Academic papers on obstetrics and gynecology
Management of common anesthesia in obstetrics and gynecology
With the progress of science and technology, medical technology is gradually improving. In the modern medical process, the function of anesthesia is not only to relieve the pain of patients during surgery, but also to be applied to clinical treatment in other departments. In recent years, in view of the special requirements of pregnant women for cesarean section and painless delivery, the clinical effect of anesthesia in obstetrics and gynecology is more important. Taking the anesthesia problem in obstetrics and gynecology as an example, this paper studies the common anesthesia management and summarizes its knowledge and understanding.
Obstetrics and gynecology; Anesthesia method; General treatment
Judging from the clinical manifestations of patients, the physical condition of pregnant women in labor is relatively good and young. Theoretically, there is no danger in the process of delivery, but pregnant women in labor still belong to the high-risk group of obstetrics and gynecology. Because the pain of childbirth is very strong, most parturients think that the pain of uterine contraction is unbearable. If the pain is severe, it will lead to maternal anxiety, fear, tension, and even reduce food intake, which will eventually lead to adverse reactions of the fetus. Some pregnant women ask for cesarean section because they are worried about severe pain in uterine contraction. At this time, medical staff are needed to anesthetize patients, so it is inevitable that there will be a crisis during the perioperative period of anesthesia. As an anesthesiologist, we should fully understand anesthesia and give correct use and first aid to patients [1].
1 Select the best anesthesia method.
1. 1 Generally speaking, most gynecological operations will use epidural anesthesia. In recent years, in order to ensure that the abdominal muscles or vagina of pregnant women are more relaxed, combined spinal-epidural anesthesia has been adopted, and the clinical effect of this anesthesia is satisfactory. Epidural anesthesia generally adopts two-point puncture, as follows: puncture from the gap between T 12-L 1, and then insert the catheter to ensure that it faces the head; Puncture another point between L3 and L4. Attention should be paid to the tail side when placing catheter, and the plane should be kept between T6 and S4 during anesthesia. In addition, when the patient is undergoing transvaginal surgery, puncture can be performed from L2-L3, and the plane can be kept between T 12-S4. If the operation requires combined spinal-epidural anesthesia, the puncture point is in the L2-L3 space, and the anesthesia plane is controlled between T5 and S4.
1.2 If the patient is unable to undergo spinal anesthesia due to his physical condition, or needs radical cure of cervical cancer, including patients with poor physical condition, he can choose general anesthesia before surgery.
2. Narcotic drugs used in obstetrics and gynecology
Anesthesia of pregnant women in obstetrics and gynecology has a great relationship with pregnant women and fetuses, and their lives must be guaranteed. Therefore, when anesthetizing pregnant women, it is necessary to consider uterine contraction and side effects on the fetus.
2. 1 Placental permeability of anesthetic
First, anesthetics will passively diffuse after entering pregnant women until they pass through the placental barrier, and their permeability is directly proportional to the diffusion coefficient of anesthetics. Secondly, most analgesics and tranquilizers have the following characteristics: low degree of dissociation, small molecular weight, low protein binding rate, high fat solubility and so on. These characteristics determine the strong permeability of anesthetics. Third, generally speaking, muscle relaxants have strong water solubility and large molecular weight, so it is difficult for similar drugs to cross the placental barrier. Fourthly, if pregnant women suffer from diabetes, hypertension or pregnancy-induced hypertension syndrome, it is easy to damage the placental capillary barrier, and anesthetic drugs are more likely to enter the placental barrier [2].
2.2 General anesthesia methods
2.2. 1 epidural block
Epidural block is a common anesthesia method, which is often used in cesarean section. This anesthesia method has little effect on hemodynamics and has certain compensation space.
2.2.2 Spinal anesthesia-combined epidural block
Combined spinal-epidural anesthesia, also known as CSE, has the advantages that the anesthesia effect is immediate, the patient's muscles are relaxed in place, the anesthesia dose is very small, and the anesthesia time can be extended to any point; This method has no damage to the dura mater, so it reduces the amount of cerebrospinal fluid to a certain extent, and patients will not have too obvious headache symptoms after operation.
2.2.3 Divide patients into two groups and compare their age, body mass index (BMI) and other data levels. It can be seen that there is no significant difference in anesthesia time and operation time between the second group and 1 group (P & gt0.05), as shown in table 1.
3 common gynecological surgery anesthesia management
3. 1 Ovarian cyst excision
3. 1. 1 This operation can be successfully completed after epidural anesthesia. If the patient has liver function damage or poor health, the operation can be performed after general anesthesia.
3. 1.2 If the patient is accompanied by a huge cyst, the cyst will squeeze the abdominal organs. If the cyst is serious, the diaphragm will also be affected, which will further compress the lungs and lead to poor ventilation. Cysts can also compress the venous cavity and reduce the amount of blood returning to the heart. Hypotension syndrome may occur when patients take a lying or supine position after anesthesia. At the same time, the increase of vena cava pressure will also lead to extravasation of venous plexus. When treating patients, especially when performing epidural puncture, we should always pay attention to bleeding. If the patient has more bleeding, other methods should be used for anesthesia.
3. 1.3 If there is a lot of fluid in the patient's capsule, it should be drained slowly to avoid hemodynamic changes, and at the same time, the patient should be rehydrated in time to ensure hemodynamic stability. In infusion, because the circulation after intravenous infusion of upper limbs is better than that of lower limbs, intravenous infusion of upper limbs is generally chosen. If the patient loses too much blood in the above process, CVP is needed for guidance in order to continue fluid replacement.
3.2 curettage
In the past, the old-fashioned curettage didn't need to anesthetize patients, but with the continuous progress of science and technology and the improvement of people's values, many patients asked for painless surgery. When anesthetizing these patients, intravenous anesthesia is generally used in surgery. If the patient's anesthesia effect is good, half dose of flufen mixture can be used for intravenous injection. However, the patient must be well monitored during the operation and prepared for artificial respiration at any time. If the patient has respiratory depression or hypoxemia, oxygen should be given in time to rescue him.
4 abstract
In the common anesthesia treatment of obstetrics and gynecology, the following points should be paid attention to: First, atropine should be banned before the operation of pregnant women to avoid the increase of heart rate and oxygen consumption of pregnant women and fetuses; Secondly, because there is no direct relationship between platelet count and coagulation function, more attention should be paid to the examination of coagulation function when detecting parturient; Thirdly, the establishment of appropriate venous access in advance before anesthesia can deal with the unexpected situation during operation in time; Fourthly, in order to avoid vasoconstriction near the spinal cord, adrenaline anesthesia should not be combined, otherwise there will be spinal nerve ischemic injury caused by intraoperative hypotension [4]. To sum up, only by ensuring the safety of parturient and fetus and reducing the incidence of complications can it be regarded as an excellent obstetric anesthesia treatment.
References:
[1] Peng Ke, Li Wenjing. Effects of propofol total intravenous anesthesia and sevoflurane inhalation anesthesia on lung function of patients [J]. Chongqing Medical, 2013 (10): 21148-1kloc-0/58.
[2] Lin Qin, Chen Yongyi. Effect of PACU holistic anesthesia nursing on psychological state of patients undergoing tumor general anesthesia surgery [J]. Oncology Pharmacy, 2013 (02):154-157
Hu Yanyan, Huang Ailan. Anesthesia management of beating heart model of Bama mini-pig in Guangxi [J]. Guangxi Medicine, 20 13 (03): 289-29 1
[4] Yang Xugang. Comparative study on clinical anesthetic effects of light-density bupivacaine and heavy-density bupivacaine in lower limb surgery [J]. Modern Diagnosis and Treatment, 20 13 (02): 287-288
Academic papers on obstetrics and gynecology II
Prevention and treatment of gynecological diseases
Obstetric and gynecological diseases are common and frequently-occurring diseases, which seriously threaten women's physical and mental health. With the continuous improvement of medical technology and medical level, all kinds of advanced science and technology have been introduced into the prevention and treatment of gynecological diseases. In this paper, the author will talk about his own views on the prevention and treatment of several common gynecological diseases according to his own work experience.
Gynecological diseases; Prevention and treatment
China Library Classification Number R27 1. 14 Document Identification Number B1004-4949 (2014) 03-0374-01.
The incidence of gynecological diseases in China is quite high. All kinds of serious gynecological diseases not only harm women themselves, but also affect family harmony, which is related to the quality and health of two generations and the quality of China population. On the other hand, the hidden secrets of the body have greatly reduced the quality of life of many female friends, causing serious psychological obstacles and increasing family and social instability. Not only should we create an effective treatment environment for women, but more importantly, we should strengthen their health awareness and carry out in-depth and extensive health knowledge education. Regular gynecological examination, timely detection and timely treatment of gynecological diseases.
1 Prevention and treatment of prenatal depression
According to statistics, about 20% pregnant women suffer from different degrees of prenatal depression, which shows that it is of great significance to do a good job in the prevention and treatment of prenatal depression. Because patients with prenatal depression will not only have serious physical and psychological discomfort, but also affect the healthy growth of the fetus. Therefore, in order to maintain the physical and mental health of pregnant women, as medical workers, we should seriously study and analyze the causes of pregnancy-induced depression, and explore the development law of its condition in combination with clinical practice. On this basis, we should formulate various preventive measures. At the same time, combined with the current knowledge of medical psychology, we should give positive psychological counseling to people who may get sick, correct patients' incorrect understanding of childbirth and various delivery methods, and avoid pregnant women from having pessimistic negative emotions in some incorrect guesses and speculations without medical basis. In addition, for some pregnant women with fear and nervousness, it is necessary to popularize relevant medical knowledge, so that they can fully understand and understand the safety and reliability of pregnancy and delivery under the modern medical level. At the same time, some pregnant women and their families who are worried about the sex of the fetus should be patiently persuaded from a scientific point of view so that they can correctly treat the problem of having boys and girls. It is worth noting that when using various methods to prevent and treat prenatal depression of pregnant women, their physical and mental conditions should be fully considered, and psychological intervention activities should be carried out in a planned and step-by-step manner to avoid bringing pressure to patients.
Prevention and treatment of fat liquefaction in abdominal incision
The most common problem after caesarean section is that the fat in the incision is easy to liquefy. The main feature of fat liquefaction is that the dressing at the surgical incision turns yellow and there is liquid oozing out. Liquefaction of fat in surgical incision will not only lead to slow healing of incision, but also affect the recovery of subcutaneous tissue. When the incision fat liquefaction is serious, it will also cause the patient's incision skin to sink and condense light yellow fat drops. But it generally does not lead to incision necrosis, only accompanied by swelling and pain and tenderness. After sampling the wound exudate, it was found that the bacteria in it were negative. The prevention and treatment measures of this kind of gynecological diseases mainly include: once the patient's incision is found to have exudate, first check whether the surgical incision is infected, and take corresponding measures to prevent the invasion of infectious sources. Then squeeze the liquefied incision, the general frequency is 2 times /d, the liquefied fat should be discharged as much as possible during the extrusion process, and the wound should be covered with iodophor gauze after operation. For patients with severe liquefaction of incision, infrared physiotherapy can be appropriately added for auxiliary treatment, and the frequency is also 2 times/d. If yellow exudate is still produced in the incision after treatment, the suture at the incision should be removed in time, and the incision should be thoroughly washed with 9% normal saline, then pressure-bound, and anti-inflammatory antibiotics should be taken orally. If there is a large amount of exudate in the patient's incision, the dressing should be changed every day to clean the incision. After adopting the above method, if the incision leakage is still not well controlled, drainage should be adopted to completely discharge the leakage.
Prevention and treatment of intractable hemorrhage in obstetrics and gynecology
The so-called obstinate bleeding in obstetrics and gynecology refers to the symptoms that conventional treatment and control methods are ineffective in the case of postoperative bleeding. Generally speaking, the criterion for judging refractory massive hemorrhage is that the patient has a bleeding volume of >: 1500 mL or pudendal bleeding volume of >: 1000 mL. The consequences of this massive hemorrhage are very serious, which will not only endanger the health of the patient, but also induce various coagulation disorders, which will lead to the death of the patient in severe cases. Therefore, we should pay full attention to the prevention and treatment of refractory massive hemorrhage. In practice, we summarized the following effective treatment methods: First, artery ligation to stop bleeding. It reduces the intra-arterial pressure of patients and slows down the blood flow velocity in vivo by ligation, so as to achieve the purpose of making the blood flow velocity less than the thrombosis velocity, thus realizing the hemostasis of thrombus. Secondly, angiography combined with TAE therapy. That is, when the patient has refractory massive hemorrhage, angiography should be performed in time to understand the bleeding site, bleeding cause and bleeding range of the patient, and then TAE therapy should be used to stop the bleeding. The gymnastics principle of TAE therapy is to intubate femoral artery in the bleeding area on the premise of knowing the bleeding location and scope of the patient, so as to improve the adhesion phenomenon formed after operation and achieve the effect of hemostasis. The main application advantage of TAE therapy is painless, and it can be treated many times according to the bleeding situation of patients.
Prevention and treatment of gynecological malignant tumor
Gynecological malignant tumor is a very serious gynecological disease, which seriously endangers women's health and normal life. Moreover, the statistical results in recent years show that the incidence of the disease is on the rise, and the relevant departments must strengthen the prevention and treatment of gynecological malignant tumors. Conventional surgery and chemotherapy can effectively control the development of the disease, but there are also many disadvantages in treatment. The most obvious thing is that after long-term chemotherapy and radiotherapy, the overall health level and quality of life have dropped significantly. In addition, routine treatment will also damage the hematopoietic function of patients' bone marrow and endanger liver function. Therefore, although routine treatment has a good effect on controlling the disease, it is not the best way to treat gynecological malignant tumors. Based on the long-term practical experience, the author thinks that the comprehensive therapy of traditional Chinese medicine can alleviate the pain of patients and achieve better therapeutic effect.
5 conclusion
The National Gynecological Disease Prevention and Control Project aims at promoting the development of women's health in China, implementing the principles and policies of the CPC Central Committee and the State Council on improving women's health level, reducing the incidence of gynecological diseases and keeping women away from gynecological diseases. Through a series of thematic activities such as health lectures, prize-winning essays, free surveys, health assistance, academic exchanges, and surgical assistance, we will provide professional medical security services for women, advocate scientific and standardized diagnosis and treatment of gynecological diseases, and strive to popularize women's health care knowledge throughout the country, making contributions to reducing the incidence of gynecological diseases in China, promoting family happiness, and building a harmonious society.
refer to
[1] Huang Xiangyuan. Psychological intervention for pregnant women [J]. Journal of Clinical and Experimental Medicine, 20 10/0,5 (10): 767-768.
[2] Jin, Gu Meijiao, Fang Ling, et al. Interventional treatment of refractory postpartum hemorrhage [J]. China Journal of Practical Obstetrics and Gynecology, 2004,20 (6): 343-345.
Yang Xiuyu. Application of vascular interventional technique in obstetrics and gynecology [J]. Chinese Journal of Obstetrics and Gynecology, 2002 (1): 6-7.