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分娩镇痛理论与实践
$66.86
本书内容翔实、用笔精炼,展示了编撰团队扎实的理论基础与实践能力。本书从分娩镇痛的基础知识、常用技术和实施管理,到技术进展、热点与争议,进行了深入浅出的介绍,兼顾了各层次读者需求。既可以作为基层医疗机构麻醉科医师学习相关基础知识和开展临床实践的参考手册,又可以为有志于从事产科麻醉研究的专科医师提供前沿的进展。尤其值得一提的是,本书编者并不满足于泛泛而谈,而是针对每一个细节问题都进行大量的考察与描述,比如单就硬膜外镇痛技术细分了...
本书内容翔实、用笔精炼,展示了编撰团队扎实的理论基础与实践能力。本书从分娩镇痛的基础知识、常用技术和实施管理,到技术进展、热点与争议,进行了深入浅出的介绍,兼顾了各层次读者需求。既可以作为基层医疗机构麻醉科医师学习相关基础知识和开展临床实践的参考手册,又可以为有志于从事产科麻醉研究的专科医师提供前沿的进展。尤其值得一提的是,本书编者并不满足于泛泛而谈,而是针对每一个细节问题都进行大量的考察与描述,比如单就硬膜外镇痛技术细分了定位技术、穿刺针的改进、导管的改进等章节,可见用心良苦。此外,本书对中国传统医学在分娩镇痛中的应用也不吝笔墨,展现了传统医学在该领域的优势与特点。
本书对分娩镇痛的理论、技术、管理及热点问题进行了全面解读,主要突出理论与实践、学术与临床的紧密结合。本书以分娩镇痛的基础知识为切入点,全面介绍了分娩期疼痛的机制和危害,以及分娩镇痛的发展简史,重点阐述了椎管内分娩镇痛的技术与实施细节、常见不良反应及并发症的诊断和处理,同时也介绍了其他分娩镇痛技术的相关知识,对分娩镇痛期间团队的合作与管理做了较为详细的说明。本书对于规范化和规模化开展分娩镇痛工作具有切实的指导意义。本书参考国内外的研究和指南,图文并茂、全面新颖,可供麻醉科医师、产科医师和助产士等医务工作者阅读。本书也能为优化镇痛管理、推广分娩镇痛、保障母婴安全提供参考。
刘志强,医学博士,主任医师,教授,博士研究生导师。同济大学附属妇婴保健院麻醉科主任,同济大学医学院麻醉与脑功能研究所副所长,上海市医学会麻醉学分会委员,《上海医学》《国际麻醉学与复苏杂志》编委。以或通讯作者发表SCI论文30余篇,核心期刊论文50余篇;主编专著3部,副主编专著2部。主持承担国家自然科学基金面上项目、上海市科委、上海市卫生健康委等课题10余项。完成人获得上海医学科技奖三等奖1项。徐振东,医学博士,主任医师,副教授,博士研究生导师。同济大学附属妇婴保健院麻醉科副主任,ICU主任。美国宾夕法尼亚大学医学院访问学者,上海市医学会麻醉学分会青年委员,《上海医学》杂志通讯编委。以或通讯作者发表SCI论文15篇,核心期刊论文20余篇;主持承担国家自然科学基金面上项目、上海市科委、上海市卫生健康委等课题7项。主编、副主编专著各1部。参与获得上海市科技进步二等奖1项(第五完成人),上海医学科技奖三等奖1项(第三完成人)。
篇 分娩镇痛的基础知识................................................................................ 001章 分娩镇痛的历史 ...................................................................................002第二章 正常分娩的临床过程及影响分娩的重要因素 ...................................007第三章 分娩疼痛的产生机制及其对母婴的影响 ...........................................011第四章 围生期药理学 .......................................................................................016第二篇 分娩镇痛的常用技术与具体实施............................................................ 021第五章 椎管内分娩镇痛技术 ...........................................................................022 节 硬膜外隙和脊神经的解剖基础 ...................................................022 第二节 椎管内分娩镇痛的常用药物 .......................................................027 第三节 椎管内分娩镇痛概述 ...................................................................032 第四节 椎管内分娩镇痛的准备 ...............................................................037 第五节 椎管内分娩镇痛的实施 ...............................................................039 第六节 椎管内分娩镇痛常见不良反应及处理 .......................................043 第七节 椎管内分娩镇痛常见并发症及处理 ...........................................046第六章 非椎管内的药物分娩镇痛 ...................................................................056 节 静脉分娩镇痛 ...............................................................................056 第二节 吸入性分娩镇痛 ...........................................................................058 第三节 外周神经阻滞分娩镇痛 ...............................................................060第四节 其他药物分娩镇痛 .......................................................................061第七章 非药物分娩镇痛技术 ...........................................................................064 节 水中分娩法 ...................................................................................064 第二节 Lamaze(拉玛泽)呼吸法 ..........................................................065 第三节 自由体位分娩法 ...........................................................................065 第四节 导乐分娩法 ...................................................................................066 第五节 冷敷与热敷 ...................................................................................066 第六节 经皮神经电刺激技术 ...................................................................067第八章 瑞芬太尼静脉分娩镇痛的实施方案 ...................................................069第三篇 分娩镇痛期间的管理................................................................................ 073第九章 麻醉科医师在分娩镇痛期间的管理 ...................................................074 节 分娩镇痛过程中医务人员的职责分工 .......................................074 第二节 镇痛效果的评定方法 ...................................................................075 第三节 分娩镇痛期间爆发痛的处理 .......................................................076 第四节 分娩镇痛期间急诊剖宫产的管理 ...............................................078第十章 产科医师在分娩镇痛期间产程的管理 ...............................................081第十一章 助产士在分娩镇痛期间的观察与护理 ...........................................085第十二章 特殊人群的分娩镇痛 .......................................................................088第十三章 分娩期间母婴的急救处理 ...............................................................094 节 产妇心搏骤停和心肺复苏 ...........................................................094 第二节 胎儿宫内复苏 ...............................................................................101 第三节 新生儿复苏 ...................................................................................103第四篇 分娩镇痛的技术进展................................................................................ 113第十四章 硬脊膜穿破硬膜外阻滞技术 ...........................................................114第十五章 程控硬膜外间歇脉冲给药技术 .......................................................119第十六章 连续蛛网膜下腔镇痛技术 ...............................................................124第十七章 闭环反馈分娩镇痛技术 ...................................................................127第十八章 超声引导下椎管内定位穿刺技术 ...................................................131第十九章 硬膜外穿刺套件的改进 ...................................................................137第二十章 硬膜外导管的改进 ...........................................................................141第二十一章 瑞芬太尼静脉分娩镇痛 ...............................................................145第二十二章 经皮神经电刺激用于分娩镇痛 ...................................................148第五篇 分娩镇痛的热点与争议............................................................................ 153第二十三章 椎管内分娩镇痛对产科结局的影响 ...........................................154第二十四章 椎管内分娩镇痛对胎儿和新生儿的影响 ...................................157第二十五章 椎管内分娩镇痛对母乳喂养的影响 ...........................................161第二十六章 分娩镇痛期间的饮食争议 ...........................................................164第二十七章 椎管内分娩镇痛与产时发热的关系 ...........................................168第二十八章 椎管内分娩镇痛与产后抑郁的关系 ...........................................172第二十九章 椎管内分娩镇痛与产后头痛的关系 ...........................................175第三十章 围生期急性疼痛与产后慢性疼痛的关系 .......................................181第三十一章 分娩后的腰痛与骨盆痛 ...............................................................187第三十二章 硬膜外分娩镇痛是否需要试验剂量 ...........................................191第三十三章 呼吸道传染病疫情期间的产科麻醉与镇痛管理 .......................195
分娩镇痛是一项安全成熟的辅助分娩的医疗手段,在欧美发达国家,分娩镇痛比例高达80%以上。然而,国内的分娩镇痛历经多年推广,依旧举步维艰,进展缓慢。2018年11月,国家卫生健康委员会发布《关于开展分娩镇痛试点工作的通知》,提出在全国开展分娩镇痛诊疗试点,并逐步在全国推广。这标志着分娩镇痛获得了政府层面的高度重视。在政策指导下,全国各级医院积极响应,多措并举,积极开展分娩镇痛工作。经过近3年的努力,上海市的分娩镇痛率由30%大幅提升至60%,成效显著;国内其他省市地区,分娩镇痛工作也在稳步推进中。我们所在的同济大学附属妇婴保健院,其2021年分娩镇痛率已达到90%,年均完成分娩镇痛1.1万余例。麻醉科团队在致力提升分娩镇痛率的同时,逐步将工作重点转向提高镇痛质量。我们推出的分娩镇痛创新服务模式,获得2018年国家卫生健康委员会改善麻醉医疗服务质量的“价值案例奖";"产科麻醉与分娩镇痛精细化管理体系的建立与推广"项目获得2019年上海医学科技奖三等奖;2021年中国妇幼保健协会授予我院麻醉科首批“产科麻醉与分娩镇痛优秀基地”称号。我们团队注重推动分娩镇痛的科普教育,由刘志强教授领衔的“为了母亲的微笑:推广分娩镇痛,助力母婴健康”科普项目,获得2021年上海科普教育创新奖科普贡献奖(个人)二等奖。麻醉科已发表分娩镇痛相关的SCI和核心期刊文章30余篇,获得国家和上海市9项课题基金的资助。刘志强教授执笔参与《中国椎管内分娩镇痛专家共识》的编写工作。在国内分娩镇痛蓬勃开展之际,我们却难言乐观,分娩痛的推广工作仍然存在不少隐忧。多年来,分娩镇痛技术本身受到的重视不够,部分专业人士包括麻醉科医师、产科医师和助产士对分娩镇痛相关知识储备不足,或存在认知偏差甚至误解。同时,在分娩镇痛的规范管理、团队合作等方面,仍有较大的改善空间。目前国内关于分娩镇痛的专著很少,且主要侧重技术和流程的介绍,缺乏背景知识和理论知识的讲解。为此,我们组织自己的麻醉团队,联合产科、新生儿科和产房等“兄弟”科室的同事,编写了这部专著,力求全面地介绍分娩镇痛的背景知识、操作技术和实施流程,并对如何开展团队合作、及时诊断和处理相关的并发症等做了较为详细的阐述。另外,我们结合国内外的文献及自己的研究成果,对当前分娩镇痛的创新技术和争议、热点问题进行了解读,力求全面展示分娩镇痛的进展。参与本书撰写的编者均为活跃在临床一线的医疗和护理专业人员,在分娩镇痛工作中具有丰富的实践经验,不少人都开展过分娩镇痛的临床研究、科普宣传,并取得了一定的成果。作为大学附属医院的医疗工作者,他们在完成临床工作的同时还承担着繁重的教学和科研任务,但仍然花费了大量的时间和精力参与了本书的编写,在此我们深表敬意和感谢。尽管每位编者认真撰写每个章节,反复多次校对书稿,但是受经验和水平的限制,书中仍难免存在不足,恳请同道和读者朋友不吝赐教。
刘志强 徐振东同济大学附属妇婴保健院
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