剖宫产术后的抗凝治疗

产科手术尤其是急诊剖宫产术导致静脉血栓栓塞疾病发病率及病死率呈显著上升趋势，多表现为术后的深静脉血栓形成和肺栓塞，这不仅与手术因素相关，也与大多数合并的病理产科因素相关。术后是否常规抗凝治疗目前尚存在争议，国内亦无大规模临床研究数据支持。本文从临床角度出发，探讨如何评估产科手术后发生血栓的风险，确定抗血栓预防干预的有效时机以及合理的治疗方案。     

Obstetric anesthesia management of the patient with cardiac disease

Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology. The obstetric anesthesiologist should formulate delivery plans for cardiac monitoring, labor analgesia, cesarean anesthesia, postpartum monitoring, as well as plans for obstetric or cardiac emergencies. Carefully co-ordinated multidisciplinary care of pregnant women with cardiac disease can result in successful outcomes.     

中西医结合护理对剖宫产术后乳汁分泌的影响

目的探析对剖宫产产妇采取中西医结合护理的效果。方法本次研究72例剖宫产产妇均为本院2018年3月-2018年11月接收,随机分为2组,对照组(n=36)行常规护理,研究组(n=36)开展中西医结合护理,统计各组护理效果。结果在初乳泌乳始动优良率、母乳喂养、乳汁分泌充足及乳房胀痛发生率方面,研究组均优于对照组,差异有统计学意义(P<0.05)。结论中西医结合护理在剖宫产产妇护理中效果突出,有助于改善产妇术后的乳汁分泌情况,值得推广。     

基于中医传承辅助平台研究儿童腹泻的推拿选穴规律

[目的]基于中医传承辅助平台(V2.0)软件,探讨辨病推拿治疗儿童腹泻病的选穴规律。[方法]收集中国知网数据库、万方数据库、重庆维普数据库1979—2019年文献中关于儿童腹泻病的辨病推拿处方,应用中医传承辅助平台(V2.0)软件,采用该软件的规则分析、改进互信息法等数据挖掘方法,分析40年来小儿腹泻病的辨病推拿处方选穴规律。[结果]儿童腹泻病的辨病推拿处方395个,涉及穴位83个,常用穴位21个,核心穴位组合46个,高频穴位中小儿推拿特定穴占66.67%,最核心组合为脾经、七节骨、大肠经、腹、龟尾、脊柱穴。[结论]辨病推拿治疗儿童腹泻病以健脾化湿、调理大肠气机功效的穴位为主,核心穴位为脾经与大肠经,推荐处方为脾经、七节骨、大肠经、腹、龟尾、脊柱穴。     

妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素分析

目的探讨妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。方法该研究为病例对照研究。回顾性纳入山东大学齐鲁医院、山东第一医科大学附属省立医院、山东省千佛山医院和青岛大学附属医院2010年5月至2020年5月妊娠合并肺动脉高压患者。根据是否发生剖宫产围产期并发症分为并发症组和对照组。收集患者的一般临床资料和辅助检查结果, 记录患者发生围产期并发症的情况。围产期并发症包括心功能恶化、新发心律失常、心脏骤停、术后42 d内全因死亡、产后出血及血栓事件。采用多因素logistic回归模型分析妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。结果研究纳入患者167例, 年龄28(24, 32)岁, 其中并发症组47例, 对照组120例。两组患者年龄, 孕周, 初产妇、存在心内分流及接受靶向药物治疗者比例, 左、右心室舒张末期内径差异均无统计学意义(P均>0.05)。与对照组比较, 并发症组患者特发性肺动脉高压者比例较高(P=0.001)、接受全身麻醉的比例较高(P=0.001)、超声心动图估测的肺动脉收缩压较高(P<0.001)、术前世界卫生组织(WHO)功能Ⅲ/Ⅳ级者比例较高(...     

DVH预测模型在VMAT计划培训中的应用

目的:以宫颈癌为例，探索使用剂量体积直方图（DVH）预测模型培训放疗物理师容积旋转调强（VMAT）计划设计的可行性及其效果。方法:随机选取20例宫颈癌测试病例对3名见习物理师进行两个阶段培训（第一阶段15例，第二阶段5例）。每位物理师分别采用两种方法设计VMAT计划:传统人工计划（MP）和基于DVH预测模型引导的自动计划（KBP）。对比不同阶段两种计划靶区和危及器官的各种剂量学参数，并做相应统计分析。结果:与人工计划相比，自动计划在明显提高PGTV靶区V60覆盖（P<0.001），改善高剂量控制（V66）（P=0.027）的情况下，显著降低膀胱（P<0.001）、直肠（P<0.001）、左右肾（P=0.001和P<0.001）以及左右侧股骨头（P<0.001和P<0.001）等绝大部分正常组织器官的受照剂量。在提高计划合格率的同时，亦减小了计划者间的质量差异。结论:DVH预测模型有助于深化物理师对VMAT初始优化参数设置的理解，加快培训进度，提升VMAT计划设计水平。     

Utility of teledermatopathology for intraoperative margin assessment of melanoma in situ,lentigo maligna type: A 6 year community practice experience

BackgroundAchieving negative margins for melanoma in situ, lentigo maligna type can be challenging, particularly on cosmetically sensitive areas.ObjectiveTo assess the utility of intraoperative frozen section margin assessment using a teledermatopathology system in the treatment of head and neck lentigo maligna.Methods and materialsOver a 6 year period, 96 patients with lentigo maligna had surgical excisions. The margins were assessed intraoperatively with frozen sections prepared in the manner used in Mohs surgery. The surgeon guided the frozen section slides around the margin while a dermatopathologist assessed the margin remotely.ResultsIn 2/96 (2.1%) cases, the safety margin was positive (frozen sections were false negative). In 1 further case (1%) there was a recurrence of the melanoma 13 months following the excision.ConclusionThe described method is effective in treating melanoma in situ, lentigo maligna type with clearance rates similar to previous studies for Mohs surgery.     

Planificación y manejo anestésico para cesárea en gestante con neumonía por SARS-CoV-2

Pregnant women experience physiological and immunological changes which make them more prone to all kind of viral and bacterial infections, this is because they have been considered as vulnerable group if infected by SARS-CoV-2. They could even deploy a severe form of this disease which may require to end pregnancy to improve oxygenation and to safeguard foetal wellbeing the in case the mother situation gets worse. In this scenario, any intervention would require a detailed planning by the whole surgical team, and, specifically, by the anaesthesiologists, in order to guarantee both mother and child wellbeing and to prevent from infections all the healthcare team. We describe the case of 37 week pregnant woman, admitted in our Critical Care Unit with respiratory high flows device support, due to severe respiratory failure due to COVID-19 which needed an urgent caesarean section.