妊娠合并心脏病100例临床分析

目的:探讨妊娠合并心脏病患者不同心功能状态对孕妇和围产儿的影响。方法:收集我院近10年间100例妊娠合并心脏病患者的临床资料进行回顾性分析。结果:妊娠合并心脏病发生率为0.75%,孕产妇病死率为0,围产儿死亡率为0.48‰,剖宫产率71.0%,心律失常发生率为76.11%。妊娠合并心脏病患者以心肌炎、心肌炎后遗症的发生率最高,占38.05%,其次为先天性心脏病,占20.75%。心功能Ⅰ~Ⅱ级与Ⅲ~Ⅳ级比较,妊娠孕周、新生儿平均体重、围产儿患病率及死亡率差异显著(P<0.01或P<0.05)。结论:妊娠合并心肌炎、心肌炎后遗症的发生率有升高趋势,而风湿性心脏病发生率已较80年代下降;妊娠合并心脏病易导致心功能不全、心律失常、心肌劳损;同时也影响孕周、新生儿体重,增加剖宫产几率。     

妊娠合并肺动脉高压12例临床分析

目的:探讨妊娠合并肺动脉高压围产期监测治疗方案及其妊娠结局。方法:回顾性分析12例妊娠合并肺动脉高压孕妇的临床资料,分析肺动脉高压的类型、严重程度、妊娠结局。结果:妊娠合并原发性肺动脉高压3例,继发性肺动脉高压9例;重度肺动脉高压8例,中度肺动脉高压4例;心功能Ⅳ级8例,心功能Ⅲ级2例,心功能Ⅱ级2例;9例心功能恶化发生在32~34周,4例重度肺动脉高压、心功能Ⅳ级患者产后5天内死亡。结论:肺动脉高压患者应避免妊娠,对已妊娠者建议早期终止妊娠,妊娠中晚期患者主张全麻剖宫产,通过多学科协作,加强产后监护治疗,尽量延长患者生命。     

75例尘肺合并心律失常临床分析

对７５ 例合并心律失常的尘肺临床资料进行了分析, 指出了心律失常的主要原因为合并感染。     

妊娠合并心脏疾患28例妊娠结局分析

目的探讨妊娠合并心脏病患者不同的种类与不同的心功能状态对孕妇和围生儿的影响及防治措施。方法对笔者所存在医院近5年来收治的28例妊娠合并心脏病患者的临床资料进行回顾性分析。结果妊娠合并心脏病发生率为0．16％,不明原因心律失常的发生率最高占32．1％,先天性心脏病25％,风湿性心脏病14．2％,围生期心脏病10．7％,心肌炎及后遗症107％,妊娠期高血压心脏病7．1％。妊娠合并心脏病心功能I～Ⅱ级和获得监护者能顺利度过妊娠分娩产褥期,而心功能Ⅲ～Ⅳ级和无监护者易出现产妇死亡、早产儿、低体重儿、死胎。结论母亲心功能状态直接影响孕产妇生命及围生儿质量,对妊娠合并心脏病患者实行住院监护分娩,选择正确分娩方式适时终止妊娠,对母儿安全有积极作用。     

妊娠合并心脏病72例临床分析

妊娠合并心脏病约占全部妊娠的1%,其中以风心病和先心病为主,为孕产妇死亡4大原因之一[1].本文回顾分析了我院4年收治的妊娠合并心脏病72例,探讨对于妊娠合并心脏病的病例,不同心功能及不同心脏病类型对母儿预后的影响及如何加强对心脏病孕产妇的管理,及时诊断与治疗,从而改善母儿预后.     

慢性心功能不全心律失常106例临床治疗分析

目的探讨慢性心功能不全患者心律失常的病因及其治疗策略。方法106例慢性心功能不全按NYHA心功能分级分为Ⅱ级36例，Ⅲ级50例，Ⅳ级20例。其中男58例，女50例，平均年龄55．6岁，对其心律失常情况进行分析。结果慢性心功能不全患者中心房纤颤发生率占49．1％，为最多，其次为室性期前收缩及房性期前收缩，发生率分别为18．9％和15．1％。病因最常见的为冠心病、肺源性心脏病、高血压性心脏病。结论有些心律失常如心房纤颤主要与心脏本身的病变密切相关，而有些心律失常可能主要与心功能不全时内环境紊乱及药物有关。因此，在处理此类心律失常时应寻找导致心律失常的原因，综合治疗，使用心律失常药物应持谨慎态度，权衡利弊，避免滥用抗心律失常药物。     

肺心病并发心律失常87例临床分析

慢性肺源性心脏病 (简称肺心病 )是主要涉及呼吸和循环系统的慢性全身性疾病 ,患病率高 ,并发症多。而心律失常是肺心病急性加重期的常见并发症之一 ,对肺心病的预后有明显的不良影响 ,如不及时治疗 ,病死率很高。我院 1998年 1月至2 0 0 2年 12月共收治肺心病急性加重期患者 2 10例 ,其中并发心律失常 87例。现对其临床资料进行回顾性分析 ,报告如下 :1　材料与方法1.1　对象收集我院 1998年 1月至 2 0 0 2年 12月间收治住院的肺心病急性加重期患者 2 10例 ,根据病史、查体、胸片等综合判定 ,诊断符合第二次全国肺心病专业会议修订的标准[1…     

1 275例青少年非意愿性妊娠临床分析

目的了解青少年非意愿妊娠的原因,为探索青少年健康教育与健康促进方式提供理论依据.方法回顾性分析1 275例青少年非意愿妊娠的临床资料.结果1 275例青少年非意愿妊娠中已婚(10.5%)与未婚(89.5%)相比有显著性差异(P＜0.05);未避孕(30.5%)与避孕失败(69.5%)相比有显著性差异(P＜0.05);但首次妊娠(47.2%)与再次妊娠(52.8%)相比较无显著性差异(P＞0.05).结论女青少年性与生殖健康知识欠缺,及早进行青少年健康教育与健康促进是减少青少年非意愿妊娠的主要手段,但其有效的教育方式仍需探讨.     

宫内妊娠合并宫外妊娠4例临床分析

目的探讨宫内妊娠合并宫外妊娠之病因、临床表现、防治措施.方法对2002～2005年间收治的4例此类病人进行回顾性分析.结果1例带环受孕人流术前未做B超和1例药流前做B超病人漏诊,出现宫外妊娠破裂后行剖腹探查;2例药物诱导排卵助孕者,1例人流术前外院B超漏诊,另1例B超发现宫外妊娠,经在院严密观察后行剖腹探查切除妊娠之输卵管后正常分娩一活女婴.结论加强B超监测有助于早期发现宫内妊娠合并宫外妊娠,从而避免宫外妊娠破裂对病人造成危害.     

Outcome of pregnancies experienced during residency

To investigate potential adverse effects of residency training on pregnancy outcome, a cohort study was conducted among 45 university-affiliated residency programs. Outcomes of the first pregnancy experienced during residency were compared between 92 female residents and 144 spouses of male residents. Despite long hours, sleep deprivation, and an increase in perceived stress, the female residents were as likely to give birth to a live, full-term newborn as the spouses of male residents. For white cohort members, an increased risk of premature labor without delivery was identified (RR = 12.3, 95% confidence interval 2.4-61.6). No significant differences were found in prematurity, spontaneous and therapeutic abortions, or presence of congenital abnormalities in the infants. Method of delivery and use of anesthetics and of other medications were similar in both groups. Pregnancy outcomes between the two groups were similar; however, the increased risk for premature labor among female residents is a cause for concern and should be further investigated.     

左卡尼汀佐治冠心病合并室性心律失常的疗效观察

目的观察左卡尼汀治疗冠心病合并室性心律失常的临床疗效。方法入选65例老年冠心病合并室性心律失常患者并随机分为A组（n=35）、B组（n=31）,B组予常规心血管药物,A组在此基础上加用左卡尼汀,疗程均为2周,对比两组治疗后冠心病与心律失常治疗效果。结果①A组心绞痛治疗显效率（54-3％）与总体有效率（91．4％）均高于B组（29．0％、77．4％）,显效率差异具有统计学意义（X2=4．292P=0．038）。②A组心律失常显效比例（48．6％）与总体有效率（88．6％）均高于对照组（29．0％、71．0％）,但差异不均具有统计学意义（X2=2．629P=0．105;x2=3．221P=0．073）。结论外源性左卡尼汀佐治冠心病合并室性心律失常能减少心绞痛与心律失常的发生几率,提高生存质量。     

妊娠合并急性肾功能衰竭19例临床分析

目的探讨妊娠合并急性肾功能衰竭(ARF)的病因、发病特点及防治.方法总结我院15年间19例妊娠合并急性肾功能衰竭患者的临床表现、治疗,进行回顾性分析.结果14例经积极治疗痊愈,3例死亡,2例发展为肾功能不全.结论妊娠合并急性肾功能衰竭应针对病因治疗,早透析可明显改善ARF预后.     

糖尿病并发气性坏疽一例报道并文献复习

正大肠埃希菌是肠杆菌科中常见的细菌,为革兰阴性杆菌,能发酵多种糖类产酸、产气。本例患者为大肠埃希菌感染所致背部皮下软组织,脾脏后缘、左肾后方、左侧后腹部、盆腔及左下肢大量积气、积液,其临床表现为气性坏疽,在大肠埃希菌感染病例中实属罕见,故结合文献复习与大家分享,以提高对糖     

早孕合并子宫肌瘤人工流产术临床分析

目的:探讨早孕合并子宫肌瘤患者终止妊娠方式、手术并发症的预防和处理。方法:回顾性分析212例早孕合并子宫肌瘤终止妊娠患者的临床资料。结果:203例行电吸术及钳刮术,2例出血较多,为合并肌壁间肌瘤,直径>5cm。9例行药物流产术,顺利排出胎囊,排出时间平均136min。出血未超过月经量。结论:早孕合并较小子宫肌瘤病例(肌瘤结节<5cm),或者肌瘤位于浆膜下者,手术难度及风险较小。合并多发性、肌壁间子宫肌瘤,以及直径≥5cm的子宫肌瘤患者,人工流产手术并发症的发生率均明显增高。早孕合并子宫肌瘤行药物流产是可行、有效的,在药流过程中,严密观察、及时处理,可减少并发症的发生率。     

The rate of maternal complications in 107 pregnancies complicated with HELLP syndrome

INTRODUCTION: HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low platelet count) is a grave, life threatening form of preeclampsia, which was named by Weinstein in 1982, on the basis of characteristic changes in laboratory findings (haemolysis, elevated level of liver enzymes and thrombocytopenia). OBJECTIVE OF THE STUDY: To assess the rate of maternal complications in HELLP syndrome. MATERIAL AND METHODS: In the past ten years, 107 patients were treated for HELLP syndrome at the Intensive Care Unit (ICU) of the 1st Department of Obstetrics and Gynaecology, Semmelweis University. The authors summed up about their experience with the treatment of patients, with special regard to the typical symptoms of HELLP syndrome, the course of the disease, postpartum maternal complications. RESULTS: The frequency of HELLP syndrome in live births was found to be 0.37%. In 96% of the patients the pregnancy was terminated via Caesarean section. Pulmonary oedema was the most common cardiopulmonary complication (11%) and developed in Mississippi Group I in the majority of the cases (21%). Transfusions had to be given quite frequently; 62% of the patients in the study were transfused using erythrocyte preparations. In persistent or progressive cases in the postpartum period, the elimination (uterine curettage and lavage) of factors responsible for the persistence of the disease (toxic and vasoactive agents in the endometrium) resulted in the recovery of one third of the patients. Maternal thromboembolic complications developed in 11% of the patients, each of them was affected in Mississippi Group I, with the lowest platelet count. CONCLUSIONS: The immediate termination of a pregnancy in which HELLP syndrome emerges may save the patient's life. It is recommended to try and lift foci applying uterine curettage and lavage as the first step, if the mothers' condition persists or progresses after delivery. Its development is accompanied by a significant increase in maternal and fetal morbidity and mortality alike, therefore it is essential for the obstetricians to be familiar with the disease.     

Dietary manipulation as a primary treatment strategy for pregnancies complicated by diabetes

The mainstay of management for gestational diabetic women (GDM) has been dietary. If it is inadequate to sustain normoglycemia, insulin therapy must be initiated. We studied whether we could prevent macrosomia by insulin therapy based on four daily self blood glucose levels (SBG). Fifty GDM, ages 28-39 years were, recruited to the study. They were divided based on fasting glucose (FBS) level on the glucose tolerance test (GTT): those with FBS less than 90 mg/dl were managed by diet alone; those with FBS greater than 90 mg/dl were immediately started on insulin. The four SBG checks [FBS and 1 hour after each meal (lhpc)] correlated with the continuous glucose monitor with r = 0.91. The women were asked to perform a dipstick for ketones on their urine upon awakening and whenever a meal or snack had been missed. Insulin was initiated when the SBG monitoring indicated that: (1) the FBS was 80 mg/dl whole blood from fingerstick (WBG) or the plasma glucose (PG) greater than 90 mg/dl and/or (2) the lhpc was greater than 140 mg/dl WBG and/or (3) the patient had persistent ketonuria on the prescribed diet which cleared only when the caloric intake was increased to a point which precipitated postprandial hyperglycemia. The prescribed diet was calculated based on body weight to be 30 kcal/kg if the women were between 80 and 120% ideal body weight; or was calculated to be 24 kcal/kg if their weight was greater than 120% ideal body weight. The calories were divided such that 40% was carbohydrate, 20% protein, and 40% fat.(ABSTRACT TRUNCATED AT 250 WORDS)