氯胺酮在高危产妇剖宫产术全麻中对新生儿呼吸的影响

目的:研究氯胺酮在合并有并发症产妇的剖宫产术全麻中应用的安全性和可行性。方法:选择ASA分级Ⅱ~Ⅲ级的产妇40例,随机分为氯胺酮全麻组(Q组)和椎管内麻醉组(Z组)。Q组方案:静注氯胺酮1mg·kg-1、司可林100 mg,气道表面麻醉后行气管插管,手术开始至胎儿娩出前一般无需追加上述药物,若追加氯胺酮其总量不超过1.5 mg·kg-1、司可林总量不超过200 mg,胎儿娩出后立即抽取胎儿脐带血行血气分析并对胎儿进行1min和5 min Apgar评分。观察产妇入室至离室各时间点的血压、心率、脉率血氧饱和度及产妇入室至手术开始所需的时间等指标。并记录两组新生儿出生后3~5 d的新生儿神经行为评分(NBNA)。结果 :在两组血气分析数值中Q组氧分压和血氧饱和度两项值均高于Z组,两组比较有统计学意义(P<0.05),其他指标差异无统计学意义(P>0.05),新生儿1 min和5 min Apgar评分两组差异无统计学意义(P>0.05)。产妇的血压、心率两组间在个别时间点比较有统计学意义(P<0.05),脉率血氧饱和度两组比较无统计学意义(P>0.05),产妇入室至手术开始所需的时间Q组明显短于Z组,两组比较有统计学意义(P<0.05)。两组新生儿NBNA评分差异无统计学意义(P>0.05)。结论:氯胺酮可以安全地用于剖宫产术全麻中,尤其适用于危重或禁用椎管内麻醉的产妇。     

围手术期护理对剖宫产患者的影响

目的探讨围手术期护理对剖宫产患者术前焦虑、术中麻醉效果及术后身体恢复的影响。方法采用随机化方法将符合条件的产妇分为实验组和对照组,两组各40名。实验组采用围手术期护理,对照组接受所在病区的一般心理护理及手术室常规护理,测定其术前焦虑、麻醉效果、手术时间、出血量、新生儿Apgar评分及术后恢复的各项指标。结果实验组术前焦虑较对照组明显减轻,手术时间缩短,术中出血、术后疼痛、新生儿窒息均低于对照组,术后首次下床及排气时间均提前,术后满意率明显提高。结论惠州市中心人民医院采用的围手术期护理在缓解术前焦虑、提高麻醉效果、缩短手术时间及身体恢复方面效果优于一般的手术室常规护理。     

黑龙江省佳木斯地区野生狭叶柴胡显微鉴别

目的:探讨黑龙江省佳木斯地区野生狭叶柴胡根、茎、叶的显微结构。方法:采用石蜡切法。结果:野生狭叶柴胡的木栓层,韧皮部,木质部的显微特征均于药典上的记载有所不同。     

Multiple Invagination Patterns and Synaptic Efficacy in Primate and Mouse Rod Synaptic Terminals

PurposeOptical retina images are scaled based on eye size, which results in a linear scale ratio of 10:1 for human versus mouse and 7:1 for macaque monkey versus mouse. We examined how this scale difference correlates with the structural configuration of synaptic wiring in the rod spherule (RS) between macaque and mouse retinas compared with human data.MethodsRod bipolar cell (BC) dendrites and horizontal cell (HC) axonal processes, which invaginate the RS to form synaptic ribbon-associated triads, were examined by serial section transmission electron microscopy.ResultsThe number of rod BC invaginating dendrites ranged 1∼4 in the macaque RS but only 1∼2 in the mouse. Approximately 40% of those dendrites bifurcated into two central elements in the macaque, but 3% of those dendrites did in the mouse. Both factors gave rise to 10 invagination patterns of BC and HC neurites in the macaque RS but only two in the mouse. Five morphological parameters: the lengths of arciform densities and ribbons, the area of the BC–RS contact, and the surface areas of BC and HC invaginating neurites, were all independent of the invagination patterns in the macaque RS. However, those parameters were significantly greater in the macaque than in the mouse by ratios of 1.5∼1.8.ConclusionsThe primate RS provides a more expansive BC–RS interface associated with the longer arciform density and more branched invaginating neurites of BCs and HCs than the mouse RS. The resulting greater synaptic contact area may contribute to more efficient signal transfer.     

阴式子宫瘢痕妊娠病灶清除术的临床疗效评价

目的 观察阴式子宫瘢痕妊娠病灶清除术治疗剖宫产术后瘢痕妊娠的意义.方法 选取我院2018年10月—2019年10月收治的64例剖宫产术后瘢痕妊娠患者的临床资料,根据手术方案的不同,将实施阴式子宫瘢痕妊娠病灶清除术的病例作为观察组(n=33),将选择腹腔镜子宫瘢痕妊娠病灶消除术的病例作为对照组(n=31).比较两组手术疗...     

Total failure of spinal anesthesia for cesarean delivery,associated factors,and outcomes: A retrospective case–control study

Spinal anesthesia is the anesthetic technique of choice for patients undergoing cesarean delivery. In the present study, total spinal anesthesia failure was defined as a case when an absent blockade or inadequate surgery required general anesthesia administration with an endotracheal tube. This study aimed to investigate factors related to this condition and report its maternal and neonatal outcomes.This retrospective matched case–control study was conducted by recruiting 110 patients with failed spinal anesthesia and 330 control patients from September 1, 2016, to April 30, 2020, in the largest university hospital, Thailand.Of 12,914 cesarean deliveries, 12,001 patients received single-shot spinal anesthesia (92.9%) during the study period. Total spinal anesthesia failure was experienced by 110/12,001 patients, giving an incidence of 0.9%. Factors related to the failures were a patient body mass index (BMI) ≤29.5 kg/m² (adjusted odds ratio 1.9; 95% confidence interval 1.2–3.1; P = .010) and a third-year resident (the most senior trainee) performing the spinal block (adjusted odds ratio 2.4; 95% confidence interval 1.5–3.7; P < .001). In the group with failed spinal anesthesia, neonatal Apgar scores at 1 and 5 minutes were lower than those of the control group (both P < .001). Two patients in the failed spinal anesthesia group (2/110; 1.8%) had difficult airways and desaturation.Independent factors associated with total spinal anesthesia failure were a BMI of ≤29.5 kg/m² and a third-year resident performing the spinal block. Although the incidence of total failure was infrequent, there were negative consequences for the mothers and neonates. Adjusting the dose of bupivacaine according to the weight and height of a patient is recommended, with a higher dose appropriate for patients with a lower BMI.     

对促宫颈成熟与引产孕产妇的全程分娩管理模式

目的 探讨在全程分娩管理模式下,为孕产妇提供促宫颈成熟与引产服务的可行性。方法 选择2018年1月1日至2020年12月31日,在南京大学医学院附属鼓楼医院接受待产、分娩到产后康复(LDRP)一体化全程分娩管理模式(以下简称为LDRP管理)的848例孕产妇为研究对象。根据孕产妇进入产房时是否进入自然产程,将其分为自然临产组(n=441)和引产组(n=407)。采用回顾性分析法,对2组孕产妇的一般临床资料,如分娩年龄、孕次、孕龄、妊娠并发症,以及母儿结局进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,并经过南京大学医学院附属鼓楼医院伦理委员会审核批准(审批文号：201702001)。结果 (1)2组孕产妇分娩年龄、孕次和高龄孕产妇所占比例比较,差异无统计学意义(P>0.05)。2组孕产妇分娩孕龄、经产妇占比、早产率、缩宫素使用率、分娩时长比较,差异有统计学意义(P<0.05)。(2)引产组孕产妇均使用前列腺素类药物促宫颈成熟或缩宫素进行引产,其中使用地诺前列酮栓、米索前列醇、缩宫素、地诺前列酮栓+米索前列醇分别为26.5%(108/407)、...     

中医馆健康信息平台建设与发展的思考

在深入分析中医馆健康信息平台建设现状和存在问题的基础上,提出相应对策和建议,以期进一步优化升级中医馆健康信息平台,更好地满足用户需求和业务需求。     

Pregnancy management for a woman with extensive vulvar and pelvic malformations caused by Klippel–Trénaunay syndrome

Klippel–Trénaunay syndrome (KTS) is a rare congenital disorder defined by a triad of capillary malformation, venous malformation, and soft tissue or bone hypertrophy most commonly affecting unilateral lower limbs. Due to the rarity of KTS, evidence‐based guidelines for the management of pregnancy in people with KTS are still lacking. A 34‐year‐old woman (gravidity 1; parity 0) presented at 25 weeks of gestation with malformations of the right side of her body. The extent of the KTS affecting the vulva, pelvis, and right leg was remarkable. As the prenatal MRI showed massive vascular malformations of the pelvis and vulva, we performed an elective cesarean section to avoid severe perinatal hemorrhage during a vaginal delivery. Intraoperatively, we observed varices on the parietal peritoneum within the vesico‐uterine pouch and the isthmocervical transition of the uterus, which were not identifiable in the preoperative MRI. Although KTS patients have been discouraged from pregnancy in the past because of a high risk for complications, successful and uncomplicated pregnancies are possible. For this purpose, we believe a multidisciplinary strategy that is crucial.     

硬膜外阻滞行剖宫产对产妇及胎儿TXA_2和PGI_2的影响

观察25例硬膜外阻滞行剖宫产的正常产妇及胎儿脐血内TXA_2及PGI_2的变化。发现母体在胎儿娩出及术毕时与麻醉前相比,TXA_2及PGI_2均无统计学的改变(P>0.05),胎儿脐血内含量在母体范围内。表明局麻药利多卡因及丁卡因经硬膜外用药后,对TXA_2和PGI_2的平衡无明显影响,可能是由于硬膜外阻滞有效地抑制手术伤害刺激所致的应激反应。