Thèses sur le sujet « Tocolyse »

L'objectif de ce travail était d'évaluer de nouvelles approches diagnostique et thérapeutique du travail prématuré chez la rate gestante. L'étude de l'électromyogramme utérin a montré que l'analyse spectrale permettait d'identifier précocement le travail prématuré, bien avant l'augmentation de la pression intra-utérine. Au cours du travail prématuré, la cyclooxydenase-2 joue un rôle central dans la synthèse des prostaglandines. Elle est donc une cible thérapeutique privilégiée pour inhiber le travail prématuré. Nous avons montré que le rofecoxib, in inhibiteur spécifique de la cyclooxydenase-2, a un eeffet tocolytique comparable aux inhibiteurs calciques in vitro et in vivo, mais plus puissant que l'indométacine, la ritodrine, et l'atosiban.

La rupture prématurée des membranes avant terme (RPMAT) est une complication de la grossesse responsable d’une importante morbi-mortalité périnatale. La prise en charge anténatale vise à réduire les conséquences délétères de cette pathologie, liées à l’inflammation intra-utérine et à la prématurité, à la fois pour la mère et pour l’enfant. L’objectif de cette thèse était d’étudier les déterminants obstétricaux du pronostic de L’enfant prématuré né dans un contexte de RPMAT, à partir des données de la cohorte EPIPAGE 2. Nous avons d’abord évalué l’impact de la durée de latence, comprise entre la RPMAT et l’accouchement, sur le pronostic néonatal. Nos résultats montrent que pour un âge gestationnel de naissance donné, la durée de latence après une RPMAT entre 24 et 32 SA n’est pas associée à la survie ou à la survie sans morbidité sévère. Le principal déterminant du pronostic néonatal est l’âge gestationnel à la naissance. Nous avons ensuite étudié la tocolyse, un traitement médicamenteux largement utilisé après une RPMAT dans le but de prolonger la grossesse. L’administration d’une tocolyse après une RPMAT n’est associée ni à l’amélioration de la survie sans morbidité du prématuré, ni à la prolongation de la grossesse. Enfin, une analyse descriptive des cas de RPMAT entre 22 et 25 SA montre qu’à ces âges gestationnels extrêmes, la RPMAT est associée à un risque élevé de mortalité périnatale et de morbidité à court et à long terme, avec de grandes variations selon l’âge gestationnel à la rupture. Nos travaux fournissent des informations pertinentes pour les équipes médicales et les femmes enceintes et questionnent certaines pratiques obstétricales, notamment l’administration d’une tocolyse après une RPMAT. Ils soulèvent des questions qui feront l’objet de nouveaux projets de recherche, en particulier un essai contrôlé randomisé sur la tocolyse après RPMAT, financé par le PHRC-N 2016 (essai TOCOPROM)
Preterm premature rupture of membranes (PPROM) is a complication of pregnancy responsible for significant perinatal mortality and morbidity. Antenatal management aims to reduce adverse consequences, relating to intrauterine inflammation and prematurity, for both mother and child. This thesis aimed to study obstetric determinants impacting the outcome of preterm babies born following PPROM, using data from the EPIPAGE 2 cohort. We first evaluated the impact of latency duration, i.e. the time from PPROM to delivery, on neonatal prognosis. For a given gestational age at birth, latency duration after PPROM at 24-32 weeks' gestation was not associated with survival or survival without severe morbidity. The principal determinant of neonatal prognosis was gestational age at birth. We then studied tocolysis, a treatment widely used after PPROM to prolong pregnancy. Administration of tocolysis after PPROM was not associated with either improved survival without morbidity of the preterm infant or prolongation of pregnancy. Finally, a descriptive analysis of cases of PPROM occurring at 22-25 weeks’ gestation demonstrated that, at these extreme gestational ages, PPROM was associated with high risks of perinatal mortality and short- and long-term morbidity, with large variations according to gestational age at rupture. Our work provides relevant information for medical teams and pregnant women and questions some obstetric practices, particularly the use of tocolysis after PPROM. They raise issues that will be the subject of future research projects, specifically a randomized controlled trial on tocolysis after PPROM, already funded by PHRC-N 2016 (TOCOPROM trial)

La prématurité reste la principale cause de mortalité et morbidité néonatales dans les pays industrialisés. Les stratégies de prise en charge médicale restent limitées et relativement inefficaces. Parmi les différentes mesures à mettre en place pour tenter de diminuer le taux de prématurité et les complications aigues ou retardées affectant le nouveau-né prématuré, le développement d'outils pharmacologiques nouveaux visant à traiter les dysfonctionnements de la contractilité utérine est indispensable. Nous nous sommes intéressés au récepteur b3-adrénergique et à ses agonistes connus pour avoir un effet myorelaxant sur le muscle lisse utérin, le myomètre. L'objectif de notre travail a été de poursuivre la caractérisation pharmacologique du récepteur b3-adrénergique dans le myomètre humain, d'une part en étudiant l'influence de la grossesse sur l'expression de ce récepteur et d'autre part en explorant les phénomènes de désensibilisation pouvant l'affecter. L'ensemble de nos résultats permet ainsi d'envisager le développement clinique d'agonistes sélectifs du récepteur b3-adrénergique dans la prise en charge pharmacologique de la menace d'accouchement prématuré
The preterm birth represents the leading cause of neonatal mortality and morbidity in developed countries. The strategies for medical management remain restricted and relatively inefficient. Amongst different actions undertaken to reduce preterm birth and health problems of preterm neonates, the development of new pharmacological tools to treat uterine contractility dysfunction is essential. We were interested in the b3-adrenoceptor and its agonists known to have myorelaxant properties on the uterus smooth muscle, the myometrium. The aim of our work consisted in the pharmacological characterisation of the b3-adrenoceptor in the human myometrium, on the one hand in studying the influence of pregnancy on the expression of this receptor and on the other hand, by exploring the desensitisation phenomenon which can affect it. Our results give arguments in favour of clinical development of selective b3- adrenoceptor agonists in the pharmacological treatment of preterm labour

Durant ces dernières décennies, l'activité électrique utérine origine des contractions menant à l'accouchement constitue une étude de recherche primordiale pour la prévention et pour la détection des accouchements prématurés. La modélisation mathématique et la simulation informatique sont devenues des outils indispensables pour la compréhension de différents phénomènes électrophysiologiques afin de prédire, et d'agir en cas d'anomalie. Sachant que le contrôle de l'excitabilité utérine s'avère avoir des conséquences thérapeutiques importantes, nous avons choisi de débuter le modèle à l'échelle cellulaire. L'analyse dynamique de ce modèle a permis de montrer l'efficacité de certains traitements tocolytiques tels que les bloqueurs des canaux calciques et les ouvreurs des canaux potassiques. Le contrôle de la contractilité utérine ne se limite pas au niveau cellulaire mais s'étend aussi au niveau tissulaire. Nous avons démontré comment un modèle de propagation biophysique permet de reproduire le couplage électrique réduit entre les cellules en début de grossesse et le couplage fort et synchronisé à l'approche du terme. Cette propagation a permis d'estimer un électromyogramme utérin de surface. Ce travail de thèse, quoique innovant et intéressant reste dans une première étape préliminaire. Il en porte en lui de futurs axes de recherches et de développement pluridisciplinaires prometteurs, dans l'objectif de fournir un modèle numérique de l'activité électrique utérine, contribuant à la compréhension de phénomènes physiologiques et à la prédiction d'accouchement prématuré
It is hypothesized that uterine electrical activity is efficiently correlated to the uterine contractions appearance. Once, forceful contractions appear, delivery is near. Therefore, the understanding of the genesis and of the propagation of the uterine electrical activity may provide an efficient tool to diagnosis preterm labour. Moreover, the control of uterine excitability seems to have important therapeutic consequences in controlling preterm labour. Modelling the electrical activity in uterine tissue is an important step for the understanding of physiological uterine contractile mechanisms. It would permit to reconstruct the uterine EMG. This work presents an electrophysiological model of the uterine cell that incorporates ion channel models at the cell level. The dynamical analysis of the uterine cell model allows a better apprehension of the main physiological effects on the cell's reponse. The cellular electrical activity will be integrated in a two dimension model, represented by the reaction diffusion equations, and will serve to the spatio-temporel integration at the uterine level for EMG reconstruction. This model validates some key physiological hypotheses considering uterine excitability and propagation

Introduction Neonatal mortality and morbidity from premature birth are still a major concern despite significant advances in perinatal medicine. Objective of the study The primary aim of the study was to establish the feasibility of accurately identifying a cohort of vvomen at increased risk of preterm birth using a modified risk assessment score and fetal fibronectin testing in order to undertake a pilot randomised placebo-controlled trial of nifedipine as a tocolytic. Methodology A population of pregnant women was screened prospectively between 24 and 34 weeks of gestation using a modified risk assessment system. Women identified as high-risk for preterm birth were then tested with fetal fibronectin. Those testing positive were randomised to either nifedipine or placebo. The study at this point was randomised, placebo-controlled and double-blind. Measures of outcome were compared for babies of trial vvomen with high-risk women who withheld consent. Main outcome measures Delivery before 34 weeks, neonatal death, admission to the Special Care Baby Unit (SCBU), chronic lung disease and major cerebral abnormality on ultrasound scan constituted the main measures of outcome. Results Five hundred and thirty four vvomen were identified as high-risk for preterm birth. One hundred and forty two women agreed to participate in the study. Forty nine women delivered before 37 weeks' gestation. The system was sensitive in predicting preterm birth before 34 weeks of gestation and within one week of testing for fetal fibronectin in symptomatic women. Babies of non-consenting mothers fared better overall than babies of the trial women. Conclusion Risk factor scoring and fetal fibronectin testing are useful screening tools that can predict preterm delivery. This sysytem can be clinically useful in the management of preterm labour or women at increased risk for preterm birth. There was no impact on the neonatal mortality or morbidity.

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This work carried out the chemical characterization, tocols and phytosterol contents from the seed oil of the species Barnebya harleyi and Diplopterys pubipetala(Malpighiaceae), Croton adamantinus (Euphorbiaceae), Couroupita guianensis (Lecythidaceae) and Hippocratea volubilis (Celastraceae) which are found in Brazil. The centesimal composition of the seeds was carried out in accordance with the AOAC (2000) and the carbohydrate content + alimentary fiber was estimated by the difference of the other components, using the following equation: CC=100% - (% humidity + % proteins + % lipids + % ash). To make the analysis of the tocols and phytosterols, the seed oils were extracted through the Soxhlet apparatus using n-hexane as solvent. The tocols were analyzed by with HPLC (High Performance Liquid Chromatography) and the components identified by compararison of the retention times and UV spectrum with HPLC patterns (α-, β-, γ- e δ- tocopherol and α-, β-, γ- e δ-tocotrienol). The sterol composition was evaluated by GC-FID according to the method of the NP EN ISO 12228 (1999). Patterns used identification was acquired of Sigma including cholestanol, cholesterol, campesterol, stigmasterol, β-sitosterol, β-sitostanol and betulin. The protein contents ranged from 9,6g/100 g H. volubilis to 30,5 g/100 g in D. pubipetala. The carbohydrate contents ranged from 14,6 g/100 g in Barnebya harleyi to 33,8 g/100 g in Croton adamantinus. The ash contents ranged from 7,78g/100 g in C. guianensis to 2,13 g/100 g in H. volubilis. The oil contents obtained from the seeds ranged from 35,5 g/100 g in C. guianensis to 49,9 g/100 g in H. volubilis. The total contents of tocols ranged from 25,1 mg/100 g in C. guianensis to 72,7 mg/100 g in B. harleyi. α-Tocopherol, γ-tocopherol and γ-tocotrienol were detected in all the oils from the species analyzed while δ-tocotrienol was detected only in the oil from B. harleyi. D. pubipetala was the species with the highest amount of α–tocopherol (23 mg/100 g oil). C. adamantinus presented the highest quantity of γ-tocopherol (63,3 mg/100 g). Among the tocotrienols, γ-tocotrienol reached the highest value (5,0 mg/100 g oil) in B. harleyi, the only species analyzed containing tocols in the oil. The total contents of phytosterols in the oil ranged from 79,81 mg/100 g in C. guianensis to 91,57 mg/100 g in the oil from C. adamantinus. Cholesterol was detected in small amounts in all analyzed species, ranging from 0,26 mg/100 g in C. guianensis to 0,90 mg/100 g in D.pubipetala. β-Sitosterol, campesterol, and 7-stigmastanol were the most representative phytosterols in the five investigated species. Two non identified peaks after Δ7- avenasterol (TR-24,440 and TR-24,680) in the chromatogram of the oil of C. guianensis corresponded to 57mg/100 g of the sterol fraction. In addition to these compounds, the clerosterol and campestanol were found in all the samples in small quantities and Δ7- avenasterol, with exception of C. guianensis. β-sitosterol was the phytosterol with the highest contents, particularly in C. adamantinus, B. harleyi and H. volubilis, with, respectively, 71,85, 70,40, and 62,64 mg/100 g. Δ7-estigmastanol was the second most abundant phytosterol in H. volubilis, D. pubipetala and B. harleyi, with, respectively, 12,26, 12,22 and 7,13mg/100 g. The results of this work, though exclusive for some species, are complementary, aiming to provide information on vitamin E, phytosterols and centesimal composition of the oil of some species with promising perspectives of economical benefits in Brazilian Northeast.
Neste trabalho foi feita a caracterização química das sementes, o conteúdo de tocois e fitosterois a partir do óleo de sementes das espécies Barnebya harleyi e Diplopterys pubipetala (Malpighiaceae), Croton adamantinus(Euphorbiaceae), Couroupita guianensis (Lecythidaceae) e Hippocratea volubilis (Celastraceae), ocorrentes no Brasil, com o objetivo de fornecer informações que possam subsidiar o aproveitamento econômico dessas espécies. A composição centesimal das sementes foi realizada de acordo com AOAC (2000) e o teor de carboidratos + fibras alimentares foi calculado pela diferença dos outros componentes, utilizando a seguinte equação: Conteúdo de carboidratos + fibras alimentares = 100% - (%umidade + % proteína + % lipídios + % cinzas). Para fazer a análise dos tocois (tocoferois e tocotrienois) e dos fitosterois, os óleos das sementes foram extraídos através de um aparelho de Soxhlet com n-hexano como solvente. Os tocois foram analisados em HPLC (High Performance Liquid Chromatography) e os componentes foram identificados por comparação dos tempos de retenção e espectro UV com padrões adquiridos da Sigma (α-, β, γ- e δ-tocoferol e α-, β-, γ- e δ-tocotrienol). A composição dos esterois foi avaliada por CG-FID de acordo com o método da Norma NP EN ISO 12228 (1999). Padrões de identificação utilizado foi adquirido da Sigma incluindo colestanol, colesterol, campesterol, estigmasterol, β-sitosterol, β-sitoestanol e betulina. Os teores de proteína variaram de 9,6 g/100 g em H. volubilis a 30,5 g/100 g em D. pubipetala. O conteúdo de carboidratos variou de 14,6 g/100 g em B. harleyi a 33,8 g/100 g em C. adamantinus. O conteúdo de cinzas variou de 7,78 g/100 g em C. guianensis a 2,13 g/100 g em H. volubilis. O conteúdo de óleo obtido das sementes variou de 35,5 g/100 g em C. guianensis a 49,9 g/100 g em H. volubilis. O conteúdo total de tocois variou de 25,1 mg/100 g em C. guianensis a 72,7 mg/100 g em B. harleyi. α Tocoferol, γ-tocoferol e γ-tocotrienol foram detectados em todos os óleos das espécies analisadas, enquanto δ tocotrienol foi detectado somente no óleo de B. harleyi. D. pubipetala foi a espécie com teor mais elevado de α-tocoferol (23 mg/100 g de óleo). C. adamantinus apresentou o maior teor de γ-tocoferol (63,3 mg/100 g). Entre os tocotrienois, γ-tocotrienol atingiu o teor mais elevado (5,0 mg/100 g de óleo) em B. harleyi, a única espécie analisada contendo todos os tocois. O conteúdo total de fitosterois no óleo variou de 79,81 mg/100 g em C. guianensis a 91,57 mg/100 g no óleo de C adamantinus. O colesterol foi detectado em pequenas quantidades em todas as espécies analisadas, variando de 0,26 mg/100 g em C. guianensis a 0,90 mg/100 g em D. pubipetala. β-Sitosterol, campesterol e 7-estigmastanol foram os mais representativos nas cinco espécies estudadas. Dois picos correspondentes a substâncias desconhecidas eluíram no cromatograma do óleo de C. guianensis após 7-avenasterol (TR-24, 440 e TR-24, 680 min.) e a soma dos dois atingiu 57mg/100 g da fração dos esterois. Além destes compostos, o clerosterol e campestanol foram encontrados em todas as amostras em pequenas quantidades e 7-avenasterol, com exceção em C. guianensis. β-Sitosterol foi o fitosterol com o maior teor, particularmente em C. adamantinus, B. harleyi e H. volubilis, com, respectivamente, 71,85, 70,40 e 62,64 mg/100 g. 7-Estigmastanol foi o segundo mais abundante fitosterol em H. volubilis, D. pubipetala e B. harleyi, com, respectivamente, 12,26, 12,22 e 7,13 mg/100 g. Os resultados deste trabalho são complementares e fornecem informações sobre vitamina E e fitosterois dos óleos e composição centesimal de sementes de algumas espécies com perspectivas de aproveitamento econômico no Nordeste Brasileiro.

Il verificarsi della presenza di micotossine nella granella di mais è di interesse mondiale perché la loro presenza negli alimenti è spesso associata a malattie acute e croniche nel bestiame e nell'uomo. Le micotossine sono metaboliti fungini secondari tossici per i vertebrati. Molti composti naturali e sintetici con proprietà antiossidanti sembrano avere una potenziale efficacia nella protezione contro gli effetti tossici delle micotossine. Questo lavoro ha avuto come obiettivo lo studio degli effetti degli antiossidanti naturali di mais (carotenoidi e tocoli) sulla crescita di funghi (fusarium verticillioides) e sull'accumulo di micotossine in preparati alimentari a base di mais e su alcuni sottoprodotti della lavorazione del mais.
The occurrence of mycotoxins in cereal grains is of great concern worldwide, because their presence in feeds and foods is often associated with chronic or acute mycotoxicoses in livestock and also in human. Mycotoxins are fungal secondary metabolites that are toxic to vertebrates. Several natural and synthetic compounds with antioxidant properties seem to be potentially efficient in protecting against the toxic effects of micotoxins. This work was aimed to study the effects of natural maize antioxidant (carotenoids and tocols) on fungi (fusarium verticillioides) growth and on micotoxins accumulation in maize-based food products and in maize by-products.

碩士
國立陽明大學
醫務管理研究所
99
Objective The essential goal of preventing premature infants’ complications is to increase the gestational weeks and reduce the incidence of preterm birth on pregnant woman with tendency of preterm birth. This study was to examine the difference of characteristics of the maternal and newborn, birth outcomes, and medical utilizations between the short-term tocolysis (≦2days) and long-term tocolysis (＞2days). The results will be a reference for tocolytics care policy. Methods A retrospective study was designed to compare the complications of the maternal and newborns, whose gestation ＜37 weeks, from the population-based in a medical center and National Health Care Insurance (NHI) from 2004 to 2005. The subjects were divided by days of inpatient tocolysis to case group (＞2days) and control group (≦2 days). There were 354 newborns in case group, while there were 197 newborns in control group. Results (1) In birth weight, the first minute and fifth minute of the Apgar scores, first aid or not, the number of first hospitalized complications were significant difference. Gestational age, weight and birth outcomes of newborn in case group were better than that in control group. (2) There was no significant difference in medical utilizations of neonatal (birth to one year old) in two groups. (3) The difference of medical care utilization was according to the gestation weeks of infants (24-28 weeks and 29-32 weeks) and no difference with days of inpatient tocolysis. (4) The medical care utilization of neonatal were significant difference with the major complications of mother in difference stage of pregnancy, but no difference with two groups in same complication. (5) Compared to newborns without tocolysis, the more tocolysis days, the more weeks of newborns’ age and the heavier weight of newborn, but no difference between the medical care utilization and days of tocolysis. Conclusions Gestational age was a major factor in neonatal care utilization, hospitalization of tocolysis did tend to make to extend the gestational weeks, thereby increasing birth weight, birth outcomes better. Since the different major complications during pregnancy, the total medical utilization of neonatal care was also affected. According to the results, tocolysis should be paid according to gestational age, pregnancy complications, and birth risk assessment of premature. Besides, the severity of complications during pregnancy should be considered to pay more to improve the quality of maternal and neonatal care. The results will be a suggestion to NHI to planning the reimbursement of TW-DRGs.

碩士
朝陽科技大學
應用化學系碩士班
89
This work study metallic element analyses of Pb, Cd, Cr, As in 13 raw samples with Tocolysis effect. Metallic element analyses of Pb, Cd, Cr used graphite furnace atomic absorption spectrometry (GFAAS), and the element analysis of As used flow injection analysis system (FIAS) coupled with hydride generation atomic absorption spectrometry. Different sample pretreatments including incineration, hot plate digestion, and microwave digestion were also investigated. The main results of this work are followed. 1. The mean value of the relative standard deviation (RSD) of four elements (Pb, Cd, Cr, As) were : incineration pretreatment= 8.8% ± 1.7%, hot plate digestion pretreatment= 7.1% ± 3.3%, microwave digestion pretreatment= 3.4% ± 0.8%. The results indicate that microwave digestion pretreatment has higher precision than other pretreatments. 2.The recovery of four elements (Pb, Cd, Cr, As) from different sample pretreatments were: incineration= 79.7% ± 12.1%, hot plate digestion= 85.7% ± 3.3%, microwave digestion= 94.9% ± 2.1%. The results indicate that microwave digestion pretreatment has higher recovery than other sample pretreatments. 3. The amount of four elements in 13 sample components were: Pb= 1.87～60.46 ppb, Cr= 0.52～23.32 ppb, Cd= N.D.～3.76 ppb, As= N.D.～8.78 ppb. The As is lower than detective limit, in most sample components. Schizonepetae Herba contains more Pb, Cr, and As elements than other components in 13 raw samples with tocolysis effect.

碩士
國立陽明大學
臨床護理研究所
89
The purpose of this study is to investigate the life experience and coping strategies of high-risk pregnant women who discharged from hospital after received tocolytic therapy. Ground Theory was employed in this study. The research time frame was from January to April 2001. The theoretical samping method was used to collect data from a medical center in Taipei until the data become saturated. A total of 16 high-risk pregnant women were involved in this study. At the time of home interviews, their gestational age ranged from 20 to 35 weeks. Each subject was taped during the home interview lasting 60-90 minutes utilizing the half-structure method. The result of the study show that high-risk pregnant women at their home often lack professional supervision, specifically fetal monitors as well as medical professional''s consultation. As a result, women pay close attention to their physical and the awareness of the body, often adjusting their activity level in order to put both body and mind at ease. In the future, nurses might advise high-risk pregnant women to maintain a similar awareness, noting the strong connection between body and mind. The health care professionals should provide holistic care, which often ignored by contemporary medicine.

碩士
國立陽明大學
臨床護理研究所
91
ABSTRACT The purpose of this descriptive correlational study is to explore the stress and coping of spouses of pregnant women undergoing tocolysis and bed rest; and to clarify the factors influencing the stress and coping. The subjects are spouses of pregnant women undergoing the first tocolysis and bed rest at hospital within a period of 1 day to 1 week. And the spouse must be a primary caregiver. Sixty-three spouses were recruited from 3 teaching hospitals in Taipei. The instruments used in the study include: analysis of demographic data of pregnant women and their spouse, spouse stress scale, and spouse coping scale. Data analysis involves descriptive statistical methods, T-test, One-Way ANOVA, and Pearson correlation. The results are summarized as follows: 1. The source of the greatest stress of the spouse is the physical and psychological conditions of the pregnant woman undergoing tocolysis and bed rest. 2. The coping of the spouse is mostly problem-oriented. 3. In analysis of the demographic data, the assistance of family significantly increases the stress of the spouse in the physical and psychological conditions. 4. In the pregnancy and labor aspects, the longer duration of hospitalization significantly increases the environmental stress of the spouse. 5. In fetus factors, gender of fetus significantly influences the stress of the spouse. The female fetus causes more stress than the male does. 6. In analysis of the demographic data, age of the spouse significantly influences the coping. The older, the more problem-oriented. Status of education also significantly influences the coping. The lower education, the more negative-emotioned coping. 7. There is a positive correlation between the stress and emotion-oriented coping. According to the results of this study, we propose the following suggestions. In nursing practice, we must give the patient emotional support, provide enough information about tocolysis, provide individualized nursing care and integrate the spouse’s support system. In nursing education, we must emphasize the concept of family-centered nursing, and enhance the ability to evaluate family stress and the coping skill. In nursing administration, we must limit the time of visiting, and provide medical information in details. This study provides a basis for nursing care of family with a pregnant woman undergoing tocolysis at hospital, and is helpful for the concept of family-centered nursing care to be carried out.

碩士
國立成功大學
護理學系
102
INTRODUCTION Sleep is a complex physiological process to restore physical agility and energy, and poor sleep quality will affect physical, emotional, cognitive, behavioral and social functioning. Since pregnant women play a key role in fetal growth and development, their sleep quality not only affects their own health, but also that of the fetus. Pregnant women who are hospitalized for tocolysis usually experience poor sleep quality , and this has been shown to increase inflammatory markers and negative pregnancy outcomes (Okun ＆ Coussons-Read, 2007). Women who are hospitalized for tocolysis are thus usually advised to stay in bed and limit the amount of activities. However, the resulting immobilization might induce muscle tightness, back pain, sleep disturbances, and other symptoms. Although this is an obvious problem, relatively little research has been carried out that aims to improve the sleep quality of high-risk pregnant women. Many methods such as massage, music therapy, meditation, relaxation could improve quality of sleep. Worth mentioning that massage has been used for improve the sleep quality of ICU bed-ridden patients. Massage can have positive effects by lowering the amount of stress hormones and helping them to relax. Field, Deigo, ＆ Hernandez-Reif (2007) reviewed 6 studies that assessed a theoretical model in which massage therapy increases serotonin and decreases cortisol and depression. In addition, massage therapy is shown to increase dopamine and, in turn, decrease norepinephrine and anxiety. Massage can also facilitate the EEG rhythmic transmit α wave, which means that it can improve the quality of sleep (Field et al., 2004b; Glover et al., 1999; Lundy et al., 1998; Wadwha et al., 1998). Effleurage massage is the most important techniques of relaxation, which can also promote blood circulation and lymphatic drainage (Field et al., 2007), and it is commonly used with pregnant women. While few studies have used massage to improve pregnant women’s sleep, effleurage massage has been used with ICU patients. Chen (2002) studied the use of effleurage massage for bed-ridden ICU patients, and showed that the patients who received massage therapy had more stable physiological indexes (i.e., heartbeat, blood pressure, and blood oxygen) and longer sleep times that those who did not receive it. MATERIALS AND METHODS Design and Sample This randomized control trial with a cross-over design study was conducted from July 2013 to September 2013. Subjects were recruited from the tocolysis ward in a University-affiliated hospital. High-risk pregnant women were eligible for participation if they were over 20 years old and their gestation periods were between 20 to 36 weeks. The following exclusion criteria were applied : diagnosis of depression, major mental disorder, taking of any medications known to affect sleep patterns, diagnosis of spine or back disease, skin of the back, arms or legs suffering from lesions or allergies or in the first active phase of labor. Subjects were allocated to the earlier-massage group (n=18) or later-massage group (n=18) by permuted block randomization with block size of 4. Procedure This study was approved by the hospitals’ institutional review board. Subjects who were eligible for participation and complete a consent form. They were allocated to earlier- and later-massage groups in four consecutive days. Effleurage massage was given with the center of the palm to slowly and softly massage from distal ends to proximal ends, applied at back, arms and legs. The earlier-massage group received effleurage massage for 20 minutes on the first and second nights before sleep, and not receive effleurage massage on third and fourth nights, while the reverse was true for the later-massage group. Measurement The demographic information that was collected included age, gestational age, pregnancy history, diagnosis, medication, and previous quality of sleep. The subjects’ previous quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989). Subjective sleep quality was measure by the 15-item Verran and Snyder-Halpern Sleep Scale (VSH; Snyder-Halpern ＆ Verran, 1987). The VSH sleep scale is a visual analogue instrument, in which the subjects are asked to answer each question about their previous night’s sleep by placing a vertical mark on a 100 mm line at a point between the verbal end statements. A higher total score means a better quality of sleep. Objective sleep time was measured by the actigraphy monitor (iHealth; Wang et al., 2011). iHealth is a portable watch-type sensor module that uses a small accelerometer to record a person’s speed and degree of motion, thus detecting their sleep/ wakefulness status. iHealth is worn on the non-dominant hand or ankle to record the total sleep time, duration of sleep latency, first wake after sleep onset, and frequency of waking up. Analysis Data were analyzed using the Statistical Package for the Social Sciences program (SPSS) for Windows 17.0 (SPSS Inc., Chicago, IL). Sample characteristics and variables of interest were summarized by descriptive statistics. The research questions were answered by paired-t tests and Wilcoxon matched-pairs signed ranks tests. A value of p 〈.05 was considered statistically significant. RESULTS The final analyses were based on the data obtained from the thirty-six women who completed the four-day study. Forty-three women were initially recruited, but four withdrew from the study after having been discharged and three entered the active phase of labor, and so were excluded from the sample. The women’s mean age was 32.4±2.9 years (range=27 to 39) and their mean gestation was 29.4±2.6 weeks, with a range of 24-35 weeks. Most of the women (63.9%) were multipara, and length of hospital stay was 2.6±1.2 days (range=2 to 6) before intervention. Twenty-three women (63.9%) had a global score of 〉5 on the PSQI. In total quality of sleep and subscale of quality of day-time function, quality of sleep undisturbed, quality of sleep latency measured by VSH were all less then one-half of total score. The effect of effleurage massage on quality of sleep The results of the paired-t test showed that women who received massage had a higher total sleep quality score compared to those who did not receive it(p 〈.001). Similar results were found for the three subscales of sleep quality (p 〈.001). The effect of effleurage massage on total sleep time The results of the paired-t test showed that the mean total sleep time for the massage group was 6.9±0.6 hours, longer than that for the group that did not receive a massage (6.4±0.5, p 〈.001). A subgroup analysis was conducted based on the subjects’ previous quality of sleep, as measured by the PSQI. No matter whether the subjects were in the good or poor PSQI groups, the total sleep time in the massage group was longer than that in the non-massage group (p 〈.001). The effect of effleurage massage on sleep latency The results of the paired-t test showed that the massage group had a shorter duration of sleep latency than the non-massage group ( p 〈.001). First wake time after sleep onset was also longer in the massage group compared to the non-massage group ( p 〈.001). DISCUSSION AND CONCLUSION Our results showed that 63.9% of the pregnant women had poor sleep quality (PSQI ≧5), echoing previous studies (Ko, Chang, ＆ Chen, 2010). The results also showed that effleurage massage can improve the perceived sleep quality and sleep time for women with tocolysis. This is similar to the findings of Cheng (2002), which examined the effects of effleurage massage on sleep quality for bed-ridden ICU patients, who had similar levels of mobility to the subjects examined in this work. We also found that sleep latency (time to fall asleep) was significantly shorter for the effleurage massage group. This may be because effleurage massage can facilitate the production of α waves, and thus subjects will easily move into NREM sleep (Ujhely, 1979; Rowen, 2002; Moyer et al., 2004; Löken et al., 2009). In addition, slow effleurage massage can increase dopamine levels whole decreasing norepinephrine and anxiety, and so it is not surprising that the women in this study who received massage found it easier to relax and fell asleep faster (Field, Deigo, ＆ Hernandez-Reif, 2007). Limitations The findings of this study are limited by the fact that it was not possible to carry out a blind intervention, and so the Hawthorne effect could not be avoided. However, this study, did use an objective method to assess sleep quality, and this may increase the credibility of its findings. Clinical Applications The findings of this study suggest that clinical health professionals can use effleurage massage for women with tocolysis in order to improve sleep quality. In addition, we also suggest adding effleurage massage into the health education programs that are offered to such women. Effleurage massage is a basic relaxation technique that ordinary people should be able to learn and apply after it has been demonstrated by healthcare professionals, and so the partners of pregnant women should be shown how to do this. In this way, we cannot only help women with tocolysis to have better sleep, but also promote bonding between the women and their partners, which is also helpful clinically.

碩士
國立陽明大學
臨床護理研究所
91
This study is to explore the perceived bodily changes and coping responses of pregnant women undergoing bed rest and tocolysis in Hospital. The method of this study is Clinical field research method. The researcher selected subjects by purposive sampling, and contacted with high risk pregnant women when they enter the hospital. Undergoing two weeks of bed rest and tocolysis in hospital, the researcher served as a primary nurse and care-giver, and understanded the perceived bodily changes and coping responses of them by participant observation. During morning care on their 3th, 7th, 14th days of they stay in hospital, the researcher gathered data by the self-report instrument, and interview. The interview was recorded as narrative data and was analysed, categorized and encoded as units of analysis by content analysis. Then, Coded and descriptive analysed the data of instruments. The result shows pregnant women undergoing bed rest and tocolysis in hospital have two types that are the general perceived bodily changes and the specific perceived bodily changes. The perceived bodily changes were variation follow the period in hospital prolong. The body mobility decreased and limited was the most frequency perceived bodily changes. When their perceived bodily changes, the body image of them was alterant continued, their have to coping with perceived bodily changes by confirm the body, protect the body, reorganize the body, and plan the body, and then, make up the body image and control the body operational functions, their can finish the maternal task that make sure self and their fetus pass pregnant period safely finally.

碩士
國立臺灣大學
護理研究所
83
The purpose of this study is to understand the actual living conditions of those pregnant women who are undergoing bed rest and tocolysis. We also want to know these women cope with the difficulties that arise from bed rest and tocolysis. We will see all these through the eyes of these women. 　　This study utilized the "observer as participant" method to collect information. The study began on the inital day of the pregnant woman''s hospitalization and continued on for two weeks. Every morning, during this study period, the researcher served as a primary nurse and collected the needed information regarding the bed rest woman''s condition for about two to three hours. 12 hours after leaving the subject, the words and the behaviors expressed by that pregnant woman were recorded down, that became our process recording which was analyzed later. In our study, we had collected information on four pregnant women, who were 26-32 weeks pregnant. Three of these women sufferd from uterine contractions and the other one preterm rupture of amniotic membrane. These four women''s 48 process recordings ( 525 pages) were analyzed using theories from hermeneutic phenomenology. We have the following results: 　　There were four main themes of living conditions experienced by these bed rest women; they were: 1) discontinuity from their ordinary living condition; 2) uncertainty about the present linving condition; 3) lake of personal control in life; and 4) sense of confinement within this time and space. These women''s coping behaviors could also be categorized into four themes: 1)re-orientation of the present living situation; 2) making sure and protect the baby inside of their body is safe and growing; 3) adjusting to the bed rest life; and 4) sustaining and supporting herself to go on. 　　Pregnant women''s situations and their coping behaviors were forever changing with time. Aside from the sudden discontinuity from their ordianary living conditions and re-orientation the present living condition in the early stage of their hospital stat, and after one week of hospitalization these women started to feel trapped, other situations and coping behaviors followed no particular time pattern. 　　When comparing the maternal task of ordinary pregnant women and the women in our study, we found: 　　Women who underwent tocolysis executed their maternal task differently from ordinary pregnant women. Timing wise, the women in our study were mostly concerned about the safty of their baby, identifying with the baby and helping other membres of the family to accept the baby will have to come later. Their concern: uncertainty of their baby''s condition; they would like other people to by more supportive of them, their family live and their emotions; they had greater devotion to their pregnancy than most pregnant women. They sacrificed greatly in the areas of physical comfort, living situation, quality of family life, and relationships with other family members. 　　When comparing this study with other studies on similar topics, we found: 　　Women who underwent tocolysis were separated from their family, worried about their family, bored, and losing control of their life. These situations created a lot of stress for these women. The level of disturbance is no less than the disturbance brought on by the change in their pregnancy. It is imperative that aside from medical help for these women, we should help these women to maintain their bonds with other family members, adjust to their hospital life, eliminate their loneliness and boredom, and help their family members to lead a normal life. 　　The results of this study could become a reference material for the obstetrical department''s nursing staff who are currently taking care of women undergoing tocolysis.

Presented work focused on researching cold resistance in insects (Pyrrhocoris apterus), especially in qualitative and quantitative composition and seasonal changes in the content of tocopherols and sterols in membranes. Collection of samples, tissue extraction, separation, sample preparation and the final analysis was included. There were detected three different sterols (animal cholesterol, plant sterols: campesterol and sitosterol). Also were detected ?-tocopherol and ?-tocopherol. Volume of cholesterol was in the range of 0.2 to 0.8 mol%, for phytosterols was the range from 1.2 to 15.2 mol%, and for tocopherols was the range from 0.1 to 31.3 mol%. Seasonal fluctuations of sterols and tocopherols were evaluated with a minimum in summer and maximum in winter.