多学科联合管理对女性围绝经期综合征的疗效分析

目的探讨围绝经期多学科联合管理对女性围绝经期综合征整体治疗效果的影响。方法观察性研究182例围绝经期综合征患者,随机分为观察组90例和对照组92例,两组患者均给予绝经激素补充治疗(MHT)6个月,观察组在MHT治疗的基础上进行多学科联合管理。填写改良Kupperman评分、焦虑自评量表(SAS)、抑郁自评量表(SDS),测定血清性激素水平。结果在激素补充治疗基础上联合多学科管理的围绝经期女性,治疗6个月后,其Kupperman评分及SAS、SDS评分下降程度、E2升高、FSH、LH下降程度,显著优于对照组。结论激素补充治疗的基础上联合多学科管理,可以显著缓解围绝经期妇女的躯体症状,还能够更好的改善焦虑、抑郁程度,提高围绝经期综合征患者的生存质量。     

Relation between Hot Flashes and Anxiety, Depression among Climacteric Women

目的:探讨围绝经期前后妇女潮热与焦虑、抑郁之间的关系.方法:将符合条件的1 206名40～60岁妇女分为潮热组、无潮热组,分别完成调查问卷.问卷具体内容包括一般情况、潮热状况、焦虑自评量表(SAS)、抑郁自评量表(SDS).结果:潮热组妇女SAS和SDS的平均值高于无潮热组妇女(SAS:39.8±7.3 vs 36.0±6.1;SDS:44.1±8.3 vs 40.9±8.9,P均＜0.05),潮热组轻度焦虑和抑郁的发生率明显高于无潮热组(焦虑:8.3％vs 3.4％;抑郁:23.3％vs 14.2％,P均＜0.05).潮热妇女焦虑、抑郁的发生风险分别是无潮热妇女的4.1倍(95％CI,1.20～13.74)、2.4倍(95％CI,1.15～4.92).重度潮热妇女较轻度潮热妇女SAS和SDS得分均高(SAS:46.4±7.9 vs 38.8±6.6; SDS:43.9±6.9 vs 52.7±12.5,P均＜0.05).潮热妇女的月经状况与SAS和SDS得分无关.结论:围绝经期潮热妇女易发生焦虑、抑郁症状,且重度潮热妇女更易发生.对妇女进行潮热治疗时,还应对妇女进行心理疏导.     

围绝经期潮热妇女焦虑与抑郁状况的分析

目的:探讨围绝经期前后妇女潮热与焦虑、抑郁之间的关系。方法:将符合条件的1 206名40~60岁妇女分为潮热组、无潮热组,分别完成调查问卷。问卷具体内容包括一般情况、潮热状况、焦虑自评量表(SAS)、抑郁自评量表(SDS)。结果:潮热组妇女SAS和SDS的平均值高于无潮热组妇女(SAS:39.8±7.3 vs 36.0±6.1;SDS:44.1±8.3 vs 40.9±8.9,P均<0.05),潮热组轻度焦虑和抑郁的发生率明显高于无潮热组(焦虑:8.3%vs 3.4%;抑郁:23.3%vs 14.2%,P均<0.05)。潮热妇女焦虑、抑郁的发生风险分别是无潮热妇女的4.1倍(95%CI,1.20~13.74)、2.4倍(95%CI,1.15~4.92)。重度潮热妇女较轻度潮热妇女SAS和SDS得分均高(SAS:46.4±7.9 vs 38.8±6.6;SDS:43.9±6.9 vs 52.7±12.5,P均<0.05)。潮热妇女的月经状况与SAS和SDS得分无关。结论:围绝经期潮热妇女易发生焦虑、抑郁症状,且重度潮热妇女更易发生。对妇女进行潮热治疗时,还应对妇女进行心理疏导。     

产后抑郁心理干预

目的:了解心理支持治疗和认知行为疗法对产后抑郁症状的影响。方法:将30名伴有抑郁症状的产妇给予常规治疗的同时采用支持性心理治疗和认知行为疗法。心理干预前、干预2月、干预4周自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS),分别评估病人心理状态。结果:心理干预四周SCL-90躯体化,焦虑精神症状得分及SAS,SDS标准分与干预前比较,差异有统计学意义(P<0.05);干预四周SCL-90各因子得分及SAS,SDS标准分与干预前比较差异均有统计学意义(P<0.05)。结论:心理支持治疗和行为疗法能有效改善心身症状。     

综合护理在绝经期妇女取环术中的应用及护理满意度分析

目的 探究综合护理应用于绝经期妇女取环术中的效果及对护理满意度的影响。方法 选取120例绝经期妇女,均实施取环术。按照红蓝球法随机分成两组,每组60例。对照组予以常规护理,观察组予以综合护理。比较两组负面情绪、疼痛程度及护理满意度。结果 观察组焦虑自评量表（SAS）、抑郁自评量表（SDS）评分、视觉模拟评分法（VAS）评分均显著较对照组更低（P<0.05）。观察组护理满意度95.00%明显高于对照组的83.33%(P<0.05)。结论 绝经期妇女在开展取环术过程中,积极开展综合护理干预,可显著改善患者负面情绪,减轻疼痛感,提高护理满意度,值得临床推广与应用。     

IVF-ET治疗过程中心理应激状态与妊娠结局相关性研究

目的:探讨IVF-ET治疗过程中心理应激变化对妊娠结局的影响.方法:60例初次接受IVF-ET/ICSI治疗的妇女,于取卵日(OPU)行焦虑自评量表(SAS)、抑郁自评量表(SDS)测试.测定OPU日、移植(ET)日和ET后5天血浆去甲肾上腺素(NA)及肾上腺素(A)水平.结果:未妊娠妇女的SDS评分明显高于妊娠妇女(P<0.05).妊娠妇女OPU日血浆A 1.36±1.04 nmol/L低于未妊娠妇女3.33±2.35 nmol/L;妊娠妇女ET日血浆NA 2.07±0.71 nmol/L低于未妊娠妇女3.78±1.36 nmol/L(P<0.05)ET日血浆NA与SDS评分正相关(r=0.670,P<0.01);OPU日血浆A和OPU日、ET日的血浆NA与SAS评分正相关(P<0.05).结论:治疗过程中不同阶段的心理应激不同,并影响治疗结局,OPU日抑郁分值高的妇女妊娠率低;OPU日A及ET日NA水平高的妇女妊娠率低.     

优质护理联合心理护理在腹腔镜全子宫切除术患者中的应用效果

目的 探讨优质护理联合心理护理在腹腔镜全子宫切除术患者中的应用效果。方法 选取80例子宫肌瘤患者为研究对象,根据随机数字表法分为对照组和观察组,每组40例。对照组采用妇科常规护理,观察组采用优质护理联合心理护理干预,比较两组手术时间及住院时间、术后并发症发生率、焦虑、抑郁情况。结果 观察组手术时间、住院时间均短于对照组（P<0.05）;观察组术后并发症发生率低于对照组（P<0.05）;干预前,两组焦虑自评量表（SAS）及抑郁自评量表（SDS）评分比较,差异无统计学意义（P>0.05）;干预后,观察组SAS、SDS评分均低于对照组（P<0.05）。结论 对行腹腔镜全子宫切除术的子宫肌瘤患者实施优质护理联合心理护理干预效果较好,可缩短手术时间及住院时间、减少术后并发症发生率、缓解焦虑、抑郁情绪,值得临床推广与应用。     

产后抑郁心理干预

目的：了解心理支持治疗和认知行为疗法对产后抑郁症状的影响。方法：将30名伴有抑郁症状的产妇给予常规治疗的同时采用支持性心理治疗和认知行为疗法。心理干预前、干预2月、干预4周自评量表（SCL-90）、焦虑自评量表（SAS）、抑郁自评量表（SDS）,分别评估病人心理状态。结果：心理干预四周SCL-90躯体化,焦虑精神症状得分及SAS,SDS标准分与干预前比较,差异有统计学意义（P〈0.05）;干预四周SCL-90各因子得分及SAS,SDS标准分与干预前比较差异均有统计学意义（P〈0.05）。结论：心理支持治疗和行为疗法能有效改善心身症状。     

产妇产后抑郁症相关因素的分析

目的:了解影响产妇产后抑郁症的相关因素,并提出相对应的心理护理干预措施。方法:采用抑郁自评表(SDS)和焦虑自评量表(SAS)以及自行设计的调查问卷对500例产妇产后的抑郁心理状态和影响产后抑郁症的相关因素进行调查分析。     

黛力新联合性激素治疗围绝经期抑郁障碍的临床研究

目的:探讨围绝经期综合征伴发抑郁障碍的合理治疗方案,提高围绝经期妇女身心健康的水平。方法:选择围绝经期抑郁障碍患者125例,随机分为两组,研究组用黛力新联合性激素治疗(HT)(64例),对照组单用HT(61例)。观察治疗前后Gr绝经相关症状评分和Zung抑郁自评量表(SDS)评分。结果:Gr绝经症状评分:治疗2周后两组均较治疗前明显下降,两组无明显差异,但4周后两组差异有统计学意义(P<0.05),并且研究组各时段分值均低于对照组,随治疗时间推移,差异逐渐显著。SDS抑郁评分:治疗2周末研究组评分较治疗前明显下降,两组差异有统计学意义(P<0.05);对照组3周末评分较治疗前明显下降,3周后无明显改善。并且研究组各时段分值均低于对照组。结论:HT联合小剂量黛力新治疗围绝经期综合征,能有效缓解抑郁障碍,减轻躯体症状,改善生活质量。     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

绒毛膜羊膜炎与胎儿及新生儿疾病

绒毛膜羊膜炎是产科炎症反应,但与新生儿预后关系密切。母体的宫内炎症反应可以直接导致胎儿和婴儿患病率和死亡率增加,胎儿炎症反应综合征（FIRS）也不可忽视。早期识别和快速诊断有助于减少母儿的近期合并症,改善新生儿的远期预后。产科和儿科共同关注,整合信息,是早期发现、实施有效干预的临床重点之一。