腰硬联合麻醉下剖宫产术中产妇不同体位干预的效果观察

目的探讨腰硬联合麻醉下剖宫产术中不同体位干预的效果。方法选取150例剖宫产产妇,采用随机数字表法分为A组、B组和C组,每组各50例,分别于剖宫产术中采用平卧体位、左侧斜卧30°体位、左侧斜卧30°并抬高床尾15°体位。比较各组产妇术前和麻醉后20min的心率和平均动脉压,低血压发生率及麻黄碱使用率的差异。结果 3组产妇麻醉后20min心率和平均动脉压比较,差异有统计学意义(均P0.05),其中C组心率较A组和B组低(P0.05),C组平均动脉压较A组和B组高(P0.05)。3组产妇低血压发生率和麻黄素使用率比较,差异有统计学意义(均P0.05),其中低血压发生率A组较B组和C组高,麻黄素使用率A组较B组和C组高。结论腰硬联合麻醉下剖宫产术中采取左侧斜卧30°并抬高床尾15°体位可获得稳定血流动力学,降低低血压发生率。     

不同比重腰麻用于剖宫产手术对母体循环及新生儿动脉血气的影响

目的观察、比较不同比重腰麻对产妇血压及新生儿动脉血气影响的差异,探讨对产妇、新生儿更为安全的麻醉方式。方法将60例足月妊娠拟行剖宫产术的产妇随机分为三组,每组20例,A组重比重组(蛛网膜下腔给予布比卡因15 mg+10%葡萄糖注射液1 ml),B组等比重脑脊液组(蛛网膜下腔给予布比卡因15 mg+脑脊液1 ml)、C组等比重芬太尼组(蛛网膜下腔给予布比卡因15 mg+芬太尼50μg),监测各组麻醉阻滞平面以及麻醉成功后各时间点的产妇血压、脐动脉血气及Apgar评分及不良反应,比较三组间麻醉效果及对产妇及新生儿的影响。结果麻醉完成1 min时,A组SBP低于B组(P=0.001);麻醉完成3 min时,A组DBP低于B、C组(P值分别为0.001、0.014),而HR高于B、C组(P值分别为0.027、0.012);麻醉完成5 min时,A组SBP低于B、C组(P值分别为0.001、0.014);麻醉完成10 min时,A组DBP低于B、C组(P值分别为0.000、0.043)。A组麻醉起效时间和麻醉维持时间均明显短于B、C组(均P<0.01)。三组间新生儿脐血动脉血气及1、5 min Apgar评分无统计学意义(P>0.05)。A组使用去氧肾上腺素的剂量高于B、C组(均P=0.001)。C组瘙痒发生率显著高于A、B组(均P=0.001)。结论单次细针重比重腰麻与等比重腰麻均为适合剖宫产手术的麻醉方式。但等比重腰麻起效快,麻醉效果完善,产妇血压波动小;等比重腰麻复合芬太尼50μg对新生儿血气、Apgar评分无不良影响。     

瑞芬太尼复合地氟烷全身麻醉用于剖宫产术的临床观察

目的探讨瑞芬太尼复合地氟烷全身麻醉对行剖宫产产妇及新生儿的影响。方法瑞芬太尼复合地氟烷全身麻醉下行剖宫产术产妇737例,依据麻醉诱导开始至胎儿娩出(induction to fetal delivery, I-D)的时间分为A1组313例(I-D时间≤15 min),A2组332例(15 min～60 min),A3组92例(I-D时间≥60 min);比较3组产妇入室时(T_0)、麻醉诱导时(T_1)、气管插管即刻(T_2)、切皮时(T_3)、胎儿娩出时(T_4)、手术结束时(T_5)、拔除气管导管时(T_6)、出室时(T_7)平均动脉压(mean arterial pressure, MAP)、心率及新生儿脐动脉血pH值,1、5、10 min Apgar评分。结果 3组产妇T_0～T_7 MAP、心率在组内及组间比较差异均无统计学意义(P0.05);A1组、A2组、A3组新生儿5 min Apgar评分[(9.6±1.0)、(9.6±0.7)、(9.4±0.9)分]、10 min Apgar评分[(9.9±0.5)、(9.9±0.4)、(9.9±0.4)分]均高于1 min Apgar评分[(8.4±1.8)、(8.3±1.5)、(6.7±1.6)分](P0.05),A1组、A2组新生儿1 min Apgar评分高于A3组(P0.05),3组新生儿5、10 min Apgar评分及脐动脉血pH值比较差异无统计学意义(P0.05)。结论瑞芬太尼用于产妇全身麻醉诱导有助于消除应激,复合地氟烷维持麻醉有利于维持术中循环稳定,长时间(≥60 min)使用可影响新生儿1 min评分,但其5 min、10 min评分不受影响,可安全用于剖宫产术全身麻醉。     

腰硬联合麻醉不同麻醉体位对剖宫产产妇及新生儿的综合影响比较

目的 比较腰硬联合麻醉不同麻醉体位对剖宫产产妇及新生儿的综合影响.方法 选取2009年1月至2011年7月行剖宫产134例产妇为研究对象,将其随机分为A组和B组,每组各67例.A组进行卧位下麻醉,B组进行坐位下麻醉.将两组产妇不同时间段的血流动力学指标、麻黄碱总用量、不良反应发生率及新生儿Apgar评分进行对比.结果 B组血流动力学指标波动幅度小于A组,麻黄碱总用量、不良反应发生率也优于A组,均有显著性差异(P<0.05),而两组新生儿不同时间段的Apgar评分则无显著性差异(P＞0.05).结论 坐位下腰硬联合麻醉更适用于剖宫产产妇,但不同麻醉体位对新生儿的影响差异不大.     

不同剂量罗哌卡因对行腰麻-硬膜外联合麻醉的剖宫产妇RAAS及镇痛效果的影响

目的探讨不同剂量罗哌卡因对行腰麻-硬膜外联合麻醉的剖宫产妇肾素-血管紧张素-醛固酮系统(RAAS)及镇痛效果的影响。方法选取160例剖宫产妇,ASA分级为Ⅰ~Ⅱ级,麻醉方式均为腰麻-硬膜外联合麻醉,按照随机数字表法分为A、B、C、D四组,每组40例。A、B、C、D组分别给予8、10、12、15 mg的罗哌卡因进行麻醉,比较四组产妇术中麻醉效果、术后不良反应以及麻醉前(T_1)、切皮即刻(T_2)、胎儿娩出即刻(T_3)和手术完成即刻(T_4)的肾素活性(PRA)、血管紧张素Ⅱ(AT-Ⅱ)和醛固酮(ALD)水平,并比较新生儿脐带血气分析及1、5 min的Apgar评分。结果 B、C、D组术中麻醉效果明显优于A组(P0.05),D组术中麻醉效果明显优于B组(P0.05);B、C、D组T_2~T_4时刻血清PRA水平均明显低于A组(P0.05),D组T_2~T_4时刻血清PRA水平均明显低于B、C组(P0.05),C、D组T_2时刻血清AT-Ⅱ、ALD水平均明显低于A、B组(P0.05);四组新生儿1、5 min Apgar评分及p H、氧分压(PO2)、二氧化碳分压(PCO2)比较差异均未见统计学意义(P0.05);D组低血压发生率明显高于A、B、C组(P0.05)。结论 8、10、12、15 mg的罗哌卡因均可完成手术要求,对新生儿无明显影响,但10、12、15 mg的罗哌卡因镇痛效果更好,能够明显抑制RAAS的过度分泌,但随着剂量增大可能会增加低血压的发生风险。     

曲马多、氟哌利多复合辅助硬膜外麻醉剖宫产对新生儿Apgar评分的影响

[目的]探讨曲马多、氟哌利多复合辅助硬膜外麻醉剖宫产时对新生儿Apgar评分、母婴安全的影响.[方法]采用随机双盲方法,选择 60例孕足月单胎产妇 (ASAⅠ～Ⅱ级)随机分为三组:静注生理盐水0.05 mL/kg为对照组(C组 );静注曲马多1 mg/kg为曲马多组(T组)和静注曲马多1 mg/kg 氟哌利多2.5 mg组为曲氟组(TD组),每组20例.在连续硬膜外麻醉下行剖宫产术,于切皮前5 min缓慢静脉给药,持续监测产妇血压、心率、血氧饱和度,并记录恶心呕吐、寒颤及牵拉不适的发生情况 ,新生儿行1,5,10 min Apgar评分.[结果]三组产妇血压、心率、血氧饱和度变化差异不具有显著性(P＞0.05).三组新生儿Apgar评分差异不具有显著性(P＞0.05).三组产妇恶心呕吐,寒颤、牵拉不适等不良反应的发生率差异具有显著性(P＜0.05),TD组的不良反应发生率明显降低.[结论]曲马多复合氟哌利多辅助硬膜外麻醉剖宫产时对新生儿Apgar评分无明显影响,对产妇安全,且能够减轻产妇呕吐、寒颤及牵拉不适等不良反应的发生.     

预输缩合葡萄糖氯化钠注射液扩容在腰硬联合麻醉下剖宫产术的临床观察

目的观察预输缩合葡萄糖氯化钠注射液扩容在腰硬联合麻醉下剖宫产术的安全性和实用性。方法100例拟在腰硬联合麻醉下行择期剖宫产的产妇随机分为缩合葡萄糖氯化钠注射液组（A组n=50）和复方氯化钠组（B组n=50），在麻醉前分别输入缩合葡萄糖氯化钠注射液和复方氯化钠注射液500ml，观察入室时、麻醉后3min、5min、10min和术毕时产妇的收缩压（SBP）、舒张压（DBP）、心率（HR）的变化及新生儿的Apgar评分。结果麻醉后3min、5min、10min时两组的SBP、DBP和职均较入室时下降，但B组下降较为明显，麻黄素的需要量及低血压发生率B组高于A组。术毕时两组的SBP、DBP、HR与基础值相比下降不明显（P〉0．05），而A组的SBP和DBP的值比B组高，B组的HR比A组快，但P〉0．05，均无统计学意义。新生儿的Apgar评分均〉8分，两组无明显差别。结论预输缩合葡萄糖氯化钠注射液扩容能改善腰硬联合麻醉下剖宫产中母体的血流动力学，降低术中低血压的发生率，提高产妇及胎儿的安全性。     

罗哌卡因联合芬太尼腰硬联合麻醉在剖宫产术中的临床观察

观察罗哌卡因联合芬太尼腰硬联合麻醉在剖宫产术中的有效性和安全性。择期行剖宫产术产妇60例,随机双盲分为两组:罗哌卡因组(R组)和罗哌卡因联合芬太尼组(RF组)(n=30),R组腰麻药物为14mg罗哌卡因,RF组腰麻药物为12mg罗哌卡因联合10g芬太尼。记录产妇手术期间麻醉效果、麻醉并发症和新生儿1、5min Apgar评分。与R组比较,RF组产妇低血压、恶心呕吐麻醉并发症的发生率明显降低(P0.05),两组患者麻醉效果和新生儿1、5min Apgar评分比较差异无统计学意义(P0.05)。罗哌卡因联合芬太尼腰硬联合麻醉用于剖宫产术麻醉效果好,麻醉并发症少。     

不同麻醉方式对子痫前期剖宫产术中产妇血流动力学影响

目的探讨气管内插管全身麻醉、蛛网膜下腔阻滞麻醉对子痫前期剖宫产术的麻醉效果及对产妇血流动力学和母婴结局的影响。方法选取2016年1月至2019年6月子痫前期产妇86例,随机分为全身麻醉组(A组)和蛛网膜下腔阻滞麻醉组(B组),各43例。比较两组产妇麻醉效果、起效时间、围术期血流动力学变化及母婴结局。结果A组产妇麻醉起效时间短于B组(P<0.05);两组产妇麻醉效果优良率比较,差异无统计学意义(P>0.05)。两组产妇不同时间点SBP、DBP、HR不同程度降低,与T0比较,差异有统计学意义(P<0.05)。在T1、T2、T3、T4时间点,A组SBP、DBP水平明显高于B组(P<0.05);两组产妇HR水平在T2~T5时间点比较,差异有统计学意义(P<0.05);两组产妇SpO2水平在T0~T5各时间点比较,差异无统计学意义(P>0.05)。两组产妇不同时间点MAP不同程度降低,与T0比较,差异有统计学意义(P<0.05);T1、T4、T5时间点血流动力学指标比较,差异有统计学意义(P<0.05);两组产妇SpOz水平在T0~T5各时间点比较,差异无统计学意义(P>0.05)。两组产妇产后出血量和术中低血压发生率比较,差异无统计学意义(P>0.05);与A组比较,B组产妇术后头痛发生率较A组增高,但差异无统计学意义(P>0.05)。两组胎儿娩出后1 min,5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论子痫前期产妇在行剖宫产术时,全身麻醉与蛛网膜下腔阻滞麻醉同样安全、有效,全身麻醉麻醉起效更快,对产妇血流动力学影响更小,且两种麻醉方法对新生儿Apgar评分均无明显不良影响,可有效保证母婴安全。     

斜坡形垫架预防剖宫产术仰卧位低血压综合征的临床应用

[目的]观察在腰硬联合麻醉下行剖宫产术时应用斜坡形垫架预防仰卧位低血压综合征(SHS)的临床效果。[方法]将450例剖宫产术产妇随机分为斜坡形垫架组(A组)、沙袋组(B组)、手术床左倾斜组(C组),每组150例,麻醉后3组进行相应体位干预,使产妇腹臀向左倾斜15～30°。分别观察记录麻醉前及麻醉后2 min、5 min、10 min、胎儿取出前各时间节点产妇的血压、心率、呼吸、血氧饱和度,比较3组发生SHS情况以及新生儿出生后1 min Apgar评分及体位摆放使用时间。[结果]3组产妇麻醉后5 min、10 min血压、SHS发生率、体位摆放时间比较,差异有统计学意义(P0.05)。[结论]在腰硬联合麻醉下行剖宫产术时应用斜坡形垫架可缩短体位摆放时间,能有效预防SHS的发生。     

Headache during pregnancy

A questionnaire was submitted to 430 women 3 days after delivery, asking mainly about features of headache before and during pregnancy and their possible modification or recurrence; moreover, delivery modalities and the condition of the newborn were evaluated. One-hundred-and-twenty-six (29.3%) were found to be primary headache sufferers (IHS criteria, 1988), 81 of whom had migraine without aura (MO), 12 migraine with aura (MA), and 33 tension-type headache (TH). In all three groups, about 80% showed complete remission or a higher than 50% decrease in the number of attacks. The improvement was more evident after the end of the first trimester; this trend was common to the three primary headaches considered. In our series of primary headaches, there was only one case (MO) which began during pregnancy. In a subgroup of pluripara, headache maintained the improvement presented in the first pregnancy also during the following gravidic periods in about 50% of cases, whereas in the remaining 50% a worsening in parallel with successive pregnancies was found. Primary headaches "per se" do not seem to increase the pregnancy or delivery risks, nor the vitality of the newborn. During pregnancy, drug use was very much reduced and was restricted to a limited number of compounds.     

Monitoring during resuscitation

Use of many different types of monitors during resuscitation has been described in the literature. These monitors differ in their usefulness, technical feasibility, initial costs, and long-term costs (Table 4). There have been many published reports of CPR success rates in the hospital and in the pre-hospital setting. In spite of considerable advances in technology over the past 30 years, survival from CPR has changed little over that time. Although numerous types of monitoring during resuscitation are possible, and sometimes useful, the impact of expensive technology on ultimate outcome (survival) must be critically evaluated.     

Parasites during pregnancy

Parasitic infection during pregnancy is common. With most parasites, primary prevention is very effective in avoiding infestation. With the exceptions of malaria, toxoplasmosis, and African trypanosomiasis, when infection does occur, treatment decisions should be based on the impact of the infection on the patient and her fetus on an individual basis. When treatment is indicated, selection of medications with the least potential to harm the mother and more particularly the developing fetus is essential.     

Exercise during pregnancy

Routine exercise has become an accepted component of a healthy lifestyle, and many women want to continue exercising during pregnancy. In most cases, pregnant women can maintain previous levels of activity, while sedentary women can undertake new activities gradually.     

Selfmedication during pregnancy

A growing publicity drives the growing market of OTC, also in pregnancy. A short overview from this giant market, composed of pharmaceutical drugs, herbal medicines and homeopathic medicaments for a selection of frequent health problems in pregnancy is presented.     

Hypocalcaemia during plateletpheresis

Hypocalcaemia is a well recognized side-effect of citrate anticoagulation associated with plateletpheresis. In order to assess the frequency of this complication and to determine whether symptoms could be abolished with oral pretreatment of subjects with milk, calcium or vitamin D we prospectively evaluated total and ionizable serum calcium in healthy volunteers undergoing routine donor plateletpheresis. 39 subjects were divided into four groups. Group 1 consisted of 24 controls and received no pretreatment. The remaining patients were randomly allocated to Group 2 (n = 5) who were pretreated with 200 mL pasteurized whole milk 30 min before the procedure, Group 3 (n = 5) were pretreated with 1 g effervescent calcium dissolved in 200 mL water, and Group 4 (n = 5) to whom 1 μg alphacalcidol was administered 4h prior to the procedure. 7 of the individuals with no prior oral supplementation developed symptoms of hypocalcaemia, requiring intravenous calcium administration during the procedure, whereas none of the pretreated patients did (P = 0.0225). It is concluded that this unpleasant side effect, which occurs unpredictably, can be avoided by the administration of 200 mL of cow's milk 30 min prior to the plasmapheresis: this is both inexpensive and well accepted by the majority of individuals undergoing the procedure.     

Conditioning during hypnosis

Hypnosis has been used to control bleeding, both in normals and hemophiliacs. Case material is presented to demonstrate how hypnosis was used as an adjunct to standard medical treatment of a boy and his mother with von Willebrands disease, initially to reduce anxíety and improve self-esteem and the parent-child relationship, and later, to reduce bleeding. This use of hypnosis illustrates the relationship between hemostatic control and psychological adaptation.