腰硬联合与硬膜外麻醉用于镇痛分娩临床效果分析

目的 探讨椎管内麻醉镇痛分娩的优缺点及副作用发生率.方法 回顾性分析西安安琪儿妇产医院行镇痛分娩396例临床病例,比较腰硬联合麻醉(联合组)和硬膜外麻醉(硬外组)麻醉后在镇痛效果、产程进展、产后出血量、新生儿评分方面的情况;并分析麻醉后在催产素使用、发热、产后尿潴留率等副作用及中转剖宫产的发生率.结果 联合组镇痛起效时间明显短于硬外组(t=27.00,P＜0.05),两组麻醉用于分娩镇痛效果均良好,VAS评分各时间点(5min、10min、30min、60min、90min)均无显著性差异(t值分别为1.41、0.71、1.46、1.54、1.75,均P＞0.05).两组三产程进展、产后出血量、新生儿评分(t值分别是1.02、0.44、1.05、1.46、1.85、1.56,均P＞0.05)均无影响.两组麻醉后催产素使用、产时发热、产后尿潴留等副作用和中转剖宫产的几率无显著性差异(x2值分别是0.00、0.10、0.08、0.05,均P＞0.05).结论 腰硬联合麻醉的镇痛起效更快,麻醉后不增加催产素使用、产时发热、产后尿潴留率等副作用的发生几率.因此腰硬联合麻醉可广泛应用于分娩镇痛.     

产房护理安全管理在产妇分娩中的临床应用

目的 探究和分析产房护理安全管理在产妇分娩当中的临床应用效果。方法 从医院于2020年1—12月收治的所有产妇当中选取其中自愿参与本次临床研究的600例产妇作为本次临床试验研究的观察分析对象,将这600例产妇按照数字随机法分为各300例的对照组和观察组两组;对照组的300例产妇实施常规基础护理管理,观察组的300例产妇实施产房护理安全管理;比较两组产妇的自然分娩率、新生儿Apgar评分、住院时间和护理质量评分;对两组产妇的护理满意度进行对比。结果 观察组的自然分娩率为92.67%,比对照组77.00%的自然分娩率高很多,差异有统计学意义（P <0.05）;观察组的新生儿Apgar评分比对照组高,住院时间比对照组短,护理质量评分高于对照组,差异有统计学意义（P<0.05）;观察组和对照组两组产妇的的护理满意度分别为97.33%和75.00%,差异有统计学意义（P <0.05）。结论 将产房护理安全管理应用到产妇分娩护理管理中,可以显著提高产妇的自然分娩率和新生儿Apgar评分,改善产房的护理质量评分和产妇的护理满意度,有助于缩短产妇的住院时间,值得在临床中进行大力推广应...     

脐动脉血pH值评价新生儿窒息的临床应用价值

目的探讨脐动脉血pH值评价新生儿窒息及预测窒息并发症的临床意义。方法抽取2006年1月—2008年4月在我院分娩的健康产妇552例。监测其新生儿脐动脉血pH值,分析脐动脉血pH值与生后1 min Apgar评分的关系,分别对脐动脉血pH值及1 min Apgar评分对于预测新生儿窒息并发症进行真实性的评价。结果1 min Apgar评分与脐动脉血pH值相关(χ2=278.13,P<0.05)。脐动脉血pH值对于预测窒息并发症较Apgar评分有更高的敏感度及特异度。pH值异常发生比例与HIE程度有关,随HIE程度的提高而增加(χ2=4.437,P<0.05)。结论脐动脉血pH值能客观评价新生儿出生时的状况,对监测新生儿预后、早期采取有效措施防治窒息并发症有指导意义。     

围产期窒息新生儿脐血中血气分析及电解质的变化

目的：观察围产期窒息新生儿脐血中血气分析及电解质的变化。方法：根据诊断标准将新生儿分为围产期窒息组和对照组。在新生儿娩出后,胎盘未娩出前从近胎盘侧抽取脐动脉血约0．5ml,采用美国I－STAT公司生产的血气分析仪,在抽取脐血3min之内检测血气及电解质。结果：围产期窒息组与对照组相比pH值、PO2明显降低,而PCO2则显著增高,差异有统计学意义（P＜0．01）;与此同时两组相比K、Na、Ca^2 差异均无统计学意义（P＞0．05）。结论：脐动脉血血气分析结合Apgar是判断胎儿新生儿缺氧缺血的敏感的客观指标。     

瑞芬太尼在产科全麻中的临床应用

目的:观察瑞芬太尼应用于剖宫产全麻时对产妇及新生儿的影响。方法:足月妊娠剖宫产30例,分为瑞芬太尼全麻组15例(R组)和对照全麻组15例(C组),观察母体的血流动力学变化及苏醒时间,及胎儿娩出后的Apgar评分。结果:两组麻醉过程血流动力学参数、苏醒时间有显著差异(P<0.015);新生儿Apgar评分无显著性差异(P>0.015)。结论:瑞芬太尼用于产科全麻诱导平稳,苏醒迅速,对新生儿无明显副作用。     

The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients

The Surgical Apgar Score (SAS) is a simple and rapid scoring system predicting postoperative mortality and morbidity. However, it remains unknown whether it might be useful in fit and frail older patients undergoing abdominal emergency surgery.MethodsConsecutive patients ≥65 years, needing emergency abdominal surgery were enrolled in this prospective study. Additionally to the SAS, the G8 screening score was used to determine the frailty status. The logistic regression analysis was conducted investigating the association between the scores and 30-day postoperative outcomes.ResultsThe study sample comprised 315 older patients (165 female, 150 male) with a median age of 77 (range 65–100) years old. The prevalence of frailty was 60.3%. The most frequent surgical indications were acute cholecystitis, followed by ileus, complicated diverticulitis, ulcer perforation, complication of gastric cancer and other causes. The decreasing SAS was significantly associated with the increasing likelihood of both 30-day postoperative major complications (p < 0.01) and death (p < 0.01) both in fit and frail older patients. Multivariate analyses have identified the G8, frailty screening test, and the SAS score as independent factors that predict postoperative adverse events. The model combining both scores increased the discriminatory ability for 30-day postoperative major morbidity and mortality.ConclusionThe SAS confirmed to be a simple and powerful predictor of 30-day postoperative morbidity and mortality both in fit and frail older patients undergoing emergency abdominal surgery. The department allocation algorithm based of the combination of the G8 and the SAS may be considered as an option to improve the outcomes of older patients undergoing abdominal emergency surgery.     

瑞芬太尼在全身麻醉下子宫下段剖宫产中的运用

目的 观察瑞芬太尼对全身麻醉下子宫下段剖宫产中产妇及新生儿的影响.方法 足月妊娠剖宫产40例,分为瑞芬太尼全麻组20例(A组)和氯胺酮全麻组20例(B组),观察产妇血流动力学的变化,胎儿娩出后1、5 min Apgar评分.结果 A组产妇血流动力学指标较B组平稳,两组插管后l min SBP、DBP、HR值降低,而插管后5 min基本恢复正常.诱导前SBP、DBP、HR值组间比较差异无统计学意义(P＞0.05),两组诱导后,SBP、DBP、HR值插管后1 min分别为(120.8±19.6 mm Hg、80.6±11.2 mm Hg、98.1±17.1 bpm),(128.1±17.5 mm Hg、98.9±13.8 mm Hg、108.7±20.7 bpm)插管后5 min分别为(98.3±24.7 mm Hg、75.3±13.8 mm Hg、79.9±22.6 bpm),(121.5±16.2 mm Hg、88.6±13.7 mmHg、110.5±17.4 bpm)比较差异有统计学意义(P＜0.05).A组Apgar评分1 min、Apgar评分5min为(9.5±0.8)分、(9.9±0.1)分,B组为(9.5±0.7)分、(10.0±0.0)分,比较差异无统计学意义(P＞0.05).结论 瑞芬太尼用于剖宫产术全身麻醉诱导,产妇血流动力学稳定,对新生儿无明显影响.     

Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study

Objective: To estimate the association between gestational diabetes mellitus (GDM) and adverse pregnancy and neonatal outcomes in Denmark.

Methods: A population-based cohort study including all singleton pregnancies in Denmark from 2004 to 2010 (n?=?403?092). Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases 10th Revision.

Results: The final study population consisted of 398?623 women. Of these, 9014 (2.3%) had GDM. Data were adjusted for maternal age, parity, smoking, gestational age, birth weight, BMI, gender of the fetus and calendar year. The risk of preeclampsia, caesarean section (both planned and emergency) and shoulder dystocia was increased in women with GDM. In the unadjusted analysis, the risk of thrombosis was increased by a factor 2 in the GDM patients, but in the adjusted analysis this association disappeared. Post-partum hemorrhage was similar in the two groups. The GDM women had an increased risk of giving birth to a macrosomic neonate although the unadjusted analysis did not show any difference between the two groups. Low Apgar score was increased in the GDM, but this association disappeared in the adjusted analysis. Stillbirth was comparable in the two groups.

Conclusions: Women with GDM still have increased incidence of obstetric and neonatal complications, which could imply that treatment of women with GDM should be tightened.     

不同分娩时间产妇的一般情况及母婴并发症发生情况的调查

目的调查不同分娩时间产妇的一般情况及母婴并发症发生情况,以期为制定针对性措施提供临床依据。方法回顾性分析2014年1月至12月在上海交通大学医学院附属国际和平妇幼保健院妊娠28周以上、单胎头位、阴道分娩的产妇8931例的病史资料。根据分娩时间分为白班组(8:00-17:00)和中夜班组(17:00至次日8:00),比较两组产妇的一般情况、母婴分娩并发症的发生情况等。结果白班组与中夜班组分娩量以及产妇的一般情况的差异无统计学意义(P0.05)。中夜班时,急产的发生率为6.43%,明显高于白班;白班组,人工破膜、镇痛分娩、产钳助产、阴道切开、宫腔探查等助产操作比例明显高于中夜班组。两组产妇阴道血肿以及产后出血发生率的差异无统计学意义(P0.05),但中夜班分娩产妇产后2h发生产后出血比率明显高于白班(P0.05)。两组新生儿娩出5min Apgar评分差异无统计学意义(P0.05)。结论产房白班与中夜班的工作量相当,白班时产科助产操作比例更高,中夜班存在母婴安全的潜在危险因素。