#1
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Ïåðèäóðàëüíàÿ àíåñòåçèÿ è íîâîðîæäåííûé.
Êîëëåãè, õîòåëîñü áû óçíàòü âàøå ìíåíèå ïî ïîâîäó âëèÿíèÿ ïåðèäóðàëüíîé àíåñòåçèè íà ðåáåíêà. Ïî âñåì èñòî÷íèêàì âðîäå äîëæíî áûòü âñå çäîðîâî, íî âîò íà ïðàêòèêå âñå ïîëó÷àåòñÿ íàîáîðîò - è äåïðåññèè òÿæåëûå, è àäàïòàöèÿ íàðóøàåòñÿ.
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#2
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 óìåëûõ ðóêàõ è ïðè àäåêâàòíûõ äîçàõ ïðîáëåì, êàê ïðàâèëî, íåò.
Ïî÷èòàéòå ïîèñêîì [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#3
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À çà÷àñòóþ åùå òàê áûâàåò: ïîä ïåðèäóðàëüíîé àíåñòåçèåé æåíùèíà íè÷åãî íå ÷óâñòâóåò è ÷òî òàêîå òóæèòüñÿ - ïðîñòî íå ïîíèìàåò. È âîò òóò â õîä èäåò ìåòîä Êðåñòåëëåðà (êñòàòè, íåóæåëè åñòü ðîääîìà, ãäå ýòîò çàïðåùåííûé ïðèåì íå ïðèìåíÿþò?). À îòñþäà âñå ïîñëåäñòâèÿ...
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#4
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äîçó è âðåìÿ íàîäî ïðàâèëüíî ðàñ÷èòàòü. ïîëüçóþñü â ðîäàõ ðåãóëÿðíî, ïðîáëåì íå âîçíèêàåò.
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#5
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Õî÷ó ïîäíÿòü òåìó.
Ïî ïåðâîìó îáðàçîâàíèþ ÿ ïñèõîëîã. Ðàáîòàþ â ðîääîìå, ñîòðóäíè÷àëà ñ ÂÎÇîâñêèì ïðîåêòîì óëó÷øåíèÿ ïåðèíàòàëüíûõ òåõíîëîãèé. Ó÷óñü â ìåäóíèâåðå (ïîñòóïèëà ïîçäíî, êîãäà îêîí÷àòåëüíî óáåäèëàñü, ÷òî âñå ðàáîòû ñâÿçàíû ñ ìåäèöèíîé, à îáðàçîâàíèÿ íåò )
Îäíà èç òåì ìîåãî èíòåðåñà - ýòî âëèÿíèå ÝÀ íà ïëîä è íîâîðîæäåííîãî. Õî÷ó ïðåäëîæèòü âàøåìó âíèìàíèþ ìîþ ñòàòüþ, íàïèñàííóþ äëÿ ïðîôèëüíîãî èçäàíèÿ äëÿ ÀèÃ. Î÷åíü ïðîøó âûñêàçàòüñÿ, íàñêîëüêî çàñëóæèâàåò âíèìàíèÿ ïîäíÿòàÿ òåìà, íàñêîëüêî óáåäèòåëüíà ñòàòüÿ, êàêèå åñòü êðèòè÷åñêèå ìîìåíòû (çà êðèòèêó è óêàçàíèå íà ïðîêîëû áóäó áëàãîäàðíà áîëüøå âñåãî). Ññûëêà íà ñòàòüþ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Îòäåëüíî âûêëàäûâàþ ïåðå÷åíü äàííûõ, íà êîòîðûå ÿ îïèðàëàñü ïðè ïîäãîòîâêå: 1. Íåéðîáèîëîãèÿ äîâåðèÿ. Ï. Çàê. «Â ìèðå íàóêè». ¹ 8-2008 2. Expectations and experiences of pain in labor: Findings from a large prospective study. Green, J. Birth, 20(2), 1993. 65–72. 3. Johnston-Robledo, I. (1998). The impact of childbirth preparation and support on labor and birth outcomes. Dissertation Abstracts International, A (Humanities and Social Sciences), 58(8-A), 3000. 4. Ransjo-Arvidson, et al., 2001. Table 4 from Ransjo-Arvidson, et al., Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying. Birth 28:1 March 2001. © 2001 Blackwell Scientific Science, Inc. 5. Epidural Opioid Analgesia and Neonatal Respiratory Depression. Manoj Kumar and Bosco Paes. Journal of Perinatology (2003) 23, 425–427. 6. Changes in Fetal Position During Labor and Their Association With Epidural Analgesia Lieberman, Ellice; Davidson, Karen; Lee-Parritz, Aviva; Shearer, ElizabethObstetrics & Gynecology: May 2005 - Volume 105 - Issue 5, Part 1 - pp 974-982 Original Research 7. “Peridural Anesthesia Disturbs Maternal Behavior in Primiparous and Multiparous Parturient Ewes,” D. Krehbiel et al., Physiol Behav 40, no. 4 (1987): 463–472. 8. “Perinatal Bupivacaine and Infant Behavior in Rhesus Monkeys,” M. S. Golub and S. L. Germann, Neurotoxicol Teratol 20, no. 1 (1998): 29–41. 9. “Labor Analgesia and Infant Brain Development,” M. S. Golub, Pharmacol Biochem Behav 55, no. 4 (1996): 619–628 (619). 10. Physiological regulation of maternal behavior in heifers: roles of genital stimulation, intracerebral oxytocin release, and ovarian steroids. Williams GL, Gazal OS, Leshin LS, Stanko RL, Anderson LL. Biol Reprod. 2001 Jul;65(1):295-300. 11. Oxytocin deficiency at delivery with epidural analgesia Goodfellow CF, Hull MG, Swaab DF, Dogterom J, Buijs RM Br J Obstet Gynaecol. 1983 Mar;90(3):214-9. 12. Physiological regulation of maternal behavior in heifers: roles of genital stimulation, intracerebral oxytocin release, and ovarian steroids. Williams GL, Gazal OS, Leshin LS, Stanko RL, Anderson LL. Biol Reprod. 2001 Jul;65(1):295-300. 13. Oxytocin receptors and maternal behavior. Insel TR, Shapiro LE. In Oxytocin in Maternal Sexual and Social Behaviors. Annals of the New York Academy of Sciences, 1992 Vol 652. Ed CA Pedersen, JD Caldwell, GF Jirikowski and TR Insel pp 122-141 New York, New York Academy of Science 14. Breastfeed Med. 2009 Jun;4(2):71-82. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum. Jonas K, Johansson LM, Nissen E, Ejdebäck M, Ransjö-Arvidson AB, Uvnäs-Moberg K. 15. Giesinger, C., & Halpern, S. (1996). Epidurals and breastfeeding. Birth, 23(4), 244–245. 16. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Int Breastfeed J. 2006 Dec 11;1:24. 17. Effects of epidural anesthesia during labor on maternal plasma beta-endorphin levels. Abboud TK, Sarkis F, Hung TT, Khoo SS, Varakian L, Henriksen E, Noueihed R, Goebelsmann U. Anesthesiology. 1983 Jul;59(1):1-5. 18. Maternal satisfaction and pain control in women electing natural childbirth. Kannan, S., Jamison, R. N., & Datta, S. (2001). Anesthesia and Pain Medications, 26(5), 468–472. 19. Hodnett, E. D. (2002). Pain and women's satisfaction with the experience of childbirth: A systematic review. American Journal of Obstetrics and Gynecology, 186(5 Suppl Nature), S160–S172. 20. Eldor, J. Combined Spinal-Epidural Anesthesia? On CSEN, the Global Regional Anesthesia website. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] .csen.com / anesthesia / Book / # ch11 21. Thorp JA, Breedlove G. Epidural analgesia in labor: an evaluation of risks and benefits. Birth. 1996 Jun; 23(2):63-83. 22. Thorp JA, Meyer BA, Cohen GR, Yeast JD, Hu D. Epidural analgesia in labor and cesarean delivery for dystocia. Obstet Gynecol Surv. 1994 May;49(5):362-9. |
#6
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Öèòàòà:
Åñëè Âàñ èíòåðåñóåò ìíåíèå àíåñòåçèîëîãîâ ïî ïðîáëåìå èñïîëüçîâàíèÿ ÝÀ ïðè îáåçáîëèâàíèè ðîäîâ - ïîñìîòðèòå ýòó òåìó. |
#7
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cactus1972
Äà ÿ íå î ðåöåíçèðîâàíèè ïðîñèëà, à ïðîñòî âûñêàçàòü ìíåíèå . È ñêîðåå ïåäèàòðîâ, à íå àíåñòåçèîëîãîâ. Ìîæåò, ïðàâèëüíî áûëî áû âûëîæèòü çäåñü âåñü òåêñò, à íå äàâàòü ññûëêó? |
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#8
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Ïðî÷èòàë, è îòêðîâåííî íå ïîíðàâèëîñü. Êîãäà ïûòàþòñÿ ÷òî ëèáî îòâåðãíóòü, òî îáû÷íî â ïðàâèëàõ õîðîøåãî òîíà ïðåäëîæèòü àëüòåðíàòèâó. Åå íå óâèäåë. Òåðïèòå, â Áîëè áëàãî. Íåâàæíàÿ àëüòåðíàòèâà. Áîëü âåùü î÷åíü òîíêàÿ, è åå ýôôåêòû ìíîãîãðàííû è çàâèñÿò îò ìíîæåñòâà ôàêòîðîâ.  îïðåäåëåííûõ ñèòóàöèÿõ áîëü ýòî áëàãî. Çàùèùàåò, ïîìîãàåò îñòàòüñÿ â æèâûõ. Ñî âðåìåíè ïåðâûõ ñóùåñòâ, íàäåëåííûõ íåðâíîé ñèñòåìîé, áîëüíî, çíà÷èò òåáÿ åäÿò, íàäî áåæàòü. Íî â äðóãîé ñèòóàöèè áîëü óáèâàåò. Èçâèíèòå çà ïàôîñ.  ïðèíöèïå, íèêòî íå óòâåðæäàåò, ÷òî àíàëüãåçèÿ ðîäîâ, à òåõíèê åñòü ïðåâåëèêîå ìíîæåñòâî, è êðîìå íåéðîàêñèàëüíîé, åñòü "çîëîòàÿ ïóëÿ". Ëþáîé ìåòîä èìååò ñâîè ïëþñû è ìèíóñû. Âîïðîñ òîëüêî â òîì, ÷òî ïåðåâåøèâàåò. À âîò òåïåðü î ìèíóñàõ.  Âàøåì òåêñòå íàïðèìåð åñòü óæàñàþùàÿ òàáëè÷êà, ñ âûäåëåííûì öâåòîì êîøìàðíûì îòñòàâàíèåì äåòîê, ðîæäåííûì ñ ÝÀ, â âîïðîñàõ õâàòàíèÿ ðóêàìè ìàìèíîé ãðóäè. È íàñêîëüêî ýòî çíà÷èìî? Íåÿñíî. Íî àêöåíò ñäåëàí. Íî ñòðàííî, îñíîâàíî ýòî íà ðàáîòå, èçó÷èâøåé àæ 28 äåòîê. À âîò â áîëåå ïîçäíåé, ñ ó÷àñòèåì óæå 115 äåòåé, ñêàçàíî, ÷òî íåò ðàçíèöû [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íî è ýòî åùå íå òûñÿ÷åïðîöåíòíàÿ ãàðàíòèÿ. Äèçàéí èññëåäîâàíèÿ íå ñëèøêîì ñèëåí. Åñòü ñìûñë ïîäîæäàòü íàïðèìåð ýòî: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîñëå ÷åãî äåëàòü êàêèå òî âûâîäû, êàñàåìî âëèÿíèÿ àíàëüãåçèè íà ðàçâèòèå ìàëûøåé. Ïîêà æå, Âàøà ñòàòüÿ ñ òî÷êè çðåíèÿ ñîâðåìåííîãî ñîñòîÿíèÿ ìåäèöèíñêîé íàóêè, íå áîëåå ÷åì ÷àñòíîå ìíåíèå. Îñíîâàííîå íà îáîáùåíèè ÷àñòíûõ ìíåíèé óçêîé ãðóïïû äðóãèõ ëèö. È áåçàëüòåðíàòèâíîñòü ðåàëüíî ïóãàåò.
ÇÛ. À âîò ýòî, èçâèíèòå, ïðîñòî ïåðë! Öèòàòà:
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#9
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Vlad34
Ñïàñèáî çà ìíåíèå. ß ðàáîòàþ â ðîääîìå, è åñòü æåíùèíû, êîòîðûì áåçàëüòåðíàòèâíî íåîáõîäèìà ÝÀ, ÷òîáû ïðîéòè ôèçèîëîãè÷åñêèå ðîäû. Íî ÿ ïðîòèâ íàâÿçûâàíèÿ àíåñòåçèè âñåì áåç èñêëþ÷åíèÿ, ïîñêîëüêó äðóãèå ìåòîäû, ïðåäïîëàãàþùèå èçìåíåíèå îòíîøåíèÿ ê ðîäîâîé áîëè, ó÷àñòèå ïàðòíåðà è ïðî÷. ìîãóò áûòü íå ìåíåå ýôôåêòèâíû äëÿ áîëüøèíñòâà ðîæåíèö. Íàñ÷åò ñâÿçè ÝÀ è ãðóäíîãî âñêàðìëèâàíèÿ - ðàçëè÷èå â ñîñòîÿíèè äåòåé, ðîæäåííûõ ñ/áåç ÝÀ âûñêàçûâàëè ìíîãî çíàêîìûõ ìíå íåîíàòîëîãîâ. Íàñ÷åò âîçìîæíîé íàðêîòè÷åñêîé çàâèñèìîñòè - ïðîñòèòå, íî ýòî ôðàçà âûäåðíóòà èç êîíòåêñòà, â êîòîðîì ðå÷ü èäåò î ïðèìåíåíèè îïèàòîâ ÂÎÎÁÙÅ, à íå äëÿ îáåçáîëèâàíèÿ ðîäîâ. Åùå ðàç ñïàñèáî çà îòçûâ. |
#10
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Öèòàòà:
Öèòàòà:
Öèòàòà:
Åñëè ÷åñòíî, äëÿ ìåíÿ îñòàåòñÿ çàãàäêîé, êàê àâòîð, íå èìåþùèé ïðîôèëüíîãî ìåäèöèíñêîãî îáðàçîâàíèÿ è íå êîìïåòåíòíûé íè â âîïðîñàõ àíåñòåçèîëîãèè, íè â îáëàñòè àêóøåðñòâà è ãèíåêîëîãèè, ìîæåò ïèñàòü ñòàòüþ ïî óçêîñïåöèàëèçèðîâàííîé òåìàòèêå äëÿ ïðîôåññèîíàëüíîãî æóðíàëà äëÿ âðà÷åé-ãèíåêîëîãîâ. |
#11
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cactus1972
Öèòàòà:
Íàñ÷åò òîãî, êàê ÿ ìîãëà ïèñàòü â ïðîôèëüíûé æóðíàë. Òàì áûëà òåìà íîìåðà (êñòàòè, çàïðîøåííàÿ ÷èòàòåëÿìè) "Îáåçáîëèâàíèå â àêóøåðñòâå", è, ñîîòâåòñòâåííî, ÷åòûðå ñòàòüè. Ïåðâàÿ - îáçîðíàÿ îò àíåñòåçèîëîãà. Âòîðàÿ - ñ êîíöåïòóàëüíûì "çà" - òîæå îò àíåñòåçèîëîãà. Òðåòüÿ - îäíîçíà÷íî "ïðîòèâ" - îò íåîíàòîëîãà, ïîñòîðîåííàÿ íà ôàêòàõ äîêàçàòåëüíîé ìåäèöèíû. ×åòâåðòàÿ - ìîÿ, ïðè÷åì ìåíÿ ïîïðîñèëè íàïèñàòü èìåííî ñ ò.çð. ïåðèíàòàëüíîãî ïñèõîëîãà. ß îòäàþ ñåáå îò÷åò, ÷òî âûáðàëà ñòèëü íåñêîëüêî áîëåå ïóáëèöèñòè÷åñêèé, ÷åì òîãî òðåáóþò íàó÷íûå ðàáîòû, íî èìåííî òàêîâ áûë çàïðîñ. Êñòàòè, íåñìîòðÿ íà òî, ÷òî â ðàçäåë "Ïñèõîëîãèÿ" ÿ ïèøó ðåãóëÿðíî ñàìà, ïî ýòîé ñòàòüå ÿ ïîïðîñèëà áûòü ìîèì ñîàâòîðîì Èãîðÿ Êàðâàöêîãî - äîöåíòà êàôåäðû íîðìàëüíîé ôèçèîëîãèè Íàöèîíàëüíîãî ìåäóíèâåðñèòåòà. |
#12
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Öèòàòà:
Çíàåòå, áîëüøàÿ ðàçíèöà ñòàòèñòèêè, êîãäà ÝÀ ïðîèçâîäèòñÿ â 80% ðîäîâ (ïðàêòè÷åñêè, âñåì ïîäðÿä) è ïðè çàâåäîìî ïðîáëåìíûõ ðîäàõ, ñîñòàâëÿþùèõ íåáîëüøîé ïðîöåíò. |
#13
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 èþíüñêîì íîìåðå æóðíàëà Anesthesia & Analgesia îïóáëèêîâàíû ðåçóëüòàòû èíòåðåñíîãî èññëåäîâàíèÿ. Íà îñíîâàíèè ïî÷òè 20-ëåòíåãî íàáëþäåíèÿ çà äåòüìè 1976-1982 ã.ð., ðîäèâøèìèñÿ â óñëîâèÿõ ýïèäóðàëüíîé àíåñòåçèè è áåç íåå, è èçó÷åíèÿ èõ ñïîñîáíîñòåé â ó÷åáå, áûë ñäåëàí ñëåäóþùèé âûâîä
Öèòàòà:
Òàê ÷òî ãîâîðèòü î êàêîì-ëèáî çíà÷èìîì îòñòàâàíèè â ðàçâèòèè äåòåé, ðîæäåííûõ â óñëîâèÿõ ýïèäóðàëüíîãî îáåçáîëèâàíèÿ, êàê-òî íåêîððåêòíî. |
#14
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Öèòàòà:
À îòñòàâàíèå â ðàçâèòèè (êðîìå ñëó÷àåâ ãåíåòè÷åñêîé ïðåäðàïîëîæåííîñòè èëè âðîæäåííûõ çàáîëåâàíèé) îáóñëàâëèâàåòñÿ âñå-òàêè êîìïëåêñîì ôàêòîðîâ, à íå åäèíè÷íûì ôàêòîðîì - ýòî óæå èç ïñèõîëîãèè ðàçâèòèÿ. Íî íàñ÷åò ðàçâèòèÿ êàê ïñèõîëîã, ðàáîòàþùèé ñ áåðåìåííûìè, âñå-òàêè ñêàæó, ÷òî ñîâðåìåííàÿ îðèåíòàöèÿ íà òîòàëüíûé êîìôîðò íå ïðèâîäèò ê äîáðó. Ïðè òàêîì ïîäõîäå þíûì áóäóùèì ìàìàì âíóøàåòñÿ ìûñëü, ÷òî îíè ìîãóò ðîäèòü - áåç òðóäà, áåç óñèëèÿ, ïîòîì âçÿòü íÿíþ (îäíó, äâå, òðè, äíåâíûå, íî÷íûå...) è ðàñòèòü áåç óñèëèÿ, ïîòîì îòäàòü â ëó÷øèé âîñïèòàòåëüíûé öåíòð - è ðàçâèâàòü áåç óñèëèÿ. Âîò ýòî áåñêîíå÷íîå ÁÅÇ ÓÑÈËÈß ñ òî÷êè çðåíèÿ ïñèõîëîãèè ìàòåðèíñòâà (ïî Ã.Ôèëèïïîâîé) åñòü î÷åíü ñåðüåçíîå èñïûòàíèå ñîâðåìåííîñòè. Íî ýòîò âîïðîñ âûõîäèò çà ðàìêè è äàííîãî îáñóæäåíèÿ, è äàííîãî ðàçäåëà ôîðóìà. |
#15
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1. Íà íåóáåäèòåëüíîñòü èñïîëüçîâàííîé Âàìè èíôîðìàöèè î âëèÿíèè ýïèäóðàëüíîé àíàëüãåçèè íà ñîñòîÿíèå äåòåé, Âàì óêàçàëè. Ñ óêàçàíèåì èñòî÷íèêîâ.
2. Ôîðìóëèðîâêà "ïîñòíàòàëüíàÿ àäàïòàöèÿ" è åå îòëè÷èå îò "ðàçâèòèÿ" íå ïîääàåòñÿ îñîçíàíèþ ãðóáûì àíåñòåçèîëîãî-ðåàíèìàöèîííûì ìîçãîì. 3. Îáñóæäåíèå ëèòåðàòóðíûõ êà÷åñòâ ïðèâåäåííîé ðàáîòû, ñòåïåíü åå ïóáëèöèçìà, âðÿä ëè â êîìïåòåíöèè äàííîãî ðàçäåëà. 4. Ñ ó÷åòîì âûøåóêàçàííîãî òåìà íà÷èíàåò ïîõîäèòü íà ôëóäèëüíþ, ñ ïðèâëå÷åíèåì ëè÷íîãî ìíåíèÿ àâòîðîâ è ðàññóæäåíèé, îñíîâàííûõ íà ïðåäïîëîæåíèÿõ, êàê àðãóìåíòà. Åñëè íåò íè÷åãî áîëåå çíà÷èìîãî, òåìà èäåò ê çàêðûòèþ. |