103例妊娠期肝内胆汁淤积症病人的护理

[目的]总结妊娠期肝内胆汁淤积症病人的护理。[方法]对103例妊娠期肝内胆汁淤积症病人给予早期诊断、积极对症治疗、适时终止妊娠、加强孕期检查和孕妇自我监护、围产期给予动态的、个体化的全面护理、加强医护配合等。[结果]103例妊娠期肝内胆汁淤积症孕妇母婴均安康出院。[结论]加强妊娠期肝内胆汁淤积症病人的护理有利于预后。     

179例妊娠期肝内胆汁淤积症的临床观察及护理

目的探讨妊娠期肝内胆汁淤积症的护理方法 ,减少妊娠期危险及围生儿死亡率。方法对179例妊娠肝内胆汁淤积症患者进行针对性的心理安慰和支持,给予妊娠期、分娩期、产褥期的有效护理,同时加强新生儿监测及护理。结果 179例妊娠期肝内胆汁淤积症患者母婴均安康出院。结论对妊娠期肝内胆汁淤积症患者给予周密细致的护理及心理支持,可提高孕产期妇女生活质量,降低围生儿死亡率。     

妊娠期肝内胆汁淤积症病人的护理

介绍了妊娠期肝内胆汁淤积症的发生率、临床表现、诊断标准、治疗及护理。强调并发胆汁淤积症的孕妇必须加强胎儿监护,做好皮肤护理。     

妊娠期肝内胆汁淤积症20例的心理护理

目的探讨妊娠期肝内胆汁淤积症的发病原因及护理措施。方法对20例妊娠期肝内胆汁淤积症患者进行观察护理和用药指导。结果通过合理的药物治疗及护理,无1例发生胎死宫内。结论护理过程中应重视早产、胎儿宫内窘迫、胎死宫内观察及处理。做好孕期、分娩期、产褥期的护理,这是抢救围产妊娠期肝内胆汁淤积症的关键。     

Citrin缺陷所致婴儿肝内胆汁淤积症43例护理体会

目的总结Citrin缺陷所致婴儿肝内胆汁淤积症的护理。方法对43例Citrin缺陷所致婴儿肝内胆汁淤积症患者的临床资料进行分析,护理重点为病情观察、饮食护理及针对性健康宣教。结果 43例患儿中,2例合并肝硬化,其他患儿治疗2月各项指标恢复正常。结论对Citrin缺陷所致婴儿肝内胆汁淤积症患儿给予精心护理可减少并发症的发生。     

妊娠期肝内胆汁淤积症患者的护理

目的探讨妊娠期肝内胆汁淤积症的发病原因及护理措施。方法对51例妊娠期肝内胆汁淤积症患者进行回顾性病例分析。结果通过合理的药物治疗及护理.无1例发生胎死宫内、产后出血等不良后果。结论护理过程中应重视早产、胎儿窘迫、胎死宫内和产后出血等先兆症状的观察及处理。做好孕期、分娩期、产褥期的护理.这是抢救围产妊娠期肝内胆汁淤积症的关键。     

妊娠期肝内胆汁淤积症患者的护理

目的 探讨妊娠期肝内胆汁淤积症的发病原因及护理措施。方法 对51例妊娠期肝内胆汁淤积症患者进行回顾性病例分析。结果 通过合理的药物治疗及护理．无1例发生胎死宫内，产后出血等不良后果。结论 护理过程中应重视早产、胎儿窘迫、胎死宫内和产后出血等先兆症状的观察及处理。做好孕期、分娩期、产褥期的护理．这是抢救同产妊娠期肝内胆汁淤积症的关键。     

妊娠期肝内胆汁淤积症患者的护理

总结了87例妊娠期肝内胆汁淤积症患者孕期、产时及产后观察的护理经验。主要包括宣传妊娠期肝内胆汁淤积症有关知识,动．态监测孕妇血清胆酸、血清转氨酶及血清胆红素水平,加强胎儿监护。认为重视孕产期保健,早发现、早治疗妊娠期肝内胆汁淤积症,严密观察、精心护理对降低母儿并发症有积极的作用。     

妊娠期肝内胆汁淤积症患者的护理

目的 探讨妊娠期肝内胆汁淤积症的发病原因及护理措施.方法 对51例妊娠期肝内胆汁淤积症患者进行回顾性病例分析.结果 通过合理的药物治疗及护理,无1例发生胎死宫内、产后出血等不良后果.结论 护理过程中应重视早产、胎儿窘迫、胎死宫内和产后出血等先兆症状的观察及处理.做好孕期、分娩期、产褥期的护理,这是抢救围产妊娠期肝内胆汁淤积症的关键.     

综合性护理措施预防妊娠期肝内胆汁淤积症的效果探讨

目的:探讨综合性护理措施预防妊娠期间产妇肝内胆汁淤积症的临床效果。方法:以广州市第一人民医院2010年1月至2018年12月诊治的100例妊娠期产妇为研究对象,并将其随机分成对照组和研究组各50例。对照组施行常规护理,研究组应用综合性护理措施,比较对照组和研究组的产妇对肝内胆汁淤积症的了解状况和预防率。结果:研究组产妇对肝内胆汁淤积症的了解状况评分明显高于对照组(15.4±5.6分vs13.1±4.8,P0.05),研究组产妇对肝内胆汁淤积症的预防率明显高于对照组(94.0%vs 70.0%,P0.05)。结论:对妊娠期产妇应用综合性的相关护理手段,有利于预防产妇罹患肝内胆汁淤积症,有助于婴幼儿的健康成长。     

护理干预在妊娠期胆汁淤积综合征患者中的应用

目的:探讨综合护理干预在妊娠期胆汁淤积综合征患者中的的临床应用价值.方法:选择2009年1月-2011年1月在我院进行分娩的82例妊娠期肝内胆汁淤积综合征患者,将35例在我院门诊筛查并入院确诊为妊娠期肝内胆汁淤积综合征,接受治疗,然后在我院分娩的患者作为治疗组,47例因未在我院进行产前检查,入院时诊断为妊娠期肝内胆汁淤积综合征但已临产或近临产未能接受治疗的为对照组,对照组采取常规护理,治疗组采用护理干预.比较两组患者的临床护理效果.结果:对照组新生儿窒息、羊水粪染、剖宫产比例明显高于治疗组(P＜0.05);而两组早产、新生儿死亡、产后出血率比较差异无明显的统计学意义(P＞0.05);治疗组ALT、AST、CG指标明显低于对照组(P＜0.05).结论:综合护理干预可以减少妊娠期胆汁淤积综合征患者的不良预后,值得临床推广应用.     

孕妇血清总胆汁酸测定的临床意义

目的 了解正常孕妇和妊娠期肝内胆汁淤积症（ICP）患者血清总胆汁酸水平。方法 检测ICP组、妊娠高血压疾病组（PIH）、正常孕妇以及正常未孕女性及男性组血清总胆汁酸（TBA）的水平,同时对ICP组其他肝功能相关指标也进行检测。结果 ICP组TBA水平较其他3组明显增高,而其他3组之间差异无显著性。ICP孕妇TBA与血清碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、直接胆红素（DBIL）的检测水平有良好的相关性;且TBA在灵敏度和特异性上均优于以上指标。结论 血清总胆汁酸的测定对孕妇胆汁淤积症的诊断、疗效评估以及预后判断均具有重要意义。     

The value of combined determination of high molecular mass API and LP-X in the differential diagnosis of intrahepatic and extrahepatic obstruction

Combined determination of serum lipoprotein-X and electrophoretic separation of high molecular mass (HMr) alkaline phosphatase has been proposed as a marker for the differential diagnosis between intrahepatic cholestasis and extrahepatic obstructive jaundice. Of 32 patients who were known to be lipoprotein-X positive and in whom a definitive diagnosis had been made, 13 had intrahepatic cholestasis and 17 extrahepatic obstruction, and 2 had both intrahepatic and extrahepatic obstruction. The detection of HMr alkaline phosphatase isoenzyme proved to be a sensitive and specific test for detecting liver disease, particularly obstructive liver disease. The diagnostic significance of the combined determination of serum lipoprotein-X to demonstrate or exclude cholestasis and electrophoretic separation of HMr alkaline phosphatase isoenzymes to allow differentiation between intrahepatic cholestasis and extrahepatic obstruction was investigated.     

Combined approach to the differential diagnosis of cholestatic jaundice with endoscopic retrograde cholangiopancreatography,percutaneous transhepatic cholangiography,ultrasonography, and liver biopsy

A prospective study of 33 patients with cholestatic jaundice was performed with combined use of endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), ultrasonography, and liver biopsy.A higher rate of success with PTC in 25 cases of extrahepatic cholestasis was offset by the better score of ERCP in 8 cases of intrahepatic cholestasis and its wider diagnostic scope. The procedures were complementary in 10 cases. Ultrasonic imaging of intrahepatic bile ducts proved useful for selecting the first cholangiographic technique. Liver biopsy established etiology in intrahepatic cholestasis. Our combined approach allowed us to develop through objective criteria a diagnostic flow chart of cholestasis.     

Sclerosing cholangitis and liver cirrhosis after extrabiliary infections: report on three cases

OBJECTIVE: To describe three unusual cases of sclerosing cholangitis after severe extrahepatic/extrabiliary bacterial infections. DESIGN: Case report, clinical. SETTING: Tertiary care intensive care unit (ICU). PATIENTS: Three patients admitted to the ICU with infections from Gram-positive bacteria followed by sclerosing cholangitis and secondary biliary cirrhosis. MAIN RESULTS: Three unusual cases of persisting cholestasis that occurred after bacterial infections originating from extrahepatic/extrabiliary foci are described. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed multiple strictures of the intrahepatic bile ducts as a sign of sclerosing cholangitis. All patients progressed to biliary cirrhosis within months after the onset of cholestasis. CONCLUSION: Infection-associated cholestasis is usually a functional disorder and subsides after effective treatment of the underlying inflammatory focus. In rare cases, however, extrahepatic/extrabiliary infections may lead to sclerosing cholangitis and secondary biliary cirrhosis via unknown mechanisms.     

Effect of Maternal Intrahepatic Cholestasis on Fetal Steroid Metabolism

Estriol, estriol sulfate, progesterone, and 17 neutral steroid sulfates, including estriol precursors and progesterone metabolites, were determined in 27 cord plasma samples collected after pregnancies complicated by intrahepatic cholestasis of the mother. The levels of these steroids were compared with those in the cord plasma of 42 healthy controls.In the cord plasma, the steroid profile after pregnancies complicated by maternal intrahepatic cholestasis differed greatly from that seen after uncomplicated pregnancy. Two main differences were found. In the disulfate fraction, the concentrations of two pregnanediol isomers, 5alpha-pregnane-3alpha,20alpha-diol and 5beta-pregnane-3alpha,20alpha-diol, were high after cholestasis. Other investigators have shown that, as a result of cholestasis, these pregnanediol sulfates circulate in greatly elevated amounts in the maternal plasma. Our results indicate that in cholestasis these steroids cross the placenta into the fetal compartment, where they circulate in elevated amounts as disulfates. Secondly, the concentrations of several steroid sulfates known to be synthesized by the fetus were significantly lower in the cholestasis group than in the healthy controls. This was especially true of 16alpha-hydroxydehydroepiandrosterone sulfate and 16alpha-hydroxypregnenolone sulfate. These results suggest that, in pregnancies complicated by maternal intrahepatic cholestasis, impairment of fetal steroid synthesis, and especially of 16alpha-hydroxylation, occurs in the fetal compartment.Thus, the changes in maternal steroid metabolism caused by cholestasis are reflected in the steroid profile of the fetoplacental circulation. Furthermore, maternal intrahepatic cholestasis may result in the production of some substance which crosses the placenta and affects fetal steroid metabolism.     

护理干预在肝内胆管结石手术中的应用

目的:探讨护理干预在肝内胆管结石手术患者围术期的应用方法。方法:将70例肝内胆管结石手术患者随机分为实验组和对照组各35例,对照组给予围术期常规护理,实验组在此基础上给予护理干预。观察比较两组引流量、残石率、术后并发症等情况。结果:实验组引流量、残石率、术后并发症发生率及结石复发率均低于对照组(P<0.05)。结论:护理干预应用于肝内胆管结石手术患者,可有效提高围术期护理质量,预防并发症发生。     

Predictive value of assessment of different modalities in the diagnosis of infantile cholestasis

This study investigated the relative accuracy and roles of abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy in the diagnosis of infantile cholestasis. A total of 50 infants (27 females) aged 1 - 12 months were classified into those with intrahepatic causes of cholestasis (n = 22) and those with extrahepatic causes (n = 28). Cholestasis is caused by a wide range of conditions and diagnosis requires meticulous history taking, thorough clinical examination and many laboratory tests. The most common cause of intrahepatic cholestasis was found to be idiopathic neonatal hepatitis (54.5%), followed by infectious hepatitis (9.1%), metabolic liver diseases (9.1%), intrahepatic biliary atresia (9.1%) and Alagille syndrome (4.5%). The most common cause of extrahepatic cholestasis was extrahepatic biliary atresia (96.4%). The incidence of choledochal cyst was low (3.6%). The cornerstone of the diagnosis of infantile cholestasis was found to be liver biopsy, which was associated with a high degree of accuracy.     

A critical examination of the value of combined determinations of lecithin:cholesterol acyltransferase and lipoprotein-X in the differential diagnosis of liver disease.

The suggestion that combined determinations of lecithin: cholesterol acyltransferase activity and lipoprotein-X can be used to distinguish between patients with intrahepatic cholestasis and extrahepatic biliary obstruction has been studied. Of 21 patients who were lipoprotein-X positive and in whom an unequivocal diagnosis was made, 11 had intrahepatic cholestasis and 10 extrahepatic obstruction. The range of plasma lecithin:cholesterol acyltransferase activity was similar in the two groups and did not enable distinction to be made between them.