BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesi...BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.展开更多
Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesi...Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.展开更多
AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Associatio...AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.展开更多
One hundred patients undergoing renal transplantation were randomly divided into com-bined acupuncture-epidural anesthesia group (group A, points selected: Ciliao, Sanyinjiao, Taixi to-gether with Shenyu and para-inci...One hundred patients undergoing renal transplantation were randomly divided into com-bined acupuncture-epidural anesthesia group (group A, points selected: Ciliao, Sanyinjiao, Taixi to-gether with Shenyu and para-incision or Zusanli; combined with small dose of epidural block) and epidural block group (group C), each 50 patients. The initial dose and total dose of local anesthetics were 5. 6 ±0. 3 ml and 13. 5±1.0ml in group A, and 14. 5±0. 4 ml and 25. 4 ±1. 2 ml in group C,respectively. There was very significant difference between the two groups (P< 0.001 ). During the operation the hemodynaminc changes were greater in group C. Ephedrine and atropine were used in 1 and 2 cases in group A, and in 9 and 5 cases in group C, respectively. The starting time of urination of the transplanted kidney was shorter in group A than in group C, being 209±25 s and 410±47 s, re-spectively (P<0.001 ). There was no significant difference in the indices of immmunologic function between the two groups. The anesthetic results in group A were evaluated according to the initial dose of epidural anesthetics. Those were excellent in 31 cases (62 % ) and good in 13 (26% ) with the ex-cellent-good rate 88 %.展开更多
Objective:To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia(CSEA)and patient-controlled epidural analgesia(PCEA)for labo...Objective:To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia(CSEA)and patient-controlled epidural analgesia(PCEA)for labor analgesia.Methods:A total of 307 participants were prospectively collected from July 2017 to December 2019.The participants were randomized into the combined acupoint injection with CSEA plus PCEA group(AICP group,n=168)and CSEA plus PCEA group(CP group,n=139)for labor analgesia using a random number table.Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process,and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli(ST 36)and Sanyinjiao(SP 6)were selected in addition.The primary outcome was Visual Analogue Scale(VAS)score,and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses.Safety evaluations were performed after intervention.Results:The VAS scores were significantly lower in the AICP group than in the CP group at 10,30,60,and 120 min after labor analgesia(all P<0.05).The latent phase of the AICP group was shorter than that of the CP group(P<0.05).There were less additional anesthetics consumption,lower incidences of uterine atony,fever,pruritus and urinary retention in the AICP group than those in the CP group(all P<0.05).Conclusion:Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption,improve analgesic quality,and reduce adverse reactions in the parturients.(Registration No.ChiMCTR-2000003120)展开更多
Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be as...Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.展开更多
基金Changning District Health Commission Medical Key(Characteristic)Specialized Program,No.20192003.
文摘BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.
文摘Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.
文摘AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.
文摘One hundred patients undergoing renal transplantation were randomly divided into com-bined acupuncture-epidural anesthesia group (group A, points selected: Ciliao, Sanyinjiao, Taixi to-gether with Shenyu and para-incision or Zusanli; combined with small dose of epidural block) and epidural block group (group C), each 50 patients. The initial dose and total dose of local anesthetics were 5. 6 ±0. 3 ml and 13. 5±1.0ml in group A, and 14. 5±0. 4 ml and 25. 4 ±1. 2 ml in group C,respectively. There was very significant difference between the two groups (P< 0.001 ). During the operation the hemodynaminc changes were greater in group C. Ephedrine and atropine were used in 1 and 2 cases in group A, and in 9 and 5 cases in group C, respectively. The starting time of urination of the transplanted kidney was shorter in group A than in group C, being 209±25 s and 410±47 s, re-spectively (P<0.001 ). There was no significant difference in the indices of immmunologic function between the two groups. The anesthetic results in group A were evaluated according to the initial dose of epidural anesthetics. Those were excellent in 31 cases (62 % ) and good in 13 (26% ) with the ex-cellent-good rate 88 %.
基金Supported by the Guangdong Science and Technology Department of China(No.2016A020226051)。
文摘Objective:To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia(CSEA)and patient-controlled epidural analgesia(PCEA)for labor analgesia.Methods:A total of 307 participants were prospectively collected from July 2017 to December 2019.The participants were randomized into the combined acupoint injection with CSEA plus PCEA group(AICP group,n=168)and CSEA plus PCEA group(CP group,n=139)for labor analgesia using a random number table.Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process,and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli(ST 36)and Sanyinjiao(SP 6)were selected in addition.The primary outcome was Visual Analogue Scale(VAS)score,and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses.Safety evaluations were performed after intervention.Results:The VAS scores were significantly lower in the AICP group than in the CP group at 10,30,60,and 120 min after labor analgesia(all P<0.05).The latent phase of the AICP group was shorter than that of the CP group(P<0.05).There were less additional anesthetics consumption,lower incidences of uterine atony,fever,pruritus and urinary retention in the AICP group than those in the CP group(all P<0.05).Conclusion:Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption,improve analgesic quality,and reduce adverse reactions in the parturients.(Registration No.ChiMCTR-2000003120)
文摘Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.