陪伴分娩临床观察与护理

目的 探讨陪伴分娩对产程的影响.方法 随机抽取陪伴分娩组的产妇60例,对产妇从宫开2 cm至整个产程结束,由助产士担当导乐实行全程一对一的陪伴观察,非陪伴组的产妇60例为对照组由轮班助产士按常规进行产程处理,对产妇进行生理、心理、精神、体力全面支持,并密切观察产程进展及母婴并发症.结果 产妇紧张、惧怕疼痛者少于对照组,产妇感觉松弛者高于对照组,有明显的差异(P＜0.01).观察组滞产率、手术率及产后出血率小于对照组,有显著的差异(P＜0.01).第一、三产程及总产程均缩短,有显著性差异(P＜0.05);第二产程有显著差异(P＜0.01).新生儿窒息率明显小于对照组.结论 陪伴分娩可明显缓解产妇紧张、焦虑、恐惧、缩短产程,减少新生儿窒息,降低滞产、手术产及产后出血率,值得推广.     

助产士"一对一"陪伴分娩的临床观察

目的：为了保护和促进更多的不同经济层次产妇的自然分娩，提高产科质量。观察助产士“一对一”陪伴分娩的临床效果。方法：210例助产士“一对一”陪伴分娩的产妇为观察组．126例同期在本院常规分娩的产妇为对照组。对两组的各产程时间、分娩方式、新生儿窒息率及产后出血率进行比较。结果：观察组各产程时间、分娩方式、新生儿窒息率及产后出血率与对照组相比有统计学差异(P＜0．01)。结论：助产士“一对一”陪伴分娩模式对促进自然分娩降低手术产率、缩短产程、降低产后出血率和降低新生儿窒息率有明显的积极作用。     

120例产妇应用拉玛泽减痛分娩法的效果观察

观察120例产妇应用拉玛泽减痛分娩法的效果.观察组第一产程进入待产室开始使用拉玛泽减痛分娩法.对照组120例只按常规一对一陪伴分娩.现察两组分娩疼痛强度、备产程时间、分娩方式、产后出血率和新生儿Apgar评分.观察组疼痛程度明显减轻,总产程明显缩短,剖宫产率、产后出血率及新生儿室息率均降低,差异有统计学意义(P<0.01).拉玛泽减痛分娩法镇痛效果显著,可以明显缩短产程,降低剖宫产率,提高自然分娩率,降低产后出血及新生儿窒息率.     

“一对一”全程陪伴分娩助产模式的临床应用

目的探讨“一对一”全程陪伴分娩助产模式对分娩的影响。方法选取的对象均为单胎头位初产妇，在产程中由助产士进行“一对一”全程陪伴至产程结束共1200例，为陪伴组，按传统交接班制助产模式进行分娩的共900例，为对照组。结果观察组产程缩短，产后出血率、新生儿窒息率均低于对照组。结论“一对一”全程陪伴分娩的助产模式，可以减轻产妇的心理压力和分娩的恐惧，能明显缩短产程，降低产后出血率、新生儿窒息率，减少分娩的并发症，有效提高产科护理质量。     

全程陪护联合中药足疗对自然分娩的影响

目的探讨全程陪护联合中药足疗对产妇自然分娩的影响。方法将400例初产妇按随机数字表法分为观察组和对照组,每组200例。对照组采用住院后值班助产士常规产程观察护理;观察组孕妇在子宫颈口开大2cm后,由助产士一对一陪伴其整个分娩过程,并联合中药足疗护理。对2组产妇剖宫产、产程时间、产后出血、新生儿窒息情况进行比较。结果观察组产程时间较对照组明显缩短,剖宫产、产后出血及新生儿窒息率均较对照组明显降低(均P<0.05)。结论全程陪护联合中药足疗护理能降低产妇的剖宫产率,减少产后出血,提高产科质量。     

导乐陪伴分娩1176例临床分析

目的:分析导乐陪伴对分娩过程的影响。方法:回顾性分析自2003年11月至2005年10月在我院接受导乐陪伴分娩服务的1176例产妇的临床资料(观察组),以2001年11月至2003年10月非导乐陪伴分娩的882例产妇为对照组,对2组的自然分娩率、剖宫产率、产程时间、产后出血量及新生儿窒息率进行比较。结果:观察组的自然分娩率明显提高,剖宫产率下降(χ2=181.35,P<0.01);产程时间缩短(t=14.07,P<0.01);产后出血减少(t=15.54,P<0.01);新生儿窒息率降低(χ2=38.52,P<0.01)。结论:导乐陪伴分娩可提高自然分娩率,降低剖宫产率及新生儿窒息率,减少产后出血量,有利于提高产科服务质量。     

助产士主导伙伴式导乐陪伴分娩200例临床效果观察

目的:探讨助产士主导伙伴式导乐陪伴分娩对减少母婴危害、促进自然分娩的临床效果。方法:将400例妊娠36周后无绝对剖宫产指征、无妊娠合并症的住院单胎初产妇随机分为对照组和观察组各200例,对照组采用传统"一对一"导乐陪伴分娩模式,观察组采用助产士主导的伙伴式导乐陪伴分娩模式。观察两组剖宫产率、产程时间、产后出血量、新生儿窒息率。结果:观察组剖宫产率、产程时间明显低于对照组(P<0.01),两组新生儿窒息率、产后出血量比较差异无统计学意义。结论:助产士主导的伙伴式导乐陪伴分娩模式可有效缩短产程时间、降低剖宫产率,提高产妇及家属满意度,是一种全新的产科服务模式,是符合现代产科人性化服务、管理的新举措。     

开展助产士陪伴分娩的临床效果观察

目的 通过助产士陪伴分娩服务模式的应用,为产妇提供人性化的护理,为探索分娩室的护理工作新模式提供依据.方法 随机将580 例初产妇分为观察组和对照组,观察组自愿要求助产士陪伴分娩,对照组采用产科常规护理.结果 观察组的剖宫产率明显低于对照组(P<0.05),总产程时间较对照组显著缩短,产后出血、胎儿窘迫和新生儿窒息的发生率均低于对照组(P<0.05).结论助产士陪伴分娩能有效提高自然分娩率,降低剖宫产率,降低产程中母婴并发症的发生率.     

导乐陪伴分娩的实施及护理管理

目的探讨导乐陪伴分娩的实施和护理管理对产程、分娩结局的影响。方法用χ^2和t检验回顾性分析、比较观察组（我院2005年1月～2005年6月500例导乐陪伴分娩产妇）和对照组（2004年同期500例非导乐分娩产妇）在分娩方式、产程、产后出血量和新生儿Apgar评分的差异。结果观察组较对照组的产程、剖宫产率、新生儿窒息率、产后出血率方面具有显著性差异。结论导乐陪伴分娩明显缩短产程,降低剖宫产率、新生儿窒息率、产后出血率,减少分娩的并发症,有效提高产科护理质量,值得临床推广应用。     

全程导乐陪伴联合分娩镇痛的临床效果对比观察

目的探讨全程导乐陪伴联合分娩镇痛对自然分娩的作用和影响.方法将2010年6月~2011年6月正常足月无阴道分娩禁忌的500例初产妇随机分为2组,对照组(240例)施行分娩镇痛,观察组(260例)施行导乐陪伴联合分娩镇痛,观察2组产妇的负性情绪状态、产程进展情况、镇痛效果、产后出血量、新生儿Apgar评分等.结果观察组分娩后焦虑评分(SAS)、抑郁评分(SDS)、产后2 h出血量明显低于对照组,差异均有统计学意义(P<0.01);观察组分娩后疼痛评分(VAS)、新生儿窒息发生率明显低于对照组,差异均有统计学意义(P<0.05);观察组较对照组产程明显缩短,差异有统计学意义(P<0.05).结论全程导乐陪伴联合分娩镇痛可以明显改善产妇的负性情绪状态,缩短产程,促进产妇顺利度过分娩期,对母婴无不良影响,值得推广应用.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.