社区产褥期妇女采用通络催乳套路疗法的研究

目的探讨通络催乳套路疗法在社区产褥期对产妇和婴儿的临床效果。方法采用系统抽样法选取社区产褥期妇女200例,随机分为治疗组和对照组,每组各100例。治疗组在对照组基础上采用通络套路疗法,比较两组产妇的乳汁充盈时间、哺乳次数、哺乳方式、产妇情况和婴儿情况。结果产妇的喂养方式、产妇恶露排尽时间、每天哺乳次数和产妇睡眠时间、婴儿黄疸消退时间和婴儿每次睡眠时间的差异有统计学意义(P0.05);婴儿在产后42天、42～60天和≥60天生病次数的差异无统计学意义(P0.05)。结论通络套路疗法能够促进产妇乳汁分泌、催乳成功和保证乳房充盈度,但对婴儿生病次数无影响。这种深入家庭的中医保健治疗方法值得在社区推广。     

Oestrogen withdrawal associated psychoses.

OBJECTIVE: Oestrogen withdrawal has been hypothesized as playing a causal role in puerperal psychoses. However, oestrogen withdrawal exists in conditions others than puerperium. We searched the published case reports where a decrease in oestrogen levels not occurring during puerperium was associated with a psychotic disorder, in order to evaluate the relevance of this hypothesis. These cases were defined as oestrogen withdrawal associated psychoses. METHOD: A systematic research of the literature was conducted for the period 1960-2000. RESULTS: We identified 26 observations reporting an association between a psychotic disorder and a phase of oestrogen withdrawal. Psychotic episodes were short and reversible with recurrences reported when oestrogen withdrawal recurred. Puerperal psychosis was frequently reported in the history of patients. CONCLUSION: The oestrogen withdrawal hypothesis can be extended to certain psychotic episodes not occurring during in puerperium. This provides an additional argument for the clinical relevance of oestrogen withdrawal in puerperal and related psychoses.     

产褥期促进产妇康复的护理研究进展

产褥期是妇产分娩后身体各器官复原的一个重要时期，产妇身体恢复的好坏关系到其一生的健康与幸福，也是新生儿健康成长及母乳喂养是否成功的关键时期。随着社会经济的发展和人民生活水平的提高，产后促进产妇康复已日益受到普遍重视，逐渐成为研究的热点问题之一。本文综合有关资料，探讨如何促进产褥期产妇的产后康复，提高生活质量和促进母乳喂养成功的保健新模式，旨在使产褥期产妇能得到更高质量的保健服务。     

Delirium in Hospitalized Elderly Patients and Post-Discharge Mortality

OBJECTIVE:

To determine the impact of delirium on post-discharge mortality in hospitalized older patients.

INTRODUCTION:

Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality.

METHODS:

This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium) and group B (without delirium). One year after discharge, the patients or their caregivers were contacted to assess days of survival.

RESULTS:

The sample included 199 patients, 66 (33%) of whom developed delirium (Group A). After one year, 33 (50%) group A patients had died, and 45 (33.8%) group B patients had died (p = 0.03). There was a significant statistical difference in average age (p = 0.001) and immobility (p <0.001) between groups A and B. There were no statistically significant differences between groups A and B in number of drugs taken greater than four (p = 0.62), sex (p = 0.54) and number of diagnoses greater than four (p = 0.21). According to a multivariate analysis, delirium was not an independent predictor of post-discharge mortality. The predictors of post-discharge mortality were age ≥ 80 years (p = 0.029), albumin concentration < 3.5 g/dl (p = 0.001) and immobility (p = 0.007).

CONCLUSION:

Delirium is associated with higher post-discharge mortality as a dependent predictor.     

剖宫产产后出血相关因素分析

目的分析剖宫产产后出血相关因素,探讨对它的处理和预防措施。方法对该院2003年1月￣2004年12月期间剖宫产产后出血51例病例进行回顾性分析。结果分娩总人数2778例,产后出血74例,发生率2.66%,其中剖宫产(A组)771例,产后出血51例,发生率为6.61%,阴道分娩(B组)2007例,产后出血23例,发生率为1.14%,A组明显高于B组(P<0.01),差异有显著性,A组产后出血51例,平均出血量为(1173±985)mL,B组产后出血23例,平均出血量为(682±333)mL,A组明显高于B组,P<0.01,差异有显著性。剖宫产产后出血51例中主要手术指征,前6项依次为瘢痕子宫、巨大儿、前置胎盘、胎方位异常、胎儿窘迫、社会因素。产后出血原因:宫缩乏力占54.9%,胎盘因素占25.9%,子宫下段切口裂伤占19.6%。结论剖宫产产后出血率及产后出血出血量均明显高于阴道分娩者,严格把握剖宫产指征及尽量减少无指征剖宫产手术,以达到降低产后出血率。     

Menstrual psychosis

This paper reviews some of the literature on menstrual psychosis, and proposes a new classification, adapting that of v. Krafft-Ebing (1902) and Jolly (1914). The world literature consists almost entirely of case reports; they include a few with statistical evidence of an association between the onset of psychosis and menstruation, and many other claims with less solid evidence. The complete cases include those with premenstrual, catamenial, paramenstrual and mid-cycle onsets, and continuous phasic illnesses with switches in rhythm with the menstrual cycle. In affected women, psychosis complicates only a small number of cycles, which seem to be concentrated around the menarche and after childbirth. The clinical picture resembles puerperal psychosis, with which it has often been associated. Nosologically menstrual psychosis seems to fall under the manic depressive rubric. Menstruation is one of a family of triggers linked to female reproduction. The evidence for an association with anovulatory cycles suggests that a relative excess of oestrogen may be implicated in the pathogenesis.     

孕产妇死亡高发原因及干预措施

目的:分析凤凰县1991-2002年孕产妇死亡原因,寻求有效降低孕产妇死亡的干预措施。方法:利用妇幼卫生监测网络,收集统计孕产妇死亡资料。结果:1991-2002年孕产妇死亡率为233.21/10万,12年间孕产妇死亡率一直居高不下。前5位死因分别为产科出血、产褥感染、妊娠合并心脏病、妊高征、羊水栓塞。结论:孕产妇死亡高发原因与当地特定的历史环境因素有关。降低孕产妇死亡率的干预措施是政府领导重视,全社会参与,大力开展健康教育,提高文化素质,取消家庭接生,提倡住院分娩。     

1998～2002年6731例重度高危妊娠管理探讨

为了有效地保证母婴安全 ,在做好孕产妇系统管理的基础上 ,加强高危妊娠的管理 ,特别是对重度高危妊娠的管理 ,慈溪市从 1998～ 2 0 0 2年 5年中对重度高危妊娠孕妇实行个案报告制 ,发现重度高危妊娠 6 731例 ,上报个案报告卡 74 87份 ,对此进行分析探讨 ,通过一系列高危妊娠的干扰措施 ,及时筛选、追踪等规范管理 ,从而降低了孕产妇死亡率 ,而且无一例因高危妊娠管理失误而导致死亡     

54例晚期产后出血的临床分析

1980年9月—1988年8月,我院10380例分娩中有晚期产后出血(LPH)54例,占0.52％;有人工流产既往史者的发生率高于无人工流产史者。54例LPH出血原因有胎盘残留22例,感染30例,子宫下段横切口裂开1例,阴道血肿1例,均治疗痊愈。遇有患者产后红恶露淋漓不净和子宫复旧不良,应提高警惕,B型超声监测有助于诊断与处理。