剖宫产与产后出血

剖宫产与产后出血李莉李怀芳附属甘泉医院妇产科（上海，２０００６５）关键词剖宫产术；出血，产后分类号Ｒ７１９．８产后出血是产科的严重并发症，如处理不当易造成产妇死亡。剖宫产术是临床应用最多的解决难产的手术之一，是在危急情况下，抢救婴儿，保护母亲的重要手...     

剖宫产产后出血的相关危险因素探讨

目的研究分析剖宫产产妇出现产后出血的相关危险因素。方法选取我院2015年10月-2016年10月妇产科收治的50剖宫产产后出血患者为研究组,再选取同期行剖宫产手术后未出血患者50例为对照组,对其临床资料进行分析,找到产后出血的相关影响因素。结果剖宫产产妇术后出血重要影响因素有多胎妊娠、前置胎盘和宫缩乏力、产前收缩抑制剂使用、凝血功能障碍、其他胎盘因素等。结论针对导致剖宫产产后出血的危险因素进行防治能降低剖宫产手术术后产妇出血率,因此找到相关危险因素是关键。     

剖宫产产后出血应用改良子宫背带式缝合术治疗的临床效果

目的研究分析在剖宫产产后出血的治疗中采用改良子宫背带式缝合术的临床治疗效果。方法选取2016年1月至2018年12月在我院接受剖宫产手术且产后出血的产妇18例,所有产妇均给予改良子宫背带式缝合术,并总结探讨其治疗剖宫产产后出血的临床效果。结果本组18例产妇,总体止血有效率为94.4%,术后恢复良好,无并发症出现。结论在剖宫产产后出血的治疗中采用改良子宫背带式缝合术,止血效果显著,值得在临床上大力推广。     

产后出血病因探讨及临床分析

目的:通过分析产后出血患者的临床病例,探讨产后出血的发病原因,为产后出血的临床治疗提供参考。方法:回顾性总结分析我院妇产科在2010年4月至2012年4月期间收治的151例产后出血患者的临床病例资料,总结造成产妇产后出血的原因并进行统计分析,并探讨对于产后出血的治疗和预防措施。结果:在导致产妇产后出血的原因中,宫缩乏力病例患者为95例,所占比例为62.91%,显著高于其他出血原因的所占比例,差异均具有统计学意义(P0.05);其中151例产后出血产妇中为阴道自然分娩者37例,所占比例为24.50%,显著低于进行剖宫产手术组,差异具有统计学意义(P0.05)。结论:总结并分析产妇产后出血的发病原因,并对产妇给予相应的针对性诊断和治疗,能够有效降低产后出血的并发症以及病死率。     

剖宫产手术中出血的临床分析与预防措施分析

目的探讨剖宫产手术中出血的临床分析与预防措施。方法选择2015年1月-2017年3月我院收治的剖宫产手术中出血的53例患者作为此次研究对象,针对患者出血情况,分析患者的出血原因,同时采用有效的预防措施进行临床治疗,观察患者的治疗效果。结果 (1)产妇剖宫产手术中出血原因分析:通过对产妇剖宫产手术中出血原因进行分析,发现导致产妇剖宫产手术中出血原因主要包括子宫乏力、胚盘因素、子宫肌瘤、切口撕裂、凝血障碍等因素。其中宫缩乏力所造成产妇剖宫产手术中出血的比重要高于其他因素,其比重达到47.17%。差异具有统计学意义(P0.05);(2)产妇临床治疗情况比较:53例产妇在经过临床治疗后,治疗总有效率高达100.00%。结论对产妇剖宫产出血原因进行分析,并采用有效的预防措施,有利于提升剖宫产成功率,减少产妇术中出血量。     

背带式缝合术在剖宫产产后出血的临床应用

目的探讨在剖宫产产后出血的治疗中应用背带式缝合术的临床效果。方法选择我院妇产科2016年2月至2018年2月收治的120例剖宫产产后出血产妇作为研究对象。按照不同的止血治疗方法随机分为对照组(60例,实施常规止血治疗),观察组(60例,实施背带式缝合术治疗)。对比两组产妇的手术时间、住院时间、出血量、止血效果等。结果相较于对照组,观察组产妇的手术时间及住院时间均显著缩短,术中出血量更少、止血效果更佳。且两组差异具有统计学意义(P0.05)。结论在对剖宫产产后出血产妇的治疗中,背带式缝合术具有很好的止血效果,使产妇术后更加有效、快速地康复,值得在临床治疗中推广应用。     

33例产后出血的临床分析及其防治

目的通过分析产后出血结论研究相应的防治措施。方法选取本院妇产科2010年1月至2011年1月的产后出血患者33例的临床资料进行分析回顾。结果剖宫产产妇、有引产或人工流产史产妇出血量较多;子宫收缩乏力20例（60.6%）,是产后出血的首要威胁。结论重视产前保健、产程处理和产后观察。     

剖宫产产后出血215例临床分析

目的：探讨剖宫产产后出血的相关因素和防治措施。方法以2013年1月—12月在我院住院剖宫产分娩4536例作为观察对象,通过研究剖宫产产后出血215例患者的临床资料,对产后出血量、出血因素和原因进行回顾性分析。结果我院剖宫产产后出血发生率4.74%,剖宫产产后出血原因主要有子宫收缩乏力、胎盘因素和子宫下段切口裂开。结论造成剖宫产产后出血的因素很多,而剖宫产手术本身就是产后出血很重要的危险因素,降低剖宫产率,剖宫产手术中采取正确的治疗方法是减少和防止剖宫产产后出血的根本措施。     

探讨分娩方式对产后出血的影响

目的:探讨分娩方式对产妇产后出血情况的影响,以降低产妇产后出血的发生。方法:随机选取2012年5月至2013年6月期间于我院妇产科进行分娩的200例产妇作为本组研究的观察对象,按照分娩方式将其分为自然分娩组与剖宫产组各100例,对比两组产后出血率、出血量、出血时间及休克等情况。结果:自然分娩组的出血率为4%(4/100),出血量为(639.15±114.38)ml,未出现休克产妇,出血主要发生在产后0~2h内(75%,3/4),未出现晚期出血产妇,各项数据均明显优于剖宫产组,差异明显,具有统计学意义(P0.05)。结论:剖宫产产后出血的比例及出血量要明显多于阴道自然分娩,因此在今后的工作中应尽量鼓励具备条件的产妇进行自然分娩,减少剖宫产率,对于行剖宫产手术的产妇要注意手术操作,避免产后出血的发生。     

宫缩乏力性产后出血的临床治疗进展

产后出血是引起孕妇产后死亡的首位原因,宫缩乏力是产后出血的首要因素。近年来,随着医学技术的快速发展,剖宫产率也明显升高,剖宫产属于有创的手术,若产妇又有高危妊娠的因素就很容易出现产后出血的现象。产后出血若不及时处理有可能造成严重的并发症,如DIC、休克、呼吸窘迫综合征等,甚至威胁产妇的生命。本文在阐述产后出血概念的基础上对产后出血临床治疗方法,包括药物治疗、保守性手术治疗、介入治疗及外科技术控制产后出血进行综述,以期为临床宫缩乏力性产后出血的治疗提供理论依据。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.