罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用

目的探讨罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用效果。方法选取2014年3月至2016年7月期间收治的295例产妇,分为观察组(147例)和对照组(148例)。对照组采用罗哌卡因复合舒芬太尼常规分娩镇痛,观察组采用罗哌卡因复合舒芬太尼硬膜外阶梯式分娩镇痛。分析比较两组的镇痛效果、产程时间、产妇Bromage评分、新生儿Apgar评分。结果观察组的总镇痛时间长于对照组,潜伏期产程短于对照组,缩宫素使用率低于对照组,差异均有统计学意义(P<0.05)。观察组产妇Bromage评分为0分的比例高于对照组(P<0.05)。两组新生儿1 min、10 min Apgar评分比较差异均无统计学意义(P>0.05)。结论罗哌卡因复合舒芬太尼用于硬膜外阶梯式分娩镇痛,可明显缩短产妇的产程潜伏期,并改善其下肢阻滞情况。     

甲磺酸罗哌卡因复合舒芬太尼用于PCEA分娩镇痛的临床观察

目的 观察甲磺酸罗哌卡因复合舒芬太尼硬膜外自控镇痛（PCEA）用于分娩镇痛的效果.方法 选择124例ASA Ⅰ～Ⅱ级初产妇,随机分为舒芬太尼组（S组）和芬太尼组（F组）,每组62例.硬膜外腔置管后,接电子镇痛泵采用PCEA,S组：舒芬太尼0.4 μg/ml＋0.15%甲磺酸罗哌卡因;F组：芬太尼2 μg/ml＋0.15%甲磺酸罗哌卡因.观察各组不同时段视觉模拟评分（VAS）和不良反应,同时记录两组镇痛起效时间、产程时间、分娩方式、新生儿Apgar评分.结果 两组在PCEA 5、30、60 min及宫口开全时VAS差异有统计学意义（P〈0.05）,PCEA 5 min,两组VAS差异有统计学意义（P〈0.05）,两组不良反应、产程时间、分娩方式、新生儿Apgar评分差异均无统计学意义.结论 甲磺酸罗哌卡因复合舒芬太尼用于分娩镇痛与芬太尼比较,对母婴无明显不良影响、均能达到良好的镇痛,舒芬太尼镇痛起效时间、镇痛效果、镇痛持续时间优于芬太尼组,是一种较好的镇痛方法.     

舒芬太尼复合罗哌卡因用于分娩镇痛的效果观察

目的 观察舒芬太尼复合罗哌卡因腰硬联合阻滞用于分娩镇痛对产妇和胎儿的影响.方法 经阴道分娩的初产妇110例随机分为舒芬太尼复合罗哌卡因组(观察组)和芬太尼(对照组),记录两组产妇不同时间点的视觉模拟疼痛评分(VAS)、运动神经阻滞评分(Bromage);新生儿出生后1、5 min呼吸抑制情况评分(Apgar)及1～5d的神经行为评分(NBNA).结果 观察组镇痛后30、60、90min及宫口开全时的VAS均低于对照组,镇痛起效时间、维持时间短于对照组,Bromage评分优于对照组,差异均有统计学意义(P＜0.05).两组出生后1、5分钟的Apgar评分差异均无统计学意义(P＞0.05),出生后1天,对照组NBNA评分明显低于观察组(P＜0.05),出生后2～5天,两组NBNA评分无统计学差异(P＞0.05).结论 舒芬太尼与罗哌卡因联合腰硬膜外麻醉用于分娩镇痛,效果好、起效快,对产妇和新生儿无明显不良影响.     

舒芬太尼联合不同浓度罗哌卡因行阶梯式分娩镇痛对产程进展和新生儿的影响研究

目的探讨舒芬太尼联合不同浓度罗哌卡因行阶梯式分娩镇痛对产程进展和新生儿的影响。方法选取2013年2月~2014年5月间在该院住院待产的足月单胎妊娠初产妇190例,随机分为对照组和阶梯镇痛组,每组各95例。对照组始终给予0.5μg/ml舒芬太尼联合0.15%的罗哌卡因进行治疗;阶梯镇痛组在分娩潜伏期给予0.5μg/ml舒芬太尼联合0.075%的罗哌卡因,活跃期给予0.5μg/ml舒芬太尼联合0.15%的罗哌卡因。比较两组产妇各时间段的视觉模拟(VAS)评分、镇痛起效时间、缩宫素使用情况、各产程时间、产妇Bromage评分、不良反应情况,以及出生后1 min、5 min、10 min的新生儿Apgar评分。结果对照组和阶梯镇痛组各时间段VAS评分和镇痛起效时间之间差异均无统计学意义(P0.05)。阶梯镇痛组产妇缩宫素使用率明显低于对照组产妇,分娩潜伏期明显短于对照组产妇,差异均有统计学意义(P0.05);分娩活跃期、第二产程、第三产程两组产妇持续时间组间差异无统计学意义(P0.05)。阶梯镇痛组产妇Bromage评分为0分的比例明显高于对照组产妇,差异有统计学意义(P0.05)。两组新生儿出生后1 min、5 min、10 min的Apgar评分组间差异均无统计学意义(P0.05);两组产妇均未出现麻醉镇痛相关不良反应。结论阶梯镇痛法对产妇宫缩和产程的影响小,对新生儿健康无影响,可在临床中推广应用。     

11250例硬膜外病人自控分娩镇痛临床应用状况分析

目的：回顾分析低浓度罗哌卡因复合舒芬太尼硬膜外自控镇痛在不同时机用于分娩镇痛的效果及对产妇选择分娩方式的影响。方法：将嘉兴市妇幼保健院2005年1月-2011年12月间临产后实施硬膜外分娩镇痛的产妇11 250例,按镇痛实施时间不同分为2组：Ⅰ组宫口开至1～3cm（n=8 270）,Ⅱ组宫口开至3cm以上（n=2 980）。分别观察产程时间、手术助产率、新生儿体重和Apgar评分情况,产后24小时随访。结果：各组镇痛效果确切,产程时间、新生儿体重和Apgar评分组间差异无统计学意义（P〉0.05）;产妇对镇痛效果满意,硬膜外镇痛对自然分娩有帮助。结论：低浓度罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛安全、有效,可以在第一产程早期施行,能促进产妇选择自然分娩,从而降低剖宫产率。     

左布比卡因复合舒芬太尼硬膜外分娩镇痛的临床应用

目的:研究左布比卡因复合舒芬太尼对硬膜外分娩镇痛的影响.方法:将120例足月初产妇随机分为两组,观察组(60例)接受0.10％左布比卡因+0.5μg/ml舒芬太尼硬膜外分娩镇痛,对照组(60例)未行分娩镇痛.观察观察组镇痛效果,记录Bromage评分、产程时间、产后出血量、Apgar评分及不良反应发生情况.结果:观察组产妇镇痛后视觉模拟评分低于镇痛前(P＜0.05),镇痛效果明显.两组产妇产程时间、产后出血量及Apgar评分比较差异均无统计学意义(P＞0.05).两组产妇均无严重不良反应.结论:左布比卡因复合舒芬太尼硬膜外分娩镇痛安全、效果好,产妇和新生儿不良反应少.     

舒芬太尼复合不同剂量罗哌卡因蛛网膜下腔阻滞在产程潜伏期分娩镇痛中的应用

目的探讨不同剂量舒芬太尼复合罗哌卡因蛛网膜下腔阻滞在产程潜伏期分娩镇痛的效果。方法选择足月妊娠初产妇120例,按照随机数字表法分为4组,产程潜伏期分别行蛛网膜下腔注射舒芬太尼4μg(S组),舒芬太尼4μg+罗哌卡因2 mg(SL1组),舒芬太尼4μg+罗哌卡因3 mg(SL2组),舒芬太尼4μg+罗哌卡因4 mg(SL3组),每组30例,宫缩时采用数字疼痛评分法评定镇痛5、10、30、60 min,宫口开7~8 cm及宫口开全时疼痛程度,记录产妇的镇痛显效时间、镇痛起效时间、镇痛维持时间及总镇痛时间,并观察产妇的产程时间、产程阴道出血量及新生儿Apgar评分。结果 4组产妇的镇痛显效时间、镇痛起效时间、镇痛维持时间及总镇痛时间比较差异有统计学意义(P0.05);4组镇痛显效时间和镇痛起效时间比较,SL2组SL3组SL1组S组(P0.05),4组镇痛维持时间和总镇痛时间比较,SL2组SL3组SL1组S组(P0.05)。镇痛5 min、10 min、30 min、60 min、宫口开7~8 cm及宫口全开时,4组NRS评分比较,SL2组SL3组SL1组S组(P0.05)。4组产妇阴道出血量比较差异有统计学意义(P0.05),且SL3组SL2组SL1组S组。4组产程和新生儿Apgar评分比较,差异无统计学意义(P0.05)。结论 4μg舒芬太尼复合3 mg罗哌卡因或4μg舒芬太尼复合4 mg罗哌卡因蛛网膜下腔阻滞分娩镇痛效果最佳,具有镇痛起效快,维持时间长,疼痛较轻,减少阴道出血量的优点,是一种安全有效的分娩镇痛模式,值得临床推广应用。     

罗哌卡因复合舒芬太尼自控硬膜外镇痛对初产妇分娩结局的影响

目的探讨罗哌卡因复合舒芬太尼自控硬膜外镇痛对初产妇分娩结局的影响。方法选取2018年6月-2019年6月在该院分娩的初产妇150例为研究对象,依据随机数字表法将其分为对照组和观察组,每组各75例。对照组产妇给予罗哌卡因复合芬太尼自控硬膜外镇痛,观察组产妇给予罗哌卡因复合舒芬太尼自控硬膜外镇痛。观察组分析两组产妇的分娩结局(分娩方式、缩宫素使用)、疼痛程度、各产程时间、出血量及新生儿Apgar评分状况。结果两组产妇器械助产率比较,差异无统计学意义(P>0.05)。观察组产妇自然分娩率高于对照组,剖宫产率及缩宫素使用率低于对照组,差异有统计学意义(P<0.05)。观察组产妇第一、第二及第三产程时视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05)。两组产妇第三产程时间比较,差异无统计学意义(P>0.05)。观察组产妇第一产程、第二产程时间低于对照组,产后2 h阴道出血量低于对照组,差异有统计学意义(P<0.05)。两组新生儿出生后1 min、5 min及10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论对初产妇给予罗哌卡因复合舒芬太尼自控硬膜外镇痛能够起到较好的镇痛效果,且作用时间较长,对产妇及胎儿的影响较小,具有较高的安全性,有效降低了剖宫产率,在临床分娩镇痛中值得推广应用。     

分析舒芬太尼、罗哌卡因椎管内麻醉联合应用于分娩镇痛的临床效果

目的:探讨分娩镇痛中采用舒芬太尼复合罗哌卡因椎管内麻醉的应用效果。方法:抽取2019年1月~2020年4月本院80例分娩产妇,依据分娩镇痛情况分组,对照组产妇为常规分娩,观察组产妇则采用舒芬太尼复合罗哌卡因椎管内麻醉进行分娩镇痛,对比2组的分娩方式、疼痛评分、总产程时间以及新生儿Apgar评分等。结果:观察组的自然分娩率高于对照组,阴道助产率、剖宫产率低于对照组,P 0.05;观察组的总产程时间、分娩疼痛度评分短于/低于对照组,新生儿Apgar评分高于对照组,P 0.05。结论:采用舒芬太尼、罗哌卡因椎管内麻醉进行分娩镇痛可有效缓解自然分娩产妇的疼痛感并提高自然分娩率,且有助于缩短产程时间并改善母婴结局。     

罗哌卡因复合舒芬太尼用于硬膜外分娩镇痛对产程和母婴结局的影响

目的 观察产妇在产程潜伏期应用罗哌卡因复合舒芬太尼硬膜外分娩镇痛的临床效果,评价其可行性.方法 选取在2015年1月至2017年1月在湖北省宜昌市夷陵区妇幼保健计划生育服务中心自愿选择分娩镇痛的单胎初产妇420例,排除硬膜外阻滞禁忌症和药物过敏者,进行随机编号分组,每组210例.一组给予罗哌卡因复合舒芬太尼0.5μg/mL(S组),一组给予罗哌卡因复合芬太尼1.5μg/mL(F组).待宫口>2cm时进行硬膜外穿刺分娩镇痛,先硬膜外推注1%利多卡因5mL,10分钟后推注混合液8mL.记录VAS疼痛评分、产妇不良反应、新生儿Apgar评分、产后出血、产程时间等. 结果 产程各时点中,S组VAS疼痛评分均明显小于F组(t值分别为8.58、6.53、4.14、2.55,均P<0.05).两组产妇不良反应如头晕、呕吐、皮肤瘙痒的发生率差异无统计学意义(χ2值分别为0.15、0.10、0.09,均P>0.05),两组新生儿产后5min的Apgar评分差异也无统计学意义(t=1.54,P>0.05). 结论 硬膜外分娩镇痛产妇应用罗哌卡因复合舒芬太尼,有良好镇痛效果安全有效,可以临床推广.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.