自体全血在慢性难愈合创面中的应用研究进展

【摘要】慢性难愈合创面的治疗具有耗时长、 费用高、 难治愈等特点。 近年来,随着慢性难愈合创面发病 原因及防控关键技术的进一步研究,其诊疗技术逐渐呈现多样化,且最近研究发现,自体全血中含有的血浆及具 有生物活性、 生物相容性以及代谢活性等的活细胞能够通过促进修复细胞的增殖、 分化,缩短炎症反应期,加快 肉芽组织生长等多种途径加速创面的愈合,且具有经济成本低、 技术环境要求低、 操作简单、 安全有效等优点。 本研究主要针对自体全血在慢性难愈合创面中的应用研究进展进行综述,以期为自体全血在慢性难愈合创面中的 治疗提供理论依据。     

刮痧痧象研究进展

刮痧现有研究多集中在疗效观察,并初步尝试作用机制探索,但对痧象研究稍显不足。目前痧象研究主要包括皮肤外观、皮肤血流灌注量以及皮肤温度等方面,这些研究为今后刮痧技术的标准化、规范化、可视化研究奠定了基础,提供了借鉴。但是这些研究尚处于初级阶段,还有待于进一步深入研究。     

胃癌病人自杀干预研究进展

对胃癌病人自杀的高危因素及其干预措施的研究进展进行综述,以期引起医护人员对胃癌病人心理健康的关注,尤其是对有自杀倾向的病人,采取针对性的干预防范措施以减少自杀等不良事件的发生。建议护理科研人员能尽早制定适用于胃癌等恶性肿瘤病人的自杀评估量表;同时建议护理科研人员对胃癌病人的自杀情况进行更深入的研究,从而为自杀干预提供更多参考资料。     

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study

ObjectivesTo describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.MethodsA convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.ResultsEighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.ConclusionsFear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.     

导乐陪伴联合分娩镇痛对促进初产妇自然分娩的影响分析

目的分析导乐陪伴联合分娩镇痛对初产妇产程及分娩结局的影响。方法回顾性选取首都医科大学附属北京友谊医院2019年1月1日至2019年9月30日收治的200例初产妇作为研究对象。所有患者均实施分娩镇痛,依据是否实施导乐分娩分成导乐组100例和对照组100例(无导乐分娩),采用两独立样本的t检验和x^(2)检验,比较两组产妇的产程及分娩结局。结果导乐组自然分娩率为76%(76/100),明显高于对照组[61%(61/100)],两组比较差异有统计学意义(x^(2)=5.214,P=0.022)。导乐组第一、二、三产程时间分别为(8.35±3.59)、(1.07±0.26)、(0.54±0.19)h,对照组分别为(10.94±4.76)、(1.86±0.63)、(0.78±0.21)h,两组比较差异均有统计学意义(t=10.354,P=0.016;t=5.312,P=0.042;t=8.169,P=0.039)。导乐组及对照组新生儿窒息率分别为1%(1/100)、3%(3/100),两组比较差异无统计学意义(P=0.621)。导乐组及对照组产后出血发生率分别为3%(3/100)、10%(10/100),产后尿潴留发生率分别为0(0/100)、6%(6/100),新生儿早吸吮成功率分别为98%(98/100)及90%(90/100),两组比较差异均有统计学意义(P值分别0.045、0.029、0.017)。导乐组的住院时间为(3.17±0.85)d,明显短于对照组(5.64±1.29)d,两组比较差异有统计学意义(t=6.359,P=0.031)。导乐组患者产后2 h视觉模拟疼痛评分为(3.49±0.98)分,明显低于对照组(5.82±1.06)分,两组比较差异有统计学意义(t=9.327,P<0.001)。结论导乐分娩联合分娩镇痛能有效减轻宫缩疼痛,促进自然分娩,降低剖宫产率,有助于提高产科医疗服务质量,提升患者满意度,值得在有条件的医院进行推广。     

糖尿病前期中医药研究进展

糖尿病前期的发病率逐年递增,中医治疗该病疗效明确,优势突出。该文从病因病机及临床治疗等方面综合整理分析了近年来有关糖尿病前期的中医临床研究,大多数学者认为其发病与禀赋、饮食、情志及劳逸失度密切相关,以中满内热,脾不散精,气阴两虚,肝郁脾虚,痰湿内阻为主要病机。目前,中医对该病的辨治不尽相同,如何更有效的发挥中医诊疗特色,还需进一步研究和探讨。     

荚蒾属植物化学成分的研究进展

荚蒾属植物化学成分种类丰富,以vibsane型二萜、环烯醚萜等萜类成分为主,还有黄酮、木脂素、酚类和植物甾醇等成分,药用价值很高,有较大的开发潜力。本文通过查阅和分析相关文献,对荚蒾属植物的化学成分进行全面整理,旨在为该属植物的进一步研究和开发利用提供参考。     

五味子甲素研究进展

五味子甲素为五味子木脂素类有效成分。该文对近年来关于五味子甲素的研究情况作一系统综述,包括其药理作用、提取工艺、测定方法,为进一步研究、开发和合理应用五味子甲素提供参考。     

外排泵抑制剂研究进展

细菌耐药性一直是全球关注的热点,细菌外排泵造成了抗生素耐药的严重问题,为此,近年来研究外排泵抑制剂广受关注。外排泵抑制剂可以抑制耐药细菌对药物的外排,从而恢复其对抗生素的敏感性。本文简要介绍了几类外排泵的结构,对其作用机制、化学合成、微生物代谢来源和天然产物来源的各类第三代外排泵抑制剂、筛选方法等方面进行了综述,及对三维结构的解析将有助于发现活性更好的新型外排泵抑制剂。     

The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study

BackgroundLabor epidural analgesia is highly effective, but can be limited by slow onset and incomplete blockade. The administration of warmed, compared to room temperature, bupivacaine has resulted in more rapid onset epidural anesthesia. We hypothesized that the administration of bupivacaine with fentanyl at 37°C versus 20°C would result in improved initial and ongoing labor epidural analgesia.MethodsIn this prospective, randomized, doubled blinded study, 54 nulliparous, laboring women were randomized to receive epidural bupivacaine 0.125% with fentanyl 2 μg/mL (20 mL initial and 6 mL hourly boluses) at either 37°C or 20°C. Pain verbal rating scores (VRS), sensory level, oral temperature, and side effects were assessed after epidural loading (time 0), at 5, 10, 15, 20, 30, 60 min, and at hourly intervals. The primary outcome was the time to achieve initial satisfactory analgesia (VRS ⩽3). Secondary outcomes included ongoing quality of sensory blockade, body temperature and shivering.ResultsThere were no differences between groups in patient demographics, initial pain scores, cervical dilatation, body temperature or mode of delivery. Epidural bupivacaine at 37°C resulted in shorter mean (±SD) analgesic onset time (9.2 ± 4.7 vs. 16.0 ± 10.5 min, P = 0.005) and improved analgesia for the first 15 min after initial bolus (P = 0.001–0.03). Although patient temperature increased during the study (P < 0.01), there were no differences between the groups (P = 0.09). Six (24%) and 10 (40%) patients experienced shivering in the 37°C and 20°C groups, respectively (P = 0.23).ConclusionsThe administration of epidural 0.125% bupivacaine with fentanyl 2 μg/mL at 37°C versus 20°C resulted in more rapid onset and improved labor analgesia for the first 15 min. There was no evidence of improved ongoing labor analgesia or differences in side effects between groups.