护理干预对剖宫产手术麻醉后体位性低血压的影响课题外文检索

干预对剖宫产手术麻醉后体位性低血压的影响课题外文检索主要内容（简要罗列）cesareansection剖宫产spinal-epiduralanesthesia腰硬联合麻醉hypotension低血压1Doweneedcephalicspreadofspinalanaesthesiaforcaesareansection?AdifferentapproachtoCSE-EVEforreducinghypotension一种不同方法对抗剖宫产腰硬麻醉后低血压Authors:Fabris,LK,et.al.....Journal:ZeitschriftfürGeburtshilfeundNeonatologie(ZGeburtshilfeNeonatol),Vol.217(4):130-8,2013....Snippet:Theaimofthisstudywastoevaluatetheinfluenceofepiduralrestriction(injectionofsaline)onthedistributionofanaesthesiaaswellastheincidenceofhypotensionduringthespinalanaesthesia.Aftertheapprovalbytheethicscommittee,60full-termparturientwomen(ASAIorII)withuncomplicatedpregnancieswereprospectivelyrandomizedinto2groups:theSAgroup(singleshotspinalanaesthesia)included37patientsandtheCSE-EVRgroup(combinedspinal-epiduralanaesthesia)included39patientsinwhomweinducedtherestrictionofthespinalspacebyepiduralvolumecompression.完整摘要SpinalanaesthesiaisthemostpreferredanaesthetictechniqueforelectiveaswellasforunplannedCaesareansections.对选择性剖宫产椎管内脊髓麻醉是首选的麻醉方法Spinal-inducedhypotensionremainsthemostimportantsideeffectwithareportedincidencebetween20%and100%.而麻醉后引起最重要的副作用仍是低血压Itcancause-maternaldiscomfort(nauseaandvomiting)andimpairedutero-placentalperfusion.低血压可导致恶心、呕吐、子宫胎盘血液灌注不足Thepresentstudywasdesignedtoexaminetheinfluenceofepiduralvolumeeffectonthespreadanddurationoflow-dosehyperbariclevobupivacaine目前研究主要通过观察小剂量高压力注射左布比卡因对硬膜外麻醉后体积效应的扩散和持续时间的影响Theaimofthisstudywastoevaluatetheinfluenceofepiduralrestriction(injectionofsaline)onthedistributionofanaesthesiaaswellastheincidenceofhypotensionduringthespinalanaesthesia.本次研究目的是观察使用生理盐水扩散椎管内麻醉平面对低血压发生影响是否一样Aftertheapprovalbytheethicscommittee,经医院伦理委员会批准，60full-termparturientwomen(ASAIorII)withuncomplicatedpregnancieswereprospectivelyrandomizedinto2groups:对无孕期并发症足月临床孕妇60例随机分为2组theSAgroup(singleshotspinalanaesthesia)included37patientsandtheCSE-EVRgroup(combinedspinal-epiduralanaesthesia)included39patientsinwhomweinducedtherestrictionofthespinalspacebyepiduralvolumecompression.对照组37例采用单纯脊髓麻醉，实验组39例采用控制麻醉平面扩散的联合体位干预麻醉。TheblockswereperformedattheL2/3orL3/4levelinasittingposition,intheCSE-EVRgroupusingtheneedle-through-needletechnique.实验组采用坐着在腰2-3或腰3-4间隙注射麻醉控制平面TheinitialdoseforCSE-EVRwasexactlyhalfoftheSAdose(0.5mgper10cmheightofhyperbariclevobupivacaineand20microgfentanyl).实验组采用重比重左布比卡因和芬太尼初始剂量0.5毫克10毫升的一半Afterspinalinjection,anepiduralcatheterwaslocatedintheCSE-EVRandavolumeof20mLsalinesolutioninjected.脊髓麻醉后给予实验组硬膜外导管的位置注射20毫升生理盐水Afterinjection,thewomenwereturnedsupinewithaleftuterinedisplacement.麻醉后孕妇转成仰卧位并将子宫往左推移。SurgerywasallowedwhenasensoryblockatorabovetheT8dermatomewasestablished.当麻醉平面控制到胸8时手术被允许开始。WeevaluatedtheheightoftheblockbythepinprickmethodandthemotorblockbytheBromagescale,10minafterspinalinjection,duringtheoperationtimeandattheendofsurgery.我们评估注射后麻醉平面的峰值控制在手术开始后10分钟到结束后全程Haemodynamicmonitoring(NIBP,HR)wasassessedevery2minuntilthechildbirth,thenevery5minduringoperativetime.血流动力学监测血压和心率每2分钟测一次直到孩子出来，之后5分钟测一次直到手术结束Anaestheticefficacywasevaluatedforbreakthroughpainbyvisualanaloguepainscore(VAPS),；Apgarscoreatbirth,umbilicalarterypH,andepinephrineconsumption.使用VAPS视觉模拟疼痛评分法对麻醉控制疼痛效果、阿普加评分进行评估，脐动脉PH值，肾上腺素用量Thelevelofanaesthesia10minaftertheinductionwassignificantlyhigherinthespinalgroup(SA)thanintheCSE-EVRT5(T4-T7)vs.T7(T6-T8)group。实验组T5和T7麻醉效果在麻醉诱导10分钟后的水平明显高于对照组.TheSAgroupexperiencedcompletemotorblockduringthetimeofanaesthesia,whiletheCSE-EVRgroupdemonstratedsignificantlyfastermotorrecovery.实验组麻醉恢复比对照组手术全程完全扩散麻醉明显快TheincidenceofhypotensionandephedrinesupplementationwassignificantlylowerintheCSE-EVRgroup(19vs.35patients)thanintheSAgroup(p<0.05).19-35岁的患者实验组比对照组低血压发生率和麻黄素补充量明显低(p<0.05)。TheneonataloutcomeandumbilicalarterypHwerehigherintheCSE-EVRgroup.实验组新生儿评分和PH值要好Bothgroupswerecomparableindemographicdata,VASscores,preloadingandinfusionvolume,atropineorephedrineuse,andadverseeffectssuchasnauseaorskinpruritus.两组在统计人数上，在疼痛程度测试上，在麻醉注射试验剂量上，在麻黄素和阿托品使用上，在副作用如恶心和皮肤瘙痒上具有可比性Wedemonstratedapossiblerestrictionofthespreadofspinalanaesthesiabyusingepiduralvolumerestrictionwith20mLsalineaspartofacombinedspinalepiduraltechnique.我们研究了通过脊髓麻醉平面控联合20毫升生理盐水进行脊髓麻醉技术ThestudyshowsthatCSEwithEVRusingonly50%ofthelevobupivacainedoseprovidedadequateanaesthesiaforelectiveCaesareandelivery,aswellasbettermaternalhaemodynamicstability.结果本研究显示可使用一半剂量的左布比卡因进行实验组麻醉穿刺同样可以满足选择性剖宫产的麻醉，而且在控制血流动力学方面更稳定。2Title:[Comparisonofthematernalandneonataleffectsofcombinedspinal-epiduralblockandspinalblockforcesareansection].腰硬麻醉比较孕妇和新生儿的影响Authors:Uysallar,Ersin,et.al.....Journal:Aǧrı:Ağrı(Algoloji)Derneği'ninYayınorganıdır=ThejournaloftheTurkishSocietyofAlgology(Agri),Vol.23(4):167-73,2011....Snippet:OBJECTIVES:Combinedspinal-epiduralblock(CSEB)hasgainedincreasinginterestasitcombinesthereliabilityofaspinalblock(SB)andtheflexibilityofanepiduralblockincesareansection.目的：OBJECTIVES:Combinedspinal-epiduralblock(CSEB)hasgainedincreasinginterestasitcombinesthereliabilityofaspinalblock(SB)andtheflexibilityofanepiduralblockincesareansection.在剖宫产手术中腰硬联合麻醉可以被灵活广泛应用。WeinvestigatedthematernalandfetaleffectofCSEBagainstSBincesareanoperation.我们调查是为研究腰硬联合麻醉对孕妇和新生儿的影响。方法：METHODS:Fortyhealthy,termpregnantwomenwererandomizedintotwogroups.随机抽查四十名健康足月孕妇分两组PatientsintheCSEBandSBgroupsweregiven1.5mland2.5mlof0.5%hyperbaricbupivacaineintrathecally,respectively.在腰硬联合麻醉和腰麻组分别给予1.5毫升和2.5毫升0.5%重比重布比卡因。IfsensorialblockdidnotreachT4within10min,假如在十分钟内没有达到感觉阻滞平面，supplementalbupivacainewasinjectedepidurally2mlperunblockedsegmentintheCSEBgroup.腰硬联合组可追加2毫升布比卡因。Thequalityandsideeffectsofsurgicalanesthesia,，hemodynamicparameters,Apgarscores,neurologicalandadaptivecapacityscore(NACS)andpostoperativedurationofpainwerecomparedbetweenthetwogroups.在两组间比较外科手术麻醉的效果和副作用，血流动力学参数，阿普加评分，神经适应能力评分和术后疼痛时间比较。结果：RESULTS:ThetimefortheblocktoreachtheT4levelwassignificantlylowerintheSBgroup(p<0.05).在腰麻组达到T4麻醉平面的时间显著缩短P<0.05.MorepatientsintheSBgroupachievedcompletemotorblockadesoonerthanintheCSEBgroup(p<0.05).腰麻组比腰硬联合组更早完全阻滞达到麻醉平面。MeanarterialpressurewaslowerintheSBgroup(p<0.05).TherewerenosignificantdifferencesbetweenthegroupswithrespecttoApgarscores,cordbloodgases,NACS,andadverseeffectssuchasnauseaandvomiting.组间对于阿普加评分，脐带血气，低血压耐受力，恶心呕吐等副作用无显著性差异。结论;ConcluSION:BothSBandCSEBprovidegoodsurgicalanalgesiaforcesareansection腰麻和腰硬联合麻醉在剖宫产麻醉上提供了良好的镇痛效果。Maternalhypotensionisariskwithbothtechniques,butitoccursearlierandisgreaterwithSB.但腰硬联合麻醉在防范发生产妇低血压的风险和技术优与单纯腰麻组。Thereisnodifferenceinneonataloutcome,providedthatmaternalbloodpressureiscautiouslymonitoredandhypotensionpromptlytreated.只要对低血压谨慎监控及时防范和治疗，两组麻醉对新生儿的影响无明显差别3Doesthebaricityofbupivacaineinfluenceintrathecalspreadintheprolongedsittingpositionbeforeelectivecesareandelivery?Aprospectiverandomizedcontrolledstudy.在剖宫产开始前保持坐姿对布比卡因麻醉平面扩散影响Authors:Loubert,Christian,et.al.....Journal:Anesthesiaandanalgesia(AnesthAnalg),Vol.113(4):811-7,2011....Snippet:BACKGROUND:Difficultiesininsertinganepiduralcatheterwhileperformingcombinedspinal-epiduralanesthesiaforcesareandeliverymayleadtounduedelaysbetweenthespinalinjectionofthelocalanestheticmixtureandtheadoptionofthesupinepositionwithlateraltilt.背景：BACKGROUND:Difficultiesininsertinganepiduralcatheterwhileperformingcombinedspinal-epiduralanesthesiaforcesareandeliverymayleadtounduedelaysbetweenthespinalinjectionofthelocalanestheticmixtureandtheadoptionofthesupinepositionwithlateraltilt.在左侧卧位行腰硬联合麻醉时硬膜外导管置入困难会对剖宫产造成不必要的延误。Wehypothesizedthatthisdelaymayaffecttheintrathecaldistributionoflocalanestheticofdifferentbaricitiessuchthathypobariclocalanestheticwouldleadtoahighersensoryblocklevel.这种延迟会使低比重的局麻药在鞘内分布不同而影响麻醉平面的判断。方法：METHODS:Healthyparturientswithuncomplicatedpregnanciesundergoingelectivecesareandeliveryundercombinedspinal-epiduralanesthesiawereenrolledinthisprospectivedouble-blindrandomizedcontrolledtrial.选择健康无孕期并发症的剖宫产孕妇参加这种前瞻性随机对照试验进行体位干预麻醉。Thesubjectswereallocatedtoreceivehyperbaric(hyperbaricgroup),isobaric(isobaricgroup),orhypobaric(hypobaricgroup)spinalbupivacaine10mg.受试者分别接受重比重、等比重、低比重布比卡因10毫克。Afterthespinalinjection,thesubjectsremainedinthesittingpositionfor5minutes(tosimulatedifficultyininsertingtheepiduralcatheter)beforebeinghelpedintothesupinelateraltiltposition.麻醉开始前帮助孕妇取横向倾斜位，麻醉后受试者保持5分钟的坐姿（以模拟置管困难耽误的时间）Theprimaryoutcomewasthesensoryblocklevelduringthe25minutesafterthespinalinjection.在注射后25分钟内观察感觉阻滞水平面的主要结果。Otherendpointsincludedmotorblockscore,maternalhypotension,andvasopressorrequirements.其他目的包括麻醉平面达到程度，产妇低血压发生，血管升压药需求。结果:RESULTS:Datafrom89patientswereanalyzed.抽查89个病人分析Patientcharacteristicsweresimilarinallgroups.在所有组中病人特征资料相似具有可比性。Themedian[interquartilerange](95%confidenceinterval)sensorylevelsafterspinalinjection在脊髓穿刺后感觉水平的中位数明显更高（95%可信区间）weresignificantlyhigherwithdecreasingbaricity:hyperbaricT10[T11-8](T10-9),isobaricT9[T10-7](T9-7),andhypobaricT6[T8-4](T8-5)(P<0.001,Cuzicktrend).高比重T10，等比重T9，低比重的T6的结果均P<0.001。AllpatientsinthehypobaricgroupreachedasensoryblocklevelofT4at25minutesafterspinalinjectioncomparedwith80%ofthepatientsinboththeisobaricandhyperbaricgroups(P=0.04;difference20%,95%confidenceintervalofdifference4%-33%).脊髓注射25分钟后低比重组的所有患者相比等比重和高比重组80%的病人能达到麻醉感觉阻滞T4水平（20%，P=0.04;差异20%，95%可信区间的差异为4%-33%）Significantlymorepatientsinthehypobaricgrouphadcompletelowerlimbmotorblock(Bromagescore=4)(hyperbaric43%,isobaric63%,andhypobaric90%;P<0.001).值得注意低比重组患者有完整下肢运动功能（Bromage得分=4）,高比重的43%，低比重的90%,P<0.001。Theincidencesofmaternalhypotensionandnauseaandvomitingweresimilaramonggroups,产妇低血压和恶心呕吐的发生率在组间相似，althoughtheephedrinerequirementsweresignificantlyincreasedintheisobaricandhypobaricgroupsbyfactorsof1.83and3.0，在等压和低比重1.83和3.0因素组尽管麻黄素的需求显著增加，respectively,comparedwiththehyperbaricgroup(P<0.001,Cuzicktrend).分别与高压组相比P<0.001，统计学有差异趋势。结论：CONCLUSIONS:Wedemonstratedthatwhenparturientsundergoingcesareandeliveryweremaintainedinthesittingpositionfor5minutesafterspinalinjectionofthelocalanesthetic,hypobaricbupivacaineresultedinsensoryblocklevelsthatwerehighercomparedwithisobaricandhyperbaricbupivacaine,respectively,duringthestudyperiod.经过研究，我们证明剖宫产病人在局麻药注射后维持5分钟的坐姿，低比重布比卡因组阻滞感觉水平分别高于等比重和高比重布比卡因组。