新生儿缺氧缺血性脑病的多普勒诊断

新生儿缺氧缺血性脑病(HIE)是指围产期窒息导致的脑缺氧缺血性损伤。通过对65例HIE患儿经颅多普勒(TCD)检测结果，分析TCD对HIE的诊断价值，对HIE的早期诊断、早期治疗、改善患儿预后有重要意义。     

新生儿缺氧缺血性脑病临床特点和治疗探讨

目的:探讨新生儿缺氧缺血性脑病((Hypoxic ischemic encephalopathy,HIE)的临床特点和治疗方法,提高对本病的认识。方法:选择我院儿科2008年2月至2010年10月收治的34例新生儿缺血缺氧性脑病患者临床资料,对其临床表现与病因、辅助检查等相关因素进行回顾性分析。结果:围产期宫内缺氧及产后窒息是导致本病的重要原因,常合并低钠血症、低钙血症、高钾血症及代谢酸中毒,其严重程度取决于缺氧缺血的持续时间和程度。结论:对诱发因素的早期预防、及时的个体化干预措施,可提高临床疗效,减少HIE病死率、致残率。     

新生儿缺氧缺血性脑病398例临床分析

目的总结新生儿缺氧缺血性脑病(HIE)的临床特点及预后情况,为提高该病诊治水平总结经验。方法对398例新生儿缺氧缺血性脑病患儿住院资料进行分析总结。结果所有病例均有异常围产史,急性宫内窘迫、窒息、催产素助娩、脐带、胎位和羊水异常以及胎头吸引助娩等异常围产史为HIE常见原因;患儿在生后3d内行血尿素氮、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶、α羟丁酸脱氢酶、肌酸激酶、肌酸激酶同功酶检测,中度、重度与轻度比较,差异均有统计学意义(P0.01);对305例系统治疗患儿随访观察至12个月,总预后不良率7.54%。结论加强和规范孕期保健、提高产科技术、规范新生儿窒息抢救是预防HIE防治重点;中、重度HIE多合并心、肝、肾等多脏器损害,强调综合治疗;头颅CT对HIE病情及预后判断有重要作用,早期诊断应侧重于临床表现;综合治疗、早期干预、科学连续、坚持全程治疗可明显改善中、重度HIE预后,减少神经系统后遗症。     

新生儿缺血缺氧性脑病的观察和护理

医学中所说的新生儿缺氧缺血性脑病是新生儿在围生期窒息导致脑的缺氧缺血性损害,而且是引起新生儿慢性神经系统损伤和急性死亡的主要病因之一。并在临床上出现一系列脑病的表现,部分病例可留有不同程度的神经系统后遗症。因此,做好早期治疗和护理,减少脑损害对提高其生活质量具有重要意义。1临床资料我科2010年1月至2011年8月共收治新生儿缺氧缺血性脑病60例,经及时有效的抢救,54例痊愈,抢救成功率为90%。现将临床观察     

宫内缺氧所致Apgar评分正常的新生儿缺氧缺血性脑病

目的　分析宫内缺氧所致Apgar评分正常的新生儿缺氧缺血性脑病 (HIE)的临床特点及随访结果。　方法　 2 0 0 2年 1月～ 12月我院收治的足月新生儿HIE 88例中 ,选择诊断为宫内缺氧所致HIE 30例进行分析。其诊断符合以下条件 :(1)有宫内缺氧史 ,出生Apgar评分 8～ 10分 ;(2 )生后早期出现神经症状 ;(3)排除感染、遗传代谢及畸形等神经系统疾病 ;(4)头颅B超或CT有HIE特征性改变。　结果　本组病例生后第 1天起均表现有轻度抑制症状 ,其中 2 2例间歇出现兴奋症状。临床症状属轻度者 17例 (5 7% ) ,中度 13例 (43% ) ,无一例重度 ,与出生时有窒息的 5 8例HIE比较差异无显著性。本组有不足 4 0 %病例有血尿素氮 (BUN)增高 ,低钠、低钙、低糖血症 ,代谢性酸中毒等并发症 ,与出生有窒息的HIE比较也基本一致。分别分析了单纯急性及慢性缺氧病例的B超改变 ,发现两者有所不同。本组随访 2 8例 ,出院后平均 (11.7± 3.8)个月 ,除一例脑瘫外 ,余体格、智能发育正常。B超复查 2 0例 ,出生时侧脑室扩大 4例、第 3脑室扩大 1例均恢复正常 ;出生时脑室不大 ,随访中出现脑室扩大者 6例 ,其中 1例为脑瘫 ,余者均恢复正常。　结论　胎儿有宫内缺氧史 ,新生儿出生时虽无窒息 ,但仍可发生HIE ,头颅B超可见有胎儿期脑损害 ,个别     

脑电图对新生儿缺氧缺血性脑病预后的诊断评估

目的　对缺氧缺血性脑病 ( HIE)患儿进行随访观察 ,以评价脑电图 ( EEG)在判断 HIE预后中的价值。　方法　对 62例 HIE中存活的 57例患儿进行体格检查及智力测试 ,对异常者行CT、EEG检查 ,评价其临床后遗症与新生儿期 EEG的关系。　结果　 62例 HIE患儿新生儿期 EEG显示电静息 3例 ,2例死亡 ,1例偏瘫 ;爆发抑制 4例 ,2例死亡 ,1例脑瘫 ,1例未见明显异常 ;低电压 5例 ,1例死亡 ,1例脑瘫 ,1例 IQ低下 ,2例未见异常 ;9例节律性放电者 ,1例出现癫。EEG重度异常后遗症发生率为 2 9% ,轻度异常其发生率为 3 %。　结论　EEG异常情况与临床 HIE程度呈正相关 ,且重度异常者其后遗症发生率显著高于轻度异常者。新生儿 EEG可作为 HIE早期判断预后的一种有效、方便的检查手段。     

新生儿缺氧缺血性脑损伤脑脊液氨基酸含量的变化及临床意义

缺氧缺血性脑损伤是导致永久性神经损伤的重要原因之一。兴奋性氨基酸(EA A)和抑制性氨基酸 (IAA)在缺氧缺血性脑损伤的发病中所起的作用 ,已引起国内外学者的注意。我们检测了 2 6例新生儿缺氧缺血性脑病 (HIE)的患儿和8例正常新生儿脑脊液氨基酸含量的变化 ,探讨新生儿缺氧缺血性脑损伤患儿脑脊液 EAA和 IAA含量的变化及其与脑损伤程度的关系。一、对象和方法1.研究对象 :2 6例患儿系我院新生儿科 1998年 3～ 6月收治的足月新生儿 ,均因窒息复苏后 2 4h内出现神经系统症状转入我科治疗 ,待病情稳定后头颅 CT检查。根据 CT结果将其…     

新生儿缺氧缺血性脑病急性期血糖变化及临床意义的研究进展

新生儿缺氧缺血性脑病(HIE)不仅造成各器官系统缺氧缺血性损伤;同时也对机体的代谢产生影响,尤其对糖代谢的影响及血糖变化对机体的损伤引起广泛关注;糖代谢紊乱与HIE的程度相关,病情越重血糖越高;且血糖变化也预示其预后,积极调控血糖有重要的临床意义。临床应重视HIE的血糖监测及治疗,以提高治愈率,减少后遗症。     

新生儿缺氧缺血性脑损伤程度与血清乳酸脱氢酶同工酶及CT值的关系

新生儿缺氧缺血性脑病 (hypoxic ischem ic ence-phalopathy,HIE)脑损伤程度、预后的早期判断 ,及时合理的治疗仍然是我国围产医学的突出问题。血清乳酸脱氢酶同工酶 (lactate dehydrogenase isoenzym es,L DHi)在参与细胞氧代谢中的变化较灵敏的反映了新生儿脑缺氧的状况。头颅CT对 HIE的诊断具有公认的重要价值。为了客观、全面的早期评价 HIE程度、预后并及时合理的治疗 ,我们将血清L DHi监测与脑实质 CT值结合 ,临床应用结果分析如下。一、对象和方法1.对象 :足月、正常体重 HIE新生儿 5 1例 ,男 36例 ,女15例 ;出生时重度窒息…     

早期干预改善宫内缺氧缺血性脑损伤新生大鼠学习记忆能力的效果评价

新生儿缺氧缺血性脑病(HIE)发病率高，常导致智能迟缓等严重后遗症。对急性期发生的脑损伤尚缺乏有效的治疗方法。有研究发现早期干预可改善宫内缺氧缺血性脑损伤(HIBD)新生大鼠的脑功能。本研究对宫内HIBD干预组及正常干预组新生大鼠进行早期干预28d，通过“Y”臂迷宫检测学习分辨能力、记忆保持百分率判断干预效果，并观察额皮质和海马CA2区、     

Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer

OBJECTIVE: To document symptoms associated with borderline, early and advanced ovarian cancer and identify personal characteristics associated with early versus late diagnosis. METHODS: Information concerning symptoms and diagnosis history was available from 811 women with ovarian cancer who took part in an Australian case-control study in the early 1990s. Women were classified into three groups for comparison based on their diagnosis: borderline, early (stage I-II) and advanced (stage III-IV) invasive cancer. RESULTS: Sixteen percent of women with borderline tumors, 7% with early cancer and 4% with advanced cancer experienced no symptoms before diagnosis (P < 0.0001). Among women with symptoms, abdominal pain (44%) or swelling (39%) were most frequently reported; an abdominal mass (12%) and gynecological symptoms (12%) were less common. Compared to advanced stage cancer, women with early stage cancer were more likely to report an abdominal mass or urinary symptoms but less likely to report gastrointestinal problems or general malaise. General malaise and 'other' symptoms were least common in borderline disease. Older women, and those with higher parity or a family history of breast or ovarian cancer, were more likely to be diagnosed at an advanced stage of disease. CONCLUSIONS: Women who experience persistent or recurrent abdominal symptoms, particularly swelling and/or pain should be encouraged to seek medical attention and physicians should be alert to the possibility of ovarian cancer even in the absence of an abdominal mass. Further information about the prevalence of these symptoms in the general population is essential to assist physicians in patient management.     

Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

Objective: The aim of this study was to evaluate baccalaureate nursing students' attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms. Methods: This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0. Findings: The average age of participants was 19.89 ± 1.43. The MAQ's five subscales' mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05). Conclusions: The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.     

Symptoms,coping strategies,and timing of presentations in patients with newly diagnosed ovarian cancer

OBJECTIVE: The purpose was to explore whether health education on symptoms of ovarian cancer would aid in early detection, by examining the relationship between symptoms, coping strategies, and timing of presentation in patients with newly diagnosed ovarian cancer. METHODS: Eighty women were included. A questionnaire consisting of a series of open questions was designed to collect information on the sequence of events from the onset of symptoms to the diagnosis of ovarian cancer. The Coping Response Inventory (CRI) was used to assess the coping strategies. RESULTS: A majority (90.0%) of women with ovarian cancer did have symptoms before the diagnosis. Abdominal pain or discomfort, abdominal distension, a palpable abdominal mass, menstrual, bowel, or urinary symptoms were the commonly reported symptoms. Eight (10.0%) patients were totally asymptomatic prior to the cancer diagnosis. The presence of bowel symptoms was significantly associated with late stage disease. Most of the patients sought medical advice within 2 weeks from the onset of symptoms. There was no association between the presence of any particular symptom(s) and the timing of presentation. There was also no correlation between the coping strategies and stage of disease and timing of presentation. On average, patients with early stage disease saw one more doctor compared to patients with late stage disease before the affirmative diagnosis of ovarian cancer. CONCLUSION: Most patients presented early after the onset of symptoms. Health education in this regard may not be useful for early diagnosis of ovarian cancer.     

Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

Objective: The aim of this study was to evaluate baccalaureate nursing students’ attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms. Methods: This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0. Findings: The average age of participants was 19.89 ± 1.43. The MAQ’s five subscales’ mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05). Conclusions: The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.     

剖宫产瘢痕妊娠的诊断及处理

目的:探讨剖宫产瘢痕妊娠的发病机制、早期诊断以及恰当的治疗方法。方法:回顾分析1994年1月至2006年5月北京协和医院收治的25例剖宫产瘢痕妊娠患者的临床资料,包括:患者的发病年龄,孕产次,发病至剖宫产术的间隔时间,首发症状,发病部位,诊断过程,辅助检查、治疗方法,经过及结局。结果:剖宫产瘢痕妊娠占同期异位妊娠的1.1%,与同期正常妊娠数之比为1:1368。25例患者的平均年龄31.4岁,92%的患者仅有一次剖宫产手术史,发病至末次剖宫产术的间隔时间为4月至15年,最常见的临床表现为停经和阴道流血,其中11例发生阴道大出血。16例(64%)患者分别误诊为宫内早孕(14例)和滋养细胞肿瘤(2例)而给予相应处理,仅9例治疗前确诊。通过剖宫产病史,妇科检查和超声、磁共振等辅助检查综合分析可作出诊断。治疗方法包括全子宫切除和保守性治疗(全身或孕囊内甲氨蝶呤注射和保守性手术)。25例患者均治愈出院。结论:剖宫产瘢痕妊娠较少见,临床易误诊,对有剖宫产手术史的患者应结合妇科检查及辅助检查以早期诊断,强调根据患者情况予以个体化治疗,可获得较好疗效。     

宫外孕多普勒超声的影像特征

目的:探讨超声检查诊断异位妊娠的临床价值,提高输卵管妊娠的早期检出率。方法:对113例早期异位妊娠患者经腹超声的声像图特征进行回顾性分析。结果:超声检查具有捕获图像清晰、准确、快速的特点,对不典型、未破裂的输卵管妊娠可获得早期诊断。结论:超声是诊断异位妊娠的最直接、最重要的方法,并对早期诊断输卵管妊娠有重要的临床价值。     

护理干预在小儿重症肺炎中的临床价值分析

目的：探讨对小儿重症肺炎进行护理干预所取得的临床治疗效果，并对其临床价值进行分析。方法：选择曾于我院进行治疗的60例重症肺炎患儿，对患儿行综合护理干预。结果：在完成护理治疗之后，观察组中患儿的护理有效率为93．3％。观察患儿临床症状改善时间；观察患儿家属对护理满意率。结论：对重症肺炎患儿行综合护理干预，有较好的临床效果。可使临床治疗效果明显提高，尽快改善患儿临床症状，在临床上有重要作用和意义，可进行推广。     

Differences in symptoms between patients with benign and malignant ovarian neoplasms

OBJECTIVE: The purpose of this study was to determine the symptoms that are experienced by patients who receive a diagnosis of early ovarian cancer and to compare those symptoms with the symptoms that are experienced by patients with late ovarian cancer, borderline ovarian cancer, and benign ovarian neoplasms. STUDY DESIGN: This study used a retrospective case-control design. Cases of invasive and borderline ovarian cancer (n=147 patients) were compared with 76 patients with benign ovarian neoplasms. RESULTS: Patients with early ovarian cancer were significantly more likely to have symptoms of mass effect (urinary frequency, constipation, palpable mass, pelvic pressure) compared with patients with benign ovarian neoplasms (67% vs 15%; P <.001), late stage disease (67% vs 40%; P =.008), and borderline cancer (67% vs 33%; P =.007). CONCLUSION: Mass effect symptoms were the only symptoms that differentiated patients with early-stage ovarian cancer from all other groups of patients. However, one third of the patients with early ovarian cancer did not report any of these symptoms.     

Frequency of nursing, physician and hospital interventions in women at risk for preterm delivery.

OBJECTIVE: To determine the frequency of nursing intervention, physician treatment and hospital evaluation for women receiving outpatient management services for preterm labor. METHODS: Outpatient services included: patient education; daily and as-needed nursing assessment of monitored uterine activity (MUA) and patient symptoms; treatment compliance; and physician notification for values exceeding established limits. We analyzed service data from women with singleton gestations at 20.0-34.9 weeks. RESULTS: Overall, 307 249 days of data from 10 660 women were reviewed, and 634 983 hours of MUA was assessed. On 53 665 (17.5%) of monitored days, patients exhibited increased MUA and/or symptoms of preterm labor with nursing intervention and reassessment. Physician notification/intervention was required 7316 (13.6%) times, and hospital admission was needed for 3163 (43.2%) of these patients. In the hospital 1400 (44.3%) patients received tocolysis. The mean ( +/- standard deviation) length of hospital stay was 3.2 +/- 7.2 days, and 428 (13.5%) of women remained hospitalized until delivery, with 324 (10.2%) delivering within 48 h. CONCLUSION: In this population of women receiving outpatient preterm-labor management services, 95.1% of excessive MUA or patient-reported symptoms of preterm labor were managed on an outpatient basis. Outpatient management allowed for appropriate identification and triage of women requiring hospital admission.     

Clinical picture of women with early stage ovarian cancer

OBJECTIVE: The objective of this study was to review the clinical picture of women with early stage ovarian cancer, to examine the difference between women with borderline ovarian tumors (BLOT) and those with ovarian cancer (OC), and to estimate the average time interval between the onset of symptoms and diagnosis. METHODS: A retrospective review of all women with surgical stage I and II OC or BLOT was performed and the following information abstracted: age, parity, family history of cancer, personal history of previous malignancies, symptoms, signs, date of start of symptoms, imaging studies, CA-125 values, date of diagnosis at surgery, tumor stage, histology, grade, date of last follow-up, and condition at last follow-up. Comparison between patients with BLOT and OC was performed using chi(2) and two-sample t tests. RESULTS: Our search identified 72 women with surgical stage I and II BLOT (n = 22) or OC (n = 50). Seventy-eight percent of the patients had presenting symptoms, the most common of which were abdominal or pelvic pain (34. 7%), bloatedness (31.9%), and vaginal bleeding (19.4%). Symptoms were similar among women with BLOT and those with OC, with a higher proportion of BLOT patients reporting no symptoms (31.8% versus 18. 0%, respectively). Abdominal and/or pelvic masses were palpable in 72.2% of the patients and ascites was present in 12.5%. Ovarian masses were most commonly complex in appearance and CA-125 was elevated in 52.2% of the patients in whom CA-125 values were known. The average time interval between onset of symptoms and diagnosis was 4.6 months (range 0.1-24.4 months). Women with BLOT had a significantly longer average time interval than women with OC (8.0 +/- 7.7 versus 3.4 +/- 3.7 months, respectively, P = 0.03). CONCLUSIONS: The majority of women with early stage ovarian cancer have nonspecific symptoms. The array of symptoms is similar between women with BLOT and those with OC. However, women with BLOT tend to have a longer time interval from onset of symptoms to diagnosis.