孕产妇宫缩乏力“死亡者”与“幸存者”相关因素对比研究

目的:对产后宫缩乏力进行相关研究,从中寻找孕产妇幸运生存下来的宝贵经验,为可持续性地降低孕产妇死亡提供科学依据。方法:对贵州省58个"降消"项目县4年间在县乡级医院住院孕产妇,发生宫缩乏力死亡者42例与发生宫缩乏力严重者由于幸运和得到了良好的救治而存活的39例孕产妇,进行对比研究。结果:两组在产次、入院时病情、分娩地点、发生原因等方面无明显差异(P>0.05);两组在分娩过程中使用药物情况、处理方法、治疗抢救情况等均有显著差异(P<0.05),幸存组宫缩乏力处理方法以按摩子宫配合宫缩剂及宫腔填纱布为主,占79.49%。死亡组宫缩素给药途径75%是肌注,幸存组是宫缩素静滴配合使用米索占82.05%。结论:正确使用宫缩剂是减少阴道流血的重要手段,早发现、早处理宫缩乏力致产后出血是阻断死亡之路的关键。宫按摩法配合宫缩剂及宫腔填塞纱布应用可以明显减少产后出血量,方法简单易行,安全有效,值得在基层推广。     

胎盘滞留致农村产妇死亡及有关因素分析

<正> 为掌握在农村产妇死亡原因中,由于胎盘滞留致死发生的比例,及有关因素,现将51例胎盘滞留致农村产妇死亡病例,作一简要分析。一、资料来源本资料来源于株洲市5县(市)及郊区,1984～1989年农村产妇死亡档案,筛选出由于胎盘滞留致死的51例,进行分析。二、结果分析(一)死亡情况本市1984～1989年孕产妇死亡206例,农村198例,占96.1%,城市8例,占3.88%。农村产妇死亡原因共有28种,直接产科原因10种,共146例,占73.7%;间接产科原因18种,共39例,占19.6%;原因不明13例,占6.7%。在146例直接产科原因死亡中,胎盘滞留51例,占34.9%,居死亡原因顺位之首。     

产后胎盘滞留的彩超诊断与临床

目的探讨彩超对胎盘滞留的诊断价值。方法对30例胎盘滞留的超声图像进行分析。结果30例均经临床病理证实，胎盘植入4例．胎盘粘连8例，胎盘残留18例。结论彩色多普勒对胎盘滞留的诊断具有重要价值。     

产后胎盘滞留的原因及处理

胎盘俗称＂衣包＂,担负着营养胎儿、保护胎儿、排泄代谢废物和内分泌等功能.胎盘功能的好坏决定着胎儿发育的状况.一旦分娩,胎儿来到世上,胎盘亦即完成使命,随子宫收缩排出体外.胎盘滞留是指在第三产程的时候,全部或者部分的胎盘、或者胎膜留在子宫内.年来,由于流产、刮宫、剖宫产史及子宫内膜感染等因素增加,胎盘滞留有上升趋势,约占产后出血原因的20%.     

宫角妊娠胎盘滞留3例分析

1病例介绍 病例1,31岁,因＂停经5月余,阴道流血2次＂于2010年12月14日入院。孕5产1存0。停经4余月曾阴道流血1次,经保胎治疗痊愈。2010年12月15日难娩流产,产后30min胎盘未娩出,行胎盘钳夹术,术中感胎盘位置高,仅夹出少量胎膜,考虑胎盘植入停止操作。     

彩色多普勒诊断胎盘滞留3例报告

胎盘滞留包括:胎盘残留、胎盘粘连及胎盘植入,这些胎盘异常均是因子宫蜕膜化所至。临床上最常见症状是产后持续性出血,重症病人需要做子宫切除。彩色多普勒(Doppler)在产后胎盘滞留诊断上有较大实用价值,现将我们发现的3例报告如下。1 病例资料1.1 例1:女,26岁,停经42W,入院待产,于住院后第2日产下1男婴,体重3.8kg,婴儿发育良好,但产妇产后出血较多,临床     

重庆市1995～1997年73例胎盘滞留死亡相关因素分析

我们对原重庆市１９９５～１９９７年３年７３例胎盘滞留死亡相关因素进行分析。１资料与方法根据原重庆市１９９５～１９９７年２１个区、县妇幼保健所报送死亡孕产妇调查表格及死亡经过,评审结论,进行整理分析和总结。２结果１９９５～１９９７年３年间原重庆市的活产...     

子宫动脉介入栓塞合并氨甲喋呤注射在胎盘完全滞留中的应用

目的观察子宫动脉介入栓塞＋MTX子宫动脉注射用于阴道分娩后胎盘完全滞留的临床效果。 方法回顾性分析华中科技大学同济医学院附属湖北妇幼保健院2012年1月至2018年1月期间阴道分娩后胎盘完全滞留的26例患者的病例资料,12例使用子宫动脉介入栓塞＋MTX作为观察组,14例未做子宫动脉介入作为对照组,比较两组患者阴道出血量、胎盘娩出时间、住院天数等指标。 结果观察组阴道出血量为(543.3±190.4)mL,高于对照组的(408.6±109.3)mL(P<0.05)。观察组胎盘娩出平均时间为6.5 d,低于对照组的22.6 d(P<0.05);观察组住院天数为(9.6±2.4) d,低于对照组的(15.7±5.0) d(P<0.05)。 结论阴道分娩胎盘滞留行子宫动脉介入栓塞加MTX子宫动脉注射可迅速止血、促进胎盘的坏死脱落以及排除,为胎盘钳夹创造条件。对胎盘穿透性植入导致的胎盘完全滞留,非手术治疗仍需谨慎。     

先天性肥厚性幽门狭窄的影像诊断比较

目的 回顾分析应用高频超声对先天性肥厚性幽门狭窄进行检测的结果 与X线造影检查结果 对照,以探讨高频超声检查与X线造影在先天性肥厚性幽门狭窄诊断中的应用价值.方法 对33例X线造影下诊断为肥厚性幽门狭窄的患儿进行高频超声检查,测量幽门管各径线,观察胃腔情况,并与X线造影结果 进行对照、分析.结果 1例X线造影检查疑似肥厚性幽门狭窄病例,经超声检查后排除;其余32例高频超声诊断为肥厚性幽门狭窄的病例均经胃镜检查证实.高频超声测得幽门管长度为20.3±3.31mm,X线造影下测得16.2±3.68mm,与胃镜下测量相比较,超声下测量较为准确,X造影下测得的幽门管较短.结论 高频超声可作为先天性肥厚性幽门狭窄诊断的首选筛查方法 .     

广东省57例传染性非典型肺炎死亡病例流行病学分析

目的　分析传染性非典型肺炎 (SARS)死亡病例的流行病学特点 ,为降低SARS的病死率 ,控制SARS传播提供科学依据。方法　用描述性流行病学方法 ,用统一的个案调查表对 2 0 0 3年 1月 2日至 5月 30日广东省各市SARS死亡病例进行调查 ,分析其三间分布特点、基础病情况和死亡原因。结果　截止 5月 30日全省累计报告SARS病例 1 5 1 1例 ,死亡 5 7例 ,病死率为 3 77%。死亡病例以广州为多 ,占 78 9%。 1月上旬病死率最高 ,为 1 1 1 % (4 / 36 ) ,2月份后病死率下降 ,4月 1 6日以后无死亡病例。病死率随着年龄的升高而升高 (χ2 =1 84 2 ,P <0 0 1 ) ,以 70岁以上年龄组最高 ,为 1 3 5 % (1 2 / 89) ,6 0～ 6 9岁年龄组次之 ,为 9 91 % ;死亡病例以离退休及家务待业为多 ,占 31 5 8%。农民的病死率最高 ,为 1 5 6 3% (5 / 32 )。死亡病例中 1 7例 (2 9 8% )患有严重的基础性慢性疾病。聚集性病例病死率为4 5 9% (2 4 / 5 2 3) ,散发病例病死率为 3 34% (33/ 988) ,两者比较差异无显著性 (χ2 =1 4 6 9,P >0 0 5 ) ;社区聚集性病例病死率为 1 0 1 1 % (1 9/ 1 88) ,医院聚集性病例病死率为 1 4 9% (5 / 335 ) ,两者比较差异有显著性 (χ2 =2 0 4 0 7,P <0 0 1 )。采用多因素分析死亡的可能因素 ,社区     

A study of clinical dietetic workforce recruitment and retention in Queensland

Aims: The aim of the present study was to investigate factors influencing the recruitment and retention of the clinical dietetics workforce in metropolitan practice, with a focus on Queensland Health. Methods: A qualitative study using semistructured telephone and face‐to‐face interviews among a purposively recruited sample of 28 Queensland clinical dietitians. The interviews explored factors affecting recruitment and retention, job satisfaction and possible strategies for the recruitment and retention of hospital‐based dietitians within Queensland Health was conducted. Interviews were audio‐recorded, transcribed verbatim and content analysed by two researchers (authors 1 & 2) before comparing, confirming, describing and interpreting themes identified. Results: All but two of the interviewees (26/28) were either existing (n = 16) or previous (n = 10) employees of Queensland Health. The demographic attributes of the sample reflected the broader Australian dietetic workforce. Factors effecting recruitment to current positions were the position itself, the closeness of the position to home and job security associated with Queensland Health positions. The most common factors assisting retention in Queensland Health were the team collegiality, opportunities, and the closeness to home of the workplace and professional development opportunities. The negatives of employment were high work demands or workload and bureaucratic frustrations within Queensland Health. Increasing remuneration rates, career pathways and increasing the flexibility of work hours were strategies considered as most important for Queensland Health to enhance clinician recruitment and retention. Conclusion: Factors effecting recruitment and retention of clinical dietitians are largely amenable to human resource and organisational management strategies that address these determinants of staff turnover.     

生化参数在不同类型胎盘早剥孕妇血中的变化

目的 通过对不同类型胎盘早剥孕妇血清中癌抗原(CA125)、甲胎蛋白和胎盘生长因子水平的检测,探讨其与不同类型胎盘早剥的关系,为胎盘早剥的预测及早期诊断提供理论依据.方法 采用微粒酶免疫分析法和双抗体夹心酶联免疫吸附试验法检测孕妇血清中癌抗原(CA125)、甲胎蛋白和胎盘生长因子水平,并对其进行分析.结果 重型胎盘早剥组的CA125和甲胎蛋白水平明显高于轻型组(t分别为6.20、2.72,均P<0.05),胎盘生长因子水平明显低于轻型组(t=2.71,P<0.05).结论 通过检测外周血癌抗原(CA125)、甲胎蛋白和胎盘生长因子水平预测胎盘早剥具有一定的临床价值.     

A case of chronic hypomagnesemia in a cancer survivor

Objectives: Hypomagnesemia is common among hospitalized patients, particularly those who are critically ill. It can be associated with a number of potentially life-threatening cardiovascular, neurological and behavioral manifestations. As opposed to acute, chronic hypomagnesemia is often underdiagnosed and underreported and as such may pose a diagnostic and therapeutic problem.

Case presentation: We describe a case of magnesium wasting in a middle-aged woman with head and neck cancer who presented with recurrent syncopal episodes complicated by a femur fracture 4 months after completing a course of carboplatin-containing chemotherapy. Fractional excretion of magnesium of 16% was consistent with renal wasting of magnesium. After ruling out all common causes of hypomagnesemia, it was concluded that she sustained carboplatin-induced renal tubular damage making her relatively resistant to magnesium supplementation.

Conclusion: Several antineoplastic agents have been linked to chronic hypomagnesemia including anti-epidermal growth factor receptor agents such as cetuximab and panitumumab, cyclosporine, and the platinum-based agents cisplatin and carboplatin. The example case presented here illustrates the importance of chronic hypomagnesemia and its possible debilitating effects following carboplatin-containing chemotherapy. A growing numbers of cancer survivors are treated with these antineoplastic agents, and are hospitalized for non-cancer-related problems. These patients may have prolonged hypomagnesemia, and hence pose a diagnostic dilemma. We review the pathophysiology, etiology, diagnosis, clinical manifestations, monitoring and treatment of hypomagnesemia, with special attention to mechanisms of renal damage caused by platinum-containing chemotherapeutic agents.     

阿立哌唑与利培酮治疗儿童青少年首发精神分裂症的对照研究

目的评价阿立哌唑与利培酮治疗儿童青少年首发精神分裂症的疗效和安全性。方法阿立哌唑组40例,剂量范围10～20mg／d;利培酮组42例,剂量范围2—5mg／d,疗程12周。于治疗前及治疗后1、2、4、8、12周末根据简明精神病评定量表（BPRS）和不良反应量表（TESS）评定疗效和不良反应。结果阿立哌唑治疗的显效率75％,有效率85％;利培酮治疗的显效率69％,有效率83％。两组比较无显著性差异;不良反应方面两组均有轻度的胆碱能副作用,在锥体外系副反应、体质量增加、闭经等方面阿立哌唑少于利培酮组。结论阿立哌唑治疗儿童青少年首发精神分裂症安全有效。     

Competition and medical groups. A survivor analysis.

This paper extends the survivor analysis of medical practice provided by Frech and Ginsburg (1974). Changes in the distribution of medical practice sizes are examined for the periods 1965-69, 1969-75, and 1975-80. Through 1975, we find that, almost uniformly, all sizes of medical groups were found to be optimal. In particular, the optimality of large (100 or more physicians) multi-specialty groups was strongly confirmed. Later data, however, suggest that the equilibrium size distribution may have shifted. For the 1975-80 period only large multi-specialty groups continue to be in the optimal size range. In addition, we find some evidence that suggests that solo practices may be optimal in some geographic regions.