妊娠合并Graves病对妊娠结局的影响

目的 探讨妊娠合并Graves病对妊娠结局的影响.方法 回顾统计分析比较60例妊娠合并Graves病患者、60例正常对照者的妊娠结局及其影响因素.结果 Graves病组60例中妊娠结局不良48例;20例在孕32～37周内由于重症而提前终止妊娠.孕期发生妊娠高血压综合征(妊高征)10例,其中重度妊高征并心力衰竭3例;甲状腺危象2例,胎膜早破6例,贫血10例,无产后出血.妊娠合并Graves病组与正常对照组相比,妊娠周数、新生儿评分、新生儿体质量均降低(P＜0.05).结论 妊娠合并Graves病对妊娠结局有不良影响.Graves病患者孕前未控制或孕前、孕期自行停药,均可导致母儿严重并发症.加强甲状腺功能的监测,及时调整用药剂量,可以减少不良妊娠结局的发生.     

5例主动脉夹层合并妊娠病人的急救护理

[目的]探讨主动脉夹层合并妊娠病人的监测重点及急救护理要点。[方法]收集2016年1月—2018年10月5例主动脉夹层合并妊娠病人的临床资料进行分析。[结果]5例病人均手术救治成功,均无并发症发生,胎儿均存活。[结论]对主动脉夹层合并妊娠病人实施急救护理是赢得手术时间、提高母婴生存质量的重要环节。     

妊娠合并急性主动脉夹层一例并文献复习

目的探讨妊娠合并急性主动脉夹层的早期诊断与治疗方法。方法报道妊娠合并Stanford B型主动脉夹层1例,并收集近年文献进行复习,总结该疾病的临床表现、诊断及治疗方法。结果收集近年来8篇妊娠合并急性主动脉夹层的文献,共9例,所有患者均通过临床表现及经胸超声心动图(TTE)、经食管超声心动图(TEE)、CT血管造影(CTA)等检查手段而确诊。其中8例为Stanford A型,1例为B型。8例A型患者均行剖宫产+急诊手术治疗,出现1例患者死亡,1例胎儿死亡;1例B型患者行药物保守治疗,患者存活,胎儿流产。本文报道病例为妊娠合并Stanford B型主动脉夹层,早期行药物保守治疗,于妊娠37周胎儿发育成熟时行剖宫产术,而后择期行主动脉夹层腔内隔绝术,患者及胎儿均存活。结论妊娠合并急性主动脉夹层起病凶险,进展迅速,早期诊断、根据母婴情况选择合适的治疗方法是挽救患者及胎儿生命的关键。     

妊娠合并心脏病患者的妊娠结局

目的 探讨妊娠合并心脏病患者的心功能对妊娠结局的影响.方法 对2001年1月至2007年1月在本院产科分娩的资料齐全的22例妊娠合并心脏病患者的临床资料进行分析.根据患者心功能状态分为:Ⅰ级组8例、Ⅱ级组5例、Ⅲ级组4例、Ⅳ级组6例,观察各组的围生儿结局,分析以上妊娠合并心脏病患者的妊娠结局.结果 结果表明,心功能Ⅰ～Ⅱ级组患者的平均孕周及新生儿平均出生体质量分别比较,差异无统计学意义(P＞0.05),而心功能Ⅲ级组平均孕周为(36.1±2.9)周,新生儿平均体质量为(2 375±225)g;心功能Ⅳ级组平均孕周为(34.3±1.7)周,新生儿平均体质量为(1 933±333)g,明显低于心功能Ⅰ级组.医源性早产7例(31.8%),胎儿生长受限3例(13.6%),围生儿死亡3例(13.6%),而心功能Ⅰ～Ⅱ级组患者以上指标均为0;妊娠合并心脏病患者中,心功能Ⅲ～Ⅳ组中,心功能衰竭的发生率为90%,结论妊娠合并心脏病患者中,心功能Ⅲ～Ⅳ级组的心脏病患者的医源性早产和围生儿患病率均增加,围生儿结局不良.     

妊娠合并卵巢肿瘤的处理和妊娠结局的临床分析

妊娠合并卵巢肿瘤,文献报道其发生率差异较大,1:81~1:2500,其相关因素较多,但妊娠合并卵巢肿瘤的并发症高于非妊娠期[1-3]。目前对卵巢肿瘤处理时间和方法尚有争议,本文回顾性总结江苏省涟水县人民医院和本院诊治的92例妊娠合并卵巢肿瘤患者的临床资料,探讨其处理时间及方式对妊娠结局的影响。1资料及方法2001年1月~2006年12月在孕前和孕期检查或剖官产术中发现的卵巢肿瘤患者92例,占同期两院分娩总数的0.95%。患者年龄20~41岁,平均(27.49±4.23)岁。初产妇74例,经产妇18例。孕早、中期发现42例,孕晚期发现40例,其中36例为剖宫产术中发现。有6例因卵巢肿瘤放弃本次妊娠,在孕早期、中期人工终止妊娠。期待治疗为卵巢肿瘤直径6~8 cm,孕妇自愿选择定期产前检查,B超监测肿瘤变化者;卵巢肿瘤>8 cm的,在孕早、中期行手术治疗,采取开腹肿瘤剥除或附件切除;以急腹症就诊者行开腹探查。术后给予硫酸镁、沙丁胺醇、黄体酮等保胎治疗。妊娠合并卵巢肿瘤发现时间及处理方法:孕前发现10例,放弃妊娠2例、期待手术6例、择期手术2例;孕早期发现10例,放弃妊娠2例、期待手术6例、急诊手术1例、择期手术13...     

糖尿病合并妊娠与妊娠期糖尿病妊娠结局的分析

目的:比较糖尿病合并妊娠与妊娠期糖尿病(GDM)的妊娠结局,探讨引起不良结局的因素,从而力图减少母婴并发症的发生。方法:回顾分析2000年1月至2004年9月期间在我院住院分娩的正常孕产妇100例、糖尿病合并妊娠患者26例、妊娠期糖尿病患者72例的妊娠结局。结果:母婴并发症均与血糖控制的情况密切相关(P<0.05)。结论:做好孕期保健宣传,使糖尿病患者于孕前即严密监测、控制血糖;使孕妇进行正规的产前检查,早发现,早治疗妊娠期糖尿病对减少母婴并发症有重要意义。     

妊娠合并心脏病孕妇心功能情况及不良妊娠结局影响因素分析

目的探讨妊娠合并心脏病孕妇心功能情况及不良妊娠结局影响因素。方法选取妊娠合并心脏病51例,观察其心脏病类型及心功能情况,比较心功能Ⅰ和Ⅱ级与Ⅲ和Ⅳ级妊娠合并心脏病孕妇不良妊娠结局发生情况,并对妊娠合并心脏病孕妇不良妊娠结局的影响因素进行分析。结果妊娠合并心脏病51例中,先天性心脏病19例,风湿性心脏病16例,围产期心脏病13例,贫血性心脏病3例;心功能分级Ⅰ级32例,Ⅱ级10例,Ⅲ级4例,Ⅳ级5例。心功能分级Ⅰ和Ⅱ级妊娠合并心脏病孕妇不良妊娠结局总发生率为42.86%低于心功能分级Ⅲ和Ⅳ级妊娠合并心脏病孕妇不良妊娠结局发生率88.89%,差异具有统计学意义(P0.05)。妊娠合并心脏病51例中非不良妊娠结局25例,不良妊娠结局26例。单因素分析结果显示,孕次、心功能分级、心脏病类型及高血压与妊娠合并心脏病孕妇不良妊娠结局发生有关;多元Logistic回归分析结果显示,孕次、心功能分级、心脏病类型及高血压是导致妊娠合并心脏病孕妇不良妊娠结局的独立危险因素。结论妊娠合并心脏病孕妇不良妊娠结局总发生率心功能分级Ⅰ和Ⅱ级低于心功能分级Ⅲ和Ⅳ级。孕次、心功能分级、心脏病类型及高血压是导致妊娠合并心脏病孕妇不良妊娠结局的独立危险因素。     

妊娠合并卵巢囊肿89例诊治分析

目的分析妊娠合并卵巢囊肿的临床诊断方法与治疗效果。方法选取2011年至2014年妊娠合并卵巢囊肿患者89例,经调查病史、全面检查及追问病史对其进行临床诊断,对比妊娠合并卵巢囊肿在孕早期及孕中晚期的检出率。结果妊娠合并卵巢囊肿孕早期检出率显著高于孕中晚期,差异有统计学意义(P0.05)。足月产72例(80.90%),早产6例(6.74%),流产11例(12.36%)。结论超声和磁共振检查应用于妊娠合并卵巢囊肿的诊治具有重要的作用,孕中期为最佳治疗时机,肿瘤切除术为其常见治疗办法。     

妊娠合并肝硬化的妊娠安全性及其结局探讨

目的:探讨妊娠合并肝硬化的妊娠结局与孕产期处理。方法:回顾分析妊娠合并肝硬化33例临床资料。结果:33例孕妇中代偿期肝硬化孕妇27例,失代偿期肝硬化孕妇6例,失代偿期肝硬化孕妇死亡2例(33.3%),其中1例为中孕流产,另1例为足月顺产。33例妊娠合并肝硬化孕妇孕早中期流产9例(27.2%),早产12例(50%);无新生儿死亡;阴道分娩4例(16.7%),剖宫产20例(83.3%)结论:妊娠合并肝硬化严重威胁母儿的安全,失代偿期肝硬化患者不宜妊娠。适时终止妊娠是治疗妊娠合并肝硬化的重要手段,终止妊娠的方式首选剖宫产。     

双胎妊娠并发主动脉夹层1例及文献复习

目的:探讨妊娠并发主动脉夹层的早期诊断与治疗方法。方法:报道双胎妊娠合并Stanford B主动脉夹层1例,并收集复习相关文献,总结该病的临床表现、诊断及治疗方法。结果:通过临床常规诊断,明确诊断,稳住生命体征,在复合手术室进行多科会诊,根据病情选择最佳治疗方案,并在术后严密监控患者病情变化,防止并发症的发生,有效地挽救了患者生命。结论:妊娠合并主动脉夹层起病凶险,进展迅速,及时明确诊断、多科会诊、严密监护、根据母婴情况在符合手术室选择合适的联合治疗方法是挽救患者及胎儿生命的关键。     

胸主动脉夹层26例的手术治疗

目的总结26例各型胸主动脉夹层的手术治疗经验。方法2008年8月至2012年6月手术治疗26例胸主动脉夹层患者,男22例,女4例,年龄36～69岁,平均（51．1±12．9）岁。Stanford分型：A型10例,B型16例。A型中行升主动脉及全弓置换加术中象鼻支架植入术6例,Bentall术1例,升主动脉置换术3例;B型中行降主动脉置换术2例,降主动脉覆膜支架腔内隔绝术（EVGE）14例（其中1例2d后再行腹主动脉置换术）。6例全弓置换脑保护采用深低温停循环（DHCA）加上腔静脉逆行灌注（RCP）,1例降主动脉置换下半身供血采用左心转流。术后定期复查CTA。结果10例StandfordA型患者死亡2例（20％）,1例术中死于鱼精蛋白反应后大出血,另1例术中出血多,术后第1天死于多脏器衰竭,余治愈出院。16例B型患者死亡1例（6．2％）,死于大出血,余均治愈出院。术后CTA显示人工血管血流通畅,支架系统位置良好,无内漏,主动脉真腔较术前明显扩大,未闭的假腔血栓形成。结论手术是挽救主动脉夹层患者的重要手段,手术方式应根据破口特点及主动脉及其瓣膜具体情况来选择。全弓置换采用DHCA＋RCP脑保护效果良好。采用EVGE治疗StandfordB型夹层手术时间短、创伤小、效果佳。     

超声在多胎妊娠筛查和选择性减胎中的临床应用

目的评估超声在多胎妊娠筛查和选择性减胎中的临床应用价值。 方法选择2011年7月至2015年4月在南京大学医学院附属鼓楼医院妇产科产前诊断中心接受超声筛查及减胎术的46例多胎妊娠孕妇,分析其超声检出的多胎类型、绒毛膜性、胎儿异常及减胎手术指征,追踪减胎术后的妊娠过程和临床结局。 结果46例多胎妊娠孕妇中,双胎妊娠28例（60.87%,28/46）,均是双绒毛膜双羊膜囊,5例妊娠无异常,孕妇要求减去其中一胎。21例因超声检出双胎之一发育异常减胎,2例因孕妇合并症减胎。三胎妊娠15例（32.61%,15/46）,其中三绒毛膜三羊膜囊8例,胎儿均无异常,孕妇要求减去其中一胎;双绒毛膜三羊膜囊5例,3例胎儿无异常,均减去其中单绒毛膜双羊膜囊两胎,2例因单绒毛膜双羊膜囊两胎之一异常,分别减去单绒毛膜双羊膜囊中两胎及一胎;双绒毛膜双羊膜囊2例,其中1例单绒毛膜单羊膜囊两胎之一异常,均减去单绒毛膜单羊膜囊两胎。四胎妊娠3例（6.52%,3/46）,胎儿发育均正常,均减去其中两胎,保留两胎。随访：双胎妊娠减胎术后保留28胎,1胎中孕超声检出左侧多囊性肾发育不良,2胎流产,其余25胎正常。三胎、四胎减胎术后保留胎儿均正常。 结论早期超声可以检出多胎妊娠的类型及异常胎儿,重视多胎妊娠的早期产前诊断并及时干预可以改善其妊娠结局。     

主动脉夹层的临床病理特点及CT临床诊断

目的分析主动脉夹层的临床特征、病因及CT对主动脉夹层的临床诊断。方法对我院收治的57例主动脉夹层患者资料进行回顾性分析,总结主动脉夹层的临床病理特点,并对CT平扫和CT血管成像扫描检查主动脉夹层结果进行对比。结果主动脉夹层患者临床症状主要表现为突发性疼痛52例(91.2%)以及高血压48例(84.2%),57例患者中Stanford A型39例,Stanford B型18例,DebakeyⅠ、Ⅱ型27例,DebakeyⅢ型30例;CT血管成像的检出率显著高于CT平扫检出率(χ2=4.940,P0.05)。结论主动脉夹层是以一种高致死性疾病,高血压可能为其主要诱发因素,CT平扫及CT增强扫描有较高的敏感性和特异性,能够对主动脉夹层进行快速准确的诊断。     

Ischemic stroke with left hemiparesis or shock should be evaluated by computed tomography for aortic dissection

An 82-year-old woman with consciousness disturbance, left hemeparesis, and dysarthria was discovered at home by her family and was transported to a hospital. On arrival, she remained in a sleepy and disorientated and shock state. She complained of nausea but no chest or back pain. She obtained stable circulation after infusion. Her chest roentgen results showed widening of the mediastinum and the existence of a separation of the intimal calcification from the outer aortic soft tissue border, thus suggesting a Stanford A–type aortic dissection. Her head computed tomography depicted no signs of cerebral infarction. Because she did not complain of any pain, the possibility of acute phase aortic dissection was rejected. A permissive hypertensive therapy was initiated. Next day, she suddenly died. We diagnosed that she had died of a Stanford A–type aortic dissection based on the following facts: (1) patients presenting with stroke due to a Stanford A–type aortic dissection tend to have left hemiparesis because of malcirculation of the innominate artery and (2) a patient presenting with stroke by aortic dissection may have hypotension, which is unusual in standard stoke cases. Ischemic stroke induced by aortic dissection is not common among the patients with aortic dissection. However, given the high morbidity and mortality after misdiagnosis of aortic dissection, patients with ischemic stroke with left hemiparesis or shock should be evaluated by enhanced truncal computed tomography.     

主动脉夹层动脉瘤患者不同Stanford分型的临床特征分析及意义

目的分析主动脉夹层动脉瘤患者不同Stanford分型的相关临床特征,探讨其影响预后的危险因素及其意义。方法收集主动脉夹层动脉瘤患者病例79例,按Stanford分型分为A型组26例和B型组53例,回顾性分析两组患者的临床资料,观察病情变化及预后。结果StanfordA型患者的胸痛、背痛、胸闷气促和意识障碍的发生率高于StanfordB型患者,差异均有统计学意义（P均〈0．05）;而腹痛、腰痛和无症状的发生率StanfordB型患者要高于StanfordA型患者,差异均有统计学意义（P均〈0．05）。StanfordA型患者的就诊时间、平均年龄、入院时血压和既往有高血压史的病例均少于StanfordB型患者,而既往有马凡综合征病史的病例StanfordA型高于StanfordB型,差异均有统计学意义（P均〈0．05）。StanfordA型患者的心包积液和意识障碍的发生率及死亡率均高于StanfordB型患者（P〈0．05）。结论主动脉夹层动脉瘤StanfordA型患者的发病年龄相对较轻,病情凶险,并发心包积液,心力衰竭和意识障碍的发生率和死亡率高。明确诊断为StanfordA型主动脉动夹层动脉瘤或是StanfordB型患者出现心包积液、胸腔积液等并发症是提示患者死亡的危险指标。     

Treatment of Stanford type A aortic dissection with triple pre-fenestration,reduced diameter,and three-dimensional-printing techniques: A case report

BACKGROUNDA 63-year-old female was diagnosed with acute Stanford type A aortic dissection. The patient had pain in the chest and back for 1 wk. The computed tomography angiography (CTA) showed Stanford type A aortic dissection (Myla type III aortic arch). The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta.CASE SUMMARYPreoperatively, a three-dimensional (3D)-printed model of the aortic arch was made according to CTA data. Then, under the guidance of the 3D-printed aortic model, a pre-fenestrated stent-graft was customized, and the diameter of the stent-graft was reduced intraoperatively by surgeons. 3D printing, triple pre-fenestration, and reduced diameter techniques were used during the surgery. The CTA examinations were performed at the 3^rd mo and 1st year after the surgery; the results showed that the aortic dissection was repaired without endoleak, and all three branches of the aortic arch remained unobstructed.CONCLUSIONApplying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case. The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.     

血管内支架移植物置入术治疗StanfordB型主动脉夹层

目的评价血管内支架移植物置入术治疗Stanford B型主动脉夹层的安全性和有效性.方法10名主动脉夹层患者,均在全麻下进行移植物置入术治疗,4例置入TALENT内支架移植物,6例置入国产内支架移植物.结果2例未能有效封堵动脉破裂口,其中1例治疗后12 h因动脉破裂死亡.1例移植物部分遮盖左锁骨下动脉,但无上肢进行性缺血加重,余7例动脉夹层及假腔均较好封堵.术后1周,9例行CTA检查,除1例夹层未得到封堵外,其余8例内支架移植物均无移位,假腔均缩小,真腔均扩大.随访8例(2～38个月),均无症状再发.结论内支架移植物置入术可有效治疗Stanford B型主动脉夹层;严格选择适应证可提高治疗的安全性和有效性.     

Aortic Dissection Presenting as Isolated Lower Leg Ischemia

Background: Aortic dissections that present only with symptoms of lower extremity ischemia are rare. Few case reports exist documenting this phenomenon. Objectives: We report an unusual case of aortic dissection presenting as unilateral lower extremity pain. Case Report: A 56-year-old man presented with left lower extremity pain of 1 h duration. He had no associated complaints. Doppler imaging revealed decreased flow in the left iliac artery, thus, initial treatment with anticoagulation was begun for presumptive obstruction. Subsequent imaging with arteriography revealed a Stanford type A/DeBakey type 1 aortic dissection. This was confirmed by computer-assisted tomography angiography, and the patient was taken to surgery for repair. Conclusion: It is important to consider the connection between lower extremity symptoms and possible aortic dissection.     

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report

BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.     

术中置入新型三分支主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层临床研究

目的应用新型三分支型主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层,总结其临床应用经验,并评价其安全性和疗效。方法 2009年12月至2011年1月7例急性Stanford A型主动脉夹层患者在我科接受新型三分支主动脉弓覆膜支架手术治疗。结果全组手术时间(259.2±53.6)分钟,体外循环时间(136.4±28.5)分钟,心肌血运阻断时间(85.3±11.7)分钟,深低温停循环选择性脑灌注时间(17.6±8.2)分钟。术中死亡1例,系术中主动脉开放后主动脉根部后壁大出血无法止血;其余6例患者术后及时清醒,循环稳定,无严重并发症发生。随访2～15个月,主动脉血管成像显示患者主动脉弓部及分支动脉内支架扩张贴壁满意,相应部位假腔消失,远端假腔内血栓填充;无与覆膜支架相关的并发症发生;患者心功能改善,生活质量良好。结论 采用新型三分支主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层,可以简化主动脉弓部操作,降低手术风险,提高手术成功率,适合于大多数Stanford A型主动脉夹层患者的治疗。