202例产褥期妇女便秘的护理

目的探讨产褥期妇女便秘发生的相关因素。方法将202例产褥期妇女随机分为两组,治疗组采取综合护理措施(健康宣教、运动、饮食、心理等),对照组采取一般护理措施,比较两组治疗后便秘的改善情况。结果治疗组便秘的改善情况优于对照组。结论综合护理措施能使产褥期妇女便秘发生率明显下降。     

实施平价产房临床路径效果分析

目的评价平价产房临床路径实施效果,为产妇选择最佳的医疗管理模式。方法将2008年9月-2009年3月在我院产科进行分娩的127例产妇随机分为两组．一组采用临床路径（CP）,另一组继续采用传统的诊疗方法。比较两组间的住院天数、平均住院费用、顾客满意度。结果实施临床路径后,产妇的住院天数明显缩短,平均住院费用下降,顾客满意度明显提高,两组比较皆有统计学意义。结论实施平价产房临床路径后．有效控制了产妇分娩的医疗费用减轻了群众住院负担。     

早产儿出院后配方奶喂养有营养不良高危因素早产儿的疗效

目的观察早产儿出院后配方奶对具有营养不良高危因素的早产儿出院后喂养的效果。方法采用前瞻性研究,以2005年九省市中国儿童生长标准为对照,对具有营养不良高危因素的100例早产儿出院后采用早产儿出院后配方奶喂养,定期进行生长发育检测,当生长参数(头围、身高、体重)均达到相当月龄生长曲线第25百分位者即转换婴儿配方奶或者母乳,探索喂养时间的长短。矫正年龄1岁时,以头围、身高、体重作为评判指标,将生长指标≤P10(生长曲线第10百分位)定义为宫外生长发育迟缓,分别记录其发生率;应用贝利婴幼儿发展量表评估其智力发展指数与运动发展指数。结果本组病例中无退出病例,最短的喂养时间为4个月即转换奶粉,最长的喂养时间是12个月才转换奶粉,大部分为喂养7～11个月即转换奶粉,其中以喂养10月转换奶粉者为最多,为32例。矫正年龄1岁时以头围、身高、体重作为评判指标,宫外生长发育迟缓分别为3%、2%、2%,智力发展指数平均为(92.26±9.84),运动发展指数为(90.04±8.84)。结论早产儿出院后配方奶对具有营养不良高危因素的早产儿出院后喂养的效果较好,大部分喂养7～11个月即能够帮助其实现追赶性生长,矫正年龄1岁体格发育与神经系统发育大致正常。     

Molecular genetic studies of bipolar disorder and puerperal psychosis at two polymorphisms in the estrogen receptor α gene (ESR 1)

A number of lines of evidence point to the possible involvement of estrogen pathways in the pathophysiology of bipolar disorder in general and puerperal psychosis in particular. There is strong evidence from clinical, follow‐up, and genetic studies to support the hypothesis that most cases of puerperal psychosis are manifestations of an affective disorder diathesis with a puerperal trigger and that genes influence susceptibility to both diathesis and trigger. The nature of the trigger is unknown but in view of the abrupt onset at a time of major physiological change it is widely believed that biological, probably hormonal, mechanisms are of paramount importance, with estrogen receiving the most attention to date. We have undertaken a case control association study of bipolar disorder and puerperal psychosis at two known polymorphisms within the estrogen receptor α gene (ESR 1) in a sample of 219 unrelated bipolar probands and 219 controls. We could exclude these polymorphisms from an important contribution to susceptibility to bipolar disorder with a high level of confidence. We found no support for the hypothesis that they contribute specific susceptibility to the puerperal trigger, but due to the small numbers of puerperal probands (n = 26) no firm conclusions can be drawn regarding their involvement in puerperal psychosis. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:850–853, 2000. © 2000 Wiley‐Liss, Inc.     

Dopamine efflux in the rat nucleus accumbens evoked by dopamine receptor stimulation in the entorhinal cortex is modulated by oestradiol and progesterone

This study compared the effects of dopamine receptor stimulation in the entorhinal cortex on dopamine release in the nucleus accumbens, measured by in vivo microdialysis in conscious Sprague-Dawley rats, with and without oestradiol and progesterone priming. Nonselective dopamine receptor stimulation with apomorphine reduced dopamine release in the nucleus accumbens, an effect which was prevented by injection of cis-flupenthixol into the entorhinal cortex. Selective D₁ receptor stimulation with SKF38393 increased dopamine release, whereas selective D₂ receptor stimulation with quinpirole did not affect dopamine release. Combined administration of oestradiol and progesterone potentiated the response to apomorphine and prevented the response to SKF38393. The effects of single hormone administration on the response to apomorphine suggested that the modulation was primarily due to oestradiol enhancing effects of progesterone. Experiments with high [K⁺] suggested these hormonal effects were exerted predominantly in the entorhinal cortex. The present experiments have demonstrated that dopaminergic modulation of transmission in a cortico-striatal loop linking temporal and prefrontal cortex is regulated by oestradiol and progesterone. Dysfunction in this system in humans may give rise to affective and cognitive symptoms which may, if initiated by a postpartum fall in oestrogen and progesterone concentrations, constitute the core pathophysiology of puerperal psychosis. Synapse 25:37–43, 1997. © 1997 Wiley-Liss, Inc.     

赵瑞华教授治疗产后身痛经验

产后身痛是指产褥期内出现肢体或关节酸楚、疼痛、麻木、重着，日久不愈，延续至产褥期以后者。文章总结了赵瑞华教授治疗产后身痛的经验，赵教授谨遵产后身痛“气虚百节开张”的病机特点，治疗以调补脾胃气血、调和营卫阴阳、调畅气机升降为关键，兼以散寒除湿，活血止痛，通阳除痹等，临床疗效显著，并附验案2则详述。     

基于奥马哈系统延续护理服务对产褥期妇女健康商数水平的影响

目的 探索基于奥马哈系统的延续护理服务系统对产褥期妇女健康商数水平的影响。方法 采用方便抽样法选取湘潭市某三级医院在2022年10月-2023年1月期间分娩的92例产妇为研究对象,随机分为实验组和对照组,实验组采用基于奥马哈系统的延续护理,对照组采用常规延续护理。结果 出院前1天,实验组和对照组健康商数分别为61.57±12.84、62.63±10.57,差异无统计学意义。产后42天实验组和对照组健康商数分别为74.35±9.16、68.07±12.11,实验组明显高于对照组,且具有统计学意义。结论 基于奥马哈系统的延续护理服务比常规延续护理效果显著,可明显提高产褥期妇女的健康商数。     

早产儿出院后随访研究热点北大核心CSCD

早产儿,特别是极、超早产儿是生长迟缓和神经发育障碍的高危人群,出院后的定期随访、早期干预和及时的追赶性生长是提高早产儿生活质量、改善人口素质的重要保障。该文概览了近2年国内外在早产儿出院后随访管理方面的研究热点,包括早产儿出院后随访模式、营养代谢和体成分随访、生长模式随访、神经发育随访、早期干预等内容,以期为国内同行提供临床指导和研究思路。     

Mineralocorticoid receptor antagonist initiation during admission is associated with improved outcomes irrespective of ejection fraction in patients with acute heart failure

Aims

Heart failure (HF) guidelines recommend initiation and optimization of guideline-directed medical therapy, including mineralocorticoid receptor antagonists (MRAs), before hospital discharge. However, scientific evidence for this recommendation is lacking. Our objective was to determine whether initiation of MRA prior to hospital discharge is associated with improved outcomes.

Methods and results

We performed a secondary analysis of 6197 patients enrolled in the RELAX-AHF-2 study. Patients were divided into four groups according to MRA therapy at baseline and discharge. At baseline 30% of patients received MRA therapy, which increased to 50% of patients at discharge. In-hospital initiation of an MRA was observed in 1690 (27%) patients, 1438 (23%) patients remained on MRA therapy, 418 (7%) patients discontinued MRA treatment, and 2651 (43%) patients did not receive an MRA during hospital stay. Compared with patients who did not receive MRA therapy, in-hospital initiation of an MRA was independently associated with lower risks of mortality (multivariable hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60–0.96; p = 0.02), cardiovascular death (HR 0.77, 95% CI 0.59–1.01; p = 0.06), hospitalization for HF or renal failure (HR 0.72, 95% CI 0.60–0.86; p = 0.0003) and the composite endpoint of cardiovascular death and/or rehospitalization for HF or renal failure (HR 0.71, 95% CI 0.61–0.83; p < 0.0001) at 180 days. These results were independent of baseline left ventricular ejection fraction.

Conclusion

In patients hospitalized for acute HF, in-hospital initiation of an MRA was associated with improved post-discharge outcomes, independent of left ventricular ejection fraction and other potential confounders.