麻黄碱在预防剖宫产腰麻时仰卧位低血压综合征中的应用

仰卧位低血压综合征(SHS)系指妊娠晚期孕妇仰卧位时出现头晕、恶心呕吐、胸闷、面色苍白、出冷汗、心率加快、不同程度的血压下降,但当转向侧卧位后症状立即消失的一组综合征.     

新生儿脐血血气分析在新生儿窒息中的应用价值分析

目的 分析新生儿脐血血气分析在新生儿窒息中的应用价值.方法 对2018年6月-2019年6月期间在我院出生的足月产新生儿进行研究,共计80例,出生后立即采集新生儿的脐动脉血然后进行血气分析,将数据与Apgar评分诊断情况进行对比.结果 可根据评分的情况将其区分成参照组和窒息组,根据数据显示,窒息组的PaO2、pH值较低,PCO2较高(P<0.05);参照组新生儿酸中毒的发生率显著低于窒息组(P<0.05).结论 新生儿脐血血气分析能够对胎儿缺血缺氧的情况进行客观的反映,可以作为新生儿窒息诊断的依据,因而新生儿脐血血气分析的检验方式可以广泛应用于临床,作为诊断新生儿窒息的重要依据.     

妊娠期糖尿病新生儿脐血血气水平对分娩结局的影响

回顾性分析2017年9月至2018年5月60例GDM临床资料,结局良好的32例,结局不良的28例。采用血气分析仪检测新生儿脐血血气。结果良好组新生儿脐动脉的pH值低于不良组,脐动脉的碱二氧化碳分压(p(CO₂))值与脐静脉的pO₂、pCO₂均高于不良组,(P<0.05);良好组脐动脉的剩余(BE)、脐静脉的pH值、BE高于不良组,脐动脉pCO₂低于不良组,(P>0.05)。进行ROC分析,脐动脉PH值、脐动脉pO₂、脐静脉pO₂、脐静脉pCO₂指标预测妊娠结局的AUC均> 0.8,具备一定的预测价值。结论上述指标在GDM分娩结局评估中具有重要应用价值。     

盐酸罗哌卡因腰麻剖宫产脐动脉血气与脐静脉/母体静脉血药浓度比的观察

目的评价盐酸罗哌卡因腰麻剖宫产脐动脉血气与脐静脉/母体静脉血药浓度比(UV/MV)的影响关系。方法 26例足月剖宫产妇,ASAⅠ～Ⅱ级,无心、肺、肝、肾疾患。于L2～3间隙穿刺蛛网膜下腔注药给予0.75%盐酸罗哌卡因12～15 mg。观察药物起效时间、注药至切皮时间、暴露时间。断脐后立即用肝素化注射器抽取脐动脉血3 mL,即刻送检行血气分析测定。同时抽取脐静脉及产妇静脉血3 mL,母婴标本采用高效液相色谱法(HPLC)测定血浆中盐酸罗哌卡因血药浓度,并计算UV/MV值。结果术中暴露时间越长,脐静脉血药浓度越高。脐静脉血气pH 7.33±0.04,随胎儿酸中毒加重,即Lac升高或pH降低,UV/MV呈高浓度比率,存在明显"离子捕获"。结论应尽可能缩短暴露时间,减轻胎儿酸中毒程度,降低UV/MV值,提高母婴安全性。     

不同速率去氧肾上腺素预防腰硬联合麻醉下行剖宫产术产妇低血压的效果观察

目的 探讨不同速率去氧肾上腺素(PE)预防腰硬联合麻醉下行剖宫产术产妇低血压的临床效果.方法 将80.例择期行剖宫产手术的产妇随机分为对照组及PE Ⅰ、Ⅱ、Ⅲ组各20例,腰硬联合麻醉成功后,对照组静滴生理盐水;PE Ⅰ、Ⅱ、Ⅲ组将PE 5 mg加生理盐水稀释至50 mL,其静滴速率分别为25、50、75 μg/min.观察各组切皮至胎儿娩出时间、术中液体输入总量、出血量、娩出前(BD)血压下降及上升例数、娩出后(AD)血压下降及上升例数及心动过缓、恶心、呕吐例数,胎儿娩出即刻的新生儿脐动脉血血气分析值及生后Apgar评分,以及PE Ⅰ、Ⅱ、Ⅲ组单次追加PE例数、追加PE的总量、静滴PE总量、中止静滴PE例数、PE总用量.结果 与对照组比较,PE各组胎儿BD、AD的低血压发生率明显降低,高血压发生率PEⅢ组高于其他3组(P均＜0.05);恶心、呕吐发生率PE各组明显低于对照组(P均＜0.05);与PE Ⅰ、Ⅱ组比较,Ⅲ组的PE总用量、术中输注PE最多,术中需要中止的例数较多(P均＜0.05);单次追加PE最多的是对照组,其次为Ⅰ组.其余观察指标各组比较P均＞0.05.结论 PE可减少剖宫产产妇在胎儿BD的低血压发生率,PE 50μg/min的速率可为产妇提供更稳定的血流动力学环境.     

等比重腰麻行剖宫产术的麻醉经验

近年来,剖宫产手术多采用硬膜外麻醉,腰麻也以重比重腰麻较多见、等比重腰麻较少见。为了解等比重腰麻对剖宫产手术的麻醉效果,我院自2010年至今采用腰麻-硬膜外联合穿刺技术注入等比重腰麻药行剖宫产手术50例。现总结如下。     

体位对早产儿血气指标的影响

使用美国产i-STAT手掌式血气分析仪分别对54例早产儿于生后1～4 d交替于仰卧位或俯卧位进行血气分析相关性检测.结果俯卧位时,需吸氧的早产儿PaO2、氧合指数较仰卧位明显增加,PaCO2明显降低.认为俯卧位为改善需吸氧早产儿氧合和通气功能的适宜体位.     

腰麻后应用留置针膀胱穿刺导尿的体会

腰麻后的病人常可发生急性尿潴留的情况，但留置导尿能并发尿路感染，并偶有遇到导尿困难的病人。我们于1999-08／2002-07，对腰麻手术105例中32例发生急性尿潴留者应用静脉留置针作膀胱穿刺导尿，替代尿路导尿，对这类病人确有许多优点，现分析报告如下。     

高频振荡通气联合猪肺磷脂注射液治疗新生儿呼吸窘迫综合征的临床疗效及对血气分析指标的影响

目的探讨高频振荡通气联合猪肺磷脂注射液治疗新生儿呼吸窘迫综合征的临床疗效及对血气分析指标影响。方法选择2010年1月—2014年10月于陕西省咸阳市第一人民医院住院的新生儿呼吸窘迫综合征患儿78例,按照随机数字表法分为对照组和观察组,每组39例。对照组患儿给予高频振荡通气治疗,观察组患儿在高频振荡通气基础上加用猪肺磷脂注射液。比较两组患儿的临床疗效,治疗前及治疗后1、6、12、24 h呼吸频率、心率、舒张压及血气分析指标〔动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、p H值〕,观察治疗过程中两组患儿不良反应发生情况。结果观察组患儿临床疗效优于对照组(u=1.789,P=0.037)。治疗前两组患者呼吸频率、心率、舒张压比较,差异无统计学意义(P>0.05);治疗后1、6、12、24 h观察组患儿呼吸频率、心率低于对照组,舒张压高于对照组(P<0.05)。治疗前两组患儿PaO2、PaCO2、p H值比较,差异无统计学意义(P>0.05);治疗后1、6、12、24 h观察组患儿PaO2、p H值高于对照组,PaCO2低于对照组(P<0.05)。对照组2例患儿、观察组3例患儿出现轻度二氧化碳潴留。结论高频振荡通气联合猪肺磷脂注射液治疗新生儿呼吸窘迫综合征的临床疗效确切,可有效改善患儿的血气分析指标。     

瑞芬太尼、丙泊酚时段靶控诱导全麻对剖宫产新生儿呼吸的影响

目的观察瑞芬太尼、丙泊酚时段靶控诱导全麻对剖宫产新生儿呼吸的影响。方法32例拟行全麻剖宫产分娩者,给予丙泊酚3μg／ml、瑞芬太尼4ng／ml靶控诱导,脑电双频谱指数（BIS）达40时气管插管并开始手术,术中按需间断给予维库溴胺,术中维持脑电双频谱指数（BIS）在40～50,手术结束前30min静注芬太尼4～5μg／kg。另选680例常规腰麻剖宫产孕妇。记录并比较两组麻醉诱导至胎儿娩出时间,胎儿娩出即刻及5min时的Apgar评分。结果两组麻醉诱导至胎儿娩出时间无明显差异;全麻组有1例新生儿即刻Apgar评分为6分,其余均在8分以上;所有新生儿5min Apgar评分均为10分。结论BIS指导下瑞芬太尼、丙泊酚靶控时段诱导全麻对剖宫产新生儿的呼吸无明显影响。     

Transversus abdominis plane block provides effective and safe anesthesia in the cesarean section for an amyotrophic lateral sclerosis parturient: A case report

Rationale:Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant.Patient concerns:A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks’ gestation due to the rapid deterioration of the mother.Diagnoses:The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria.Interventions:Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure.Outcomes:This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications.Lessons:Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.     

两种吸痰方法对下呼吸道感染者血气分析影响的对比研究

目的比较常规吸痰和麻醉喉镜暴露声门后吸痰两种方法对下呼吸道感染患者血气分析的影响。方法 61例患者随机分为两组,对照组31例,实验组30例。对照组以普通吸痰管吸痰,实验组以麻醉喉镜暴露声门后普通吸痰管吸痰,吸痰前和吸痰后30 min分别对患者进行血气分析检查。结果对照组吸痰前后血气分析结果无差异（P〉0.05）,而实验组显示吸痰后血气分析结果较吸痰前改善（P〈0.05）。结论麻醉喉镜暴露声门后吸痰的方法可改善下呼吸道感染患者血气分析。     

Changes in cesarean section rate before and after the end of the Korean Value Incentive Program

Background:The Korean government implemented a value incentive program providing incentives to providers based on C-section rates, with the rates being publicized. The program ended in 2014 after the administration decided that the effects of the incentive program were limited. In this report, we analyzed changes in C-section rates with the value incentive program.Methods:The analysis used claim data from Korea’s National Health Insurance. The study period (2011–2016) was divided into two phases: before and after the program. This study included 95 providers that were tertiary or general hospitals having more than 200 deliveries per year during the study period. The dependent variable was the risk-adjusted C-section rate. Independent variables included time and hospital characteristics such as hospital type, district, and ownership. Interrupted time series analysis was performed to analyze the data.Results:Our results showed that risk-adjusted C-section rates increased immediately after the end of the incentive program for C-sections. The immediate effect of intervention, a change of 1.73% (P < .05), was statistically significant, as was the trend after intervention, at 0.21% (P < .0001). The slope showed an increase after the intervention to 0.25% per medical institution, which was contrary to the trend of the preintervention decline (negative slope).Conclusion:Risk-adjusted C-section rates increased immediately after the discontinuation of a value incentive program. Tertiary hospitals showed greater increases in C-section rates than general hospitals after the intervention.     

血气分析对气管肿瘤的诊断价值

目的探讨血气分析对气管肿瘤的诊断价值。方法回顾性分析6例气管肿瘤的血气指标的变化,并与6例支气管哮喘的血气指标比较。结果气管肿瘤患者的平均动脉血氧分压和二氧化碳分压高于支气管哮喘的平均动脉血氧分压和二氧化碳分压。结论与呼吸困难不一致动脉血氧分压增高应考虑气管肿瘤的可能,血气分析对气管肿瘤有一定的诊断价值。     

Effect of blood transfusion during cesarean section on postpartum hemorrhage in a tertiary hospital over a 4-year period

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and death worldwide. The history of cesarean section and the occurrence of placenta previa were significantly associated with the increase in blood transfusion. Therefore, to prevent PPH, it is important to understand the effect of blood transfusion during cesarean section on postpartum hemorrhage. The purpose of this study is to determine the cause of blood transfusion during cesarean section, especially large amounts of blood transfusion, and to take measures to reduce the blood demand caused by PPH with limited blood supply.This study was a retrospective study of patients who underwent blood transfusion during cesarean section in Qilu Hospital of Shandong University (China) from January 2013 to December 2016. Red blood cell infusion ≥10 U during cesarean section was defined as massive blood transfusion. The study collected the demographics of pregnant women, obstetric characteristics and reasons for blood transfusions, as well as blood components and blood transfusion results. Multivariate regression analysis was performed for evaluating the risk factors of PPN.From 2013 to 2016, a total of 587 patients received blood transfusions during cesarean section. The proportion of women receiving blood transfusion during cesarean section increased (from 3.21% to 7.40%, P < .001). The history of cesarean section (P = .005) and the occurrence of placenta previa were positively correlated with the increase in blood transfusion (P = .016). There were 72 cases of massive blood transfusion, accounting for 12.27% of blood transfusion patients. Among mass blood transfusions, 93.1% of cases had prior cesarean delivery, and placenta previa accounted for 95.8%. 19.4% of patients receiving massive blood transfusions underwent hysterectomy. There was no significant difference in maternal BMI and gestational age between the mass blood transfusion group and the non-mass blood transfusion group.From 2013 to 2016, the demand for blood transfusion, especially the demand for massive blood transfusion, increased. Repeated cesarean section and placental previa combined with uterine scar are positively correlated with increased blood transfusion. Reducing the initial cesarean section should help reduce the massive blood transfusion caused by placenta previa with a history of cesarean section.     

益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧的临床研究

目的：探讨益母草注射液联合缩宫素预防剖宫产产后出血及促进术后子宫复旧效果。方法选择孕龄＞28周行剖宫产患者360例,分为治疗组180例,用益母草注射液联合缩宫素治疗;对照组180例,单纯用缩宫素治疗。观察两组产妇术中及术后不同时段出血量、产后出血例数、不同时段子宫收缩情况、子宫复旧情况,较术前血红蛋白下降程度等。结果治疗组各个时段出血量少于对照组,差异有统计学意义（P＜0．05）。治疗组各个时段子宫收缩情况均好于对照组,其中术中、术后2 h、6 h差异有统计学意义（ P＜0．05）。两组术后3 d、5 d子宫底下降幅度比较差异有统计学意义（ P＜0．05）。两组术后48 h与产前血红蛋白下降程度＜1 g／L、1-2 g／L、＞2 g／L比较差异有统计学意义（ P＜0．05）。结论益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧疗效确切,可作为防治产后出血和子宫复旧的优选治疗方案。     

COPD患者经皮血气参数与动脉血气参数的相关性及影响因素的分析

目的研究慢性阻塞性肺疾病（COPD）患者经皮二氧化碳分压（TcPaCO2）、经皮氧分压（TcPO2）及经皮血氧饱和度（SpO2）与动脉血气参数的相关性和影响因素，探讨其临床应用价值。方法测定31例COPD缓解期患者的TcPCO2、TrPO2及SpO2，同步测定动脉血气参数和进行肺功能参数测定。结果①COPD患者经皮血气参数与动脉血气参数间存在线性相关关系，其相关系数和回归方程如下：TcPCO2和PaCO2（Y=3．967＋0．941X，r=0．846，P〈0．001）、TcPO2和PaO2（Y=33．502＋0．716X，r=0．602，P〈0．001）、SpO2和SaO2（Y=7．639＋0．941X，r=0．763，P〈0．001）。②年龄及肺功能参数不是影响COPD患者TcPCO2、TcPO2及SpO2的因素。结论COPD患者经皮血气参数与动脉血气参数间有较好的相关性，经皮血气参数可作为一种无创监测手段应用于临床。