手转胎头及徒手扩张宫颈在第一产程活跃期中的作用（附109例）

目的：通过加强宫缩下的徒手扩张宫颈及手转胎头以加速第一产程进展,达到顺利经阴道分娩。方法：对我院妇产科109例第一产程活跃期延长甚至停滞以及胎方位不正（如枕横位或枕后位）者采用徒手扩张宫颈口、旋转胎头等适宜技术干预。结果：第一产程活跃期大大缩短,先露迅速下降,最终顺利经阴道分娩。结论：徒手扩张宫颈口、手转胎头等产科技术缩短第一产程活跃期作用明显,效果确实有效,可缩短产程,加速分娩从而大大降低剖宫产率。     

第一产程静脉注射安定128例观察

我院2000年以来为选择分娩期用药的最佳时间，对128例足月初产妇于分娩活跃期静脉注射安定，对产程停滞，精神紧张，富颈成熟度差，宫缩不协调的孕妇有明显的效果，用药后观察宫口的迅速开全，产程明显缩短且不增加产后出血，不影响新生儿Apgar评分。现讲128例临床观察分析如下：     

微泵硬膜外麻醉用于无痛分娩40例分析

目的:探讨微泵硬膜外麻醉用于分娩镇痛的效果及对产程、母婴预后的影响.方法:在产妇宫口张开2～3 cm时,采取镇痛措施:观察组40例硬膜外麻醉阻滞术(PCEA)镇痛,对照组40例给予静脉注射安定.分别观察镇痛效果、产程时间、分娩方式、分娩并发症等情况.结果:观察组和对照组在镇痛效果、分娩方式、产程、继发宫缩乏力方面与对照组相比差异有显著意义(P＜0105).结论:观察组和对照组在镇痛效果、分娩方式、产程、继发宫缩乏力方面与对照组相比差异有显著意义(P＜0105).     

拉玛泽分娩法联合硬膜外分娩镇痛在产程不同时机中的应用

目的 探讨拉玛泽分娩法联合硬膜外分娩镇痛在产程不同时机中的应用效果.方法 选择正常足月妊娠初产妇600例,按孕妇分娩意愿镇痛分为观察组和对照组,每组各300例,观察组在孕妇第一产程潜伏期运用拉玛泽呼吸法进行减痛疗法,并在宫口开大2-3 cm时进行硬膜外分娩镇痛穿刺,对照组采取传统分娩方法、不采用任何减痛方法干预,分别观察两组镇痛效果、产程时间、新生儿Apgar评分、产后2 h出血量等情况.结果 观察组产痛程度明显减轻,总产程时间缩短,新生儿Apgar评分及两组产后2 h出血量差异无显著性.结论 护士指导孕妇掌握拉玛泽分娩法并联合硬膜外分娩镇痛在产程不同时机中的应用,能有效减轻产痛,镇痛效果显著,缩短产程,提高自然分娩率,对产妇和新生儿无明显不良反应,能提高产科医疗护理质量.     

镇痛分娩对产程的影响

目的:探讨硬腰联合麻醉时于孕妇产程进展、阴道助产及产后出血量的影响.方法:随机选择2012-08～2012-10阴道分娩的孕妇,镇痛分娩组(观察组)和非镇痛分娩组(对照组)各96例进行对照分析.结果:第一产程观察组比对照组时间短(P＜0.05),第二、三产程无明显差异,产后出血量无明显差异.结论:硬腰联合麻醉可有效缩短第一产程的时间,但是对孕妇第二、第三产程、阴道助产率及产后出血量均无明显影响,因此作为分娩时镇痛确实可行.     

高原地区孕妇瑜伽训练对孕产妇分娩结局的影响

目的：探讨高原地区孕妇瑜伽训练对孕产妇分娩结局的影响.方法：将自愿选择孕妇瑜伽训练的130例作为观察组,同期不做孕妇瑜伽训练的160例作为对照组.采用调查表对两组进行孕期运动情况、孕期体重变化、分娩方式、产程时间及巨大儿出生情况进行调查.结果：观察组孕期体重、自然分娩率、剖宫产率、巨大儿出生率、第一产程、第二产程及总产程时间与对照组比较差异有统计学意义（P＜0.05）.结论：选择孕妇瑜伽训练可使孕期体重控制在正常范围内,缩短产程,降低剖宫产率及巨大儿出生率.     

200例无创性镇痛分娩的效果观察与护理

目的 探讨分析使用分娩镇痛仪的效果及护理体会.方法 选取进行无创性镇痛分娩的初产妇200例为观察组,同期分娩无镇痛分娩的初产妇200例为对照组,比较两组缓解疼痛效果、产程长短、出血量、新生儿情况、分娩方式的影响,总结镇痛分娩的护理体会.结果 观察组产妇地第一产程明显短于对照组,差异具有统计学意义(P＜0.05),第二产程和第三产程持续时间比较差异无统计学意义(P＞0.05);观察组的疼痛明显减轻(P＜0.05),镇痛满意度显著高于对照组(P＜0.05);观察组产妇的剖宫产率、产后出血量与对照组比较明显减少,差异具有统计学意义(P＜0.05);两组新生儿窒息率比较差异无统计学意义(P＞0.05).结论 无创性镇痛分娩可使疼痛减轻,缩短产程,增强产妇采用自然分娩的信心,降低剖宫产率和产后出血发生率,从而提高阴道分娩率.     

第一产程中应用自由体位在促进分娩中的临床作用

目的 探讨第一产程中应用自由体位在促进分娩中的临床作用.方法 选取收治的98例待产产妇进行研究,以随机数字表法为依据将其分为两组,对照组49例,采用常规体位,观察组49例,采用自由体位,对比两组分娩情况.结果 观察组患者第一产程、第二产程、第三产程及总产程时间明显短于对照组(P<0.05);两组在分娩方式方面比较存在明显差异(P<0.05);两组比较产妇并发症发生率、胎儿窒息率及新生儿死亡率均明显低于对照组(P<0.05).结论 指导待分娩产妇在第一产程中取自由体位有利于缩短产程时间,且可提高自然分娩率,降低不良新生儿结局发生率,临床价值显著,可推广应用.     

产程中镇痛与无镇痛分娩的效果比较

目的分析、比较镇痛与无镇痛分娩对母婴的影响。方法选择本院住院镇痛分娩200例产妇进行分析,同期分娩的非镇痛200例产妇作为对照。对两组产妇的疼痛程度、宫缩情况、产程进展、分娩方式、新生儿情况进行对比分析。结果镇痛组产妇产痛VAS明显降低,宫缩强度降低,但第一产程明显短于对照组;镇痛分娩不影响产妇的生命体征及新生儿Apger评分。结论药物镇痛分娩能明显缓解产痛,缩短产程,降低剖宫产率。     

产程陪伴加水针镇痛对产妇的影响

如何减轻分娩痛、缩短产程 ,使产妇在分娩过程中保持一种良好的心理状态是医护人员非常关注的课题。我们对分娩产妇采用产程陪伴加水针的综合方法用于分娩镇痛 ,探讨其对产妇的影响。1　资料与方法1 1　资料　2 0 0 2年 1月 8月我院分娩总数为 415 2人 ,抽取 2 40例产妇 ,均为初产妇 ,单胎头位 ,无产科和内科并发症 ,年龄 2 332岁 ,孕周 3741 5周 ,随机分为两组 ;观察组 12 0例 ,产程专人陪伴加水针注射 ;对照组 12 0例常规观察。1 2　方法1 2 1　产程陪伴　产妇进入产程由工作 5年以上的助产士一对一陪伴 ,用通俗易懂的语言讲解妊娠分娩…     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Temporal changes in the oxidation state in in vitro blood

The rates at which the paramagnetic compounds deoxyhemoglobin (Hb) and methemoglobin (MHb) form in vivo within an area of hemorrhage are unknown. The present experiment establishes the baseline concentrations and rates of change in paramagnetic hemoglobin concentrations, as well as the pH in normal heparinized and clotted human blood maintained in vitro at 37 degrees C under anaerobic conditions over 30 hours. There was a moderate increase in Hb concentration in normal heparinized blood (average increase was 15.5%, rate = 0.50%/hour) and a slight increase in MHb concentration in the heparinized blood and clots (average increase was 1.4%, rate = 0.044%/hour). A second experiment was done to verify the activity of the RBC systems responsible for maintaining the hemoglobin molecule in the reduced state. Conversion of MHb to Hb in these samples proceeded at a rate of 5.6%/hour. In a third experiment, blood from 11 normal subjects maintained at 4 degrees C 25 degrees C was analyzed for MHb concentration over the course of 28 days. The level of MHb formation remained in the range of normal for at least 11 days in all subjects. The authors conclude that at basal conditions created in vitro, the blood levels of both Hb and MHb remain at relatively low levels. Therefore, if the accumulation of Hb and/or MHb occurs in acute in vivo hematomas it must be driven by intrinsic tissue factors.     

Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.     

新时期军医学院人才培养的思考

在新的历史条件下 ,军医学院迎接未来高技术局部战争的挑战 ,适应部队武器装备的不断更新以及医学科技、社会发展对人才素质提出的新要求 ,必须在更为广阔的时空背景下找准人才培养的着眼点 ,科学确立人才培养方向 ,提高人才培养质量。现就人才培养思考如下 :1　改变教育观念 ,     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。