不同妊娠期经阴道子宫颈环扎术后妊娠结局分析

Objective?To investigate the differences in pregnancy outcomes between the different transvaginal cervical cerclage. Methods?This retrospective study included pregnant women with cervical insufficiency admitted to Peking University People’s Hospital between January 2013 and September 2021. There were 37 patients in the study group underwent Shirodkar’s cerclage, and 32 patients in the control group underwent McDonald’s cerclage. The pregnancy outcomes were compared. Results?Compared with the control group, the study group showed more weight gain during pregnancy[(12.66±6.00) kg/m2, (9.21±5.79) kg/m2; P=0.022], long operation time [45 min(40-51.3 min) vs. 20.5 min (17.3-25.0), P<0.001] and later cerclage removal [36.71(36.14-37) vs. 34.43(24.32-36.75), P=0.003]. Gestational weeks at delivery in the Shirodkar group were more advanced than in the McDonald group[38.9 (36.3-39.8) vs.35.0 (30.1-39.0), P=0.005]. Compared with the McDonald group, the Shirodkar group had higher incidences of deliveries≥28 gestational weeks (91.9% vs. 68.8%, P=0.027), deliveries≥34 gestational weeks (81.1% vs. 59.4%, P=0.037), deliveries≥37 gestational weeks (67.6% vs. 37.5%, P<0.001), induced labor (43.2% vs. 12.5%, P=0.006), and fewer fetal loss (8.1% vs. 31.3%, P=0.017). Multivariate regression analysis of preterm birth factors showed that Shirodkar cervical cerclage was a protective factor to reduce the incidence of preterm birth(OR=0.063, 95%CI: 0.008, 0.492, P=0.008). Conclusion?Shirodkar cerclage appears to have advantages over McDonald cerclage in preventing fetal loss and a fewer frequency of preterm deliveries.     

PICC在重度慢性阻塞性肺疾病患者的应用及护理

目的 探讨外周静脉穿刺置入中心静脉导管在重度慢性阻塞性肺疾病患者中的应用及观察有效护理方法.方法 选取我院住院重度慢性阻塞性肺疾病患者为研究对象,每组各100例,使用PICC途径的为A组,使用外周静脉留置针的为B组.A组采用PICC技术置管的护理方法;B组采用外周静脉留置针置管的护理方法.比较两组患者的并发症、置管时间等情况.结果 A组一次性穿刺成功90例（90％）,平均置管操作时间为（23.8±6.6）min,B组一次性穿刺成功92例（92％）,平均置管操作时间为（5.5±2.8）min.主要并发症如静脉炎、感染、导管阻塞、导管脱落等,A组6例（6％）出现并发症,B组13例（13％）出现并发症.A组留管时间为（12±1.5）天,B组留管时间为（5±1.0）天.结论 PICC在重度慢性阻塞性肺疾病患者置管中具有较高的成功率,可有效减少穿刺并发症的发生率,值得临床应用.     

足月新生儿动脉导管自然闭合情况的研究

目的 探讨足月新生儿动脉导管自然关闭的情况,以及是否进行早期人工干预的必要性.方法 将2007年3月～2007年12月间正常产检,孕期超声筛查胎儿心脏正常并在该院分娩的1 437名足月新生儿纳入研究,在新生儿出生后24～96 h内进行超声心动检查,对其中发现的单纯动脉导管开放的新生儿,在生后3月复查超声心动了解其闭合情况并电话随访其发育情况.结果 1 437例足月新生儿中发现单纯动脉导管开放的318例,生后 24 h动脉导管59.3%处于开放状态,48 h、72 h、96 h的比例分别为27.1%、15.2%、9.0%.11例失访,304例在生后3月内自然闭合,诊断PDA 3例,其发生率为1:475.男:女为1:2.结论 足月新生儿动脉导管在生后96周后仍有自然闭合的可能,如无临床症状,无须过度干预,但应注意随访,确定其闭合情况.     

北京地区52例女性不孕不育患者染色体核型及临床分析

目的对809例女性不孕不育患者进行染色体核型及临床分析,探讨染色体畸变与表型的效应关系,分析女性不孕不育患者染色体异常检出率及异常类型和频率分布。方法外周血淋巴细胞培养,常规染色体G显带400带分析。结果809例女性不孕不育患者中52例存在染色体核型异常,其中常染色体结构异常35例,占67．31％;性染色体数目异常12例,占23．07％;性染色体结构或功能异常5例,占9．62％。52例患者反复自然流产、多次胎停育29例,占55．77％,畸形儿分娩史6例,占11．54％,女性生殖器发育不全17例,占32．69％。其染色体异常涉及3、4、6、7、8、9、10、13、14、15、21、22和X、Y等。结论染色体畸变是不育的重要因素,久治不愈的不孕不育患者应检查染色体以排除染色体畸变的可能。     

医护联合查房的实践及效果

目的探讨开展医护联合查房对提高整体护理质量的有效性。方法选择本院心血管内科作试点病区,将2012年1~6月实施传统护理查房设为对照组(实施前),2012年7~12月实施医护联合查房设为实验组(实施后)。比较实施前后医生及患者对护士工作满意度情况。结果实施前后医生及患者对护士工作满意度情况比较,均P0.05,实施医护联合查房后明显优于实施前。结论医护联合查房提高了整体护理质量及医生与患者对护士工作的满意度,同时也激发了护士学习的积极性。     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

46,XX,t（4;6）携带者3次流产一例

病例：女，30岁，汉族。结婚两年流产3次。3胎均在70天左右，无诱因流产。夫妇非近亲婚配，孕期无患病及有毒、有害接触史。家族中无类似病史。     

对妇产科门诊护理工作的探讨

在比较大医院的中,妇产科门诊病人都是较为集中,并且人流量较大、就诊对象较为复杂的地方,由此而产生的管理问题也凸显而出,许多患者对医护人员的服务态度较为敏感。因此,作为妇产科门诊的护士,应该做好检诊、领取物品、准备用物,并且协助医生做手术,完成门诊的治疗工作例如阴道镜、冲洗等,让工作能够正常运转,尽量减少患者候诊的时间,对一些老弱病残的患者要及时安排提前就诊。努力构建和谐的工作氛围。     

细菌性阴道病128例临床报告

目的：了解细菌性阴道病（BV）在妇科门诊的患病率及治疗方法。方法：以2430例妇科门诊病人按诊断BV的四项标准，确诊为BV患者128例，采取口服替硝唑片，每日1g，连用7天，同时阴道放置甲硝唑泡腾片0.2g，每晚1次，连用7天。结果：BV患者在妇科门诊患病主为5．3％，128例BV患者中，计划生育科及不育症科共占28．1％，性病科占30．5％，60．2％以白带增多就诊，其余以不育或节育术检查时发现，128例治愈率为96．9％，结论：BV是妇产常见的生殖道感染性疾病，建议各级医疗单位及计划生育服务站，所，应将BV列为常规检测项目。全身治疗配合局部用药效果好。