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Objective:To investigate the efficacy and safety of high semi-decubitus position in the second stage of labor in epidural analgesic delivery of primipara.Methods:A total of 120 women who gave birth in Hang-zhou women's Hospital from May 1,2021 to July 30,2021 were randomly divided into experimental group(n=60)and control group(n=60)by random number table method.The control group adopted supine position in the sec-ond stage of labor,and the experimental group transferred to high semi-supine position after the supine position was used applied for 30 minutes when the fetal head was not exposed.To compare the effects of different postur-al positions on the duration of the second stage of labor,mode of delivery,postpartum injury,perineal tearing,la-bor force experience and labor control,and neonatal asphyxia.Results:The duration of uterine opening to fetal head exposure,the duration of uterine opening to fetal head crown and the duration of second stage of labor in experimental group were shorter than those in control group.The rate of natural delivery of experimental group was higher than that of control group.The episiotomy rate and the second degree perineal laceration rate were lower than that of control group.The amount of blood loss during delivery and 2h postpartum of experimental group was less than that of control group.The scores of birth experience and birth control of experimental group were higher than those of control group,and the differences were statistically significant(P＜0.05).There was no significant difference in 1-minute Agpar score and 5-minute Agpar score between the two groups(P＞0.05).Conclusions:The application of high semi-decubitus position under epidural labor analgesia promoted vaginal natural labor,shortened the time of second stage of labor,reduced episiotomy rate and perineal laceration de-gree,reduced postpartum hemorrhage,had positive labor force experience,and increased the sense of labor con-trol.
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Objective:To discuss the influencing factors of neonatal scalp hematoma, and provide a basis for reducing the occurrence of neonatal scalp hematoma.Methods:Retrospectively analyzed the data of 13 151 parturients and their newborn infants who delivered in the Hangzhou Women′s Hospital from January to December 2020, counted the incidence of neonatal scalp hematoma, and Logistic regression analysis was used to analyze its influencing factors.Results:Among 13 151 newborn baby, 68 cases of neonatal head hematoma occurred, the incidence was 0.52%. Vaginal delivery, forceps, intraspinal analgesia were statistically significant in the occurrence of neonatal scalp hematoma ( χ2=19.26, 19.59, 6.11, all P<0.05). Conclusions:Vaginal delivery, forceps, and intraspinal analgesia are the risk factors for neonatal scalp hematoma. Lateral perineal incision during delivery did not reduce the incidence of neonatal scalp hematoma. In this study, many cases of neonatal scalp hematoma occurred before the crown of the fetal head. Labor management, improve the rate of non-drug analgesia, promote natural delivery, early detection, early prevention, and reduce the incidence of neonatal hematoma.
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OBJECTIVE：To systematically evaluate the c linical efficacy and safety of misoprostol versus oxytocin in preventing postpartum hemorrhage ，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from CNKI，VIP，Wanfang database ，CBM，PubMed，Embase and the Cochrane Library ，randomized controlled trials （RCTs） published at home and abroad about clinical efficacy and safety of misoprostol and oxytocin in preventing postpartum hemorrhage were collected during the inception to Feb. 15th，2021. According to the inclusion and exclusion criteria ，the included studies were screened and evaluated. RevMan 5.3 software was used for Meta-analysis. RESULTS ：A total of 14 RCTs involving 25 732 lying-in women were included. The results of Meta-analysis showed that compared with oxytocin group ，there was no difference in the mean blood loss （MD＝14.96，95％CI（－2.62，32.54），P＝0.10），the time of the third stage of labor （MD＝－0.03，95％CI （－0.19，0.13），P＝0.69），the incidence of blood transfusion （RR＝0.91，95％CI（0.74，1.12），P＝0.37）or the incidence of nausea（RR＝1.06，95％CI（0.85，1.31），P＝0.60）in misoprostol group ；but the incidence of shivering（RR＝2.99，95％CI （2.22，4.04），P＜0.000 01），the incidence of fever （RR＝4.31，95％CI（2.79，6.67），P＜0.000 01），the incidence of vomiting （RR＝2.16，95％CI（1.63，2.88），P＜0.000 01）and the incidence of diarrhea （RR＝2.67，95％CI（1.79，3.98），P＜0.000 01）in misoprostol group were higher. CONCLUSIONS ：The effect of misoprostol in the prevention of postpartum hemorrhage is similar to oxytocin ，but the incidence of ADR is higher. It is necessary to pay close attention to the adverse reactions during use. Due to the limitation of included studies ，multi-center，large-scale and high-quality RCTs are needed for further validation.
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Objective To explore and analyze the clinical efficacy and effects of the application of dexmedetomidine in the tube drawing period of general anesthesia for the patients receiving laparoscopic surgery. Methods Sixty-eight pa-tients who received laparoscopic surgery in our hospital from December 2012 to December 2013 were selected as the study subjects and randomly divided into the control group and the study group. By the end of surgery, the patients were transferred to the post-anesthesia care unit (PACU) with catheter and different anesthetic drugs were used. The control group received target controlled infusion of propofol and the study group received dexmedetomidine. Results The four groups of patients were different in MAP and BIS at T2, T3, T4 and T5, with statistically significant differ-ences (P<0.05). Regarding to VAS scores and adverse reactions, group A2 and group A3 were different from the control group respectively, with significant differences (P<0.05). Conclusion The application of dexmedetomidine in the tube drawing period of general anesthesia after laparoscopic surgery for the purpose of analgesia and sedation is conducive to maintaining hemodynamic stability, relieving postoperative pain and reducing the incidence of postoperative complica-tions.
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Objective To observe and analyze the clinical analgesic anesthesia effect of propofol combined with pare-coxib sodium for the patients receiving bronchofiberscope examination. Methods Eighty-seven patients receiving bron-chofiberscope examination in our hospital from January 2012 to February 2014 were selected as the study subjects and randomly divided into group A, group B and group C. The three groups of patients received parecoxib sodium combined with propofol, propofol combined with fentanyl, and propofol respectively for preoperative anesthesia. The MAP and SPO2 changes, usage amount of anesthetic drugs, and awakening time of the three groups at different time were recorded, and the results were tabulated and analyzed. Results SpO2 of the three groups at different time did not change obvi-ously, with no significant differences (P>0.05). The three groups did not have statistically significant differences in the bronchofiberscope examination time (P>0.05). Group A had the lowest usage amount of anesthetic drugs and the short-est awakening time, which had statistically significant differences to the other two groups (P<0.05). Conclusion In analgesic bronchofiberscope examination, the application of propofol combined with parecoxib sodium for anesthesia and analgesia plays a positive role in increasing the patients' postoperative comfort sensation and postoperative living quality.
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We establish the new capacity-based teaching mode in clinical teaching of nursing obstetrics and gynecology.We have obtained more satisfied teaching quality.
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We establish the new student-centered teaching mode and reform the evaluation system in clinical teaching of nursing obstetrics and gynecology. We have got more satisfied teaching quality.