无线结巩膜层间Z字缝合法的病理及力学分析

目的对一种新式缝合固定技术即无线结的巩膜层间Z字缝合法的安全性及力学参数进行分析。方法将日本大耳白兔50只随机分为A、B、C、D、E组,每组10只,其中A、B、C、D组右眼为实验眼,分别给予1针、2针、3针、4针的巩膜层间Z字缝合,使用微型测力计测其拉力,比较各组间拉力的差异;E组右眼均给予巩膜层间Z字缝合(3针),于术后1 d、7 d、14 d、30 d、45 d每次处死2只,取其巩膜组织进行病理切片HE染色,观察巩膜缝线处愈合状态。结果A、B、C、D四组拉力逐渐增大,两两比较,差异均有统计学意义(均为P<0.001),且3针巩膜层间Z字缝合平均拉力(0.2423±0.0242)N,大于人工晶状体最大悬吊力(0.0583 N),足以稳固人工晶状体。E组HE染色结果显示,术后1 d缝线周围有少量炎性细胞,术后7 d巩膜组织有大量炎性细胞,术后14 d炎性细胞向缝线处聚集成簇,术后30 d炎性细胞仅局限于缝线处,术后45 d缝线周围形成纤维结缔组织包裹,几乎不见炎性细胞。结论巩膜层间Z字缝合3针足以稳固晶状体;病理切片HE染色结果提示,缝线在远期不会引起炎症反应。     

Prévention de l’hypotension induite par la rachianesthésie au cours de la césarienne programmée : coremplissage par HEA 130/0,4 vs sérum salé isotonique

ObjectiveThe aim of this study was to compare the efficacy of HES 130/0.4 coloading compared to normal saline solution for prevention of hypotension during spinal anesthesia for elective caesarean section.Study designProspective, randomized.Patients and methodsOne hundred and twenty ASA I and II patients scheduled for elective caesarean section were recruited. Patients were randomized to receive either 500 mL of HES 130/0.4 (Voluven^®) coloading (Group V) or 500 mL of normal saline solution coloading (Group C). Spinal anesthesia technique and ephedrine administration were standardized in both groups. The primary endpoint was the incidence of maternal hypotension during spinal anesthesia for elective caesarean section.ResultsHypotension occurred in 43 patients in group C and 24 patients in group V (p = 0.001). Ephedrine consumption was significantly lower in group V (P = 0.005). Nausea, vomiting and headache incidence was higher in group C (p = 0.006). Apgar scores and umbilical blood gazes were comparable between groups.ConclusionHES 130/0.4 coload was more effective than normal saline solution to prevent hypotension following spinal anesthesia for elective cesarean section. HES 130/0.4 coload reduced the incidence, the duration of longest hypotension, the need for ephedrine and the adverse maternal effects.     

剖宫产产后出血的危险因素分析

目的探究剖宫产产后出血的危险因素。方法对本院508例行剖宫产的患者的临床资料进行回顾,分析可能与剖宫产产后出血相关的危险因素。结果 508例剖宫产分娩的产妇中发生产后出血的有45例(8.9%,45/508)。不同病理特征分组的组间分析结果显示:高龄、多胎妊娠、多次流产史、妊娠期高血压、胎盘早剥、前置胎盘和子宫切口撕裂均是产妇行剖宫术分娩后产后出血的重要危险因素。单因素分析和多因素回归分析结果显示:前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素(P0.05)。结论前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素。     

排气汤对剖宫产术后胃肠功能恢复的影响

目的分析排气汤促进剖宫产术后胃肠功能恢复的作用。方法采用随机数字表法将2018年1月—2019年1月收治的120例剖宫产术产妇分为对照组(60例)、观察组(60例)。对照组产妇采用优质护理模式,观察组在对照组基础上结合中医排气汤治疗,对比2组产妇术后肠胃功能恢复效果以及术后12 h的腹胀、恶心呕吐、发热的症状积分。结果术后72 h,观察组产妇腹胀、恶心呕吐、发热等症状积分均低于对照组,差异有统计学意义(P<0.05);观察组产妇术后首次排气时间、肠鸣音恢复时间、首次排便时间较对照组短,差异有统计学意义(P<0.05)。结论对剖宫产产妇术后施以排气汤可有效降低其肠胃功能症状,促进肠胃功能恢复。     

镇痛泵在剖官产术后应用中的护理研究

目的探讨剖宫产术后应用镇痛泵对剖宫产患者术后自理能力、肛门排气、恶心呕吐的影响。方法以170例剖宫产手术后的产妇为对象，随机分为实验组（95例）和对照组（75例），实验组术后留置镇痛泵，对照组按传统方法使用镇痛剂止痛。监测2组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间和患者的恶心呕吐、肛门排气情况。结果实验组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间比无使用镇痛泵者早，P〈0．05；而恶心呕吐、肛门排气情况无差异，P〉0．05。结论镇痛泵能有效地解决了手术后切口疼痛的问题，使患者有充分的时间休息，术后自理能力恢复快，且不增加恶心呕吐和延缓肠蠕动的恢复。     

胎头前不均倾13例临床分析

目的探讨头位难产中前不均倾的诊断与处理。方法对2000年6月至2006年6月13例前不均倾位难产合并症进行回顾分析。结果颅内出血1例，宫颈裂伤1例，全部病例均行剖宫产术。结论前不均倾易合并胎膜早破，宫颈裂伤，颅内出血，胎儿窘迫，脐带绕颈，胎盘早剥，一经诊断立即手术结束妊娠。     

剖宫产病人术后早期进固体饮食对产后恢复的影响

[目的]研究剖宫产病人术后首次即恢复固体饮食的安全性和临床意义。[方法]以327例剖宫产术后初产妇作为研究对象,随机分为术后固体饮食组和传统饮食对照组,比较两组术前、术中的临床情况(孕周、手术指征、手术情况、术后镇痛)及术后首次进食接受情况、肠鸣音恢复时间、正常饮食恢复时间、肛门排气时间、泌乳时间及肠梗阻有关症状、术后病率、切口裂开、吸入性肺炎的发生率。[结果]固体饮食组正常饮食恢复时间、泌乳时间均较传统饮食组早(P<0.01),两组首次进食接受情况、肠鸣音恢复时间、肛门排气时间及肠梗阻相关症状、术后病率、切口裂开的发生率比较差异无统计学意义(P>0.05),两组均无吸入性肺炎发生。[结论]剖宫产术后首次即恢复固体饮食安全有效,建议剖宫产术后6 h开始向病人提供固体饮食。     

导乐陪伴式分娩的临床观察

[目的]探讨导乐陪伴式分娩在产程中的疗效。[方法]选取2005年1月—2005年6月住院分娩的正常足月初产妇200例,随机分为导乐组和对照组各100例,导乐组采用专职助产师陪伴下的导乐式分娩,对照组采用传统的待产、接产方法,比较两组分娩方式、产后出血量、产程时间等情况。[结果]两组产妇的剖宫产率、产程时间、产后出血量相比有统计学意义。[结论]导乐陪伴式分娩是提高产科服务质量的一项技术。     

Prioritizing surgical waiting lists

Rationale, aims and objectives This paper deals with the problem of surgical waiting lists and is aimed, in particular, at comparing two different prioritization approaches: (1) the clinical assessment of treatment urgency aimed at categorizing patients into urgency‐related groups (URGs) with a given recommended maximum waiting time for treatment; and (2) the implementation of an original prioritization scoring algorithm aimed at determining the relative priority of each patient in the waiting list and the corresponding order of admission. Methods A modelling exercise based on a cohort of 236 patients enrolled on the waiting list of a surgical department in an Italian public university hospital, from 1 January to 30 June 2004, is presented. The comparison is based on a measure called need‐adjusted‐waiting‐days, which allows to take into proper account both urgency and priority. Results The results show that both methods should be implemented simultaneously for increasing the department’s performance in terms of both efficiency– outcome gained from a given amount of resources – and equity– how patients are admitted according to their need. Conclusions Waiting list prioritization should not be limited to classifying patients into URGs, but to using a scoring system as well, in order to schedule patient admissions in an explicit and transparent way.     

脐动脉彩色多普勒超声检查在产前监测中的应用

目的:评价脐动脉超声检测在高危妊娠中监护的效果。方法:1026例高危妊娠妇女分别接受脐动脉超声检测和无应激实验这两种方法的监护,将研究对象随机分成2组,根据剖宫产率的高低及胎儿健康情况进行对比研究。结果:在宫内窘迫导致的剖宫产中,脐动脉超声检测组明显低于无应激实验组(P<0.01),胎儿健康状况无明显区别。结论:作为一种常规检测手段,脐动脉超声检测法优于无应激实验法(P<0.01)。在不影响胎儿健康的情况下,脐动脉超声检测法能降低剖宫产率。