首例妊娠合并SARS的诊治成功报告

【目的】报告首例妊娠合并严重急性呼吸综合征(SARS)的诊治成功经验。【方法】回顾我院收治的1例双胎妊娠30周合并严重急性呼吸综合征的诊治经过和围产结局。【结果】患于妊娠31周5天因胎膜早破剖宫产两活男婴。产后2月孕妇痊愈，新生儿未发现SARS病征。【结论】妊娠合并严重急性呼吸综合征经过适当的内科和产科处理可取得良好的围产结局。     

妊娠期糖尿病的孕产期监测与护理

糖尿病合并妊娠（包括糖尿病患者妊娠和妊娠期糖尿病）可使妊娠高血压综合征、羊水过多、巨大胎儿、胎儿畸形、死胎、新生儿呼吸窘迫综合征等并发症发生率增高,孕产妇死亡率高,围产儿成活率仅有40％。糖尿病对围产结局的影响与多种因素有关,孕妇血糖水平为其中一个重要因素。我院自2006年1月～2009年6月共诊治56例糖尿病孕产妇,现对本组病例的护理体会总结报告如下：     

急性肺损伤/急性呼吸窘迫综合征机械通气的共识和争议

急性肺损伤/急性呼吸窘迫综合征的诊治作为呼吸系统疾病的主要组成部分,近年来愈来愈受到呼吸专业领域的重视,而且在危重病专业领域也占据了最为重要的地位。2 0 0 3年冬春季严重急性呼吸综合征(SARS)的暴发更加突出了急性肺损伤/急性呼吸窘迫综合征研究的紧迫性。因此深入了解、研究其对呼吸和危重病医学领域的医务人员显得格外重要。本文主要阐述近年来有关急性肺损伤/急性呼吸窘迫综合征机械通气的研究进展。196 7年Ashbaugh等[1] 首次报道成人呼吸窘迫综合征(acuterespiratorydistressinadults)。1994年,美国和欧洲呼吸与危重症医学学…     

严重急性呼吸综合征患者血清细胞因子的分析

严重急性呼吸综合征(severe acute respiratory syndrome，SARS)是一种急性呼吸系统传染病。虽然世界卫生组织已经将变异的冠状病毒确定为SARS的病原体^[1]，但由于目前对它的发病学机制还了解很少，因此临床还缺乏特异有效的治疗手段。SARS以呼吸系统的损害和表现为主要特征，以呼吸交换膜的损伤为主要的病理改变^[2]，严重者导致急性呼     

糖尿病孕妇血糖水平与围产结局的关系

[目的]探讨糖尿病孕妇妊娠期血糖控制水平与围产结局的关系.[方法]根据血糖控制水平分为血糖控制不良组和血糖控制理想组,并设正常对照,回顾性总结比较209例妊娠期糖尿病和糖尿病合并妊娠的母儿并发症.[结果]孕妇血糖控制不良组妊高征、羊水过多、羊水过少、胎儿生长受限、剖宫产、巨大胎儿、新生儿窒息和呼吸窘迫综合征、低血糖的发生率均明显高于血糖控制理想组和正常对照组(P<0.01).[结论]妊娠时糖尿病,母体血糖水平控制不良增加妊娠并发症的发生.     

SARS患者的呼吸机治疗1例报告

严重急性呼吸综合征(SARS)是由变异性冠状病毒所致的一种新的呼吸道传染病，部分重症病例发展为急性呼吸窘迫综合征(ARDS)。笔者回顾性分析我院对1例重症SARS患者的呼吸机治疗经过。     

妊娠与柯兴氏综合征--附1例病案分析

目的 :提高妊娠合并柯兴氏综合征的诊治水平。方法 :结合国内外文献 16例 ,分析讨论妊娠与柯兴氏综合征的相互影响所导致的各种临床结局。结果 :肾上腺皮质腺瘤位于妊娠合并柯兴氏综合征的病因首位 ,而高肾上腺皮质激素刺激征和特征性腹部、大腿宽大紫纹 ,结合B超、CT可以诊断妊娠合并柯兴氏综合征 ;严重的并发症威胁母婴安全 ,积极进行手术治疗和并发症的处理可以降低母婴死亡率、延长孕周。结论 :妊娠合并柯兴氏综合征是极度的高危妊娠 ,妊娠期的早期诊断、早期治疗能改善妊娠质量。     

激素在严重急性呼吸综合征治疗中的应用

严重急性呼吸综合征是一种由新型冠状病毒所致的新发现的急性呼吸道传染病,患者肺部的病变进展迅速,严重者可发生急性肺损伤乃至呼吸窘迫综合征。世界卫生组织将其命名为严重急性呼吸综合征(severe acute respiratory syndrome,SARS)。目前关于SARS治疗中激素的应用问题仍是SARS     

急性呼吸窘迫综合征的新进展

严重急性呼吸综合征(SARS)的暴发流行已经引起全世界医务人员和公众的关注.目前在全球范围已有数千人发病.数百人死亡。此病传染性极强、危害性极大.对人民的生命安全形成严重威胁。而呼吸衰竭和急性呼吸窘迫综合征(ARDS)是SARS病人病情危重和死亡的主要原因.因此.尽管目前SARS在全球范围已得到有效的控制.但SARS或其他呼吸道传染病仍然可能再次袭击人类.因此我们应该更加重视呼吸道感染和肺损伤的研究。目前,尚需深入研究对SARS痛毒的病原学的进一步认识、对SARS病毒致肺损伤的机制的深入探讨.以及对SARS造成严重肺损伤的早期干预,本文简述了近年来急性呼吸窘迫综合征(ARDS)的发病机制及诊治新进展。     

妊娠合并心脏病的监护与治疗（附74例分析）

目的 探讨妊娠合并心脏病正确的诊治方法。方法 对74例妊娠合并心脏病患者进行回顾性分析。结果 对妊娠合并心脏病患者积极地围产保健系统监护，能有效地降低心衰的发生，从而改善妊娠结局。结论 妊娠合并心脏病发生率虽低，但严重威胁着母婴健康，只有重视围产保健系统监护，才能降低孕产妇死亡率。     

Right ectopic gestation following in vitro fertilisation: case report

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure. A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an "evacuation" one-week prior to this episode due to an initial diagnosis of an incomplete abortion. No chorionic villi were reported on histology. The repeat serum BhCG was 777 mimicro/l and at laparoscopy a right unruptured ampullary ectopic gestation (4 cms in size) was evident. A right linear salpingostomy was subsequently performed laparoscopically. Histology confirmed the presence of tubal chorionic villi. The laparoscopic management of ectopic pregnancies is now regarded as the gold standard in many centres in the world. In this patient the ectopic pregnancy resulted following an intra-uterine zygote transfer, and was managed successfully.     

Laparoscopic management of an ovarian ectopic pregnancy: case report

Ovarian pregnancy is a rare variant of ectopic gestation. The diagnosis is often made at surgery and requires histological confirmation. The condition has not been reported locally and its diagnosis is easily missed. A case of an ovarian ectopic pregnancy in a 41 year old para 1 + 1 with secondary infertility is reported. The patient presented with lower abdominal pain and vaginal bleeding at six weeks gestation with a serum B-hCG of 79.12 mlU/L. An ultrasound showed a complex left adnexal mass. She underwent a diagnostic and operative laparoscopy. A left oophorectomy was performed due to difficulty in achieving haemostasis.     

Intussusception complicating triplet pregnancy

Intestinal obstruction complicating pregnancy is one of the surgical emergencies that may be associated with high incidence of morbidity and mortality for both mother and fetus. Our case is a case of triplets' pregnancy at 25 weeks gestation complicated by jejunal intussusception. The patient was admitted to our hospital with acute abdominal pain and diagnosis of intussusception was made. The patient had an urgent laparotomy with excision of a gangrenous loop of small bowel and primary re-anastomosis was carried out. Post operatively she developed wound dehiscence, which was repaired, and an emergency caesarean section was made on the same setting.     

45例妊娠合并急性阑尾炎临床病例分析

目的 探讨妊娠合并急性阑尾炎的临床特点和诊疗策略.方法 对2010年1月至2016年6月45例于该院手术确诊为妊娠合并急性阑尾炎病例的临床资料进行回顾性分析.结果 45例患者均出现腹痛表现,其中转移性右下腹痛15例(33.3％),腹部压痛44例(97.8％).术中发现阑尾坏疽4例,大网膜坏死1例.术后并发症共5例,其中切口愈合不良2例,感染性休克1例,炎性肠梗阻1例,不全性粘连性肠梗阻1例.术后11例患者(孕22+3～36+2周)出现先兆流产或先兆早产,最终流产1例(孕25+3周),早产3例(孕28+4～30+4周).结论 妊娠合并急性阑尾炎以腹痛为主要临床表现,易出现严重并发症.     

单绒毛膜双胎一胎无心畸形围产结局分析

目的 探讨单绒毛膜双胎并发一胎无心畸形的围产结局及围产期管理。方法 选择2010年5月至2014年5月在我院产科诊断、分娩的单绒毛膜双胎并发一胎无心畸形病例,回顾性分析在诊断无心畸形后期待治疗、选择性终止无心畸形胎儿妊娠方式的围产结局及管理。结果 共13例单绒毛膜双胎并发一胎无心畸形,单绒毛膜单羊膜囊（MCMA） 4例,单绒毛膜双羊膜囊（MCDA）7例,三胎妊娠合并无心畸形2例〔为单绒毛膜三羊膜囊（MCTA）、MCDA三胎妊娠〕。1例MCDA三胎妊娠孕21+3周因难免流产转入本院,产后尸检发现无心畸形,12例于孕11+5～31+6周产前诊断无心畸形。9例行期待治疗,其中2例MCMA双胎发生泵血胎死亡行引产,7例分娩孕周为31+3～39+5周,泵血胎生长发育良好。2例在孕24周、24+2周行脐带双极电凝术成功阻断无心胎脐带血流,于孕33+5周、32+1周剖宫产分娩,泵血胎生长发育良好。1例因未足月胎膜早破（PPROM）于孕28+6周转入本院后诊断出无心畸形,因宫内感染及时终止妊娠。结论 早期诊断、密切监护单绒毛膜双胎并发一胎无心畸形十分重要,必要时需要进行选择性终止无心胎妊娠以改善泵血胎妊娠结局,脐带双极电凝术为有效的宫内干预手段。     

早发性卵巢功能不全患者赠卵IVF获得妊娠在孕期合并系统性红斑狼疮:1例报告并文献复习

为探讨早发性卵巢功能不全(POI)与免疫因素的关系,对我院生殖中心接诊的1名POI患者通过赠卵成功妊娠后发生系统性红斑狼疮(SLE)的病例进行报告,并结合相关文献,回顾POI病因,讨论SLE与妊娠的相互影响以及POI患者妊娠后合并SLE的临床特点及产科处理,以期为不明原因/免疫因素POI患者孕前处理及妊娠后产科随访提供参考.该病例中,患者确诊卵巢早衰4年,2003年我中心行赠卵IVF成功妊娠.孕11周以颜面部浮肿为首发症状,经免疫学检查、肾脏穿刺活检后确诊为SLE、狼疮性肾炎.综合相关专科意见以及患者意愿,予口服强的松控制狼疮活动,加用阿司匹林、低分子肝素改善胎盘血流,密切监测孕妇各项指标及胎儿生长发育.期间孕妇病情反复,孕晚期出现肝功能损害、胎盘功能下降,B超监测不除外胎儿发育迟缓可能,经全院讨论,择期剖宫产分娩一早产男婴.产后继续专科治疗,随访14年,期间患者复查免疫指标逐渐好转,无狼疮相关表现,考虑SLE临床治愈.其子经新生儿科诊治,其生长发育与同龄人无异.通过病例分析和文献回顾,我们认为免疫因素是POI重要病因,并建议不明原因POI患者孕前完善免疫学检查以保障母胎生命.     

Advanced abdominal pregnancy: a case report of good maternal and perinatal outcome

Advanced abdominal pregnancy is understood to mean any extra-uterine pregnancy found within the peritoneal cavity that is greater than 20 weeks gestation. Its management is one of laparotomy with varying complications including poor perinatal outcome and increased maternal morbidity and mortality. There is no accepted consensus for the complete removal of the placenta at laparotomy. This paper reports the management of a unique case of advanced abdominal pregnancy that was diagnosed by ultrasound at 20 weeks gestation and treated conservatively until delivery of a viable female neonate at 33 weeks and 4 days by elective laparotomy. At the time of laparotomy, the placenta was removed completely with good maternal outcome. This, to the best of our knowledge, is the first case in the West Indian literature documenting complete removal of the placenta at the time of laparotomy with good maternal outcome.     

Myomectomy during second trimester pregnancy: a case report

The prevalence of leiomyoma during pregnancy is reported as approximately 2%. Although during pregnancy leiomyomas usually remain asymptomatic, they may complicate its course. The management of leiomyoma during pregnancy is medical, but in certain circumstances surgical intervention and myomectomy may be required. This 28-year-old primigravida presented with progressively worsening lower abdominal pain at 14 weeks gestational age. Ultrasonography demonstrated a large fundally sited multi lobulated fibroid extending up to the right hypochondrium. There was an intrauterine gestation compatible with her menstrual dates. Laparotomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. She was admitted at 34 weeks gestation with a diagnosis of antepartum haemorrhage. She was managed conservatively in the ward until 37 completed weeks gestation when she had an elective caesarean section and delivered of a live male neonate with a birth weight of 2.7 kg. She had type III placenta praevia.     

Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves’ thyrotoxicosis in pregnancy

Background  Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy. Aims  To report a case of a 31-year-old woman with Graves’ disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis. Methods  After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation. Results  The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41  weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated. Conclusion  This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient’s thyrotoxicosis.     

妊娠晚期骨肉瘤复发剖宫产麻醉处理1例

骨肉瘤大多发生于15～25岁青少年,发病率为每年每百万人2～3例,占恶性肿瘤发生的0.2%[1],联合新辅助疗法使位于肢体末端非转移性骨肉瘤的治愈率为60%～70%[2],局部肿瘤的复发预示预后不良[3-5]。孕期发现骨肉瘤通常建议