肾母细胞瘤介入栓塞治疗患儿的护理

目的了解产后家庭访视护理指导对产妇和新生儿安康的影响,解决产后护理问题。方法对996例产妇进行2次家庭访视,检查产妇乳房、会阴和伤口,观察新生儿健康状况,进行脐部护理和预防接种,指导母乳喂养、新生儿抚触和产后运动。结果第1次访视时新生儿和产妇存在不同程度的健康问题,仅有52.01％产妇纯母乳喂养,29．42％产妇及家属进行新生儿抚触。通过护理指导,解决了产妇产褥期和新生儿期存在的护理问题;第2次访视时新生儿和产妇存在健康问题显著减少．乳汁充足、母乳喂养率达90．56％。产后2个月产妇和家属均对婴儿进行了抚触。结论产后家庭访视可及早发现母婴异常问题,降低新生儿发病率;提高母乳喂养率;提高产妇自护能力和护理人员的整体素质;有利于整体护理和新生儿抚触的深入发展。     

临床护理路径在母乳喂养健康教育中的应用

目的提高产妇的母乳喂养率及相关知识知晓率。方法顺产产妇128例随机分为两组,对照组60例采用传统的教育方法进行母乳喂养指导,观察组68例采用以临床护理路径为基础制定的母乳喂养健康教育。观察两组产妇母乳喂养率、相关知识知晓率及对护理服务满意度。结果观察组母乳喂养率100%,相关知识知晓率96%,对护理服务满意度为98%,均明显优于对照组。结论应用临床护理路径对产妇进行母乳喂养健康教育,可提高其母乳喂养率,相关知识知晓率及对护理服务的满意度。     

居家高龄老年人照护需求及满足情况调查

目的了解居家高龄老年人的照护需求及满足情况,为建立合理有效的居家养老服务网络提供参考。方法采用自制居家高龄老年人养老服务需求调查问卷对上海市某社区272名年龄≥80岁老年人进行入户调查。结果188人(69.1%)有照护需求,精神慰藉需求最高(46.7%),其次为生活照料(42.3%)、上门医疗护理(31.2%);陪同外出、临终关怀、志愿者陪伴分别是生活照料、上门医疗护理、精神慰藉需求中满足率最低的项目。结论居家高龄老年人的照护需求较高,但部分项目的满足率较低。为更好地满足其照护需求,应采取措施扩大社区照护资源、扩展精神慰藉途径、提高上门访视的数量及质量,建立专业化的居家养老服务团队。     

浅议产后访视对母婴健康的影响

目的探讨产后访视在产褥期母婴健康中的作用。方法将200例出院的产妇分为访视组和未访视组,了解2组产妇和婴儿的健康状况。结果访视组产妇及婴儿的患病人数明显少于未访视组(P0.05)。结论产后访视可提高产妇的健康水平,保证新生儿的健康成长。     

“互联网+”产后康复护理工作室的初步构建及实践

目的构建"互联网+"产后康复护理工作室,满足产妇不断增长的产后康复服务需求。方法制定"互联网+"产后康复护理工作室制度规范,遴选5名工作室成员,通过互联网提供线上线下产后康复服务。结果 2020年1～3月共进行线上母乳喂养咨询128次,门诊母乳喂养咨询31次,产后盆底肌修复203次,产后塑形指导52次,科学"坐月子"指导24次,婴儿照护75次,心理康复31次,服务对象满意度高达96%。结论 "互联网+"产后康复护理工作室的建立改变了传统服务模式,有效满足产妇的多样化、多层次康复需求,为护理人员实现职业价值提供了更多的可能。     

延续护理对产妇产褥期心境及自我护理能力的影响

目的探讨延续护理对产妇产褥期心境及自我护理能力的影响。方法将425例健康产妇随机分为观察组(212例)和对照组(213例),观察组实施产后延续护理,采用产后电话随访和上门访视相结合的方式,指导产妇产后自我护理和护理婴儿及协助解决产褥期并发症,并提供心理疏导服务等方法;对照组采用一般随访。结果出院后第30天,观察组负性心境得分显著低于对照组,正性心境得分显著高于对照组;观察组自我护理能力及护理水平较对照组显著升高;观察组大部分产褥期并发症发生率较对照组显著下降(P0.05,P0.01)。结论产后延续护理有利于产妇产褥期心境的改善,有效提升产妇的自我护理能力及护理水平,减少产褥期并发症,提高母婴健康水平。     

健康教育对产褥期母婴健康的影响

目的:了解健康教育对产褥期母婴健康的影响.方法:选择本辖区2010-2011年住院分娩,出院后产后访视的产妇620例作为研究对象.结果:第三次访视产妇母乳汁不足,伤口愈合不良,乳头皲裂,乳腺炎,产褥感染,产后抑郁;新生儿口腔粘膜感染,脐部感染,黄疸,红臀,湿疹均明显低于第一次访视.结论:通过健康教育,可降低产褥期产妇及新生儿的发病率,切实保障产妇及新生儿的健康,对提高母婴保健水平具有重要意义.     

产后访视护理干预对产褥期妇女健康信念及生活质量的影响

目的:探讨产后访视护理干预对产褥期妇女健康信念和生活质量的影响.方法:选择在我院产科住院分娩的120例孕产妇为研究对象,采取随机分组法将符合本研究纳入标准的产妇分为A组和B组,A组仅给予产褥期常规产后访视,B组妇女则对产褥期进行产后访视护理干预及实施,观察并比较两组妇女健康信念水平和生活质量.结果:B组妇女健康信念水平和SF-36量表中各维度指标得分均明显高于A组妇女,差异有显著性(P＜0.05).结论:产后访视护理干预能够明显提高产褥期妇女采取相应健康行为的信念,改善产褥期妇女的生活质量,具有积极的临床意义,适合应用于我区产褥期产妇的护理.     

产后康复治疗延伸对产褥期产妇产后康复的临床效果观察

目的探讨分析产后康复治疗延伸对产褥期产妇产后泌乳情况、恶露消失时间和母乳喂养情况的影响。方法基于随机双盲的方法,选取2016年1月至2017年12月在本院住院的产褥期妊娠产妇共计70例,将所有患者分为实验组和对照组各35例,对照组给予常规治疗;实验组在常规治疗之后,再使用低频脉冲治疗仪行催乳、促子宫复旧等治疗,并且采取按摩的手法进行形体恢复、改善阴道松弛状况、分清阴道和肛门括约肌的舒缩、子宫卵巢复旧、产后疲劳恢复等产后康复治疗。在完成上述治疗后,观察并记录产妇的泌乳量、母乳喂养情况和恶露情况,并且进行统计学分析,P0.05表示差异具有显著性。结果实验组中产妇97.2%的产妇泌乳量充足,对照组94.3%的产妇泌乳充足;实验组产妇恶露消失时间(12.59±3.14)天,对照组产妇恶露消失时间(19.55±5.89)天;实验组产妇满意评分(92.66±7.14),对照组产妇满意评分(82.55±5.89);实验组产妇82.9%能够完全母乳喂养,对照组产妇68.6%可以进行完全母乳喂养;上述差异均具有统计学意义(P0.05)。结论产后康复治疗产褥期延伸服务在对于孕产妇的康复应用,有助于促进产后哺乳和产妇康复,对于新生儿和产妇的健康有积极意义,值得推广。     

短视频在父亲支持母乳喂养健康教育中的应用

目的 探讨基于短视频的健康教育在父亲支持母乳喂养中的应用效果。方法 选取103对住院分娩的初产妇及其配偶按照住院时间顺序分组。对照组52对,给予常规健康教育;干预组51对,在常规健康教育的基础上增加基于短视频的健康教育。结果 干预组产后42 d父亲支持母乳喂养自我效能评分、初产妇对配偶参与母乳喂养满意度评分、产后3 d及42 d纯母乳喂养率显著优于对照组（均P<0.05）。结论 基于短视频的健康教育能够提高父亲支持母乳喂养自我效能,提升产妇对配偶参与母乳喂养的满意度,进而促进纯母乳喂养。     

产后家庭访视质量标准的制订与应用

目的落实产后家庭访视举措,提高访视效果。方法由课题组成员在理论研究与实践调研的基础上初拟产后家庭访视质量标准(下称产后访视标准),采用德尔菲法对15名专家进行2轮咨询、筛选与论证;按出院日将产妇286人单号分为观察组(154人)、双号分为对照组(132人),分别行常规访视和采用产后访视标准访视,连续3次时评价效果。结果形成8个一级条目、45个二级条目的产后访视标准;2轮专家咨询问卷的回收率均为100%,专家的权威系数为0.81,第2轮的协调系数为0.567,一致性检验P<0.01。观察组健康教育、访视前后处理、整体服务效果得分显著高于对照组(均P<0.01)。结论产后访视标准内容合理,评分客观,用于产后家庭访视可提高访视效果。     

“互联网+”产后母婴保健咨询服务项目的构建与初步实施

目的 构建线上产后母婴保健咨询服务项目并探讨其实施效果.方法 依托"上海健康云"平台,为出院后产妇提供线上母婴保健咨询服务.结果 2019年12月至2021年2月,167例产妇订购此线上服务,服务平台运行良好,例均咨询1.95次/d;抽取46例用户调查使用体验,服务的有用性和便捷性评分分别为(4.65±0.64)分和(4.59±0.76)分,总体满意度(4.59±0.72)分.结论 "互联网+"产后母婴保健咨询服务项目可根据需求提供专业、及时、针对性强的线上咨询指导,满足产妇居家母婴保健需求.     

The effect of progressive muscle relaxation on the postpartum depression risk and general comfort levels in primiparas

In the postpartum period, mode of delivery, planned pregnancy, rapid changes in estrogen and progesterone hormone concentrations, quality of care, and environmental conditions affect the postpartum depression and comfort of the women. This study was conducted to evaluate the effect of progressive muscle relaxation (PMR) on the postpartum depression risk and general comfort levels in primiparas. A quasi‐experimental design was used with pretest, post‐test, and control group. The intervention and control groups consisted of 35 women each. PMR was applied to intervention group for 8 weeks. There was a statistically significant difference between Edinburgh Postnatal Depression Scale pretest and third follow‐up scores of the intervention group (p < .05). There was a statistically significant difference between the intervention and control groups in the mean General Comfort Questionnaire scores at the first, second, and third follow‐ups (p < .05). PMR may be effective on decreasing the postpartum depression risk and increasing general comfort. PMR could be administered through home visits to help women in postpartum period cope with their mental health problems after discharge.     

Mental disorder in pregnancy and the early postpartum

Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal outcomes, and mental disorder remains one of the leading causes of maternal death in the UK. Women with mental ill health face difficult decisions in balancing risks and benefits of treatment. Stigma related to mental disorder may lead to non-engagement with maternity care. Some disorders bring specific challenges for anaesthetists working in maternity settings and it is vital that anaesthetists have knowledge of these disorders so they may offer care which is sensitive and appropriate.     

产后女性疲乏与气质类型及应对方式的相关性分析

目的了解产后女性的疲乏现状及与气质类型、应对方式的相关性,为产后疲乏管理提供参考。方法采用疲乏评定量表、气质评定量表和应对方式问卷调查136名产后女性。结果存在产后疲乏症状的女性占75.00%,整体属于中度疲乏;产后女性为多血质型气质的占17.65%,胆汁质型69.12%,粘液质型7.35%,抑郁质型5.88%;产后女性采用的应对方式依次为解决问题(0.65±0.21)分、自责(0.47±0.16)分、求助(0.51±0.19)分、幻想(0.47±0.14)分、退避(0.46±0.12)分、合理化(0.40±0.13)分。回归分析显示,胆汁质、粘液质、抑郁质、自责、退避为产后疲乏程度的预测因子(调整R2=0.209)。结论胆汁质和抑郁质型气质、自责、退避型应对方式是产后疲乏的危险因素,医护人员应注意观察产后女性的气质类型和应对方式,预防产后疲乏发生。     

An entrapped epidural catheter in a postpartum patient

Background and Objectives: Epidural catheters are seldom difficult to remove from patients. In fact, a review of the literature demonstrates only a few cases pertaining to epidurals and the unusual complication of catheter entrapment. Methods: This case report involves an uncomplicated obstetric patient who had an epidural placed for labor and in whom multiple attempts were needed to remove the catheter.     

Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage

Limited data exist on platelet transfusion during postpartum haemorrhage. We retrospectively analysed a consecutive cohort from a single centre of 347 women with moderate or severe postpartum haemorrhage, transfused according to national guidelines. Twelve (3%) women required a platelet transfusion. There were no differences between women who did and did not receive platelets with respect to age, mode of initiation of labour or mode of delivery. Women receiving a platelet transfusion had a lower median (IQR [range]) platelet count at study entry than women who did not receive platelets before haemorrhage (135 (97–175 [26–259])×10⁹.l^?1 vs 224 (186–274 [91–1006])×10⁹.l^?1), respectively), and at diagnosis of postpartum haemorrhage (median 114 (78–153 [58–238])×10⁹.l^?1 vs 193 (155–243 [78–762])×10⁹.l^?1 respectively). Six women were thrombocytopenic pre‐delivery. The cause of haemorrhage that was associated with the highest rate of platelet transfusion was placental abruption, with three of 14 women being transfused. If antenatal thrombocytopenia or consumptive coagulopathy were not present, platelets were only required for haemorrhage > 5000 ml. Early formulaic platelet transfusion would have resulted in many women receiving platelets unnecessarily. Using current guidelines, the need for platelet transfusion is uncommon without antenatal thrombocytopenia, consumptive coagulopathy or haemorrhage > 5000 ml. We found no evidence to support early fixed‐ratio platelet transfusion.     

剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血

目的探讨剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血的效果。方法 研究组中央性前置胎盘34例,在暂时阻断子宫血流下行子宫下段和(/或)宫颈内口局部正方形缝合以预防中央性前置胎盘剖宫产后大出血,必要时加行子宫动脉下行支结扎。26例中央性前置胎盘患者为对照组,采用常规方法预防产后出血。结果研究组在平均出血量、平均手术时间、宫腔填纱率、子宫切除率以及产褥病率方面均明显优于对照组(P0.05或P0.01)。术后56~60 d B超检查两组子宫复旧情况,研究组32例(94.1%)子宫复旧良好,对照组20例(90.0%)恢复正常,组间比较无统计学差异(P0.05)。结论该方法具有安全、止血快、效果可靠、能保留子宫等优点,是预防中央性前置胎盘剖宫产出血的可靠方法。