Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eight...Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eighty patients who underwent cesarean section in our hospital from January 2017 to April 2019 were enrolled in the hospital. They were divided into two groups according to the patient's anesthesia. Fourty patients receiving epidural anesthesia were included in the control group, and another 40 patients received lumbar stiffness. The combined anesthesia patient was included in the observation group. Changes in pain mediators [Serum neuropeptide Y (NPY), endorphin (β-EP), substance P (SP)], stress indicators [Serum cortisol (Cor), C-peptide (C-P), advanced oxidative protein product (AOPP)], inflammatory factor levels [Hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α)], and immunoglobulin levels [Serum IgA, IgG, IgM] were compared between the two groups. Results: Before anesthesia, there were no significant difference in pain media, stress index, inflammatory factor level and immunoglobulin level between the two groups (P>0.05). At 12 h after operation, the two groups of patients were NPY, β-EP, SP, Cor. The levels of C-P, AOPP, hs-CRP and TNF-α were higher than those before operation (P<0.05). The levels of IgA, IgG and IgM were lower than those before operation (P<0.05). Among them, observation group NPY, β-EP, SP, Cor, C-P, AOPP, hs-CRP and TNF-α were significantly lower than those of the control group (P<0.05). The serum levels of IgA, IgG and IgM were significantly higher than those of the control group (P<0.05). Conclusion: Combined spinal and epidural anesthesia can more effectively alleviate maternal pain in high altitude cesarean section, more effectively reduce the inflammatory stress response of patients, promote the humoral immune function of patients, and is beneficial to the early recovery of maternal postoperative, and has high clinical value.展开更多
Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fe...Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fear of childbirth and labor pain is supposed to be one predictable drive of high cesarean section rate in present China. Little qualitative information on women’s awareness and perceptions of epidural anesthesia was found, but conscious efforts should be focused on this part to help generate policy-making priority. Methods: This study was carried out under an exploratory descriptive design in Bao’an Maternity and Child Health Hospital. Those interested in participating would be invited to focus group discussion or individual interview according to a semi-structured open-ended guide after collecting the participants’ demographic characteristics. The thematic content analysis approach was used for data analysis. Results: Five major themes were identified: 1. the sources to gain information on epidural anesthesia;2. clinical impact;3. social impact on awareness;4. association between epidural anesthesia and cesarean section;5. attitudes and questions about the current service implementation. Discussions: The interplay between pregnancy knowledge, socio-economic conditions, social support, insurance policy environment, women’s judgment of health care quality influences the ways women acknowledge and utilize epidural anesthesia service. Conclusions: As maternal requested CS due to low pain tolerance emerges gradually, natural labor with epidural anesthesia is a more suitable childbirth option, which is also expected to function in reducing CS rate by service-providers and administrators in the health departments of China besides building up a pain-free labor environment.展开更多
BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia fo...BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.展开更多
Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue o...Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.展开更多
目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗...目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。展开更多
基金supported by Scientific Project of Sichuan Hygiene and Family Planning Committee(No.18PJ169).
文摘Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eighty patients who underwent cesarean section in our hospital from January 2017 to April 2019 were enrolled in the hospital. They were divided into two groups according to the patient's anesthesia. Fourty patients receiving epidural anesthesia were included in the control group, and another 40 patients received lumbar stiffness. The combined anesthesia patient was included in the observation group. Changes in pain mediators [Serum neuropeptide Y (NPY), endorphin (β-EP), substance P (SP)], stress indicators [Serum cortisol (Cor), C-peptide (C-P), advanced oxidative protein product (AOPP)], inflammatory factor levels [Hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α)], and immunoglobulin levels [Serum IgA, IgG, IgM] were compared between the two groups. Results: Before anesthesia, there were no significant difference in pain media, stress index, inflammatory factor level and immunoglobulin level between the two groups (P>0.05). At 12 h after operation, the two groups of patients were NPY, β-EP, SP, Cor. The levels of C-P, AOPP, hs-CRP and TNF-α were higher than those before operation (P<0.05). The levels of IgA, IgG and IgM were lower than those before operation (P<0.05). Among them, observation group NPY, β-EP, SP, Cor, C-P, AOPP, hs-CRP and TNF-α were significantly lower than those of the control group (P<0.05). The serum levels of IgA, IgG and IgM were significantly higher than those of the control group (P<0.05). Conclusion: Combined spinal and epidural anesthesia can more effectively alleviate maternal pain in high altitude cesarean section, more effectively reduce the inflammatory stress response of patients, promote the humoral immune function of patients, and is beneficial to the early recovery of maternal postoperative, and has high clinical value.
文摘Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fear of childbirth and labor pain is supposed to be one predictable drive of high cesarean section rate in present China. Little qualitative information on women’s awareness and perceptions of epidural anesthesia was found, but conscious efforts should be focused on this part to help generate policy-making priority. Methods: This study was carried out under an exploratory descriptive design in Bao’an Maternity and Child Health Hospital. Those interested in participating would be invited to focus group discussion or individual interview according to a semi-structured open-ended guide after collecting the participants’ demographic characteristics. The thematic content analysis approach was used for data analysis. Results: Five major themes were identified: 1. the sources to gain information on epidural anesthesia;2. clinical impact;3. social impact on awareness;4. association between epidural anesthesia and cesarean section;5. attitudes and questions about the current service implementation. Discussions: The interplay between pregnancy knowledge, socio-economic conditions, social support, insurance policy environment, women’s judgment of health care quality influences the ways women acknowledge and utilize epidural anesthesia service. Conclusions: As maternal requested CS due to low pain tolerance emerges gradually, natural labor with epidural anesthesia is a more suitable childbirth option, which is also expected to function in reducing CS rate by service-providers and administrators in the health departments of China besides building up a pain-free labor environment.
基金Supported by the Applied Medical Research Project of Hefei Health and Family Planning Commission,No.Hwk2020yb0016.
文摘BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.
文摘Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.
文摘目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。
