妇产科围术期预防用抗菌药物干预前后的对比分析

目的：分析妇产科围术期预防用抗菌药物干预前后情况,并作一对比。方法：选择 2011 年1—6 月间妇产科 I、II 类手术病历 230 份作为非干预组;在进行一系列干预措施后,另选取 2013 年 1—6 月妇产科 I、II 类手术病历 230 份作为干预组;分析 2 组抗菌药物的使用情况。结果：I类切口手术预防性抗菌药物的使用率由干预前的 100% 降至干预后的 40%,抗菌药物的合理用药率也由干预前的 15.22%上升至 72.41%;干预前围术期预防用抗菌药存在的主要问题,在干预后均有较好的控制。结论：实施的干预措施对规范妇产科围手术期抗菌药物的合理使用起到了积极的作用,但仍存在一定问题,有待进一步规范。     

贝伐珠单抗注射液联合紫杉醇注射液和顺铂注射液治疗卵巢癌的临床研究

目的观察贝伐珠单抗注射液联合紫杉醇注射液和顺铂注射液治疗卵巢癌的临床疗效及安全性。方法将86例卵巢癌患者随机分为对照组45例和试验组41例。对照组予以紫杉醇每次135 mg·m^-2,第1天,静脉滴注+顺铂每次75 mg·m^-2,第2天,静脉滴注;试验组在对照组治疗的基础上,予以贝伐珠单抗每次15 mg·kg^-1,第1天,静脉滴注。2组患者均治疗3个周期,每个周期21 d。比较2组患者的临床疗效,肿瘤标志物水平,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的客观缓解率分别为82. 93%(34例次/41例次)和62. 22%(28例次/45例次),差异有统计学意义(P <0. 05)。治疗后,试验组和对照组的甲胎蛋白分别为(5. 23±0. 64)和(9. 06±1. 29) ng·m L^-1,癌胚抗原分别为(3. 28±0. 42)和(4. 92±0. 60) ng·m L^-1,糖链抗原199分别为(17. 55±2. 23)和(29. 90±5. 34) U·m L^-1,差异均有统计学意义(均P <0. 05)。2组患者的药物不良反应均以转氨酶上升、腹痛、恶心呕吐、中性粒细胞减少、白细胞减少和血小板减少为主,试验组和对照组的各类药物不良反应发生率比较,差异均无统计学意义(均P> 0. 05)。结论贝伐珠单抗注射液联合紫杉醇注射液和顺铂注射液可提高卵巢癌化疗中的临床效果,能够下调肿瘤标志物表达,且未明显增加药物不良反应的发生率。     

双胎妊娠妊娠期并发症及妊娠结局分析

目的探讨双胎妊娠妊娠期并发症对妊娠结局的影响及防预措施。方法回顾性分析82例双胎妊娠（双胎组）的主要并发症、妊娠结局及同期800例单胎妊娠（单胎组）的病例资料,比较2组孕妇妊娠期并发症、分娩方式、产后出血及新生儿情况。结果双胎组妊娠期高血压疾病、贫血、胎膜早破（PROM）、早产、胎儿生长受限（FGR）发生率均明显高于单胎组,差异均有统计学意义（P〈0.01）。双胎组剖宫产、产后出血、低出生体质量儿、新生儿窒息发生率及围生儿病死率均明显高于单胎组,差异均有统计学意义（P〈0.01）。结论加强双胎妊娠的产前监护和指导,积极预防和治疗并发症,对改善双胎妊娠预后和降低围生儿病死率有重要意义。     

瘢痕子宫孕妇阴道试产对母儿结局的影响

目的 探讨瘢痕子宫孕妇不同分娩方式的选择以及对母儿结局的影响。方法 选择2017年1月至2018年12月在合肥市第一人民医院产科住院且符合剖宫产后阴道试产纳入标准的产妇160例,依据医生评估结果及产妇意愿选择分娩方式,按实际分娩结果分为剖宫产后阴道分娩（简称阴道分娩）组68例,再次剖宫产（简称剖宫产）组80例,12例因阴道试产失败急诊行子宫下段剖宫产术（简称阴道试产失败组）。同时选择同期住院分娩的40例单胎顺产初产妇作为对照组。比较各组产妇的临床特征以及分娩信息,分析影响瘢痕子宫产妇阴道试产成功的相关因素。结果 在瘢痕子宫患者中,阴道分娩成功率为85%。阴道分娩组与阴道试产失败组相比,孕妇体质量、体质量指数、距上次剖宫产时间、新生儿体质量、产时出血量、产后24 h出血量差异均有统计学意义（P<0.05）,而孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异无统计学意义（P>0.05）。阴道分娩组孕妇体质量、体质量指数、孕周、距上次剖宫产时间、新生儿体质量、产后24 h出血量、住院时间均小于剖宫产组,差异有统计学意义（P<0.05）,孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异均无统计学意义（P>0.05）。阴道分娩组与对照组相比,分娩时出血量、产后24 h出血量、新生儿Apgar评分、产后住院时间差异均无统计学意义（P>0.05）。结论 瘢痕子宫孕妇在严格的操作规程以及孕期控制体质量指数、胎儿体质量可鼓励阴道试产。     

Stathmin基因在卵巢癌组织中的表达水平及其与紫杉醇联合顺铂敏感性的研究

目的观察Stathmin基因在卵巢癌组织中的表达水平及其与紫杉醇联合顺铂化疗敏感性关系。方法选取30例进行根治性切除术的原发性卵巢癌患者癌组织(试验组)和癌旁正常组织(对照组)作为研究对象。用免疫组化法检测Stathmin基因的表达水平,用甲基环戊二烯基三羰基锰(MMT)检测卵巢癌组织对0.30,3.00,30.00,300.00 mg·L^-1紫杉醇联合顺铂的敏感性,分析卵巢癌组织中Stathmin基因表达水平和紫杉醇联合顺铂化疗敏感性关系。结果试验组和对照组的Stathmin基因阳性率分别为53.33%和10.00%,差异有统计学意义(P<0.05)。0.30 mg·L^-1组的高度敏感、中度敏感和不敏感构成比为分别为30.00%,50.00%和20.00%,3.00 mg·L^-1组的高度敏感、中度敏感和不敏感构成比为分别为43.33%,40.00%和16.67%,30.00 mg·L^-1组的高度敏感、中度敏感和不敏感构成比为56.67%,26.67%和16.67%,300.00 mg·L^-1组的高度敏感、中度敏感和不敏感构成比为20.00%,16.67%和63.33%。300.00mg·L^-1组和30.00 mg·L^-1组的高度敏感和不敏感构成比比较,差异均有统计学意义(均P<0.05)。300.00 mg·L^-1组和0.30 mg·L^-1组的中度敏感和不敏感构成比比较,差异均有统计学意义(均P<0.05)。30.00 mg·L^-1组和0.30mg·L^-1组的高度敏感构成比比较,差异有统计学意义(P<0.05)。以30.00mg·L^-1紫杉醇联合顺铂处理卵巢癌细胞,高度敏感组、中度敏感组和不敏感组Stathmin基因阳性率分别为29.41%,62.50%和80.00%,差异均有统计学意义(均P<0.05)。结论 Stathmin基因在卵巢癌组织中表达水平显著高于癌旁正常组织,且与紫杉醇联合顺铂敏感性存在一定关联。     

Maternal use of antihypertensive drugs in early pregnancy and delivery outcome,notably the presence of congenital heart defects in the infants

Purpose  To investigate the association between maternal use of antihypertensives in early pregnancy and delivery outcome, notably infant congenital malformations. Methods  A cohort study of 1,418 women who had used antihypertensive drugs in early pregnancy but had no diabetes diagnosis were identified from the Swedish Medical Birth Register. Results  There was an excess risk for placental abruption, caesarean section, delivery induction, and post-delivery hemorrhage in women taking hypertensives. Infants were more often than expected born preterm, were small for gestational age, and had an excess of various neonatal symptoms. Cardiovascular defects occurred with an adjusted odds ratio of 2.59 (95% CI 1.92–3.51). The results were similar when the woman had used ACE inhibitors or other antihypertensives, notably beta blockers. Stillbirth rate was increased (risk ratio 1.87, 95% CI 1.02–3.02), again without any clear drug specificity. Conclusions  There seems to be little drug specificity in the association between maternal use of antihypertensives and an increased risk for infant cardiovascular defects.     

GPs’ views on patient drug use and the pharmacist’s role in DRP management

Objective The aim of this study was to examine general practitioners’ (GPs’) views on (1) patients’ drug-related problems (DRPs) and noncompliance and (2) the role of pharmacy practitioners in DRP management. Method A brief questionnaire was designed and distributed to 224 GPs in Sweden. Results Totally 152 GPs responded (68%). Most felt that pharmacy practitioners could improve patients’ drug use by identifying DRPs. A majority of the GPs also found presentations and analyses of their local pharmacies’ DRP documentation valuable. According to the GPs’ experiences, adverse drug effects and therapy failure were the most salient problems in patients’ drug use. Half of the doctors believed that 50–75% of their patients were compliant with their prescribed drug treatments. A majority of the GPs found a 75–95% degree of compliance acceptable. Conclusion The surveyed GPs demonstrated very positive attitudes towards the role of pharmacy practitioners in improving patients’ drug use and managing DRPs. The GPs realised that many patients were not compliant with their prescribed drug treatments and accepted an imperfect compliance.     

Perinatal mortality and one-year infant morbidity.

Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.     

Premature rupture of membranes seen at the Befelatanana maternity,Antananarivo University Hospital Center

Generally preterm ruptures of membranes (PRM) are harmless, but they become serious if the labor doesn't occur in the following 24 hours. Then, they might generate neonatal infections which provoke heavy fetal and maternal mortality. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to sum up knowledges on epidemiology and fetal prognosis of this disease, and to draw up measures to aim to reduce causes of PRM. 4232 cases of PRM were registered for the study period. The average age of parturient women was of 27 years old. PRM occur frequently among primiparas and high level multiparas. Risk factors and determinative causes are gyneco-obstetrical history as abortion, preterm delivery, cicatricial uterus, urogenital infections; uterine malformation; placenta praevia; hydramnios; dystocic labor presentation; uterine distension due to either multiple pregnancy or disproportion of fetus and birth canal; irregular and poor prenatal visits quality; low standard of living. Numerous premature infants of PRM outcomes had infections: 1,619 out of 4315 new-borns. Infant perinatal mortality rate was of 11.7 per cent. Maternal complications were infections, uterine rupture, hemorrhages. 5 deaths were noted. The reduction of PRM rate might be obtained by improvement of standard of living and hygiene, correct cares during pregnancy and intergenesic periods.     

孕龄对未足月胎膜早破围生儿及分娩方式的影响

目的：探讨孕龄对未足月胎膜早破围生儿及分娩方式的影响。方法：选择本院2007年1月～2010年12月住院的86例未足月胎膜早破患者进行回顾性分析,按发病孕龄分为两组：A组32例,发病孕龄28～34＋6周;B组54例,发病孕龄35～36＋6周。比较不同孕周对围生儿及分娩方式的选择的影响。结果：两组围生儿胎儿窘迫率分别为45.7%、31.5%,新生儿窒息率分别为51.4%、35.2%,肺部并发症及感染率分别为57.1%、31.5%,围生儿死亡率分别为22.9%、5.6%。差异有统计学意义（P〈0.05）。两组的分娩方式比较,阴道分娩和剖宫产比较差异无统计学意义（P〉0.05）。结论：对于孕周为28~34＋6周胎膜早破的孕妇宜采用期待疗法,尽可能延长孕周,同时给予促胎儿肺成熟、预防感染治疗,以减少新生儿并发症的发生,降低新生儿死亡率。     

尼卡地平联合拉贝洛尔治疗妊娠期高血压患者的临床研究

目的观察尼卡地平联合拉贝洛尔治疗妊娠期高血压的临床疗效及安全性。方法将142例妊娠期高血压患者随机分为对照组和试验组,每组71例。对照组给予拉贝洛尔0. 2 mg·min^-1,持续静脉滴注,血压平稳后口服拉贝洛尔片100 mg,每8 h给药1次。试验组在对照组治疗的基础上,给予尼卡地平0. 2μg·kg^-1·min^-1,持续静脉滴注,血压平稳后口服尼卡地平片20 mg,每12 h给药1次。比较2组患者的临床疗效、血压、胎盘组织基质金属蛋白酶-9(MMP-9)、水通道蛋白-9(AQP-9)和药物不良反应发生情况。结果治疗后,试验组和对照组的总有效率分别为94. 37%(67例/71例)和77. 46%(55例/71例),差异有统计学意义(P <0. 05)。治疗后,试验组和对照组舒张压(DBP)分别为(82. 21±6. 68)和(90. 63±8. 74) mm Hg,收缩压(SBP)分别为(120. 48±9. 48)和(131. 59±11. 39) mm Hg,MMP-9分别为(4. 51±0. 67)和(5. 80±0. 96)ng·L^-1,AQP-9分别为(3. 92±0. 57)和(5. 14±0. 70) ng·L^-1,差异均有统计学意义(均P <0. 05)。对照组的药物不良反应主要为晕厥、嗜睡、头晕和头痛;试验组的药物不良反应主要为心悸、潮热、头晕和头痛,对照组和试验组的药物不良反应发生率分别为23. 94%(17例/71例)和32. 39%(23例/71例),差异无统计学意义(P> 0. 05)。结论尼卡地平联合拉贝洛尔治疗妊娠期高血压的临床疗效较好,能够调节胎盘组织MMP-9及AQP-9表达,且不增加药物不良反应发生率。     

Preterm labor: current tocolytic options for the treatment of preterm labor

While tocolytic therapy may not be indicated in all cases of spontaneous preterm labor (SPTL), the evidence that they are superior to placebo is robust. The perfect tocolytic that is 100% efficacious and 100% safe does not exist and efforts should continue to develop and introduce safer and more effective agents. A reduction in the rate of neonatal mortality and morbidity using tocolysis has not been shown but no tocolytic study has been powered by numbers sufficient to demonstrate such an effect. Tocolytics can delay delivery long enough to administer a course of antepartum glucocorticoids and arrange in utero transfer to a center with neonatal intensive care facilities, both of which reduce neonatal mortality and morbidity. Few tocolytics (β₂-agonists and atosiban) are licensed for use as tocolytics and only one was developed specifically to treat preterm labor (atosiban). Accordingly, most tocolytics have multi-organ adverse effects. Currently, based on the evidence of safety and efficacy, atosiban should be the first-choice tocolytic for the treatment of SPTL to prevent or delay preterm birth.     

胎膜早破136例临床处理结果分析

目的:总结胎膜早破的临床处理结果。方法:对2011年1月—2012年12月住院治疗的136例胎膜早破患者的临床资料和治疗结果进行统计分析。结果:胎膜早破占分娩总数的11.8%。全组早产率为13.9%,剖宫产率为40.4%,新生儿窒息率为17.6%,新生儿死亡率为2.29%。结论:胎膜早破最好实施期待疗法,根据胎儿所处危险的大小来选择分娩时机及分娩方式,适时地选择剖宫产,可降低新生儿的死亡率。     

甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床研究

目的观察甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床疗效及安全性。方法将植入性胎盘孕妇50例随机分为对照组24例和试验组26例。对照组予以常规止血、促宫缩、抗感染等治疗,试验组在对照组治疗的基础上,在超声引导下植入胎盘附近注射甲氨蝶呤每次60 mg,qd+米非司酮每次50mg,bid,口服,连续治疗10 d。比较2组患者的胎盘排出时间、阴道流血量、子宫内膜恢复时间、子宫复旧天数,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的胎盘排出时间分别为(11.21±4.15)和(15.83±3.92)d,阴道流血量分别为(742.56±105.60)和(891.52±125.44)mL,子宫内膜恢复时间分别为(20.14±3.53)和(24.95±2.87)d,子宫复旧天数分别为(22.12±2.86)和(26.83±3.25)d,差异均有统计学意义(均P<0.05)。试验组的药物不良反应主要有肝损伤、消化道反应和口腔溃疡,对照组的药物不良反应主要有肝损伤。试验组和对照组的总药物不良反应发生率分别为15.38%和8.33%,差异无统计学意义(P>0.05)。结论甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床疗效确切,且不增加药物不良反应的发生率。     

Vaginal misoprostol for induction of labour: a more effective agent than prostaglandin F2 alpha gel and prostaglandin E2 pessary

OBJECTIVES: To compare labour outcome in women who had labour induced with PGF2 alpha gel, PGE2 vaginal pessary or misoprostol administered intravaginally or orally. STUDY DESIGN: Unmasked randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare. SUBJECTS: Women with a singleton foetus in cephalic presentation after 37 weeks gestation admitted for induction of labour who were randomised to prostaglandin F2 alpha gel (n = 76), prostaglandin E2 pessary (n = 75) and misoprostol administered either intra-vaginally (n = 128) or orally (n = 127). MAIN OUTCOME MEASURES: Primary outcome was induction to delivery interval. Secondary outcomes included use of oxytocin during labour, mode of delivery, duration of labour, neonatal condition at delivery and maternal complications. METHODS: Four hundred and six women admitted for induction of labour with a singleton foetus in cephalic presentation after 37 weeks gestation were enrolled. To estimate the risk with induction using other agents the odds ratio and 95% confidence interval was calculated using the group that received prostaglandin F2 alpha gel as referents. RESULTS: The women were comparable for baseline characteristics. Compared to prostaglandin F2 alpha gel, the need for augmentation with oxytocin in labour was significantly reduced in women induced with prostaglandin E2 pessary (OR 0.46; 95%CI 0.23 to 0.93), vaginal misoprostol (OR 0.34; 95%CI 0.18 to 0.63) and oral misoprostol (OR 0.42; 95%CI 0.22 to 0.78). There was no difference in mode of delivery. There was a significantly reduced risk (OR 0.20; 95%CI 0.04 to 0.86) of Caesarean section (CS) for failure to progress in the vaginal misoprostol group. Labour induced with misoprostol and prostaglandin E2 pessary was significantly shorter than in prostaglandin F2 alpha gel. Vaginal misoprostol significantly shortened the induction to delivery interval. There were more admissions to the neonatal unit in the misoprostol groups. CONCLUSION: Compared to prostaglandin F2 alpha gel, misoprostol and prostaglandin E2 pessary had reduced need for oxytocin and a shorter duration of labour. Effects of misoprostol on the foetus need further investigation before it is used as a routine agent for induction of labour.     

欣普贝生与催产素用于足月妊娠促宫颈成熟及引产的临床对比观察

目的探讨并比较欣普贝生与催产素用于足月妊娠促宫颈成熟及引产的临床效果和安全性。方法选取我院产科2010年3月至2012年3月产妇100例,采用随机数字表法分为催产素组和欣普贝生组,每组各50例,分别采用催产素及欣普贝生治疗。比较两组产妇临床促宫颈成熟及引产总有效率,临产时间,剖宫产率,新生儿窒息率,新生儿评分及不良反应发生率等。结果欣普贝生组产妇促宫颈成熟及引产总有效率、产妇临产时间、剖宫产及新生儿评分均明显优于催产素组产妇,组间比较差异显著(P<0.05);但两组产妇新生儿窒息率及不良反应发生率组间比较无显著差异(P>0.05)。结论相较于催产素,欣普贝生用于足月妊娠促宫颈成熟及引产效果确切,能够有效缩短妊娠时间,减少剖宫产出现,改善胎儿状况,且无严重不良反应。     

The effect on medication errors of pharmacists charting medication in an emergency department

Objective To determine the frequency and clinical significance of medication errors when (a) pharmacists elicit medication histories in the Emergency Department after medications have been prescribed by doctors and (b) pharmacists obtain and chart medication histories prior to doctors’ approval. Setting The Queen Elizabeth Hospital, a 350 bed South Australian teaching hospital, serving the local adult community. Method Emergency Department patients at risk of medication misadventure were recruited in two phases with a ‘usual practice’ arm (6 weeks) and a ‘pharmacist medication charting’ arm (5 weeks) reflecting an alternative intervention. In the ‘usual care’ arm, medication histories were compiled by a pharmacy researcher after a doctor had completed the medication chart. The researcher-elicited medication histories were compared with the doctors’ medication charts and unintentional discrepancies were recorded. In the ‘pharmacist medication charting’ arm, the same process was followed except the researcher compiled the patients’ medication histories at triage, prior to patients seeing a doctor. The medication history was then transcribed onto a medication chart for authorisation by a doctor. In addition, whether resolution of unintentional discrepancies for patients in the ‘usual care’ arm had occurred by discharge was determined by examining patients’ medical records. Main outcome measure Frequency of unintentional discrepancies and medication errors. Results The study included 45 and 29 patients in the ‘usual care’ and intervention arms, respectively. In the ‘usual care’ arm, 75.6% of patients had one or more unintentional discrepancies compared with 3.3% in the ‘pharmacist medication charting’ arm. This resulted in an average of 2.35 missed doses per patient in the ‘usual care’ arm and 0.24 in the intervention arm. In addition, an average of 1.04 incorrect doses per patient were administered in the ‘usual care’ arm and none in the ‘pharmacist medication charting’ arm. The differences observed between the arms were statistically significant (P < 0.05) and deemed clinically significant by a multidisciplinary panel. Conclusion This study provides evidence for pharmacists eliciting medication histories to prepare medication charts at the earliest possible opportunity following a patient’s presentation to the Emergency Department