高危新生儿的护理体会

目的：探讨高危新生儿的护理方法。方法：评估患儿的病情,对患儿采取保温、预防感染、出院教育等措施。结果：77例患儿治愈或者好转出院,1例患儿死亡。结论：对于早发现、早诊断、早干预、早治疗,及早地发现病情的变化,使得患儿得到及时而有效的治疗,减少并发症发生,可以提高患儿的生活质量。     

高危新生儿的护理体会

目的:探讨高危新生儿的护理方法。方法:评估患儿的病情,对患儿采取保温、预防感染、出院教育等措施。结果:77例患儿治愈或者好转出院,1例患儿死亡。结论:对于早发现、早诊断、早干预、早治疗,及早地发现病情的变化,使得患儿得到及时而有效的治疗,减少并发症发生,可以提高患儿的生活质量。     

新生儿低血糖(附58例临床分析)

目的 研究新生儿低血糖的高危因素、诊断标准及治疗中出现的反复低血糖和高血糖的病因。方法 采用血糖检测试纸对６３８例患儿进行血糖筛查。结果 发现低血糖５８例,经治疗血糖恢复正常时间平均为１０．９ｈ;低血糖持续时间：≤２４ｈ５２例,～４８ｈ１例;反复低血糖１６例,高血糖８例。结论 对有低血糖高危因素的新生儿要连续监测血糖,及早发现,合理治疗,尽快纠正,减少反复低血糖和高血糖的发生,避免血糖大幅度波动加     

远程胎儿监护在高危妊娠中的临床应用

目的:探讨远程胎儿监护在高危妊娠中的临床应用。方法:2004年3月至2005年6月在产科门诊诊断为高危妊娠的孕妇57例作为研究组,并于孕35周以后用远程胎儿监护终端部分(以远程胎儿监护结合胎动计数进行家庭自我监护),随机选择同期高危妊娠孕妇58例,在家中以胎动计数结合门诊常规NST检查作自我监护,作为对照组,比较两组的NST异常和围生儿不良预后发生率。结果:研究组57例孕妇中,NST异常21例,检出率为37%,对照组58例,NST异常11例,检出率为19%,两组比较差异有显著性(P<0.05),对照组58例中,发生围生儿不良预后27例,发生率为47%,研究组57例中发生围生儿不良预后12例,发生率为21%,两组比较差异有显著性(P<0.05)。结论:应用远程胎儿监护对高危妊娠的监测,可降低新生儿窒息等围生儿预后不良的发生率,为高危妊娠孕妇的自我监护和管理开辟了一条有效、实用、可行的途径。     

妊娠合并糖尿病的新生儿监护与处理

1病理生理 新生儿的并发症均与糖尿病孕妇的胎儿高胰岛素血症密切相关.正常妊娠胎儿胰岛素细胞在孕11周时开始分泌胰岛素,糖尿病孕妇血中葡萄糖增高,葡萄糖持续经胎盘进入胎儿血循环,而胰岛素不能通过,胎儿的高血糖状态刺激胰岛β细胞增生,胰岛素分泌增多,继而发生高胰岛素血症.     

糖尿病孕妇分娩新生儿的监护和处理

近年来 ,由于妊娠期严格控制糖尿病孕妇血糖 ,产前加强胎儿监测 ,糖尿病孕妇分娩的新生儿死亡率明显下降 ,但新生儿近期、远期并发症仍较高 ,出生后应对新生儿加强监测 ,给予及时处理。妊娠合并糖尿病对围生儿的影响程度与孕妇病变程度及妊娠期高血糖出现的时间、血糖水平等密切相关 ,糖尿病孕妇所导致的新生儿常见并发症包括[1] :巨大儿、新生儿产伤、新生儿低血糖等。远期并发症有肥胖、2型糖尿病发生率增加等。1　妊娠合并糖尿病对新生儿的影响糖尿病孕妇导致新生儿一系列合并症 (除畸形外 )均与胎儿高胰岛素血症相关。妊娠合并糖尿病时…     

新生儿低血糖症与高血糖症的诊治

糖代谢的稳定是机体对糖的利用与其产生及调控之间平衡的结果。新生儿处于从宫内完全依赖母体到出生后由自身调节的代谢过渡时期 ,糖代谢平衡的调节功能尚不完善 ,而围生期孕母和胎儿的多种病理生理状况以及新生儿疾病均可导致血糖平衡紊乱 ,出现低血糖 (hypoglycemia)症或高血糖 (hyperglycemia)症 ,如程度严重或持续时间较长 ,均可引起严重的中枢神经系统损害[1] 。1　新生儿低血糖症和高血糖症的定义1 1　新生儿低血糖症新生儿低血糖症的定义一直存在较大争议。以往将其界限定为生后 72h内以全血标本检测 ,足月儿血糖 <1 7mmol/L ,小于…     

新加坡KK妇幼医院新生儿重症监护病房介绍

1999年我曾在新加坡 KK妇幼医院新生儿科研修学习。 KK妇幼医院全称为 Kandany Kerbau Women's andChildren's Hospital,为新加坡最大的妇产科和儿科医疗机构。医院设有 2 4个病房 ,898张病床 ,每年在该院出生的婴儿约 15 0 0 0人 ,占全国出生人口的 1/ 3。KK医院新生儿科成立于 195 6年 ,首先为早产儿建立特护病房 ,195 8年开始使用暖箱 ,196 4年首次应用肺表面活性物质治疗早产儿肺透明膜病 ,并普及筛查葡萄糖 - 6 -磷酸脱氢酶缺乏症 (G- 6 -PD) ,防治新生儿溶血性黄疸 ,从而使新生儿病死率明显下降。 1976年建立母乳库 ,为患病新生…     

新生儿败血症临床诊治分析

目的:探讨新生儿败血症的病因、诊断、治疗及防范措施。方法:对30例新生儿败血症的临床资料进行回顾性分析。结果:新生儿败血症临床表现不典型,应及时确诊,同时合理应用抗生素。结论:合理应用抗生素是新生儿败血症的治疗关键。     

新生儿呼吸窘迫综合征高危因素研究进展

新生儿呼吸窘迫综合征是新生儿最为常见的呼吸系统疾病,严重威胁新生儿健康。近年来,据一些国家和地区报道,随着早产率及剖宫产率的增加,新生儿呼吸窘迫的发生率也呈上升趋势,已引起了广泛关注。本文从母婴两方面综述了新生儿呼吸窘迫综合征(NRDS)的高危因素,发现胎龄、胎儿性别、极低出生体重儿、胎儿窘迫和出生时窒息,种族、孕妇年龄、孕产次、选择性剖宫产以及某些妊娠合并症均能影响新生儿呼吸窘迫综合征的发病率。     

Postdischarge nutrition for high risk neonates

Despite improvements in neonatal care, many preterm babies suffer growth failure during their hospitalization. This appears to persist through early childhood, and possibly into adolescence. The use of enriched formulas improves the early growth of preterm infants, although most if not all of the benefit seems to be lost by 18 months. This growth benefit seems to be restricted to male infants. The improved growth does not improve developmental outcome. Although there are no direct comparisons of 22 kcal/oz post-discharge formulas and 24 kcal/oz preterm formulas, they are probably equally effective. Exactly which component (or components) of enriched formulas is responsible for this growth advantage is not known. Preliminary studies suggest that it may not be protein. Whether this growth benefit leads to decreased morbidity from cardiovascular disease in later life has not been studied. Further research is urgently needed to assess what nutritional factors can improve catch up growth in high-risk infants and whether this improved growth leads to decreased long-term morbidity.     

Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia

OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflicting results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medication use. This prospective study examines associations between aspects of asthma (diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. METHODS: A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,052 had no asthma diagnosis, were included in this analysis. Asthma symptoms, treatment, and severity were classified according to Global Initiative for Asthma guidelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institute guidelines. RESULTS: There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medication during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Initiative for Asthma severity; 3) Global Initiative for Asthma symptom and treatment steps; and 4) Global Initiative for Asthma symptom step and medication type. Women at increased risk of preeclampsia were those classified as Global Initiative for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95% confidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95% confidence interval 1.02-1.33). In contrast, neither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION: Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthma diagnosis or treatment, are at increased risk of preeclampsia compared with women with no symptoms.     

Synchronous bilateral breast cancer: risk factors, diagnosis, histology and treatment

OBJECTIVE: Synchronous bilateral breast carcinoma (SBBC) is not uncommon. Women with unilateral breast carcinoma are at increased risk for developing contralateral disease. The purpose of this study was to evaluate risk factors, diagnostic circumstances, histological characteristics and therapeutic methods for SBBC. PATIENTS AND METHODS: Between July 1992 and May 2006, 62 patients with SBBC were treated at Tenon hospital (Paris, France). Population was divided into two sub-groups corresponding with two successive periods. Epidemiological characteristics, diagnostic circumstances, therapeutic methods and histological characteristics were analysed. RESULTS: Global incidence of SBBC during this period was 2.6%. The patients presenting a CSBS had a family antecedent of breast cancer in 23.7% of the cases. The most frequent situation associated a palpable tumour and an infraclinic contralateral lesion (43.5%). MRI made diagnosis possible in seven tumours. Among the patients 38.7% had a bilateral mastectomy and 33.9% profited from the technique of the ganglion sentinel. The proportions of invasive lobular carcinomas and the multifocal tumours were 17.7%. The tumours had the same histological type in 78.3% of the cases and the expression of oestrogen receptors was identical in 91.4% of the cases. DISCUSSION AND CONCLUSION: The principal risk factors of CSBS are a family history of breast cancer, the histological type lobular invasive and the multifocal character of the first tumour. A conservative surgery is possible as well as the use of the technique of the ganglion sentinel. The CSBS have histological similarities, probably due to environmental factors.     

Ovarian hyperstimulation syndrome: pathophysiology, risk factors, prevention, diagnosis and treatment

The ovarian hyperstimulation syndrome is a major complication of ovulation induction for in vitro fertilization, with severe morbidity and possible mortality. Whereas its pathophysiology remains ill-established, the VEGF may play a key role as well as coagulation disturbances. Risk factors for severe OHSS may be related to patients characteristics or to the management of the ovarian stimulation. Two types of OHSS are usually distinguished: the early OHSS, immediately following the ovulation triggering and a later and more severe one, occurring in case of pregnancy. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related-complications. Thrombotic complications that can occur in venous or arterial vessels represent the major risk of OHSS, possibly conducting to myocardial infarction and cerebrovascular accidents. Once the OHSS is diagnosed, prevention of thrombotic accidents remains the major issue.     

The genetics, diagnosis and treatment of amenorrhea

The menstrual cycle is regulated by complex feedback interactions between the ovaries, pituitary and hypothalamus. A disruption at any point in one of these pathways may lead to irregularities in the menstrual cycle. In particular, amenorrhea, the cessation of menstrual functioning, serves as an indicator of ovarian, pituitary and/or hypothalamic dysfunction. Historically, diagnosing and treating amenorrhea presented medical professionals with numerous practical difficulties. In recent years, however, studies of amenorrhea have yielded new understandings and new treatments of the disorder. This paper synthesizes these current methodologies for diagnosing, treating and understanding both primary and secondary amenorrhea.     

监测胎儿血流速度波形对估计高危妊娠胎儿预后的价值

目的：通过大样本临床监测结果，分析血流速度波形对估计胎儿宫内状况的价值。方法：检测718例高危妊娠胎儿的脐动脉（UA）、大脑中动脉（MCA）血流波形，以胎儿出生时脐动脉血PH＜7．19、1分钟Apgar评分≤7分、出生体重低于同孕周标体重第10百分位数以下为胎儿窘迫的诊断标准，分析血流速度波形指数异常诊断胎儿窘迫的敏感度和特异性。结果：各项指标诊断胎儿窘迫的敏感度和特异性分别为：UA－RI为49．8％、96．6％；UA－PI为49．3％、95．6％；MCA－RI为34．0％、96．5％；MCA－PI为21．5％、97．3％。结论：胎儿UA、MCA血流速度波形对诊断胎儿窘迫特异性较高，但敏感度仍然有限，临床应结合其它指标综合分析。     

Fetal brain blood flow velocity monitoring in high risk pregnancies

OBJECTIVES: Blood velocity in the fetal vein of Galen and straight sinus is normally even and without fluctuation. Transverse sinus blood velocity pattern shows a characteristic triphasic shape. The aim of this study was to establish whether blood flow velocity pulsations in the Galen vein, straight sinus and transverse sinus velocimetry in high-risk pregnancies are related to an adverse outcome. MATERIALS AND METHODS: The Galen vein, straight sinus and transverse sinus were located by color Doppler ultrasound in 110 pregnancies complicated by pregnancy-induced hypertension and intra-uterine growth retardation with blood velocity recorded by pulsed Doppler. The incidences of blood velocity pulsations in Galen vein and straight sinus as well as peak systolic velocity, lowest diastolic velocity and resistance index (RI) from transverse sinus were correlated to pregnancy outcome, including emergency operative intervention and/or neonatal distress. Umbilical artery and venous and uterine and middle cerebral artery blood velocity was also recorded at the same time. RESULTS: Pulsating blood velocity in the Galen vein and transverse sinus was found in 40 and 10 cases, respectively. Signs of brain sparing in the middle cerebral artery were seen in 23 fetuses. Abnormal values for RI, peak systolic velocity and lowest diastolic velocity from transverse sinus were found in 20.6 and 18 cases, respectively. Galen vein pulsations were highly significantly related to adverse outcome of pregnancy and significantly more frequent in the present study than in the umbilical vein. Parameters studied in straight sinus and transverse sinus showed poor correlation with outcome of pregnancy. CONCLUSIONS: Venous pulsations in the Galen vein are significantly correlated to adverse outcome of high-risk pregnancy. Straight sinus and transverse sinus velocimetry was not associated with perinatal outcome and might not be useful in predicting fetal distress.