剖宫产术后再次妊娠的人工流产现状分析

目的:了解海淀区妇幼保健院2004年7月～2008年12月剖宫产术后宫内早期妊娠的人工流产现状,为剖宫产术后再次妊娠的高危管理提供依据。方法:对7 355例剖宫产术后再次宫内早期妊娠行人工流产患者的年龄、职业、户籍、文化程度、避孕措施、人流距剖宫产时间等临床资料进行回顾性分析。结果:①剖宫产后各年龄段患者人工流产率(已婚患者为基数)不同,≤25岁及41≥岁组较低,分别为10.15%及11.98%;26～30岁、31～35岁及36～40岁组较高,分别为20.96%、22.52%及22.02%,≤25岁及41≥岁两组与26～30岁、31～35岁及36～40岁三组间比较差异有统计学意义(P<0.000 1);②本地户籍及有固定职业的剖宫产术后患者人工流产率较低,分别为8.79%及9.83%,非本地户籍及无固定职业的剖宫产术后患者人工流产率较高,分别为23.36%及16.84%,经比较差异有统计学意义(P<0.000 1);③小学及以下文化程度者人工流产率低(10.15%),初中及以上各文化程度患者人工流产率较高,分别为20.96%、22.52%及22.02%,小学及以下文化程度与初中及以上各段文化程度比较差异有统计学意义(P<0.000 1);④避孕失败者1 312例,人工流产率5.65%;未避孕者6 043例,人工流产率14.61%,两者间比较差异有统计学意义(P<0.000 1);⑤此次人流距剖宫产时间间隔≤6个月、6+～12个月、12+～24个月及≥24个月的人工流产率分别占总百分比的5.96%、16.07%、42.26%及34.94%。结论:加强对剖宫产术后高危流动人口、高危年龄段患者的管理,大力宣传剖宫产后的避孕知识及非意愿妊娠的危害,剖宫产后半年及时落实安全有效的避孕措施,对降低剖宫产后人工流产率意义重大,从而保障妇女生殖健康。     

122例过敏性紫癜的临床分析

目的 提高对过敏性紫癜(HsP)的临床认识和诊治水平,探讨肾损害的高危因素.方法 对2003年12月～2007年12月间1 22例HSP住院患者的临床特点进行总结分析.结果 发病季节冬春季占77.05%.发病年龄多为学龄前和学龄期儿童,3～14岁占81.14%.主要诱因感染占45.05%.多数病人以双下肢紫癜为首发表现占66.39%,部分病人以消化道症状及关节肿痛为首发表现,分别占18.85%、14.75%.以消化道症状及关节肿痛为首发表现者易误诊,误诊率18.03%.紫癜多在1个月内消退.34.43%病人有肾损害.紫癜超过1月者,肾损害占84.61%,复发者肾损害占88.89%,3例患者因紫癜严重导致皮肤坏死,此3例患者均有肾损害.结论 HSP好发于学龄前和学龄期儿童,冬春季多见,感染为主要诱因,以消化道症状与关节肿痛为首发表现者易误诊,HSP病人易出现肾损害,紫癜持续时间长、复发、紫癜严重可能是肾损害的高危因素.     

重症监护室呼吸机相关性肺炎病原菌分析及护理对策

目的:探讨呼吸机相关性肺炎(VAP)发生的原因及护理对策。方法:收集重症监护室内行机械通气患儿31例,其中符合VAP诊断标准19例,对其进行临床资料、病原菌分布情况分析。结果:重症监护室VAP发生率62%(19/31),病死率13%(4/31),病原菌的阳性率100%,其中G-菌占89%。结论:积极做好重症监护室内常规护理的同时,应严格掌握有创机械通气指征,提倡早期无创机械通气及有创与无创序贯性机械通气是减少重症监护室内呼吸机相关性肺炎发生的关键。     

针对3类艾滋病高危人群的健康传播方式研究

目的探索艾滋病高危人群健康传播的有效途径，提高健康传播的效果。方法问卷调查和个人访谈相结合，采用方便抽样的方法调查了203名暗娼和154名吸毒人群，采用整群抽样的方法调查了178名既往有偿献血人群。结果暗娼希望从医生处获得更多的艾滋病防治知识，吸毒人群希望从艾滋病防治人员处获得更多的艾滋病知识，既往有偿献血者希望通过文艺节目获得艾滋病知识。结论要想提高艾滋病健康教育传播效果，必须针对不同人群采取不同传播方式。     

湖北省4类艾滋病高危人群高危行为分析

[目的]通过分析湖北省全球基金艾滋病项目基线调查资料,了解湖北省4类艾滋病高危人群高危行为情况。[方法]采用描述性分析方法对艾滋病高危人群的高危行为进行对比。[结果]4类高危人群最近1次性行为安全套使用率平均为52.5%,暗娼人群安全套使用率最高,为92.8%,吸毒者和性病门诊就诊者次之,为26.7%,有偿献血人群最低,为22.3%。高危人群在过去3个月内发生性行为总是使用的人占17.1%,暗娼过去3个月性行为安全套使用率最高,总是使用的占65.4%;性病患者在过去3个月与非婚性伴发生性行为总是使用的有8.8%。暗娼人群中吸毒率为0.94%。吸毒者有24.9%采取口吸的方式,60.3%采取注射方式。性病门诊就诊者中吸毒率为0.48%,并且3种吸毒方式都存在。[结论]安全套使用项目应该扩大高危人群覆盖面,并加强健康教育的力度,降低艾滋病高危人群的高危行为。     

原发性肝癌高危人群的筛查及可行性分析

肝癌高危人群标准的确立以及选择有效的筛查方法、制订正确地筛查规程对肝癌的早发现、早诊断、早治疗,降低肝癌死亡率,节约筛查资源都有重要作用.现今生物学和影像学技术的迅速发展、影像学设备的更新换代以及经济的发展都为肝癌的筛查提供了强有力的保障,使肝癌的筛查成为可行.     

硒与高危妊娠病理生理的关系

硒(Se)是人体必需的微量矿物质,对妊娠有着极其重要的作用。Se是含硒蛋白的一个组分,有维持酶蛋白催化功能的作用。Se缺乏可诱发妊娠高血压疾病,妊娠肝内胆汁淤积症,胎儿宫内发育迟缓,羊水过少,胎膜早破等高危妊娠的发生。增加硒摄入可降低高危妊娠的危险度。     

Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia

Background

There is considerable debate regarding the optimal management of congenital diaphragmatic hernia (CDH) in high-risk infants (those cases presenting with respiratory distress within 2 hours of birth or those diagnosed prenatally). The aim of this study was to analyze patient outcomes using a new treatment protocol for CDH in a tertiary care non-extracorporeal membrane oxygenation (ECMO) neonatal unit.

Methods

The records of 78 consecutive neonates with CDH presenting to Bambino Gesù Children’s Hospital from 1996 to 2001 were analyzed retrospectively. Of these infants, 70 high-risk patients were identified (prenatal diagnosis or respiratory distress requiring intubation and assisted ventilation within 2 hours after birth), regardless of associated anomalies, medical condition on presentation, or degree of pulmonary hypoplasia. A prenatal diagnosis was made in 46 of 70 (66%) patients. Associated lethal malformations were present in 6 of the children (8.5%). The patients were placed in 3 historical groups: group 1, 19 patients from 1996 to 1997, group 2, 22 patients from 1998 to 1999, and group 3, 29 patients from 2000 to 2001. In the first 2 groups, a new protocol was introduced using inhaled nitric oxide (iNO) and high-frequency oxygen ventilation (HFOV). In the third group, gentle ventilation and permissive hypercarbia were also used routinely. Mortality and severe morbidity—defined as O₂ requirement at discharge, need for a tracheostomy, neurologic impairment, or bilateral hearing loss—were evaluated when the patients were at 6 months old. Univariate analysis was performed.

Results

The 3 groups were comparable with respect to predictive risk factors such as side of hernia, prenatal diagnosis, polyhydramnios, stomach and liver in the thorax, associated lethal malformations, and patch. Overall survival rate significantly increased from 47% (9 of 19) in group 1 and 50% (11 of 22) in group 2 to 90% (26 of 29) in group 3 (P = .02). None of the 19 patients in group 1 had severe morbidity compared with 2 of 22 (9%) patients in group 2 and 2 of 29 (7%) patients in group 3. Hearing loss was observed in 4 patients. Mortality rate and preoperative pneumothorax significantly decreased in group 3 compared with groups 1 and 2 (P = .03 and P = .00, respectively).

Conclusions

(1) The application of new treatment protocol for CDH, using gentle ventilation and permissive hypercarbia, produced a significant increase in survival with concomitant decrease in morbidity. (2) The rate of pneumothorax was significantly decreased by the introduction of permissive hypercarbia and gentle ventilation. (3) As more infants survive CDH without the use of ECMO, severe long-term sequelae of CDH can be recognized in these children.     

Effects of dopexamine,dobutamine or dopamine on prolactin and thyreotropin serum concentrations in high-risk surgical patients

Objectives Catecholamines are often used for optimisation of cardiac index and oxygen delivery in high-risk surgical patients; however, infusions of dopamine and dopexamine are associated with dose-dependent hypophysiotropic and thyreotropic properties. The objective was to compare endocrine effects of equipotent inotropic doses of dopexamine, dobutamine and dopamine on prolactin and thyreotropin release perioperatively.Design A prospective, randomised, blinded clinical trial.Setting Adult surgical intensive care unit in a university hospital.Patients Thirty male patients (ASA III) undergoing elective major abdominal surgery.Interventions Patients were randomised to receive dopexamine (DX, n=10), dobutamine (DO, n=10) or dopamine (DA, n=10) on the first postoperative day for 8 h.Measurements and results All patients received a catecholamine infusion in doses adjusted to increase cardiac index by 35% within the first hour. Blood samples were obtained and prolactin and thyreotropin serum concentrations were determined by radioimmunoassays. Mean doses of dopexamine, dobutamine and dopamine used were 0.73±0.27, 4.06±1.95 and 5.0±1.84 µg kg^–1min^–1, respectively. Cardiac index was increased by 36% (DX group), 38% (DO group) and 38% (DA group). Alterations of oxygen delivery and oxygen consumption were not significantly different between the study groups. Dopexamine and dobutamine had no hypophysiotropic effects. In contrast, dopamine suppressed prolactin and thyreotropin secretion with a maximal effect after 4 h. After dopamine withdrawal, a rebound release of prolactin and thyreotropin was observed.Conclusions In high-risk surgical patients dopexamine or dobutamine produced fewer effects on prolactin and thyreotropin serum concentrations in comparison with DA when used in equivalent dosages.     

Patterns of treatment failure following radiotherapy with combination chemotherapy for patients with high-risk stage IIB cervical carcinoma

Background To evaluate the patterns of treatment failure in patients with stage IIB cervical carcinoma with high-risk factors following radiotherapy given concurrently with combination chemotherapy.Methods A retrospective analysis of 349 patients with stage IIB cervical carcinoma with high-risk factors (lesion size 4cm, lymph node metastasis, high-risk cell type) treated by radiotherapy and cisplatin-based chemotherapy was performed. Sites of treatment failure were categorized as pelvic, pelvic plus distant metastases, and distant metastases alone. Pelvic failure included local and pelvic nodal failures.Results Of the 349 patients, treatment failure occurred in 79 patients (22.6%). Forty-six (13.2%) had persistent disease and 33 (9.5%) had recurrent disease. Among these 79 patients, overall pelvic failure was observed in 67%, of whom 72% had local failure; 19%, pelvic nodal failure; and 9%, local with pelvic nodal failure. Incidences of distant metastases alone and pelvic with distant metastases were 24% and 9%. In the 26 patients with distant metastases either alone or combined with pelvic failure, the most frequent metastatic region was the paraaortic lymph node (50%). The distant metastasis rate was 6.5% (19/289) in the pelvic tumor control group and 11.6% (7/60) in the pelvic failure group. Pelvic failure was the most frequent failure in the group with tumor size of 4cm or more, whereas, for the positive-lymph-node group, distant metastasis was most frequent and metastases to paraaortic lymph nodes were common. The incidences of pelvic failure alone and distant metastases were similar in the high-risk cell-type group, and the distant metastasis regions were mostly paraaortic lymph nodes.Conclusion Although systemic chemotherapy was administered concurrently with radiotherapy, the incidence of pelvic failure was highest, followed by paraaortic lymph node metastases, in patients with stage IIB cervical carcinoma with high-risk factors, following radiotherapy with combination chemotherapy.