剖宫产术后再次妊娠经阴道分娩的观察及护理

［摘要］　目的　探讨剖宫产术后再次妊娠经阴道分娩的可行性及护理措施。方法　对2013-01～2014-12收治的58例剖宫产术后再次妊娠并同意阴道试产者的产程和护理措施进行回顾性分析。结果　阴道试产成功者45例,占77.59%（45/58）,再次剖宫产术者13例,占22.41%（13/58）;经阴道分娩产妇住院时间、住院费用、产后出血量均明显少于剖宫产产妇（P<0.05）,两组新生儿窒息、Apgar评分比较差异无统计学意义（P>0.05）。结论　对于具有阴道试产条件的剖宫产后再次妊娠者,可在严密监护下进行阴道试产,有利于降低剖宫产率。     

分娩球配合自由体位助产对初产妇妊娠结局的影响

目的探讨分娩球配合自由体位助产对初产妇妊娠结局的影响。方法选择2015年1月到2017年10月80例临产初产妇,运用随机数字表法将其分为对照组(n=40)与实验组(n=40),对照组予以常规的平卧体位助产方式,实验组予以分娩球配合自由体位助产方式,观察两组初产妇的产后2h出血量、第一产程时间、第二产程时间、第三产程时间、总产程时间、自然分娩率、剖宫产率与新生儿Apgar评分。结果实验组初产妇的产后2h出血量、第二产程时间、第三产程时间与新生儿Apgar评分的显著差异不具有统计学意义(P0.05);其第一产程时间、总产程时间明显短于对照组,其自然分娩率明显高于对照组,剖宫产率明显低于对照组,差异具有统计学意义(P0.05)。结论分娩球配合自由体位助产对初产妇妊娠结局具有较大的积极影响,不仅能够提升自然分娩率,并且缩短总产程时间,具有较高的临床推广价值。     

循证护理干预对产妇产后出血的影响

［摘要］　目的　探讨循证护理干预对产妇产后出血的影响。方法　210例产妇按住院号单双分为两组，对照组(105例)应用常规护理措施。循证护理组(105例)采用循证护理干预法，循证护理组由护士长带领临床经验丰富的护士组成，依据循证护理的原定方法，逐步按护理计划进行护理工作。比较两组护理效果。结果　循证护理组产妇产后2 h及24 h出血量均明显少于对照组(P<0.05),第3产程时间明显短于对照组(P<0.05),循证护理组产妇产后护理满意度明显高于对照组(P<0.05)。结论　将循证护理模式应用于产妇产后出血护理，可以系统地、有针对性地发现产妇临产时所存在的问题，消除产妇紧张、焦虑的心理，使产程进展顺利，缩短产程，促进分娩，减少产后出血量，从而提高了患者及家属对护理工作的满意度，值得推广。     

穴位注射缩宫素预防产后出血的效果观察

［摘要］　目的　观察穴位注射缩宫素预防产后出血的效果。方法　选择2019年2月至2020年10月于贵港市中医医院分娩且存在子宫收缩乏力高危因素的孕妇150例,采用随机数字表法分为观察组和对照组,每组75例。在分娩的第三产程,观察组于合谷穴予缩宫素注射5 U;对照组予肌肉注射缩宫素20 U。比较两组产后出血量、血红蛋白、红细胞计数水平,以及子宫收缩乏力和产后出血发生率。结果　观察组产后2 h、24 h的出血量均少于对照组,差异有统计学意义（P<0.05）。观察组产后24 h的血红蛋白、红细胞计数高于对照组,差异有统计学意义（P<0.05）。观察组子宫收缩乏力和宫缩乏力性产后出血的发生率均低于对照组,差异有统计学意义（12.00% vs 25.33%,5.33% vs 16.00%;P<0.05）。结论　采用合谷穴注射缩宫素可以有效增强产妇产后宫缩力度,可有效预防宫缩乏力性产后出血的发生。     

助产分娩球在骨盆倾斜度过大孕妇中的应用

将200例住院分娩的骨盆倾斜度过大的孕妇随机分为两组各100例.当分娩进入第一产程,出现规律宫缩后,观察组采用助产分娩球助产,对照组采取常规体位分娩.结果与对照组比较,观察组胎头下降顺利,第一产程时间及总产程时间缩短,剖宫产率降低,产后出血量减少,新生儿窒息率降低,P均<0.05.证明助产分娩球可改变骨盆倾斜度,促进自然分娩,降低新生儿窒息率.     

间苯三酚联合安定在产程活跃期的应用(附100报告)

将200例正常初产妇随机分为观察组和对照组各100例,对照组按产科常规处理;观察组于宫口开大3 cm、宫缩规律时予间苯三酚80mg宫颈封闭及安定10 mg肌注.观察两组疼痛程度、产程、分娩方式、产后2 h出血量及新生儿 Apgar评分等情况.结果 与对照组比较,观察组疼痛程度明显减轻、产程明显缩短(以第一产程最为明显),剖宫产率明显降低(P均＜0.05).认为产程活跃期联用安定及间苯三酚能明显缩短产程,减轻分娩疼痛,且对产妇及新生儿无不良影响.     

不同剂量舒芬太尼复合罗哌卡因在分娩镇痛中的应用效果及对母婴转归的影响评估

［摘要］　目的　评估不同剂量舒芬太尼复合罗哌卡因在分娩镇痛中的应用效果及对母婴转归的影响。方法　选择2017年1月至2020年8月于唐山市妇幼保健院接受无痛分娩的产妇210例。采用随机数字表法将其分为A组、B组和C组,每组70例。因有14例中转剖宫产,最终纳入产妇196例,其中A组65例,B组66例,C组65例。三组镇痛方案不同：A组,舒芬太尼0.3 μg/ml复合0.1%罗哌卡因;B组,舒芬太尼0.4 μg/ml复合0.1%罗哌卡因;C组,舒芬太尼0.5 μg/ml复合0.1%罗哌卡因。比较三组分娩镇痛前（T₀）、分娩镇痛开始后30 min（T₁）、宫口开全时（T₂）以及产后2 h（T₃）的视觉模拟量表（VAS）评分。比较三组分娩后1 h的改良Bromage评分。比较三组产程及产妇和新生儿的转归情况。结果　C组产妇第一产程较A组和B组显著延长（P<0.05）。三组第二和第三产程比较差异均无统计学意义（P>0.05）。三组产钳使用率、侧切率,以及产道裂伤和产后出血发生率比较差异均无统计学意义（P>0.05）。在T₀～T₃时间点,三组VAS评分均呈下降趋势,B组和C组的VAS评分下降趋势较A组更显著（P<0.05）,且在T₁～T₃时间点,C组的VAS评分较B组、C组更低,差异有统计学意义（P<0.05）。三组改良Bromage评分比较差异无统计学意义（P>0.05）。三组新生儿出生体重,第1分钟、第5分钟和第10分钟Apgar评分,脐动脉血pH值,脐动脉血PCO₂以及脐动脉血PO₂比较差异均无统计学意义（P>0.05）。结论　0.3、0.4、0.5 μg/ml舒芬太尼复合0.1%罗哌卡因均可安全有效应用于分娩镇痛,其中0.4 μg/ml舒芬太尼联合0.1%罗哌卡因镇痛对产程影响小,推荐临床使用。     

松弛挂线术与多切口引流术治疗复杂性肛周脓肿的临床疗效观察

［摘要］　目的　观察松弛挂线术与多切口引流术治疗复杂性肛周脓肿的临床效果。方法　纳入2018-01～2019-09该院收治的64例肛周脓肿患者为研究对象,随机分为观察组和对照组,每组32例。观察组行松弛挂线术,对照组行传统的多切口引流术。比较两组手术相关情况、疼痛评分、肛门功能评分、生活质量指数评分及并发症发生率。结果　两组手术时间、住院周期、住院费用比较差异无统计学意义（P>0.05）。观察组术中出血量、总换药次数、>2 cm瘢痕数均显著优于对照组（P<0.05）。观察组术后1 d、7 d疼痛严重程度低于对照组,差异有统计学意义（P<0.05）。观察组术后1周、8周Wexner肛门失禁评分优于对照组,差异有统计学意义（P<0.05）。观察组术后2周、8周胃肠道生存质量指数评分显著优于对照组（P<0.05）;两组术后并发症总发生率比较差异无统计学意义（χ²=0.674,P>0.05）。结论　与传统的多切口引流术比较,松弛挂线术的近期疗效具有一定优势,为肛周脓肿提供了一种更简便、微创的治疗方法。     

低位水囊联合静滴缩宫素引产在足月妊娠分娩中的疗效观察

2015年3月~2017年3月足月妊娠分娩产妇120例,随机平分为对照组产妇单纯正静脉滴注缩宫素进行引产,给予研究组地位水囊+静脉滴注缩宫素进行引产。结果:研究组诱发产程时间、第一产程时间、总产程时间、产后2h出血量、引产自然分娩例率、宫颈Bishop评分均显著优于对照组,(P 0.05);新生儿出生1min及5min时,两组新生儿Apgar评分均差异轻微,(P 0.05)。讨论:低位水囊联合静滴缩宫素具有促进宫颈成熟、缩短产程时间、降低产妇产后出血量、增加阴道自然分娩例率的特点,且不影响新生儿Apgar评分,高效安全,且可操作性强。     

腹腔镜下经腹腔腹膜前疝修补术治疗腹股沟疝效果分析

［摘要］　目的　观察腹腔镜下经腹腔腹膜前疝修补术治疗腹股沟疝疗效。方法　选择102例腹股沟疝患者按照手术方式分为两组,观察组57例采用经腹腔腹膜前疝修补术,对照组45例采用开放无张力疝修补术,观察两组手术情况和并发症。结果　与对照组比较,观察组手术时间较长、住院费用较高,术中出血量较少,术后下床时间、住院时间较短（P均<0.01）。观察组发生切口感染、术后疼痛发生率均明显低于对照组（P<0.05）。结论　腹腔镜下经腹腔腹膜前疝修补术治疗腹股沟疝效果明显,安全,无明显的并发症。     

Preterm delivery

Preterm delivery and its short-term and long-term sequelae constitute a serious problem in terms of mortality, disability, and cost to society. The incidence of preterm delivery, which has increased in recent years, is associated with various epidemiological and clinical risk factors. Results of randomised controlled trials suggest that attempts to reduce these risk factors by use of drugs are limited by side-effects and poor efficacy. An improved understanding of the physiological pathways that regulate uterine contraction and relaxation in animals and people has, however, helped to define the complex processes that underlie parturition (term and preterm), and has led to new scientific approaches for myometrial modulation. The continuing elucidation of the mechanisms that regulate preterm labour, combined with rigorous clinical assessment, offer hope for future solutions.     

Oxygen delivery and resuscitation

Modern concepts of oxygen delivery date from the work of Joseph Barcroft, who in 1920 classified deficits of oxygen delivery as "anoxic" when the blood is not filled with oxygen, "anemic" when hemoglobin concentration is low, or "stagnant" when blood flow is inadequate. These three pathologic states may occur singly or in combination, and may be quantitated by the expression: Oxygen delivery = cardiac output X arterial oxygen content Oxygen delivery is an extremely important physiologic concept for resuscitating critically ill patients because tissue availability of oxygen is totally dependent on oxygen delivery. However, other physiologic alterations also can alter tissue use of oxygen, even in the presence of adequate oxygen delivery. These include alterations of oxyhemoglobin dissociation, alterations in microcirculatory blood flow, the presence of carbon monoxide, and mitochondrial dysfunction. The major goal of resuscitation of seriously ill and injured patients is to provide them with sufficient oxygen to meet their metabolic requirements. These needs are significantly increased following shock, injury, and illness. Only by meeting these increased cellular oxygen demands can adequate cellular function be maintained and organ failure avoided.     

Heat decreases formoterol delivery

STUDY OBJECTIVES: Based on anecdotal reports of formoterol aggregating in mailboxes in the summer in Arizona, we examined the effect of heat on formoterol as well as on drug delivery. DESIGN: Formoterol capsules in original blister packaging were heated to 40 to 70 degrees C (104 to 158 degrees F) for 3 h and at 70 degrees C (158 degrees F) for 15 to 180 min. Capsules were removed from packaging, and a vacuum setup was used to dispense the formoterol into a filter using the device provided by the manufacturer. The weights of the capsule predispensation and postdispensation were measured to calculate drug delivery. Measurements were compared to those of capsules not exposed to heat. For comparison, tiotropium and a combination of fluticasone propionate and salmeterol (Advair; GlaxoSmithKline; Research Triangle Park, NC) were similarly tested. RESULTS: Visual inspection of the heated capsules revealed gross distortion as well as visible clumping of formoterol at the higher temperatures. The mean (+/- SEM) change in the weights of capsules that underwent heating were significantly less than those obtained from capsules that had not been heated (mean change after heating for 3 h at 70 degrees C, 2.3 +/- 0.7 vs 24.7 +/- 0.6 mg, respectively; p < 0.001), indicating decreased formoterol delivery. Heat produced a dose-responsive and time-responsive decrease in formoterol delivery. One of six capsules that were subjected to temperatures as low as 40 degrees C (104 degrees F) for 3 h had decreased delivery, and three of six capsules subjected to a temperature of 70 degrees C (158 degrees F) for times as short as 30 min decreased delivery. In contrast, neither tiotropium nor fluticasone propionate/salmeterol delivery was decreased by heating for up to 3 h at 70 degrees C (158 degrees F). Thermometers placed in mailboxes or in car windows in mid-summer in Arizona (approximate outside temperature, 110 degrees F [43 degrees C]) exceeded 70 degrees C (158 degrees F). CONCLUSIONS: These data demonstrate that the exposure of formoterol to heat decreases drug delivery and that caution should be used when mailing, transporting or storing formoterol.