剖宫产术中胎头娩出困难174例临床分析

目的:总结剖宫产术中胎头娩出困难的原因及处理方法。方法:回顾性分析174例剖宫产术中胎头娩出困难患者的临床资料。结果:剖宫产术中是否存在胎头娩出困难与腹部切口方式、先露高低、新生儿体重,麻醉效果、产妇肥胖、术者手术熟练程度等有关。结论:针对剖宫产术中胎头娩出困难发生的不同原因,采取不同的处理方法,可有效的确保母婴安全。     

母婴同室护理体会

创建爱婴医院,实行母婴同室是促使母乳喂养成功的重要新举措.胎儿娩出后交婴儿室护理,是产科传统管理方法,我院对该方法进行了改革,实行平产母婴同室护理,从2010年1月至2010年12月共母婴同室护理180例,收到较好效果,早期频繁吸吮有助于尽早下奶,让婴儿吸吮到营养和免疫价值极高的初乳,尽早促使胎粪排出,使血中胆红素水平降低减少病理黄疽[2].我院母乳喂养率达95%,婴儿黄疽率有原来的50%下降到2%.     

神经源性膀胱并发上尿路损害患者膀胱漏尿点压测定的意义

目的探讨神经源性膀胱并发上尿路损害患者膀胱漏尿点压的变化。方法对33例神经源性膀胱患者先行泌尿系统的B超或静脉肾盂造影检查,再行尿动力学检查的膀胱漏尿点压测定。结果 21例上尿路损害患者中,20例膀胱漏尿点压〉40cmH2O,明显高于正常值。而12例无上尿路损害患者,膀胱漏尿点压均〈40cmH2O。结论神经源性膀胱患者行尿动力学检查的同时应了解膀胱漏尿点压力和膀胱尿道功能,预测上尿路损害的危险因素,避免上尿路损害。     

丹参酮ⅡA磺酸钠注射液治疗急性脑梗死的疗效及其对血清D-二聚体的影响

目的观察丹参酮ⅡA磺酸钠注射液对急性脑梗死患者的疗效及血清D-二聚体的影响。方法采用丹参酮ⅡA磺酸钠注射液静脉滴注治疗急性脑梗死40例（治疗组）,维脑路通静脉滴注治疗急性脑梗死40例（对照组）。比较2组的临床疗效和治疗前后患者血清中D-二聚体的含量变化。结果治疗组及对照组总有效率分别为92.5%和80.0%,2组疗效比较差异有统计学意义（P〈0.05）。2组患者血浆D-二聚体含量均明显下降;治疗组较对照组血浆D-二聚体含量下降更明显（P〈0.05）。结论丹参酮ⅡA磺酸钠注射液治疗急性脑梗死有利于早期恢复脑血供,改善微循环,降低D-二聚体含量,调节体内凝血-纤溶系统功能平衡,促进患者康复,安全性好。     

海南省地市及县级结核病定点医院服务能力分析

为了解海南省地市及县级结核病定点医院服务能力现状,笔者采用中国疾病预防控制中心统一设计的调查表,收集2019年海南省18家地市及县级结核病定点医院临床诊疗科室及实验室工作人员的学历、职称信息,以及该院结核病辅助检查项目开展情况。结果显示,18家地市及县级结核病定点医院中临床诊疗科室及实验室工作人员共347名,人均服务人口2.69万名,人均服务半径为5.68km;工作人员以本科学历为主(65.7%,228/347),硕士及以上者仅11名(3.2%),县、民族自治县工作人员中硕士及以上从业人员均低至0名。职称以初级或其他为主(53.0%,184/347),高级职称者仅占15.0%(52/347)。18家结核病定点医院中,开展数字X线摄影(DR)、CT或MRI检查者的占比分别为94.4%(17/18)、77.8%(14/18);但开展计算机X线摄影(CR)、结核菌素皮肤试验、γ干扰素释放试验、纤维支气管镜等检查的医疗机构占比均不高,分别为33.3%(6/18)、33.3%(6/18)、11.1%(2/18)、11.1%(2/18)。结核病诊疗工作人员按常住人口数及土地面积分布的基尼系数均为0.38。可见,海南省地市及县级结核病定点医院工作人员中高学历、高职称者较少,辅助检查项目开展不均衡,行政区划间人员配备仍需进一步加强。     

极早早产儿早期持续鼻饲输注喂养预防早产儿喂养不耐受

目的:探讨早期持续鼻饲输注喂养能否降低胎龄为25~28周的极早早产儿喂养不耐受的发病率。方法:将2009年12月-2011年12月本科孕龄25~28周的极早早产儿在生后24h内随机分配到早期持续鼻饲输注喂养组(简称持续喂养组,共29名)或早期间歇推注喂养组(简称间歇喂养组,共30名),观察两组喂养不耐受发生率。结果:持续喂养组婴儿喂养不耐受发生率为6.9%,间歇喂养组为53.3%,两组比较差异有统计学意义[OR=0.065;95%CI(0.013,0.323);P=0.000]。结论:早期持续鼻饲输注喂养较早期间歇推注喂养更能降低胎龄25~28周的极早早产儿喂养不耐受的发病率。     

中晚期妊娠胎儿脸面部的三维超声成像

目的 探讨胎儿脸面部三维超声成像的方法及其临床应用。方法 采用表面成像方法对92例中晚期妊娠胎儿的脸面部进行三维超声成像。结果 92例孕妇中,90例均清楚显示胎儿脸面部的表面特征。立体形态及各结构间的位置关系。2例因前方羊水较少显示不满意。结论 胎儿脸面部的三维图像可提供更丰富的诊断信息。可作为二维超声诊断的补充,提高对胎儿脸面部畸形的产前诊断率。同时使孕妇及其他非超声工作人员更直观地观察胎儿面部结构,使准妈妈们提前与腹中宝宝见面。     

Postcoital administration of asoprisnil inhibited embryo implantation and disturbed ultrastructure of endometrium in implantation window in mice

Asoprisnil, a member of the selective progesterone receptor modulators, exerts high progesterone receptor selectivity, endometrial targeted advantages and significant anti-implantation effect in rats. The purpose of this study was to confirm the anti-implantation effect of asoprisil, investigate the ultrastructural changes of the peri-implantation endometrium in mice and explore the effect of asoprisnil on endometrial receptivity and its targeted contraceptive proficiency. Post-coitus mice were administered with different dosages (0.2, 0.1, 0.05 mg·g -1 ·day -1 ) of asoprisnil from day 1 of pregnancy to day 3. Then 3 animals in each group were killed on day 5 of pregnancy, and uteri were collected to examine the ultrastructural changes of endometria under a transmission electron microscope (TEM). A total of 80 animals were sacrificed on day 8 of pregnancy, and the uterine horns were examined for the presence or absence of nidation sites and the number of implantation embryos. The results showed that the implantation rate and the average number of implantation embryos in asoprisnil groups were statistically significantly decreased as compared with the vehicle control group (P<0.05). The TEM results revealed that, in vehicle control group, the tight junction between the luminal epithelia cells was short and straight, the gap was wide; the luminal epithelia cells were covered with plenty of short, clavate and neatly arranged microvilli; the endometril stromal cells were large with plenty of cytoplasm, and showed significant decidual change; there was more than one nucleus in stromal cells, and the karyotheca was integrity. In low dosage and high dosage asoprisnil groups, the tight junction was longer and more curve than in the vehicle control group; microvilli were uneven and asymmetrically distributed in luminal epithelia; the stromal cells were small and the decidual change was not significant; there were karyopyknosis and karyolysis in stromal cells; there were abnormal thick-wall vessels in the endometrium. It was suggested that asoprisnil changed the ultrastructure of the endometrium in implantation window, disturbed the endometrial receptivity and finally resulted in embryo implantation failure.     

手术室护士身心健康的维护

本文就影响手术室护士身心健康的因素作了分析,并对手术室护士如何维护身心健康提出了相应的措施,如保持积极向上的愉悦心境,培养应对挫折的能力,保持良好的人际关系和协调能力,不断提高业务素质等,以保持良好的身心状态,提高护理工作的质量.     

孕产妇住院期间的健康教育

本文探讨通过口头讲解与书面指导相结合,计划教育与灵活教育相结合的方式进行孕产妇住院期间的健康教育,其目的 是降低并发症,提高孕产妇的自我保健力,促进其及早康复,提高母子的生命质量.