耳针对于乳母泌乳量和血清基础泌乳素水平的影响

30例产后即刻行耳针封闭,24小时再行耳穴贴压疗法的产妇,与30例正常分娩产妇比较观察耳针对泌乳量和血清基础泌乳素水平的影响。发现正常产妇产后第2天泌乳素水平高于第1天,第5天已显著下降.耳针治疗组产后第1～7天泌乳量与对照组比较有非常显著性差异。第1天和5天相应基础泌乳素值有显著性差异。结论是:耳针有升高基础泌乳素水平的作用,从而增加了乳汁分泌量,促进了初乳的形成。     

产后康复仪促进产妇乳汁分泌效果观察与分析

目的：观察分析产后康复综合治疗仪对促进产妇提前泌乳、增加泌乳量、乳房胀痛的发生率的影响，寻求一种产妇乐于接受的提高纯母乳喂养率的方法，进一步巩固爱婴医院成果。方法根据产妇意愿随机选择自愿接受康复仪治疗的500例产妇为观察组，不愿接受康复仪治疗的500例产妇为对照组。观察组分娩后返回产休室24小时内应用产后康复综合治疗仪进行乳房催乳治疗，其余护理治疗措施与对照组相同。责任护士观察询间记录乳汁分泌情况，统计纯母乳喂养率及乳房胀痛的发生率。结果观察组较对照组产后乳汁分泌量增加时间提前，乳房胀痛的发生率低，出院时纯母乳喂养比例高，两组比较，差异有显著性（P〈0．01）。结论产后康复综合治疗仪用于产后催乳安全、方便、可靠，效果显著，产妇乐于接受，在产科护理中应予推广使用。     

产前抑郁状态与产后泌乳不足的相关性研究

目的了解孕产妇的产前抑郁状态及产后泌乳情况,探讨产前抑郁状态与产后泌乳不足之间的相关性。方法采用Beck抑郁量表及自行编制的一般情况与回访问卷于产前15—30天对877例孕产妇进行调查,并于产后2个半月一3个月时对产妇进行回访,详细了解婴儿的母乳喂养情况。结果泌乳充足、泌乳不足和无泌乳3组被试的产前抑郁水平差异显著（F=47．075,P〈0．001）。且抑郁组和无抑郁组产妇的泌乳水平有显著差异（r=81．983,P〈0．001）,抑郁组产妇泌乳不足的比例（67．8％）要显著高于无抑郁组产妇泌乳不足的比例（32．1％）。结论产前抑郁是影响泌乳的一个重要因素,对产前抑郁要及早预防并干预,以提高纯母乳喂养率。     

产后早期注射脐血清催乳的临床效果及其意义

产后乳汁分泌充足与否是关系到母乳喂养成败的关键问题，特别是分娩后7天内是初乳形成的关键时刻和分泌量剧增的阶段，把握这一关键是十分重要的。但产后泌乳受到许多因素如：饮食、环境、情绪、疾病、药物、手术等影响。一些产妇由于受到这些因素的影响，产后缺乳或少乳，而达不到母乳喂养的目的。本研究自1987年以来，对126例缺乳产妇行自行或异体脐血清注射治疗，随访观察120例。其中显效者（泌乳量多，能够满足婴儿需要）92例（76．68％）；一般者（泌乳量一般，尚需辅以其他乳品）27例（20．83％），无效者（仍不泌乳）3例（2．5％）。…     

护理干预对产后母乳喂养成功率的影响

目的分析护理干预对产后母乳喂养成功率的影响。方法选取在我院生产的214例产妇,将其随机分为观察组和对照组各107例,对观察组产妇进行护理干预,对照组产妇给予常规护理,比较两组产妇母乳喂养知识掌握情况、母乳喂养成功率、乳房肿胀、乳头皲裂及泌乳量情况。结果观察组产妇母乳喂养知识掌握优良率、母乳喂养成功率及产后48h泌乳量充足率分别为98.1%、100%、90.7%,均明显高于对照组,两组对比差异显著,<0.01;且乳房肿胀率、乳头皲裂率分别为4.7%、0%,也低于对照组,两组比较差异有统计学意义,<0.01。结论实施护理干预可提高产妇母乳喂养知识水平,提高母乳喂养成功率及泌乳量,减少乳房肿胀、乳头皲裂发生率,临床效果显著,值得推广。     

新生儿重症监护病房住院早产儿母亲产后抑郁与早期泌乳量的相关性

目的:探讨新生儿重症监护病房(NICU)住院早产儿母亲产后抑郁与早期泌乳量的相关关系。方法:选取山东省某三级甲等综合医院122例NICU住院早产儿母亲为研究对象,采用现况调查法对研究对象在患儿住院期间的泌乳量进行连续跟踪测定。应用爱丁堡产后抑郁量表(EPDS)对其进行产后抑郁筛查,以EPDS得分≥10分为产后抑郁筛查阳性,将阳性者纳入产后抑郁筛查阳性组;EPDS得分10分者纳入正常组,比较两组研究对象产后早期每日泌乳量及平均吸奶频率,并分析EPDS得分与泌乳量的相关性。结果:NICU住院早产儿母亲产后抑郁筛查阳性率为58%(58/100)。阳性组产后第11~14天泌乳量低于正常组(均P0.05/14),平均吸奶频率也低于正常组(P0.05)。EPDS得分与产后第2天及第11~14天泌乳量均呈负相关,相关系数在-0.38~-0.35之间(均P0.05/14)。结论:本研究提示,NICU住院早产儿母亲产后抑郁筛查阳性率高,产后抑郁可能对其产后早期泌乳量产生不利影响。     

对剖宫产妇泌乳始动时间及泌乳量实施综合护理干预的效果

目的对剖宫产妇进行综合护理干预，观察和研究护理对产妇泌乳始动时间和泌乳量的影响。方法将我院收治的40例剖宫产妇进行随机分为观察组和对照组，每组各20例。对照组对产妇进行常规的护理，观察组在对照组护理的基础上，对产妇进行综合护理干预。结果观察组产妇的泌乳始动时间和泌乳量要明显比对照组好，差异显著，具有统计学意义（P<0.05）。结论对产妇进行综合护理干预，能够有效地使得产妇的泌乳始动时间提前，同时增加其泌乳量，进而减少了产妇乳胀情况的发生，提高了母乳喂养效果。     

电动吸奶器用于母婴分离产妇促进泌乳的效果分析

目的：探讨电动吸奶器用于母婴分离产妇促进泌乳的效果。方法将新生儿因各种原因转至新生儿重症监护病房(NICU)接受治疗的100例剖宫产产妇随机分为试验组和对照组,每组50例。对照组产后第1d行常规健康教育及乳房护理;试验组产后在常规健康教育及乳房护理基础上,使用电动吸奶器进行乳房干预。观察两组产妇产后乳房肿胀、泌乳量等情况进行比较。结果试验组产妇产后乳房肿胀发生率明显低于对照组(<0.05),不同时期泌乳人数及泌乳量明显高于对照组(<0.05)。结论对母婴分离产妇使用电动吸乳器进行乳房干预可促进乳腺管通畅,减少乳房肿胀增加泌乳量,减轻产后护理的工作量。     

比较两种护理模式及护理技能对剖宫产产妇泌乳量的影响

目的:观察比较不同护理模式及护理技能对剖宫产产妇泌乳量的影响分析。方法:选取我院产科2018年10月至2019年10月期间收治的200例剖宫产产妇作为研究对象,前100例分娩产妇为对照组,采取常规护理干预;后100例分娩产妇为实验组,采取改良哺乳工具、低频电疗法、膳食指导等不同护理模式及护理技能进行干预。采用自制问卷调查表的方法调查两组患者产后干预后泌乳量、产后乳头皲裂、疼痛发生率,以及产妇对新生儿护理技能掌握情况。结果:实验组产妇产后不同时间段泌乳量明显多于对照组(P0.001);实验组产妇乳头疼痛及乳头皲裂发生率明显低于对照组(P0.05);实验组产妇对新生儿护理技能掌握情况明显高于对照组(P0.05)。结论:在剖宫产产妇产后采取分阶段护理模式及护理技能进行干预,可有效增加产妇产后泌乳量,减少产后乳头皲裂、疼痛发生率,提升产妇对新生儿技能的掌握率,效果理想。     

笑气镇痛联合陪伴分娩对产妇血清泌乳素的相关性研究

目的探讨笑气镇痛联合陪伴分娩对产妇血清泌乳素的影响。方法随机将200初产妇分为观察组100和对照组100例,观察组实施笑气镇痛联合陪伴分娩,对照组不行笑气镇痛和陪伴分娩措施,分别观察镇痛效果、宫口开全分娩前、产后2h、产后24h产妇血清（PRL）。结果两组镇痛效果、宫口开全分娩前、产后2h、产后24h产妇血清PRL比较,差异有显著性（P〈0.05）。结论笑气镇痛联合陪伴分娩对减轻镇痛、提高产妇血清PRL有良好的效果,从而有利于产后早泌乳和多泌乳,提高母乳喂养的成功率。     

Maternity blues in Athens, Greece: a study during the first 3 days after delivery

BACKGROUND: Although maternity blues have been studied in many countries worldwide the factors that influence the occurrence of this clinical entity are not well understood. The purpose of this study was to investigate the prevalence, time course and symptomatology of maternity blues in a Greek urban environment as well as the relation of maternity blues with certain clinical and sociodemographic factors. METHOD: A study of a sample of 402 women that were recruited during the first day after delivery. Each woman completed the Kennerley's Blues Questionnaire on a daily basis for the first 3 days of puerpartum. Clinical and sociodemographic data were obtained through questionnaires and personal interview. RESULTS: 179 (44.5%) women experienced severe maternity blues during the first 3 days after delivery. Delivery by caesarian section (P=0.006), stressful events during pregnancy (P=0.02), depressive feelings the last month prior to delivery (P=0.002), anxiety on the day of delivery (P=0.001) and hypochondriasis (P=0.001) were the factors that were found to relate significantly to maternity blues. CONCLUSION: The women's emotional condition prior and after delivery, delivery via caesarotomy, as well as fears concerning somatic health had strong impact on the occurrence of maternity blues.     

舌下含服卡孕栓预防产后出血的临床研究

目的:探讨舌下口服卡孕检预防产后出血的效果。方法:将正常的单胎头位足月妊娠阴道分娩初产妇400例分为两组。研究组200例;在胎头娩出时即舌下口服卡孕栓lmg。对照组200例,在胎儿娩出后肌肉注射缩宫素10u,观察产后 2,小时出血量。结果:产后 2小时内的出血量,研究组及对照组分别为 165.45和 189.36ml,有显著性差异(P<0.05)。结论:舌下口服卡孕栓促进子宫收缩作用强于催产素,能减少产后出血量。其给药简便,值得推广应用。     

Severe post-delivery blues: associated factors

Summary Objectives: To study severe postpartum blues and associated factors. Study design: One hundred and two women in two maternity units in the suburbs of Paris completed self-administered questionnaires, including Maternity Blues questionnaire, three days after giving birth. We defined severe blues as a score on the maternity blues scale above the 90th percentile of our sample distribution (cut-off point = 12/28). Results: Severe blues was associated with the mothers' unemployment but not with their socio-demographic characteristics. Women who breast-fed had a higher frequency of severe blues. Severe blues tended to be associated with women's expectation of little or no help with child care and with problematic relationship with their baby's father. It was strongly related to high state anxiety but not to high trait anxiety. Conclusion: These results suggest that both breast feeding and insecure psychological and social surrounding, such as unemployment, may be risk-factors for severe blues.     

Binding of tritiated yohimbine to platelets in women with maternity blues

Platelet alpha 2-adrenoceptor binding was measured in 108 women in the 36th week of pregnancy, at ten and twenty days and at three and six months post-partum. An age matched non-pregnant control group of women (N = 25) was also studied. The number (Bmax) of alpha 2-adrenoceptors was elevated antepartum but fell to control values on the tenth post-partum day. At three and six months post-partum, however, alpha 2-adrenoceptor Bmax was again increased. Women who developed maternity blues (N = 59) had significantly more platelet alpha 2-adrenoceptors than those who did not (N = 49) at both ten and twenty days post-partum. In addition their alpha 2-adrenoceptor Bmax was greater than controls at all time points measured except the tenth post-partum day. In contrast, the alpha 2-adrenoceptor Bmax of women without the blues did not differ from controls at any stage. It is suggested that women who develop maternity blues may have a relatively enduring abnormality in alpha 2-adrenoceptor sensitivity which is associated with psychological symptoms when concentrations of circulating sex-steroids suddenly change.     

Measurement of tryptophan, kynurenine and neopterin in women with and without postpartum blues

BACKGROUND: Activation of the tryptophan-degrading enzyme indoleamine (2,3)-dioxygenase was demonstrated to be critically involved in tolerance induction to prevent fetal rejection. Our study was designed to examine alterations of tryptophan and its catabolic product kynurenine in the postpartum period and to compare them to neopterin as an immunological marker. METHODS: 95 healthy women delivering without complications provided blood during labour, and 2 and 4 days after birth. The blood samples were analysed for concentrations of tryptophan, kynurenine and neopterin. Women were asked to perform the Edinburgh Postnatal Depression Scale (EPDS) on days 2 and 4. RESULTS: In women without blues symptoms (n=86) tryptophan concentrations increased within 2 days after birth, whereas they did not change in women with postpartum blues (n=9; 9.5%). The group difference reached statistical significance (p<0.05). The change of the kynurenine to tryptophan ratio (kyn/trp), which estimates the degree of tryptophan degradation, was also different between the two groups at days 0 and 2 (p<0.05). Neopterin concentrations decreased between days 2 and 4 (p<0.05), but there were no differences between the two groups. LIMITATIONS: Our study population had a low prevalence of postpartum blues symptoms. CONCLUSION: Low postpartal mood is associated with continuously low serum tryptophan after delivery due to an increased degradation to kynurenine, but is independent of the postpartal course of neopterin.     

自体内皮细胞移植在损伤动脉再内皮化及抑制新生内膜增生中的作用

目的:观察自体内皮细胞移植在损伤动脉血管再内皮化及抑制新生内膜增生中的作用。方法: 30只健康雄性纯种新西兰兔行双侧髂股动脉球囊损伤,一侧于损伤后立即经球囊导管行自体静脉内皮细胞移植,另一侧行培养基对照。其中10只动物分别于术后4 h、4 d处死,行扫描电镜检查;5只动物,先将细胞用荧光标记物标记后,再移植入体内,4 d后进行荧光示踪检查;5只动物于术后4 d行Evans blue染色,观察内皮损伤血管段再内皮化情况;其余动物于术后28 d处死,行病理学分析。结果:细胞移植术后4 h,对照组见整个内皮层剥脱,暴露出内皮下弹力膜及平滑肌,细胞移植组则见部分移植内皮已粘附在内皮剥脱血管壁,细胞呈圆形,但尚未铺展;细胞移植术后4 d,移植的内皮已变形,在内皮剥脱血管壁铺展成单层,大量荧光标记内皮细胞被覆在损伤动脉血管内膜;对照组损伤血管几乎完全被Evans blue染成蓝色,细胞移植组损伤血管则60%不被Evans blue着染;病理学分析发现细胞移植组新生内膜面积、最大动脉内膜厚度均显著少于对照组。结论: 自体内皮细胞能有效地经球囊导管移植到内皮损伤血管段,并有减轻新生内膜增生的作用。     

Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial

We tested the hypothesis that therapeutic endoscopy using the Nd:YAG (neodymium:yttrium-aluminum-garnet) laser would benefit patients with acute peptic-ulcer bleeding. Over 43 months, 174 patients with active bleeding (n = 32) or stigmata of recent bleeding (n = 142) due to peptic ulcers were randomly assigned during endoscopy to either standard treatment with laser photocoagulation or therapy without photocoagulation. There were no significant differences in a number of outcomes between the group treated with laser photocoagulation and the control group. Continued bleeding or rebleeding was observed in 22 percent of the laser-treated group and in 20 percent of the control group. Urgent surgery was necessary in 16 percent of the laser-treated patients and in 17 percent of the controls. Laser-treated patients spent a mean of 41 hours in the intensive care unit, and controls spent a mean of 32 hours. The mean hospital stay was 12 days in the laser-treated group and 11 days in the control group. One death occurred in each group. When patients with active bleeding were analyzed separately, there was no significant difference in outcome, even though laser photocoagulation stopped active bleeding in 88 percent of cases. Among patients with visible vessels, rebleeding occurred in 5 of 14 (36 percent) who received laser treatment and 2 of 15 (13 percent) who did not. Laser treatment precipitated bleeding in four patients and duodenal perforation in one. We conclude that Nd:YAG-laser photocoagulation does not benefit patients with acute upper gastrointestinal bleeding from peptic ulcers.     

Early administration of vapreotide for variceal bleeding in patients with cirrhosis

BACKGROUND: In patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. However, the effects of early administration of a somatostatin analogue followed by endoscopic treatment are unknown. METHODS: We studied the effects of treatment with vapreotide, a somatostatin analogue, begun before endoscopic treatment in 227 patients with cirrhosis who were hospitalized for acute upper gastrointestinal bleeding. The patients were randomly assigned to receive vapreotide (a 50-microg intravenous bolus followed by an infusion at a rate of 50 microg per hour for five days) or placebo within a mean (+/-SD) of 2.3+/-1.5 hours after admission. All the patients received endoscopic treatment a mean of 2.6+/-3.3 hours after the infusion was begun. After the exclusion of 31 patients whose bleeding was not caused by portal hypertension, there were 98 patients in each group. RESULTS: At the time of endoscopy, active bleeding was evident in 28 of 91 patients in the vapreotide group (31 percent), as compared with 43 of 93 patients in the placebo group (46 percent) (P=0.03). During the five-day infusion, the primary objective--survival and control of bleeding--was achieved in 65 of 98 patients in the vapreotide group (66 percent) as compared with 49 of 98 patients in the placebo group (50 percent) (P=0.02). The patients in the vapreotide group received significantly fewer blood transfusions (2.0+/-2.2 vs. 2.8+/-2.8 units, P=0.04). Overall mortality rates at 42 days were not significantly different in the two groups. CONCLUSIONS: In patients with cirrhosis and variceal bleeding, the combination of vapreotide and endoscopic treatment is more effective than endoscopic treatment alone as a method of controlling acute bleeding. However, the use of combination therapy does not affect mortality rates at 42 days.     

Burden of childbirth

Summary Background: Aims of this investigation were to study the subjective psychological and physical stressful experience of childbirth burden on a scale with 7 choises and to determine physical and psychosocial factors, which influence delivery experience. Methods: Information on sociodemographic data, physical and psychiatric anamnesis, as well as obstetrical and psychological variables were gained through a structured interview. This was carried out on 1250 women on the fifth postnatal day at the maternity ward. Results: According to the burden of childbirth score all 1250 women were divided into three subgroups. Group A (low burden, n = 433), group B (medium burden, n = 516) and group C (high burden, n = 301). The comparison between these three groups with respect to burden of childbirth revealed sig-nificant differences for length and mode of delivery, parity, pregnancy risk factors, gestational age at delivery, prior psychopharmacologic medication, occupational satisfaction, trait anxiety and depressive mood. The multiple logistic regression analysis between group A and group C showed that length of delivery had the strongest impact on burden of childbirth followed by depressive mood, elevated trait anxiety score, mode of delivery (emergency cesarean section and delivery by vacuum extraction provide significant higher burden scores than elective cesarean section and spontaneous delivery), and occupational satisfaction (higher occupational satisfaction correlates with low burden of childbirth). Conclusions: In summary, burden of childbirth assessed on the fifth postnatal day is a result of a complex interaction between physical and psychological factors, whereby physical stressors such as length of labor, emergency surgical delivery and affective alterations such as elevated trait anxiety, depressive mood, and job satisfaction seem to be of predominant relevance.