过期妊娠分娩方式探讨

目的 探讨过期妊娠的分娩方式与妊娠结局的关系.方法 对2009年1月至2012年11月406例过期妊娠病例的临床资料进行分析.结果 过期妊娠406例中,剖宫产297例,占73.2％;阴道分娩109例,占26.8％.选择阴道试产中转急诊剖宫产组及阴道分娩组的羊水粪染、新生儿窒息发生率明显高于选择剖宫产组(P＜0.05).结论 过期妊娠患者中有条件阴道分娩者应严密监测胎心,定时行宫缩应激试验、监测宫颈评分、头盆评分,观察羊水性质及产程进展情况,及时剖宫产是处理过期妊娠安全而重要的措施.     

妊娠晚期羊水Ⅲ度污染行剖宫产对母婴妊娠结局的影响

目的研究妊娠晚期羊水Ⅲ度行剖宫产对母婴妊娠结局的影响。方法选择2014年6月-2017年6月本院收治的100例妊娠晚期羊水Ⅲ度患者作为研究对象,根据分娩方式分为对照组(40例)和观察组(60例)。对照组采用阴道分娩,观察组采用剖宫产;比较两组产妇产后并发症,新生儿体质量、1 min Apgar评分和新生儿并发症。结果观察组孕妇并发症发生率明显低于对照组(P0.05),两组新生儿体质量比较差异无统计学意义(P0.05),但观察组1 min Apgar评分明显高于对照组(P0.05),新生儿并发症发生率明显低于对照组(P0.05)。结论妊娠晚期羊水Ⅲ度行剖宫产可显著改善母婴妊娠结局。     

分娩方式及妊娠终止时机对过期妊娠结局的影响

目的探讨分娩方式及妊娠终止时机对过期妊娠结局的影响。方法选取2013年10月—2015年10月过期妊娠孕妇35例作为观察组,足月妊娠住院分娩的延期妊娠孕妇35例作为对照组。收集剖宫产分娩与阴道顺产分娩过期妊娠孕妇的胎儿预后情况(胎儿窘迫、新生儿窒息、产后出血);比较两组产妇的分娩结局及胎儿预后情况,包括羊水指数(amniotic fluid index,AFI)≤5.0 cm、羊水量300 ml、胎儿窘迫、新生儿窒息。计数资料比较采用χ~2检验,P0.05为差异有统计学意义。结果观察组剖宫产15例(42.86%),顺产20例(57.14%)。经剖宫产分娩的胎儿窘迫3例,新生儿窒息2例,产后出血1例;顺产的胎儿窘迫9例,新生儿窒息4例,产后出血2例。观察组胎儿窘迫率、新生儿窒息率(34.29%、17.14%)明显高于对照组(11.43%、2.86%),比较差异有统计学意义(均P0.05)。观察组AFI≤5.0 cm、羊水量300ml情况与对照组比较差异无统计学意义(均P0.05)。结论过期妊娠产妇的最佳分娩方式为剖宫产;加强对延期妊娠的定期检查,防止出现过期妊娠,可改善妊娠结局。     

妊娠晚期羊水过少对妊娠结局及分娩方式的影响

目的 探讨妊娠晚期羊水过少与妊娠结局的关系,以及分娩方式对羊水过少围生儿的影响.方法 随机选择确诊为妊娠晚期羊水过少初产妇68例作为研究组,同期羊水正常初产妇60例作为对照组.比较、分析两组妊娠并发症、围生儿结局、分娩方式及研究组不同分娩方式对围生儿结局的影响.结果 研究组中过期妊娠、妊娠期高血压、脐带缠绕及胎儿生长受限的发生率均显著高于对照组(P＜0.05或＜0.01);研究组中胎儿窘迫、羊水胎粪污染、新生儿窒息及吸入性肺炎的发生率均显著高于对照组(P＜0.05或＜0.01);研究组剖宫产率(63.2%,43/68)显著高于对照组(30.0%,18/60),差异有统计学意义;研究组行剖宫产孕妇的胎儿窘迫、新生儿窒息及吸入性肺炎的发生率均显著高于经阴道分娩孕妇(P＜0.05或(0.01).结论 羊水过少与妊娠并发症关系密切.严重威胁围生儿预后,选择最佳方式及时终止妊娠,可显著改善围生儿预后.     

足月妊娠羊水偏少200例临床分析

目的：探讨足月妊娠羊水偏少对新生儿结局的影响。方法选择200例足月妊娠羊水偏少患者为观察组,同期154例羊水过少患者及191例羊水量正常孕妇为对照组,比较三组不同分娩方式下新生儿异常情况的发生率。结果羊水偏少组及羊水过少组新生儿异常发生率均高于羊水正常组（χ2＝0．001,P＜0．05）,但羊水偏少组与羊水过少组新生儿异常发生率无统计学差异（χ2＝0．978,P＞0．05）;不同分娩方式羊水偏少组与羊水过少组新生儿异常发生率无统计学差异（χ2值分别为0．103、0．117,均P＞0．05）;羊水偏少组与羊水过少组发生羊水污染者不同分娩方式新生儿异常情况无统计学差异（χ2值分别为0．804、0．151,均P＞0．05）。结论足月妊娠羊水偏少不容忽视,同样易导致围产儿异常,阴道试产时应密切观察产程进展。     

妊娠期肝内胆汁淤积症患者的分娩方式探讨

目的研究妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者的分娩方式及妊娠结局。方法选取152例ICP孕妇为研究对象,分为轻度组83例,重度组69例;随机抽取80例同期经阴道分娩的正常孕妇为对照组,比较妊娠结局。结果经阴道分娩产妇胎儿窘迫、新生儿窒息及围生儿死亡发生率重度ICP组高于轻度ICP组和对照组(P0.05);轻度ICP组与对照组围生儿不良结局比较,差异无统计学意义(P0.05)。轻度ICP组阴道分娩与剖宫产分娩者比较,羊水粪染及新生儿窒息率差异无统计学意义(P0.05),剖宫产产妇产后出血率高于阴道分娩产妇(P0.05)。结论轻度ICP患者可适当延长孕周,待产程发作后严密监测下经阴道试产,重度ICP适时剖宫产终止妊娠。     

计划性剖宫产后阴道分娩的临床应用效果观察

目的比较计划性剖宫产后阴道分娩和自然分娩的分娩结局。方法回顾性分析该院2014年4月-2016年10月愿意试产的单胎妊娠且有过一次子宫下段横切口剖宫产史者106例,其中计划性剖宫产后阴道分娩55例设为研究组,自然分娩51例设为对照组。计划性剖宫产后阴道分娩方法:对于宫颈Bishop评分6分者给予Cook双球囊宫颈口放置,24 h未发作再给予缩宫素引产;对于宫颈Bishop评分≥6分者直接给予缩宫素引产,自然临产者不给与任何药物。观察两组阴道分娩成功率、母亲出血量、产褥感染发生率、子宫破裂率、子宫切除率、新生儿Apgar评分、新生儿进新生儿重症监护室(NICU)率及新生儿死亡率等。结果研究组阴道分娩成功33例(60.00%);对照组阴道分娩成功27例(88.23%),两组比较差异有统计学意义(P0.05)。两组均未发生子宫破裂及子宫切除。研究组出血量为(221.85±136.40)ml,对照组出血量为(203.48±126.48)ml,两组比较差异无统计学意义(P=0.14)。两组新生儿1 min Apgar评分及5 min Apgar评分比较,差异无统计学意义(P0.05);研究组新生儿转入NICU 1例,对照组2例,差异无统计学意义(P0.05);两组均无新生儿死亡。结论剖宫产后再次妊娠分娩,计划性剖宫产后阴道分娩可以增加60.00%的阴道分娩率,只要掌握好适应证,分娩期严密监控,母婴均安全。     

妊娠晚期羊水过少对围生儿及孕妇围生结局的影响

目的探讨晚期妊娠羊水过少对围生儿及孕妇围生结局的影响,为临床对此类孕妇进行治疗提供指导依据。方法选取2014年1月-2016年1月于铜山区中医院进行分娩的86例晚期妊娠羊水过少孕妇作为观察组,另选取同期进行分娩的晚期妊娠羊水正常孕妇86例为对照组。在分娩结束后,对两组孕妇临床资料进行回顾性研究分析,对两组围生儿结局及孕妇围生结局进行统计并比较。结果观察组围生儿宫内窘迫、羊水污染、新生儿窒息及吸入肺炎的发生率均较对照组明显提高,Apgar评分明显降低(均P0.05);观察组孕妇妊娠期高血压疾病、过期妊娠、胎儿畸形、胎膜早破发生率均较对照组明显提高,且产后出血量及产程均明显增加(P0.05);观察组剖宫产率为83.7%,对照组为39.5%,两组比较,差异具有统计学意义(P0.05)。结论晚期妊娠羊水过少会严重影响围生儿及孕妇围生结局,使围生儿并发症及孕妇围生并发症明显增加,对母婴生命安全造成严重威胁,临床应及时选择正确的分娩方式对围生儿及孕妇围生结局进行改善。     

不同分娩方式对剖宫产后再次妊娠产妇妊娠结局的影响

目的探讨不同分娩方式对剖宫产后再次妊娠产妇妊娠结局的影响。方法选择2018年1月-2019年5月该院的153例剖宫产后再次妊娠产妇的临床资料进行回顾性分析。根据分娩方式不同,将所有产妇分为观察组72例和对照组81例。观察组采用阴道分娩,对照组采用剖宫产分娩。比较两组产妇的出血量、次母乳喂养时间、住院时间、住院费用、产妇结局、产妇羊水污染情况、新生儿Apgar评分及新生儿结局。结果观察组产妇术中出血量、首次母乳喂养时间、住院时间及住院费用均明显少于对照组产妇[(88.29±13.64) ml、(1.22±0.25) d、(3.21±1.04) d、(4 235.28±341.46)元vs.(172.58±20.74) ml、(2.14±0.70) d、(8.66±2.53) d、(5 317.15±682.37)元],差异有统计学意义(P0.05)。观察组产妇产褥感染、产后发热、恶露过长、产后出血及子宫下段切口愈合不良的发生率均明显低于对照组产妇(P0.05);两组产妇子宫切除发生率相比(1.39%vs. 4.94%),差异无统计学意义(P0.05)。观察组产妇产后羊水污染发生率均明显低于对照组(P0.05)。观察组新生儿1 min Apgar评分、5 min Apgar评分与对照组比较,差异无统计学意义[(8.91±0.43)分、(9.23±0.27)分、(8.87±0.46)分、(9.20±0.31)分,P0.05]。观察组新生儿感染、湿肺及肺不张发生率明显低于对照组新生儿(P0.05);两组新生儿窒息、肺炎及颅内出血相比,差异无统计学意义(P0.05)。结论剖宫产再次妊娠产妇在符合阴道试产指征情况下建议选择阴道分娩,既能降低剖宫产率,减少手术所致损伤,又有利于减少产妇和新生儿并发症,获得良好的妊娠结局。     

剖宫产子宫瘢痕缺损孕妇再次妊娠结局分析

目的:探讨剖宫产术后子宫瘢痕缺损对孕妇再次妊娠的影响。方法:2015年3月—2018年3月本院孕产的剖宫产术后子宫瘢痕缺损孕妇180例(观察组)和同期首次妊娠分娩孕妇120例(对照组),分析两组分娩结局。结果:观察组选剖宫产率(60%)较阴道试产(40%)高(P0.05);剖宫产后阴道出血量(320.6±12.1ml)高于阴道试产者(181.1±6.6ml),新生儿Apgar评分(7.1±1.7分)低于阴道试产者(9.0±2.0分)(P0.05),阴道试产成功率两组无差异(P0.05);观察组产后出血量(181.1±6.6ml)、子宫切除率(8.3%)高于对照组(103.2±4.4ml、0.0%),剖宫产后出血(13.9%)、切口感染(16.7%)、盆腔粘连(14.8%)、子宫切除(6.5%)等发生率均高于对照组剖宫产者(P0.05)。结论:剖宫产术后子宫瘢痕缺损孕妇分娩结局与无瘢痕缺损孕妇相当,如符合阴道试产条件,可鼓励孕妇选择阴道试产,对改善妊娠结局及降低剖宫产并发症发生率有一定积极作用。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.