生长抑素联合奥美拉唑治疗上消化道出血的临床分析

目的：探讨生长抑素联合奥美拉唑治疗上消化道出血的临床效果。方法整群选取该院2013年1月＿2016年5月期间收治的79例上消化道出血患者,将其随机分为研究组(40例﹚和对照组(39例﹚,研究组采取生长抑素联合奥美拉唑治疗,对照组单纯采取奥美拉唑治疗,比较两组止血时间、住院时间等。结果研究组平均止血时间(12.9±5.3﹚h、住院时间(10.4±2.2﹚d与对照组比较差异有统计学意义,P﹤0.05；研究组总有效率90.0%、再出血率12.5%与对照组比较差异有统计学意义,P﹤0.05。结论生长抑素联合奥美拉唑治疗上消化道出血效果确切,优于单纯使用奥美拉唑效果,值得临床推广。     

肾盂尿培养联合炎症指标对经皮肾镜碎石术后尿路感染的诊断价值

目的探讨经皮肾镜碎石术后,肾盂尿培养联合血清和肽素及IL-6水平对尿路感染的诊断价值。方法选取2015年6月-2018年6月于遵义医科大学附属医院行经皮肾镜碎石术的住院患者201例,根据术后尿路感染情况分为感染组32例及非感染组169例。术前中段尿、术中肾盂尿进行细菌培养,术后第1天采用酶联免疫吸附法检测血清和肽素及白细胞介素-6(Interleukin-6,IL-6)水平,比较上述指标单独及联合对术后尿路感染的诊断价值。结果感染组与非感染组术前中段尿细菌培养阳性率分别为15.63%和14.79%,差异无统计学意义(χ^2=1.218,P=0.270);感染组肾盂细菌培养阳性率为81.25%,高于非感染组的3.55%,差异有统计学意义(χ^2=121.349,P<0.001)。感染组和肽素及IL-6水平高于非感染组,差异有统计学意义(P<0.001)。肾盂尿培养、血清和肽素及IL-6联合诊断PCNL术后尿路感染敏感性为90.65%,特异性为86.44%,AUC为0.873±0.039,高于肾盂尿培养、和肽素、IL-6单独诊断水平(P<0.05)。结论术中肾盂尿培养较术前中段尿培养价值高,且血清和肽素、IL-6及肾盂尿培养联合诊断可提高诊断准确率。     

子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用价值

目的探讨子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用效果及安全性。方法回顾性分析2011年6月至2015年6月绵阳市妇幼保健院收治的中央型前置胎盘患者90例的临床资料,根据止血方式将其分为观察组(54例)与对照组(36例),对照组产妇采取常规止血治疗,观察组产妇在剥离胎盘前及子宫局部处理或全切除前,迅速使用一次性硅胶尿管环扎子宫下段阻断子宫体血液供应,在子宫体血运阻断后进行常规止血操作,术后放开环扎尿管恢复子宫血供(排除子宫已切除患者),比较两组产妇治疗效果及临床结局。结果两组产妇干预前出血量比较差异无统计学意义(P0.05);观察组产妇卡前列素氨丁三醇用量、术中总出血量、总输血量、子宫切除率明显低于对照组,差异有统计学意义(P0.05);两组患者止血成功率均为100%;两组患者子宫坏死、切口感染、宫腔积血等并发症发生率比较,差异无统计学意义(P0.05)。结论子宫下段暂时性环扎术治疗前置胎盘分娩术中出血患者,止血效果较好,能迅速降低术中出血量,有效减少患者药物应用及输血量,止血成功率较高,同时子宫坏死等并发症发生率较低,应用安全性较高。     

功能失调性子宫出血的发病机制及治疗进展

功能失调性子宫出血(功血)是一种常见的妇科内分泌疾病,近年来其发病率逐年上升。其发病机制不明,可能包括神经内分泌功能失调和子宫内膜局部微环境异常两个方面。功血的治疗主要分为药物治疗及非药物治疗,后者包括左炔诺孕酮宫内释放系统、诊断性刮宫术、子宫内膜去除术、介入治疗及子宫切除术。其中高强度聚焦超声子宫内膜去除术是一种新兴技术,可在临床中进一步推广应用。     

Anesthesiologic management of major obstetrical hemorrhage

Postpartum hemorrhage (PPH) remains a considerable burden on maternal morbidity and mortality, accounting for 80% of severe maternal morbidity. Although a consensus on definitions on major obstetrical bleeding is lacking, postpartum blood losses greater than 500 ml after vaginal delivery and 1000 ml after cesarean section is considered as postpartum hemorrhage; a blood loss greater than 2500 ml is considered as severe postpartum hemorrhage.The definition of major obstetrical hemorrhage (MOH) is a broader term characterizing antenatal or postpartal bleeding. Approximately only 10% of MOH is predictable, as etiologies and risk factors leading to MOH are still poorly understood. This lack of predictability may result in delays for initiation of proper anesthesiologic management of MOH. The quantity of blood loss, combined to the rapidity in which blood loss happens in case of MOH remains an important challenge anesthesiologic teams otherwise usually face only in major vascular or trauma surgery.Preservation of maternal fertility is one of the major aims after maternal and neonatal resuscitation has been granted. Drugs used to increase uterine tone are reviewed in detail, as well as surgical measures available today.Fortunately lessons learned from trauma management have been implemented in major MOH protocols. Not only is maternal and neonatal well being the primary aim to keep in sight, preservation of fertility whenever possible is the next aim anesthesiologists are facing.     

A Snapshot of the Guidelines on Vesicoureteral Reflux in Children

The main goal in the management of patients with vesicoureteral reflux (VUR) is the preservation of kidney function by minimizing the risk of pyelonephritis. By defining and analyzing the risk factors for each patient depending on age, sex, grade of reflux, lower urinary tract dysfunction, anatomic abnormalities, and kidney status, it is possible to identify those patients with a potential risk of upper urinary tract infection and resulting renal scarring. This paper gives a brief overview of the European Association of Urology guidelines for the management and treatment of VUR in children. These guidelines are based on the best currently available knowledge and evidence.     

对因护理对消化道溃疡患者健康行为及复发率的影响

目的探讨对因护理对消化道溃疡复发率、患者健康行为的影响。方法回顾性分析本院2010年1月—2012年6月收治的320例消化道溃疡患者的临床资料。随后选取本院2012年7月—2014年6月收治的220例消化道溃疡患者作为研究对象,其中观察组针对引起消化道溃疡复发的危险因素进行对因护理,对照组则给予常规护理,比较2组患者复发率及健康行为依从性。结果不良生活习惯、不良饮食习惯、不良情绪、服NSAIDs、用药依从性差、春秋季节是引起消化道溃疡复发的危险因素(P0.01);观察组护理后健康生活方式、健康饮食、遵医嘱用药依从性分别为75.45%、86.36%、89.09%,均显著优于护理前(P0.01),而与对照组护理后比较,观察组健康行为依从性更好(P0.05或P0.01);观察组护理后6个月、1年复发率分别为2.73%、4.55%,均显著低于对照组(P0.01)。结论对引起消化道溃疡复发的危险因素进行对因护理可有效降低消化道溃疡复发率,提高患者健康行为依从性,值得临床推广应用。