al⁸ reported a very low success rate of pulp anesthesia in first molars and lateral incisors after MINB alone. Advantages of MINB may include less patient discomfort than an IANB and a lack of lingual tissue anesthesia.⁸ In addition, anatomical landmarks for effective anesthesia may be less challenging, and there may be less risk of postoperative discomfort and trismus because the injection is not a deep block involving the muscles of mastication. The MINB does not require specialized equipment as required for intraosseous or intraligamentary methods, and conventional syringes can be used.Anecdotal reports suggest that tissue massage may encourage the movement of local anesthetic agent into the mental foramen and improve the efficacy and the distribution of anesthesia. This has never been validated in a clinical trial.The aim of this study was to assess the effect of soft tissue massage on the efficacy and distribution of anesthesia following MINB, using 2% lidocaine with 1 : 80,000 epinephrine. Secondary outcome measures included the speed of onset of anesthesia and the discomfort associated with MINB and soft tissue massage.The null hypothesis tested was that soft tissue massage at the injection site has no influence on the efficacy, onset, and distribution of pulp anesthesia or on the discomfort associated with MINB injection.     

合理情绪疗法培训对护士长压力应对方式的影响

目的 探讨合理情绪疗法培训对护士长压力应对方式的影响.方法 对44名护士长进行合理情绪疗法培训,于培训前和培训后1个月分别采用压力应对方式问卷进行测试.结果 通过合理情绪疗法培训,护士长采用解决问题和求助的积极应对方式得分比培训前显著提高(均P<0.01),而采用合理化、退避、自责、幻想的消极应对方式得分比培训前显著降低(均P<0.01).结论 对护士长进行合理情绪疗法培训可提高其对压力的管理能力,有助于其采取有效方式应对压力.     

Effect of Differential Delivery of Isoflurane to Head and Torso on Lumbar Dorsal Horn Activity

Background: The spinal cord appears to be the site where anesthetic agents prevent movement in response to noxious stimuli. When isoflurane is differentially delivered to the head and torso (with low torso concentrations), cranial anesthetic requirements increase compared with systemic administration. The aim of the current study was to test the hypothesis that isoflurane action in the brain has descending influences on spinal cord dorsal horn neurons. A secondary aim was to determine the association, if any, of high cranial concentrations of isoflurane (> 6%) with dorsal horn activity.

Methods: Ten goats were anesthetized with isoflurane and the carotid arteries and jugular veins isolated and cannulated for cerebral bypass. A laminectomy was performed for recording from single lumbar dorsal horn neurons with hind limb mechanical receptive fields (one cell per goat). A standard noxious mechanical stimulus was applied to the dew claw or hoof bulb during a control period with end-tidal isoflurane at 1.3% and during bypass with the following head/torso isoflurane concentrations: 1.3%/1.3%, 3.2%/1.3%, 9.4%/1.3%, 1.3%/0.2%, 3.0%/0.2% and 8.8%/0.3%.

Results: When torso isoflurane concentration was 1.3%, increasing cranial isoflurane concentration to 3% or 9% had no significant effect on the activity of dorsal horn units. When torso isoflurane was 0.2-0.3%, spontaneous activity increased; however, at these torso concentrations, evoked responses were significantly decreased (-60%) only when cranial isoflurane concentration was increased to 9%.     

护理干预对乙状结肠镜检查老年患者心理状态的影响

目的 了解护理干预对乙状结肠镜检查老年患者心理状态的影响.方法 将400例行乙状结肠镜检查的老年患者随机分为对照组和观察组各200例,对照组检查前行常规护理,观察组检查前进行心理支持、家庭支持、肠道准备指导、饮食指导、放松训练等护理干预.采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别测量患者预约时、检查前15min焦虑、抑郁状况,同时测量患者心率(HR)、收缩压(SBP).结果 观察组护理干预后SAS、SDS评分及HR、SBP值与对照组比较,差异有显著性意义(均P＜0.01).结论 对行乙状结肠镜检查的老年患者进行检查前护理干预,可减轻其焦虑抑郁程度并缓解其应激反应.     

骨科患者全麻术后急性精神障碍的观察及护理

目的了解护理干预对乙状结肠镜检查老年患者心理状态的影响。方法将400例行乙状结肠镜检查的老年患者随机分为对照组和观察组各200例，对照组检查前行常规护理，观察组检查前进行心理支持、家庭支持、肠道准备指导、饮食指导、放松训练等护理干预。采用焦虑自评量表（SAS）和抑郁自评量表（SDS）分别测量患者预约时、检查前15min焦虑、抑郁状况，同时测量患者心率（HR）、收缩压（SBP）。结果观察组护理干预后SAS、SDS评分及HR、SBP值与对照组比较，差异有显著性意义（均P〈0．01）。结论对行乙状结肠镜检查的老年患者进行检查前护理干预，可减轻其焦虑抑郁程度并缓解其应激反应。     

家庭功能对产妇分娩方式及产程进展的影响

目的 了解产妇家庭功能与产妇分娩方式及产程进展的关系.方法 对168例住院初产妇采用家庭功能量表评估其家庭功能,并观察产妇分娩方式及产程进展情况.结果 168例产妇家庭功能中,114例(67.9%)认为家庭功能良好;54例(32.1%)认为家庭功能障碍;家庭功能良好者要求剖宫产率、第一产程时间显著高于、短于家庭功能障碍者(均P＜0.01),产后2h出血量少(P＜0.01).结论 强化产妇家庭功能及家庭成员对产妇心理支持,有利于产程进展,减少产后2h出血量,促进产妇身心健康.     

家庭功能对产妇分娩方式及产程进展的影响

目的了解产妇家庭功能与产妇分娩方式及产程进展的关系。方法对168例住院初产妇采用家庭功能量表评估其家庭功能，并观察产妇分娩方式及产程进展情况。结果168例产妇家庭功能中，114例（67．9％）认为家庭功能良好；54例（32．1％）认为家庭功能障碍；家庭功能良好者要求剖宫产率、第一产程时间显著高于、短于家庭功能障碍者（均P〈0．01），产后2h出血量少（P〈0．01）。结论强化产妇家庭功能及家庭成员对产妇心理支持，有利于产程进展，减少产后2h出血量，促进产妇身心健康。     

改良新式剖宫产术对初产妇子宫复旧的影响

目的　探讨改良新式剖宫产术对初产妇子宫复旧的影响。　方法　306例初产妇分为改良新式剖宫产组(126例)、传统剖宫产组(78例)及自然分娩组(102例),测量产后子宫底高度,计算宫底下降速度,行常规超声检查了解子宫复旧情况。　结果　产后5日内宫底平均下降速度三组差异显著,自然分娩组最快,改良新式剖宫产组次之,传统剖宫产组最慢(P<0. 05)。产后第5dB超测量子宫三径之和,自然分娩组最小,改良新式剖宫产组次之,传统剖宫产组最大(P<0. 01)。改良新式剖宫产组、传统剖宫产组、自然分娩组产后30d宫腔积液发生率分别为5. 6%、12. 8%、2. 0%,有显著性差异(P<0. 05)。　结论　改良新式剖宫产术与传统剖宫产相比,更有利于子宫复旧,但自然分娩子宫复旧最佳。     

肌电生物反馈训练对妊娠期高血压患者心身状态的影响

目的 观察肌电生物反馈训练对妊娠期高血压患者心身状态的影响.方法 将75例妊娠期高血压患者随机分为两组,实验组(35例)在常规治疗的基础上采用肌电生物反馈放松训练,对照组(40例)只接受常规治疗护理及健康教育.观察两组干预前后血压和心理反应.结果 干预后实验组焦虑评分、收缩压、舒张压显著低于对照组(均P<0.05);实验组肌电值较干预前显著降低(均P<0.05).结论 肌电生物反馈放松训练能增加妊娠期高血压常规治疗的效果,改善其心理状态.