卡前列素氨丁三醇预防性用于产后出血高危因素产妇疗效观察

目的观察卡前列素丁三醇预防产后出血高危因素孕妇的疗效观察。方法抽取2010年1月～2013年6月收治的64例产后出血高危因素的产妇,根据用药不同将其随机分成观察组和对照组,平均每组32例。观察组娩出胎儿后给予子宫肌肉注射卡前列素氨丁三醇250ug,对照组静脉缓慢滴注缩宫素,待胎盘排出后立即给予肌内注射20U,比较两组患者术后、术后2h、24h及出血量发生率等指标。结果产后观察组出血量的总有效率为90．0％,显著高于对照组75．0％,结果具有统计学意义（P〈0．05）;两组患者的产后出血量、产后2h出血量、产后24h出血量及产后出血发生率方面均有显著性差异（P〈0．05）,卡前列素氨丁三醇组的疗效显著优于缩宫素纽。结论卡前列素氨丁三醇对产后出血起到预防和治疗的作用,产后出血量明显减少,疗效肯定,值得临床推广使用。     

Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery

Objectives: The objective of this study was to determine whether the incidence of emergence agitation (EA) can be reduced by adding an additional, faster onset, non‐IV analgesic, intranasal fentanyl or intramuscular (im) ketorolac to rectal acetaminophen. Aim: To compare the incidence of EA after analgesia with two agents vs acetaminophen alone in pediatric patients after bilateral myringotomy procedures (BM&T). Background: Anesthesia for BM&T is usually performed with volatile anesthetics as a single agent without securing intravenous access. The anesthetic agent most commonly used is sevoflurane; however, EA has been reported in up to 67% of patients. Emergence agitation is distressing for parents, can impair the ability of nursing staff to adequately monitor the child, and can result in a child injuring him/herself if it is severe. Methods/Materials: A standardized anesthetic was used with oral midazolam premedication and sevoflurane for induction, and maintenance of anesthesia. All patients received 40 mg·kg^?1 rectal acetaminophen, group 1 received acetaminophen alone, group 2 received acetaminophen and 1 mcg·kg^?1 of intranasal fentanyl, and group 3 received acetaminophen and 1 mg·kg^?1 of intramuscular ketorolac. Incidence of EA was compared using chi‐square test between the acetaminophen group alone vs the two‐agent analgesia groups combined. Results: There were no differences in demographic and clinical characteristics between the two groups. There were no statistically significant differences between the three groups for the incidence of EA at any time point during recovery from anesthesia nor were there any significant differences in pain scores or side effects. No significant side effects because of the administration of a second analgesic agent were reported. Conclusions: We conclude that two‐agent analgesia is not superior to acetaminophen alone for decreasing the incidence of EA after inhalation anesthesia with sevoflurane for BM&T surgery. Our overall incidence of EA was low compared to previous studies, which could potentially have decreased our ability to detect differences between groups.