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1.
目的随机双盲对照研究比较剖宫产手术中使用芬太尼和吗啡单独或联合进行罗派卡因蛛网蟆下腔阻滞效果差别。方法99例择期在0．75％罗哌卡因7．5mg蛛网膜下腔阻滞行剖宫产手术的产妇随机分配到三组；F组在蛛网膜下腔同时给与芬太尼15^ug，M组给与吗啡0．25mg，FM组给与芬太尼150^ug＋吗啡0．25mg，所有的产妇在手术以后给与病人自控镇痛系统（PCA）进行吗啡术后镇痛。结果各组在术中舒适度、麻黄碱消费量、恶心呕吐、瘙痒和镇静等方面没有显著的差异（p〉0．05）；F组和FM组与M组之间相比取得感觉阻滞效果时间有显著差异（p〈0．05）；F组和M组以及F和FM组之间，吗啡术后镇痛消耗量在4，8，12和24小时有显著的差异（p〈0．01），在2小时点，F组和FM组之间已有显著差异（p〈0．05）。结论与单独使用芬太尼比较，蛛网膜下腔吗啡与芬太尼合用可以提供更加良好的术后镇痛，与单独使用吗啡相比，蛛网膜下腔吗啡与芬太尼合用可以更快的建立阻滞平面；结果表明不同给药途径吗啡单独使用在手术后均能够提供良好的镇痛。  相似文献   

2.
Objective： To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness （LOC）, effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index （BIS） were studied. Methods： Forty-five patients were divided into three groups to receive epidurally administered saline （Group S）, 1.5% （w/w） lidocaine （Group L）, or 0,5% （w/w） ropivacaine （Group R） Propofol infusion was started to produce blood concentration of 4 lag/ml. Once the BIS value reached 40-50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure （MABP）, and heart rate （HR） at different study time points. Results： During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion： Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.  相似文献   

3.
随着社会经济的发展和饮食结构的变化,肥胖已经成为威胁人类健康的一大严重问题,孕妇也不例外。这类患者在分娩过程中,所面临的风险及出现异常情况导致严重并发症的几率大大超出体重正常范围内增加的产妇。文章对肥胖产妇行剖宫产术时麻醉的病理生理改变、麻醉方式的选择、围术期并发症等方面进行了阐述,以期全面探讨此类产妇的剖宫产麻醉问题。  相似文献   

4.
INTRODUCTION Cadmium (Cd) is ubiquitous in the human en-vironment and has been recognized as one of the mostdeleterious heavy metal pollutants (Robards andWorsfold, 1991; Christine, 1997). It may easily movefrom soil to food plants through root absorption andaccumulate in their tissues (Oliver, 1997). In this way,Cd may enter the food chain and affect human health(Adriano, 1986). Among many heavy metals pollut-ing soil, Cd is of concern because of its potentiallyharmful effects on…  相似文献   

5.
目的 对比盐酸罗哌卡因和盐酸布比卡因的临床效果,为盐酸罗哌卡因应用妇科手术提供临床依据.方法 选择2012年至今在襄阳职业技术学院附属医院进行择期妇科手术病人50例,均分两组分别接受A组盐酸罗哌卡因(观察组25例)和B组盐酸布比卡因(对照组25例)施行低位硬膜外麻醉.观察两组在低位硬膜外麻醉方面的临床效果,同时监测手术期间心电图P-R、QRS波间期的变化及其它局麻药不良反应.结果 A组和B组感觉阻滞达到T6平面以上的病例分别为80％和88％,Bromage≥2分的病例分别为76％和88％,两组在麻醉效能方面无显著差异.A组未见任何局麻药不良反应,而B组共有6例发生心动过缓、P-R及QRS波间期延长、恶心、胸闷、头晕、耳鸣等不适.结论 盐酸罗哌卡因与盐酸布比卡因在低位硬膜外麻醉行妇科手术中均可达到满意的麻醉效果,但使用盐酸罗哌卡因行低位硬膜外麻醉比使用盐酸布比卡因的临床安全性更高.  相似文献   

6.
目的:进一步探讨剖宫产术的麻醉及各种并发症的合理处理措施。方法:500例剖宫产者全部采用连续硬膜外麻醉,术中严密监测产妇的生命体征,保证充分供氧,及时处理术中出现的各种并发症。结果:麻醉效果满意率为94.6％,全部母婴无一因麻醉死亡。结论:选择合理的麻醉方法,对术前及术中各种并发症如妊高征、仰卧位综合征、局麻药中毒、羊水栓塞、寒战反应新生儿抢救等做到合理及时的纠正,是保证剖宫产母婴安全的基本要素。  相似文献   

7.
目的 观察镇痛分娩的镇痛效果。方法 设立对照组与实验组，观察两组的镇痛效果、产程、分娩方式、产时出血量及新生儿Apgar评分。结果 实验组的产痛明显减轻，产程较对照组缩短，剖宫产率较对照组低，产时出血、新生儿Apgar评分无差异。结论 镇痛分娩可有效缓解产痛、缩短产程、降低剖宫产率，对母婴无不良影响。  相似文献   

8.
目的:通过对110例心理护理分娩产妇的临床观察，探讨心理护理对分娩的影响。方法：正常足月妊娠，无产科手术指症及妊娠合并症并发症的初产妇220例，随机分为心理护理且和一般护理组，每组各110例，结果：心理护理的产妇、产程，剖宫产率及新生儿窒息率明显低于对照组。结论：适时恰当的心理护理能够缩短产程，促进顺利分娩，减少剖宫产及新生儿窒息率。  相似文献   

9.
剖宫产切口瘢痕妊娠的早期诊断及处理   总被引：3，自引：0，他引：3  
目的：探讨剖宫产切口瘢痕妊娠（CSP）的早期诊断及子宫动脉栓塞术在CSP治疗中的应用。方法：分析我院4例CSP的临床表现及诊治经过。结果：4例患者均有剖宫产史，经反复B超和彩色超声确诊CSP，均行子宫动脉栓塞术一次成功。结论：彩色多普勒及B超检查是诊断CSP的主要手段，对判断预后和观察治疗效果有帮助。子宫动脉栓塞术可减少剖宫产切口瘢痕妊娠手术时引起的风险及并发症，有条件的医院应将其作为首选方法。  相似文献   

10.
改良B-Lynch缝合术在剖宫产产后出血中的应用   总被引：1，自引：0，他引：1  
目的探讨改良B-Lynch缝合术在治疗剖宫产产后出血中的应用价值。方法研究组87例剖宫产术中宫缩乏力性出血病例采用改良B-Lynch缝合术治疗。随机选择45例剖宫产术中宫缩乏力性出血病例作为对照组采用传统方法治疗,在手术时间、产后出血量、住院天数、治疗效果方面对比两组术式的临床治疗效果。结果研究组病例治疗后临床效果显著,其在手术时间、产后出血、住院天数及有效率与对照组比较差异有统计学意义（P〈0.05）,无一例子宫切除,无并发症发生,子宫复旧,月经复潮时间无差异。结论改良B-Lynch缝合术具有操作简单,止血迅速和安全有效等优点,值得在临床上进一步推广普及。  相似文献   

11.
This study was designed to investigate the therapeutic approaches and prognosis for cervical cancer associated with pregnancy. Clinical information, therapeutic strategies, and follow-up results of 20 patients with cervical cancer associated with pregnancy from Jan. 2000 to June 2009 in the Zhejiang Cancer Hospital were retrospectively analyzed. The International Federation of Gynecology and Obstetrics (FIGO) stages were: in situn=1), stage IA1 n=1), stage IB1 n=5), stage IB2 n=1), stage IIA n=8), stage IIB n=3), and stage IIIB n=1). Eight patients were in the first trimester of pregnancy, four in the second, two in the third, and six at postpartum when diagnosed. The therapeutic strategies were either single or combined modalities, including surgery, radiotherapy, and chemotherapy. Fourteen patients survived, five patients died (four of remote metastasis and one of uremia), and one patient was lost to follow-up. One newborn from a patient at stage IIA carcinoma in the third trimester with postponed therapy six weeks after diagnosis survived. Retarded fetal growth was observed in one patient receiving neoadjuvant chemotherapy and cesarean section. Out of the six postpartum patients, three underwent cesarean section and survived, whereas only one out of the three who underwent vaginal delivery survived. The remaining two died of remote metastasis. Therefore, personalized treatment is necessary for cervical cancer associated with pregnancy. Cervical cancer patients in the third trimester of pregnancy can continue the pregnancy for a short period of time. There may be potential risk for the fetus by chemotherapy during pregnancy. Cesarean section is the preferred mode of delivery for pregnant cervical cancer patients.  相似文献   

12.
目的:探讨造成剖宫产术后晚期产后出血原因及预防方法.方法:通过收集近5年来在我院产科发生及由下级医院转来的剖宫产术后晚期产后出血22例临床病历进行回顾性综合分析.结果:因剖宫产术后子宫切口坏死、感染、部分裂开20例,合并胎盘胎膜残留1例,合并产后子宫收缩乏力1例,其中15例切口裂开位于子宫切口角部,5例位于子宫切口中央,13例行全子宫切除术,4例行子宫次全切除术,保守治疗5例.22例患者均治愈.结论:对于剖宫产术后晚期出血,重在预防,应防治结合.  相似文献   

13.
Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR = 28.0 (95 CI 4.6–170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.  相似文献   

14.
选用32只中国本兔进行敌杀死急性中毒试验,36只兔随机分成4组,每组8只,分别灌服104、130、162和203 mg/kg体重的敌杀死,用简化寇氏法求出家兔敌杀死的半数致死量(LD50)为133.6 mg/kg体重.  相似文献   

15.
This research was conducted in a public general hospital in Mexico City, Mexico. The objective was to evaluate efficacy of the support given by a doula during labor to reduce cesarean rate. From March 1997 to February 1998, a group of 100 pregnant women were studied. These women were at term, engaged in an active phase of labor, exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous uterine incision, and possessed adequate pelvises. The group was randomly divided into two subgroups comprising 50 women, each: The first subgroup had the support of a childbirth educator trained as a doula, while the second subgroup did not have doula support. Measurements were recorded on the duration of labor, the use of pitocin, and whether or not the birth was a vaginal birth or cesarean section. Characteristics and gestational age were similar in both groups. Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration. There was a trend toward shorter labors and less use of epidurals. The results of this study showed, as in other trials measuring the impact of a doula's presence during labor and birth, that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications.  相似文献   

16.
日粮中添加茶多酚对肉仔鸡脂肪沉积的影响   总被引：3，自引：0，他引：3  
为研究日粮中添加茶多酚对肉仔鸡脂肪沉积及色泽的影响,试验选用1日龄AA鸡200只随机分成4组,每组50只,对照组饲喂基础日粮,试验组日粮为在基础日粮中分别添加100 mg/kg、250 mg/kg、500 mg/kg的茶多酚,于14、28、42日龄每组随机抽取5只进行屠宰,测定腹脂重、腹脂色泽。结果日粮中添加不同水平茶多酚,肉鸡的腹脂重、腹脂率均有明显的降低,且随茶多酚添加剂量增加而降低,当剂量增加到500 mg/kg时,差异极显著(P<0.01);腹脂的L值(亮度)和a值(红度)随剂量增加而降低,b值(黄度)随剂量增加而升高,以添加250 mg/kg时,茶多酚对脂肪色泽改变效果最佳。结果表明日粮中添加不同剂量的茶多酚可以降低腹脂沉积,加深脂肪色泽,改善肉仔鸡的胴体品质。  相似文献   

17.
In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of continuous labor support is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. Women with continuous support are less likely to have a cesarean, an instrument delivery, and regional anesthesia. They are also less likely to report dissatisfaction with or negatively rate their childbirth experience. The value of the doula for both the laboring woman and her labor partner is discussed. The accompanying commentary-written by a leading proponent of maternity care practices-supports evidence that promotes continuous labor support. Lamaze International encourages women to plan for a supportive birth environment that includes continuous support.  相似文献   

18.
ObjectiveWe report imaging and admission ratios for children with definitive and suggestive maltreatment in a national sample of emergency departments (EDs).MethodsUsing the 2012 Nationwide Emergency Department Sample (NEDS), we generated national estimates of ED visits for children <10 years with both definitive and suggestive maltreatment. Outcomes were admission/transfer ratios for children <10 years and screening ratios by skeletal surveys and head computed tomography (CT) for children <2 years with suspected physical abuse. We compared hospitals with low, medium, and high pediatric ED volumes using multivariable logistic regression.ResultsThe 2012 national estimate of U.S. ED visits (children <10 years) with definitive maltreatment is 14,457 (95% CI: 11,987–16,928). Suggestive child maltreatment was seen in an additional 103,392 (95% CI: 90,803–115,981) pediatric ED visits. After controlling for patient case mix, high volume hospitals had a significantly higher adjusted odds ratio (AOR) of admission/transfer among definitive cases (AOR = 1.74, 95% CI: 1.08–2.81), and medium volume hospitals had a higher odds of admission/transfer among suggestive cases (AOR = 1.24, 95% CI: 1.02–1.50) when compared with low volume hospitals. In hospitals with reliable reporting of imaging procedures, high volume hospitals reported skeletal surveys (age <2 years) significantly more often than low volume hospitals, AOR = 3.32 (95% CI: 1.25–8.84); the AORs for head CT did not differ by hospital volume.ConclusionsLow volume hospitals were less likely to screen by skeletal survey, but head CT ratios were not affected by ED volume. Low volume hospitals were also less likely to admit or transfer.  相似文献   

19.
The current study was designed to investigate the mechanisms by which ropivacaine may act within the central nervous system (CNS) to produce cardiotoxicity. Eighty New Zealand rabbits were divided into four groups randomly. In Group 1, 20 rabbits received intracerebroventricular (icv) saline, and then received icv ropivacaine 30 min later. In Group 2, 20 rabbits received icv ropivacaine. Whenever dysrhythmias continued for more than 5 min, 0.1 ml saline was administered into the left cerebral ventricle. Ten minutes later, 0.1 ml midazolam was given into the left lateral ventricle. In Group 3, 20 rabbits received icv ropivacaine, and once the dysrhythmias developed, the inspired isoflurane concentration was increased from 0.75% to 1.50%. In Group 4, 20 animals received an intravenous (iv) phenylephrine infusion until dysrhythmias occurred. In Group 1, the rabbits did not develop dysrhythmias in response to icv saline, whereas dysrhythmias did develop in these animals after icv ropivacaine. In Group 2, icv saline had no effect on the dysrhythmias; however, icv midazolam terminated cardiac dysrhythmias. In Group 3, an increase in the concentration of the inspired isoflurane had no effect on dysrhythmias. In Group 4, icv midazolam had no effect on dysrhythmias in response to iv phenylephrine. Ropivacaine administered directly into the CNS is capable of producing cardiac dysrhythmias; midazolam terminated dysrhythmias presumably by potentiation of γ-aminobutyric acid (GABA) receptor activity. Our results suggest that ropivacaine produces some of its cardiotoxicity not only by the direct cardiotoxicity of the drug, but also by the CNS effects of ropivacaine.  相似文献   

20.
Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%–10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results: Rocuronium requirement, which were (0.468±0.167) mg/(kg·h) during the paleohepatic phase, decreased significantly during the anhepatic phase to (0.303±0.134) mg/(kg·h) and returned to the initial values at the neohepatic period ((0.429±0.130) mg/(kg·h)); whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.  相似文献   

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