盐酸羟苄羟麻黄碱治疗先兆早产的护理

盐酸羟苄羟麻黄碱是目前治疗先兆早产的首选药,它能有效抑制子宫收缩,防止早产和延长妊娠期。总结了２３例羟苄羟麻黄碱治疗先兆早产的护理体会如下：（１）早期发现病情、及早治疗;（２０及早用药其疗效更佳。并确保单位时间内给药量准确;（３）注意观察药物的作用;（４）督促患者坚持口服用药;（５）加强心理护理,做好卫生宣教。     

羟苄羟麻黄碱治疗早产的用药护理

通过对68例羟苄羟麻黄碱（安宝）治疗早产用药理的总结。强调在用药的护理过程中，要详细查询病史；做好解释和指导工作；严密监测孕妇和胎儿的心率情况；血压变化；血糖血钾的变化；加强心理护理；注意药物的配伍禁忌。     

羟苄羟麻黄碱治疗早产68例的用药护理

目的：探讨安宝（羟苄羟麻黄碱）治疗早产用药与护理方法。方法：对68例有晚期流产和先兆早产症状的孕妇给予100mg安宝加入5％葡萄糖500ml静脉点滴，根据宫缩强度及频率调整滴数，每10min增加0．05mg即5滴，一直达到宫缩抑制。结果：安宝有效延长妊娠期2～109d（平均55．5d）；延长妊娠有效率为100％。结论：安宝提高了新生儿的成熟度及存活率，但需要掌握用药禁忌证。     

羟苄羟麻黄碱治疗先兆早产的观察及护理

早产是围产儿死亡的重要原因之一。目前大多应用硫酸镁滴注治疗先兆早产,但疗效不甚理想。近两年我科采用β_2—肾上腺素受体兴奋剂羟苄羟麻黄抑制宫缩,作用强、显效快,在较少的副作用下能获得满意的疗效,避免了大剂量、长时间、持续用药的缺点,结果安全有效。     

羟苄羟麻黄碱抑制宫缩的临床观察与护理

通过对74例羟苄羟麻黄碱抑制宫缩的临床观察与护理,认为在用药过程中应严格掌握用药的适用证和禁忌证、正确的用药方法,做好药物知识宣教、心理护理,加强孕妇血压、脉搏及胎儿心跳速率的监测,及时处理不良反应,可取得满意疗效.     

前置胎盘先兆早产应用苄羟麻黄碱和硫酸镁的治疗效果对比

目的分析研究前置胎盘先兆早产患者通过苄羟麻黄碱以及硫酸镁进行治疗的方法以及治疗效果之间存在的差异,为临床提供依据。方法回顾性分析68例前置胎盘先兆早产患者的临床资料,将其随机分为两组,对照组34例,治疗采用苄羟麻黄碱实施治疗,观察组34例,采用硫酸镁实施治疗,比较观察组和对照组患者的治疗效果、新生儿体质量、延长妊娠时间以及阴道出血量,将结果进行统计学分析。结果观察组患者治疗有效率为97.06%,对照组为85.29%,观察组治疗效果显著优于对照组,差异有统计学意义(P0.05);观察组患者阴道出血时间明显小于对照组,差异有统计学意义(P0.05);观察组患者新生儿体质量明显高于对照组,差异有统计学意义(P0.05);观察组患者延长妊娠时间显著长于对照组,差异有统计学意义(P0.05)。结论针对前置胎盘先兆早产患者通过苄羟麻黄碱进行治疗效果显著优于使用硫酸镁治疗,应该在临床中大力推广使用。     

苄羟麻黄碱治疗先兆早产的效果分析

目的：探讨苄羟麻黄碱（安宝）治疗先兆早产的临床效果。方法：对120例先兆早产孕妇随机分为两组，A组为安宝组，B组为硫酸镁组。结果：3h、7h内宫缩抑制A组58．3％、81．7％，B组16．7％、38．3％。足月分娩率A组75．0％，B组46．7％；新生儿出生体重A组（2680±280）g，B组（2190±260）g。结论：安宝抑制宫缩作用强，显效快，延长孕周长，新生儿出生体重高，值得临床推广使用。     

安宝治疗先兆早产的副作用观察和护理

安宝(盐酸利托君,羟苄羟麻黄碱)是一种β2肾上腺素能受体激动剂:作用为抑制子宫平滑肌收缩,减少子宫活动,延长妊娠期,适用于先兆早产[1],国内外大量研究发现,安宝可以改善胎盘血液循环,利于胎儿在子宫内生长发育,提高新生儿成熟度,存活率[2]。但同时因β1受体兴奋引起的副作用,     

3例安宝致心脏不良反应患者的护理

安宝作为抑制宫缩的药物在临床上被广泛应用.其有效成分是盐酸羟苄羟麻黄碱,是一种注射、口服均有效的β2肾上腺能受体激动剂,作用为抑制子宫平滑肌收缩,减少子宫活动,延长妊娠期,适用于先兆早产[1].安宝的β1受体兴奋作用可引起心悸、心率增快、严重者可引起肺水肿.我院急诊科2011年1月至6月在使用安宝过程中3例患者出现了心脏不良反应,经过氧气吸入、强心、利尿治疗,患者症状缓解,预后良好,现将护理体会介绍如下.     

安宝治疗先兆早产的护理

目的总结安宝治疗先兆早产孕妇的护理配合。方法对66例先兆早产孕妇用安宝进行保胎治疗并加强护理。结果有效抑制了先兆早产孕妇的不正常子宫收缩,从而延长了妊娠期,提高了新生儿的成熟度及成活率。结论运用安宝治疗先兆早产应配合完善的护理措施,包括加强一般护理,注意用药的方法、剂量,加强孕妇及胎儿的监护,密切观察用药后的反应和保胎效果,从而收到显著效果。     

Genetic association of SP-C with duration of preterm premature rupture of fetal membranes and expression in gestational tissues

Background. Surfactant protein (SP) C has been shown to be expressed also outside pulmonary alveoli. Certain SP-C gene (SFTPC) polymorphisms associate with lung diseases and very preterm birth.

Aims. We investigated the association of SFTPC single nucleotide polymorphism (SNP) rs4715 with factors affecting spontaneous preterm birth and characterized the SP-C expression in human and mouse gestational tissues.

Methods. The SFTPC SNP rs4715 polymorphism was genotyped in a homogeneous northern European population of mothers and infants in spontaneous preterm birth and term controls. The expression and protein of SP-C in gestational tissues was analyzed.

Results. SFTPC SNP rs4715 did not associate with spontaneous preterm birth. However, fetuses with short interval (<72 hours) between preterm premature rupture of fetal membranes (PPROM) and preterm birth had significant over-representation of the minor allele A, whereas in fetuses with prolonged PPROM (≥72 hours) the frequency was decreased. Maternal SFTPC did not associate with the duration of PPROM. SP-C mRNA and proprotein were detected in fetal membranes, placenta, and pregnant uterus.

Conclusion. SFTPC SNP rs4715 associates with the duration of PPROM, and SP-C is expressed in gestational tissues. We propose that fetal SFTPC moderates the inflammatory activation within the fetal extra-embryonic compartment.     

A large meconium pseudocyst that developed into the generalized type during the antepartum period

A fetal intraabdominal cystic mass, measuring 6 cm, was detected at 30 weeks of gestation in a 27-year-old gravida 2 para 1 woman. At 33 weeks of gestation, the cyst disappeared. Ultrasonography showed fetal bowel dilatation, polyhydramnios, and intraabdominal calcifications. Fetal meconium peritonitis was diagnosed prenatally. Because the fetal ileus became worse, a cesarean section was performed at 35 weeks of gestation; a female infant weighing 2,131 g with an Apgar score of 8 was delivered. Six hours after birth, the neonate received an ileostomy. The bowel was reanastomosed 42 days after the initial operation. On postoperative pathology, a meconium pseudocyst was diagnosed. To our knowledge, this is the first report of a large fetal meconium pseudocyst that developed into the generalized type in the uterus during the preterm antepartum period.     

Postpartum hemoperitoneum due to avulsion of pelvic uterine adhesion band

A 31-year-old nulliparous woman presented in labor with preterm rupture of membranes at 35 weeks of gestation. The ensuing intrapartum course was uneventful, and she delivered a healthy infant (birth weight, 2,850 g) vaginally. Four hours after delivery, the patient had a syncopal episode due to hypovolemic shock. At laparotomy, a fibrous band between the right fallopian tube and uterus was found to be avulsed and actively bleeding, confirming preoperative findings obtained with multidetector row computed tomographic angiography.     

Risk of preterm birth in primiparous women with exposure to antidepressant medication before pregnancy and/or during pregnancy – impact of body mass index

Introduction: Preterm birth is a major cause of infant mortality. It is unknown whether body mass index (BMI) influences the risk of preterm birth in women, who prenatally use antidepressants.Materials and methods: The study cohort (N = 6920) consists of all primiparous European born women without previously diagnosed diabetes from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data on births, pre-pregnancy BMI and purchases of antidepressants from 12 months before conception until delivery were obtained from Finnish National Registers.Results: Of the primiparous women, 9.9% used antidepressants. The overall prevalence of preterm birth was 5.2%. In women with a pre-pregnancy BMI <18.5 kg/m², the Odds Ratio (OR) for preterm birth among antidepressant users compared with those who were non-users was 1.91 (95% confidence intervals [CI] 0.40 to 9.15, adjusted for age, smoking, education, use of fertility treatments and number of previous pregnancies) while in women with a pre-pregnancy BMI ≥30 kg/m², the OR was 0.53 (95% CI 0.21–1.36), respectively.Discussion: Primiparous women using antidepressants, who were underweight before conception should be closely monitored and provided tailored care in a maternity clinic to minimize the risk of preterm birth.

Key messages

• In primiparous women, one in ten used antidepressant medications before pregnancy and/or during pregnancy.
• In primiparous women, the prevalence of preterm birth was 5%.
• Underweight primiparous women using antidepressants should be closely monitored and provided tailored care in a maternity clinic.

     

血清表皮生长因子与早产儿肺发育相关研究

目的 探讨血清表皮生长因子水平与早产儿肺发育的相关性.方法 选择住院早产儿35例.根据胎龄分成3组,分别是①28周≤胎龄〈32周,9例,②32周≤胎龄〈35周,14例,③35周≤胎龄〈37周,12例,同时根据有无并发早产儿肺透明膜病（HMD）分为HMD组19例,非HMD组16例;对照组选择足月儿高胆红素血症住院患儿12例.无其他并发症.采用酶联免疫吸附测定法（ELISA）,35例早产儿和12例对照组足月儿分别于出生1h、24h、72h、和生后第7天空腹股静脉采血测定血清表皮生长因子水平.结果 早产儿组出生1h、24h、72h、和生后第7天.血清表皮生长因子含量水平均呈递增关系,差异有显著性;早产儿组与足月儿组血清表皮生长因子含量水平于出生1h、24h、72h差异有显著性,生后第7天差异无显著性;在生后1h、24h、72h,早产儿有HMD组与无HMD组患儿血清表皮生长因子含量水平差异有显著性.结论 早产儿出生后血清表皮生长因子含量水平呈递增关系,提示早产儿出生后体内EGF合成和释放增加,可能促进肺脏器成熟;早产儿组与足月儿组血清表皮生长因子含量水平出生后差异有显著性,早产儿出生后血清EGF浓度水平和HMD的严重程度正相关,提示在新生儿早期检测血清表皮生长因子含量可以作为HMD发病的预测指标.     

早产126例临床分析

目的：探讨引起早产的原因和影响预后的因素。方法：对我院126例早产进行回顾性分析。结果：早产发生率为5.0%,胎膜早破（PROM）、妊娠高血压综合征（PIH）是引起早产的主要因素。剖宫产与阴道分娩对早产儿结局无明显差异。破膜时间12 h内和12 h以上两组间宫内感染发生率差异无统计学意义。结论：早产儿预后与早产病因相关。不同分娩方式对新生儿结局没有影响。     

ACR Appropriateness Criteria® assessment of gravid cervix

It is well recognized that preterm birth is the leading cause of perinatal mortality and morbidity. There is a significant association between cervix length and preterm birth risk. Most authorities consider a cervical length <3 cm as the lower limit of normal. A cervical length >3 cm has a high negative predictive value for delivery less than 34 weeks. A cervical length of <15 mm is moderately predictive (～ 70%) of preterm birth within 48 hours. Cervical length is normally distributed and should remain relatively constant until the third trimester. Transabdominal US is the least reliable method of cervical length assessment. The most reliable method of documenting cervical length is transvaginal ultrasound (TVUS). Transperineal US is an alternative for imaging if TVUS is contraindicated, such as with premature rupture of membranes. However, the resolution is decreased compared to TVUS. Short cervix length is the single most important predictive finding for premature delivery. This observation should prompt consultation for high risk obstetrical care and consideration of other management options such as cerclage or activity restriction.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.     

早产儿血小板参数动态变化及其与并发症的关系

目的探讨早产儿血小板参数的动态变化及其与早产儿并发症的关系。方法对96例早产儿于出生24h内和生后1周进行血小板参数检测。结果早产儿胎龄越小、出生体重越低,出生24h内PLT越低、MPV和PDW越大。无窒息及无并发症早产儿PLT、MPV及PDW生后1周较出生24h内有不同程度升高(P<0.05或0·01)。出生24h内,IVH和RDS组PLT明显低于无并发症组(P<0.01和0·05),IVH组MPV明显大于无并发症组(P<0.01);生后1周,窒息组PLT明显低于无窒息组(P<0.01),MPV、PDW明显大于无窒息组(P<0.01和0·05),低体温和感染组PLT明显低于无并发症组(P<0.05和0·01),感染组MPV明显大于无并发症组(P<0.05)。结论早产儿血小板参数与胎龄、出生体重及日龄有关;出生时合并窒息及早产儿并发症与血小板参数密切相关。     

C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period

BackgroundThere is still no study evaluating the influence of gestational age (GA) per se on C reactive protein (CRP) and procalcitonin (PCT) reference intervals. We therefore investigated how length of gestation, age (hours), and prenatal and perinatal variables might influence the levels of CRP and PCT. We also determined 95% age-specific reference intervals for CRP and PCT in healthy preterm and term babies during the early neonatal period.MethodsOne blood sample (one observation per neonate) was taken for CRP and PCT from each newborn between birth and the first 4 (for term), or 5 days (for preterm newborns) of life by using a high-sensitive CRP and PCT assays.ResultsIndependently of gender and sampling time, GA had a significantly positive effect on CRP, and a significantly negative effect on PCT. Compared with healthy term babies, healthy preterm babies had a lower and shorter CRP response, and, conversely, an earlier, higher, and longer PCT response. CRP reference intervals were affected by a number of pro-inflammatory risk factors.ConclusionsAge- and GA-specific reference ranges for both CRP and PCT should be taken into account to optimize their use in the diagnosis of early-onset neonatal sepsis.     

中国大陆地区孕妇妊娠高血压与早产关联性及人群归因危险度的Meta分析

目的系统评价中国大陆地区孕妇妊娠高血压与早产的关联性。方法计算机检索PubMed、The Cochrane Library、ScienceDirect、Web of Science、CBM、CNKI、WanFang Data和VIP数据库,搜集2007年1月~2019年3月我国大陆地区发表的孕妇妊娠高血压与早产相关危险因素的研究。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入48个研究,包括571 271例研究对象,其中早产组43 276例,足月对照组527 995例。早产组中3 446例患有妊娠高血压,患病率为7.96%;足月对照组中14 099例患妊娠高血压,患病率为2.67%。Meta分析结果显示:妊娠高血压与早产有相关性[OR=3.27,95%CI(2.64,4.05),P<0.001]。综合人群归因危险度为13.0%。针对不同研究类型进行亚组分析,结果未发生变化。结论当前证据显示,妊娠高血压与早产相关,这提示应对患有妊娠期高血压的孕妇加强管理和干预,并监督其积极治疗,预防早产的发生。