糖尿病产妇与母乳喂养的可行性与持续性探讨

目的：探讨糖尿病（DM）产妇的母乳喂养问题以及母乳喂养后血糖的变化，方法：选择DM产妇25例，其中1型糖尿病16列，2型糖尿病9例，产褥早期开始建立母乳喂养的为母乳组9例，其他为混合组和人工组各9例，同时随机抽取无并发症的正常产褥期妇女25例作为对照组，结果：母乳组9例，其中2例在3个月后转为母乳，牛乳混合喂养。6个月后有1例转为人工喂养。混合组织中产褥6个月时有8例转为人工喂养。结论：产褥早期能够建立母乳喂养的病例以后继续维持母乳喂养的效果也非常好，且母乳组的血糖值均低于混合组及人工组，说明DM产妇在分娩后可进行母乳喂养。     

产后不同的喂养方式对产妇产后康复及婴儿生长发育的影响

选取2011年2月~2014年3月于我院自然分娩的健康产妇287例,按照喂养方式的不同进行分组,分别为母乳组115例、混合组102例和人工组70例,对三组产妇的体成分、运动功能和婴儿体重、身长等生长发育情况进行观察对比。结果产后6w,母乳组FD与其他两组比较有明显差异,P<0.05;产后3个月母乳组FD、BF%、MS改善情况均明显优于人工组与混合组(P<0.05),其余指标无明显差异。产后3个月,母乳组婴儿体重、身长与人工组、混合组有明显差异(P<0.05)。产后采用母乳喂养方式,利于产妇产后康复与婴儿生长发育。     

80后产妇院外纯母乳喂养现状反思

目的 分析影响80后产妇院外纯母乳喂养失败的主要原因。方法 电话回访2012年4月—2012年5月在我院分娩的并自愿参与纯母乳喂养4—6个月的80后产妇。结果 收集有效数据共96例,其中纯母乳喂养的产妇有26.04%(25例),混合喂养的产妇有43.75%(42例),人工喂养的产妇有30.21%(29例)。其中导致80后产妇混合喂养的原因主要有奶量不足,导致其人工喂养的原因有乳头疼痛导致不能继续哺乳;哺乳过程导致产妇不能很好休息而放弃哺乳;工作学习原因放弃哺乳。所有被调查的80后产妇都明确了解母乳喂养的好处。结论 产科护士对于产妇的宣教还不到位,除了传统上的对于喂养姿势,乳头疼痛,喂养原则,乳头皲裂的指导,产科护士也应该教会产妇母乳喂养的当的正确判断方法。     

产后妇女月经复潮、排卵与婴儿喂养方式的调查分析

目的通过对1200例经阴道分娩的产妇产后月经复潮、排卵与喂养方式的调查,说明母乳喂养的优点。方法经阴道分娩产后6个月内采用不同喂养方式的产妇随机各选取400例共1200例进行问卷调查,记录婴儿喂养方式、月经复潮时间,采用B超监测卵巢排卵。结果观察期内产后6个月内月经复潮的产妇纯母乳喂养216例,占54%,混合喂养312例,占78%,人工喂养351例,占87.75%。在观察产后6个月内排卵的产妇,纯母乳喂养192例,占48%;混合喂养288例,占72%;人工喂养344例,占86%。结论纯母乳喂养可以推迟产后妇女月经复潮及排卵,调整生育间隔,达到自然避孕的结果,有益于母亲。     

黄金三环理论激励产褥期合并胰腺炎病人母乳待喂养模式的应用

[目的]探讨黄金三环理论激励产褥期合并胰腺炎病人保持母乳待喂养模式,使更多的产褥期新生儿能从中获益。[方法]采用方便抽样法,选取25例产褥期合并胰腺炎病人作为观察组,采用西蒙·斯涅克(Simon Sinek)的黄金三环理论激励病人保持母乳待喂养,选取25例产褥期合并胰腺炎病人作为对照组,采用一般发放母乳喂养好处的宣教单并做相应的健康宣教。分别统计两组产妇出院后3d、2周、1个月、3个月纯母乳喂养率。[结果]观察组产妇出院后3d、2周、1个月、3个月喂养率均为100%,对照组产妇分别为24%、24%、16%、12%,两者比较,差异有统计学意义(P0.05)。[结论]黄金三环理论能很好地激励胰腺炎产妇在住院期间保持母乳待喂养状态,同时实现出院后纯母乳喂养,使产妇与胎儿均能从中获益。     

产后妇女月经复潮、排卵与婴儿喂养方式的调查分析

目的 通过对1 200例经阴道分娩的产妇产后月经复潮、排卵与喂养方式的调查,说明母乳喂养的优点.方法 经阴道分娩产后6个月内采用不同喂养方式的产妇随机各选取400例共1200例进行问卷调查,记录婴儿喂养方式、月经复潮时间,采用B超监测卵巢排卵.结果 观察期内产后6个月内月经复潮的产妇纯母乳喂养216例,占54%,混合喂养312例,占78%,人工喂养351例,占87.75%.在观察产后6个月内排卵的产妇,纯母乳喂养192例,占48%;混合喂养288例,占72%;人工喂养344例,占86%.结论 纯母乳喂养可以推迟产后妇女月经复潮及排卵,调整生育间隔,达到自然避孕的结果,有益于母亲.     

影响剖宫产产妇母乳喂养的相关因素及护理措施

母乳是婴儿健康成长的天然食品，而初乳又是新生儿早期最理想的天然食物，具有诸多人工喂养所不能比拟的优点。母乳喂养的重要性近年来已受到重视，而我国近年来剖宫产率呈上升趋势，剖宫产产妇受诸多因素的影响，在产褥早期乳汁分泌量少于正常产妇，直接影响了母乳喂养的成功。因此，分析探讨影响剖宫产产妇母乳喂养的相关因素及护理措施，是摆在产科护理工作者面前的一个重要课题。     

影响剖宫产产妇母乳喂养的相关因素及护理措施

母乳是婴儿健康成长的天然食品,而初乳又是新生儿早期最理想的天然食物, 具有诸多人工喂养所不能比拟的优点.母乳喂养的重要性近年来已受到重视,而我国近年来 剖宫产率呈上升趋势,剖宫产产妇受诸多因素的影响,在产褥早期乳汁分泌量少于正常产妇 ,直接影响了母乳喂养的成功.因此,分析探讨影响剖宫产产妇母乳喂养的相关因素及护理措施,是摆在产科护理工作者面前的一个重要课题.     

催产素不同剂量对产褥早期母乳喂养影响的观察

目的观察催产素在预防产后出血中用药剂量对产妇产褥早期泌乳的影响,探讨其对母乳喂养的作用。方法选择我院248例于预产期前后择期剖腹产产妇,按应用催产素剂量分为大剂量组146例和小剂量组122例,测量分析各组泌乳开始时间、来乳3 d内产妇母乳喂养情况。结果催产素大剂量组产妇比小剂量组产妇泌乳始动时间明显推迟(P<0.01),产后24 h、48 h7、2 h纯母乳喂养率、低比率母乳喂养率、人工喂养率比较差异有极显著意义(P<0.01)。结论大剂量外源性催产素对产妇产褥早期泌乳可能产生负面影响,导致泌乳始动时间推迟,降低纯母乳喂养率。     

康复护理对剖宫产术后母乳喂养的影响

目的 观察在剖宫产产妇中开展康复护理对其术后母乳喂养的影响效果。方法 本文选我院 产科 2020 年 10 月至 2021 年 6 月期间收治的 100 例剖宫产产妇，通过随机数字表法将所有产妇 分成观察组和对照组，每组各 50 例。对照组给予临床常规护理，观察组在常规护理的基础上， 添加术后康复护理。观察护理前后的焦虑情绪，母乳喂养健康知识掌握度、护理治疗依从性和护 理满意度和产妇首次泌乳时间、混合喂养率、人工喂养率以及纯母乳喂养率。结果 观察组产妇 对母乳喂养相关知识掌握度及依从性均得到显著提升，焦虑情绪得到及时改善 P<0.05）。观察组 产妇首次泌乳时间明显变长，混合喂养率和人工喂养率较对照组为低（P<0.05）。结论 将康复 护理干预运用在剖宫产产妇术后护理中，能够有效提升临床护理质量，提高产妇术后身心舒适度， 促进术后产妇乳汁分泌效率，提高产妇母乳喂养成功率。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.