方法通过测定分娩满意度水平来进行分娩镇痛

S. Cherniaiev, S. Dubrov, S. Sereda, M. Denysiuk, S. Konkevych
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摘要

介绍。阵发性交感神经亢进(PSH)是脑损伤、缺氧脑损伤、急性脑血管意外(ACVA)的结果。PSH的临床表现是由过度交感神经活动引起的,包括短暂性发作性心动过速、高血压、换气过度、高热和出汗。PSH是一种神经急症,在绝大多数病例中是排除性诊断。缺乏对该疾病的充分检测和治疗导致了高死亡率。诊断完全是临床的,因此必须排除其他病理。目前,最广泛接受的PSH诊断标准是Baguley等人提出的病例描述标准。患者D, 29岁,因大脑中动脉中风住院。患者发作以心动过速、高血压、呼吸急促伴呼吸机不同步、出汗、高血压为特征,每天2-3次,发作后约30-40分钟结束。PSH的诊断依据Baguley等人提出的评分标准,25分(17分及以上为PSH的可能诊断)。人们认为PSH的病因是皮层对下方大脑结构的抑制功能受到破坏,从而导致交感神经激活发作,表现为心动过速、高血压、换气过度、出汗和高热。在这个临床病例中,吗啡和异丙酚联合使用能更快地缓解发作。治疗的一个重要方面是适当的补液治疗,以补偿由于高温和出汗造成的液体损失,以及持续给予-受体阻滞剂
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METHODS OF LABOR ANALGESIA BY DETERMING THE LEVEL OF CHILDBIRTH SATISFACTION
Introduction. Paroxysmal sympathetic hyperactivity (PSH) can occur as a result of brain injury, hypoxic brain damage, acute cerebrovascular accident (ACVA). The clinical picture of PSH is caused by excessive sympathetic activity and includes transient paroxysms of tachycardia, hypertension, hyperventilation, hyperthermia, and diaphoresis. PSH is a neurological emergency, which in the vast majority of cases is a diagnosis of exclusion. Lack of adequate detection and treatment of the disease leads to a high mortality rate. The diagnosis is exclusively clinical, so other pathologies must be excluded. Currently, the most widely accepted diagnostic criteria for PSH are the criteria proposed by Baguley et al. Case description. Patient D., 29 years old, was hospitalized with a diagnosis of middle cerebral artery stroke. The patient had attacks which were characterized by tachycardia, hypertension, tachypnea with asynchrony with the ventilator, diaphoresis and hypertension every day with a frequency of 2-3 times per day and were ending approximately 30-40 minutes after the onset. The diagnosis of PSH was established according to the score on the scale proposed by Baguley et al., 25 points (17 or more points – a probable diagnosis of PSH). Conclusions. It is believed that the cause of PSH is a violation of the inhibition function of the cortex on the brain structures located below, as a result of which paroxysms of sympathetic activation occur, manifested by tachycardia, hypertension, hyperventilation, diaphoresis, and hyperthermia. In this clinical case, resolution of paroxysms was observed faster with the combination of morphine and propofol. An important aspect of therapy is adequate rehydration therapy to compensate for fluid losses due to hyperthermia and diaphoresis, as well as the administration of beta-blockers on an ongoing basis
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