剖宫产患者的术后护理对策分析

目的：探讨剖宫产患者的术后护理对策。方法：选取我院收治的40例剖宫产患者,在常规护理的基础上对其行针对性的临床护理干预,并对其术后恢复情况进行观察分析。结果：本组40例患者平均住院时间为（6．8±1．7）d;术后仅1例患者发生伤口脂肪液化现象,但并无感染;且本组40例患者均未发生产褥感染、下肢深静脉血栓形成、产后出血等并发症。结论：给予剖宫产患者针对性的术后护理干预可有效地促进患者恢复,减少并发症,临床效果显著,值得推广和应用。     

肺癌病人术后护理

肺癌手术后的病人采取合适的护理方式能保证术后减少并发症发生的几率。本文主要从呼吸道的观察与护理、胸腔引流管的观察与护理、伤口护理、心理护理、并发症的观察与护理几个方面介绍肺癌病人术后护理的经验。     

妇科肿瘤术后并发下肢深静脉血栓的预防

深静脉血栓是外科术后常见并发症之一。国外报道，外科术后深静脉血栓（deep venous thrombosis，DVT）的发生率为30％-50％，而在妇科肿瘤术后血栓形成发生率达7％-45％。而我国目前仍无确切的统计数字，但鉴于血栓形成可引起肺栓塞及下肢功能障碍，故对妇科肿瘤患者术后DVT的预防十分重要。本文对我院妇科肿瘤术后DVT的预防情况分析报道如下。     

颅内动脉瘤病人术后护理

颅内动脉瘤手术后的病人采取合适的护理方式能保证术后减少并发症发生的几率。本文主要从体位护理、呼吸道的观察与护理、脑室引流管的观察与护理、伤口护理、心理护理等几个方面介绍颅内动脉瘤病人术后护理的经验。     

老年妇科恶性肿瘤患者术后并发症的护理对策

目的：探讨老年妇科恶性肿瘤病人手术后并发症的临床护理对策。方法：选择2009年10月到2010年10月我院60例妇科恶性肿瘤病人资料进行回顾性分析。结果：经过采取科学有效的护理对策,60例老年妇科恶性肿瘤术后并发症病人均痊愈出院。结论：对老年妇科恶性肿瘤术后并发症患者进行科学的护理干预,能有效提高护理质量。     

剖宫产术后并发妊娠子宫切口疝1例

患者25岁.孕2产0.6年前行剖宫产术.因停经26周＋3,腹痛12h于2006-09-11急诊入院.平素月经规律,末次月经2006-03-20.妊娠早期无特殊不适.[第一段]     

妇科宫腔镜术后的护理分析

目的妇女进行妇科宫腔镜手术后一般会有一系列的不良反应出现,这些不良反应的出现会直接影响宫腔镜手术的效果,因此,为了避免因该原园,而对进行宫腔镜手术的患者进行有针对性的护理。方法通过随机抽取2009年10月至2010年10月在我院接受治疗的100例患者进行统计学分析,其中50名患者接受普通的术后护理,作为对照组;50名患者接受针对性的护理,作为实验组。结果通过对各组患者术后不良反应的发病例数进行SPSS软件统计,P〈0．05,具有统计学意义。结论对进行宫腔镜手术的患者在术后进行有针对性的护理,可以有效的减少患者出现的不良反应,从而减少了患者的术后的痛苦,又增加了妇科宫腔镜手术的疗效。     

乳腺癌术后并发症预防的护理体会

目的：探讨乳腺癌术后并发症预防的方法,提高护理质量。方法术前针对患者的不同情况做好术前宣教,采取各种方法做好心理护理。在患者手术之后对其进行密切的观察,给予其进行功能锻炼、负压吸收、心理护理、管道护理等方面的治疗和护理措施。并且做好出院宣教。结果 220例患者均痊愈出院,无护理并发症发生。结论有效的针对乳腺癌患者术后并发症进行护理,采取针对性的护理措施,提高患者的生存质量。     

护理干预对伽玛刀治疗脑肿瘤的影响

目的：探讨护理干预对脑肿瘤患者伽玛刀治疗前、中、后疗效及副反应的影响。方法：将216例行伽玛刀治疗的脑肿瘤患者随机分为干预组和对照组,两组均给予伽玛刀治疗及常规护理,干预组在此基础上给予综合护理干预。结果：综合护理干预后治疗效果显著,副反应明显减轻（P〈0.1）。结论通过对伽玛刀治疗的脑肿瘤患者系统全面的综合护理干预,融洽了护患关系,减轻患者的心理压力,提高了护理质量和患者的生存质量,达到预期的效果,值得推广。     

剖腹产术后的护理体会

目的:探析剖腹产术后的个性化护理效果。方法:我院2008年4月至2010年4月采用个性化护理方法对91例剖腹产孕妇施行个性化护理,分析比较个性化护理在产后并发症、产后忧郁症、母乳喂养等方面较常规护理之间的效果差异,总结剖腹产术后护理的注意要点。结果:91例患者,术后出现产后忧郁症3例,术后出血1例,不能成功进行母乳喂养11例,较未使用个性化护理之前的比例大大降低。结论:结合产妇实际情况施行剖腹产术后个性化护理,对临床出现频率较高的产后并发症、产后忧郁症、母乳喂养困难等问题有较好的改善效果,各项指标均优于常规护理,值得临床推广应用。     

重症脑外伤患者加强输液护理的效果观察

目的：观察强化输液护理对于重症脑外伤患者的临床效果。方法：选取120例重症脑外伤患者,对半随机分配到常规组和加强组。常规组采取常规输液,加强组强化输液护理,对比两组结果。结果：常规组60例中治愈41例占68．33％,16例患者出现并发症占了26．67％,死亡3例占了5％;加强组中治愈53例占88．33％,出现6例并发症即10％,此外死亡1例1．67％。结论：强化输液护理对于重症脑外伤患者临床效果明显,值得广泛应用。     

新生儿脑损伤产前危险因素分析

目的 探讨新生儿脑损伤产前危险因素。方法 选取2010年8月至2014年2月北京大学第三医院产科分娩并转入儿科的新生儿,行头颅影像学检查诊断为脑损伤者351例,非脑损伤者287例,对其临床资料进行回顾性分析。结果 脑损伤组分娩孕周及新生儿出生体重明显低于非脑损伤组[（34.0±3.5）周vs.（35.0±2.8)周;（2059.0±839.6）g vs.（2250.9±726.6）g,均P＜0.05]。28~30周、＞30~32周分娩新生儿发生脑损伤的风险分别是足月分娩的6.6倍和2.1倍。孕周越小新生儿发生脑损伤的风险越高（趋势χ2=26.801,P=0.000）。出生体重小于1500g新生儿发生脑损伤的风险是2000g以上的3.9倍。出生体重越小新生儿发生脑损伤的风险越高（趋势χ2=29.555,P=0.000）。脑损伤组复杂性单绒毛膜双胎比例明显高于非脑损伤组（13.1% vs. 4.5%,P=0.000）。复杂性单绒毛膜双胎新生儿发生脑损伤的风险是单胎的3.0倍。多因素分析显示新生儿发生脑损伤的独立危险因素是分娩孕周（OR=0.891,95%CI 0.842～0.943）、复杂性单绒毛膜双胎（OR=2.180,95%CI 1.108～4.288）。结论 分娩孕周越早新生儿脑损伤风险越高,早产尤其是不足30周且出生体重低于1500g时发生新生儿脑损伤的风险明显增高。复杂性单绒毛膜双胎是发生脑损伤的另一个独立危险因素。     

Evaluation and management of brain metastatic patients with high-risk gestational trophoblastic tumors

A retrospective study to evaluate the characteristics of brain metastatic patients with gestational trophoblastic tumors (GTT) and to analyze the results of treatment has been performed. During 1996-2001, 40 patients with metastatic GTT were diagnosed at Vali-e-Asr Hospital, Tehran, Iran. Of them, nine with brain metastases, which were documented with the help of computed tomography scan, were evaluated retrospectively. Eight patients received EMA-EP regimen (etoposide, methotrexate, actinomycin, etoposide, and cisplatinum) and one received EMA-CO (etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristin). All cases received whole brain irradiation therapy concurrently. The median age of the patients at diagnosis was 30 years (range: 17-53). Six of them were of early group (five with symptoms of central nervous system and one was detected during workup) and three were of late group (relapsed group). Five (56%) patients responded to treatment and four (44%) were deceased (three of them belonged to late group). It seems that multi-agent chemotherapy (EMA-EP) concurrently with whole brain irradiation results in acceptable survival rates in GTT patients with brain metastases.     

Placental site trophoblastic tumor in a patient with brain and lung metastases

Placental site trophoblastic tumor is a rare neoplasm that arises from intermediate trophoblasts and shows diversity of biological behaviors, resulting in the absence of consistency in treatment modalities. A case of placental site trophoblastic tumor that extended to the cervix, with primary manifestation of amenorrhea and yellow foul-smelling vaginal discharge, is presented. Total abdominal hysterectomy was performed initially, and serial measurements of human chorionic gonadotropin levels were obtained. She was admitted with metastases to brain and lung 1.5 years after surgery. Combination chemotherapy (etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine) and radiotherapy were administered. There was no significant response to chemoradiotherapy. Despite changing chemotherapy regimen, she is still alive with progressive disease.     

Correlation of risk categorization in gestational trophoblastic tumor between old and new combined staging and scoring system

AIM: To determine the correlation of risk categorization in gestational trophoblastic tumor between the revised International Federation of Gynecology and Obstetrics (FIGO) staging system combined with the original World Health Organization (WHO) scoring system, and the new FIGO staging system combined with the modified WHO scoring system. METHODS: We reviewed the medical records of 124 patients with gestational trophoblastic disease seen at Songklanagarind Hospital from 1988 to 2000. All patients were classified retrospectively by the FIGO staging system (both the revised system in 1992 and the new system in 2000) and the WHO scoring system (both the original and the modified one). The correlation of risk categorization between the revised FIGO staging system combined with the original WHO scoring system (old combined system), and the new FIGO staging system combined with the modified WHO scoring system (new combined system) was studied, and the remission rates in discrepant groups were identified. RESULTS: The mean score was 9.7+/-5.0 (range 1-21) for the original WHO and 8.3+/-5.0 (range 1-20) for the modified WHO. The correlation of risk categorization between old and new combined systems was 97.9%. There was no patient in the low risk group as classified by the old combined system, but patients were classified as in the high risk group by the new combined system. One patient, who was in the high risk group classified by the old combined system, but in the low risk group classified by the new combined system, achieved complete remission after treatment with single agent chemotherapy. CONCLUSION: There was good correlation between the old and the new combined systems.     

Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score,and menopausal status in borderline ovarian tumor

Objective: The aim of this study was to assess the prognostic values of risk of malignancy index (RMI IV), ultrasound score, menopausal status, and serum CA125 and CA19-9 level in patients with borderline ovarian tumor (BOT). Methods: Fifty women having borderline ovarian tumor (BOT) and 5O individuals with benign adnexal mass were enrolled in this retrospective study. The sensitivity, specificity, positive predictive values, negative predictive values and diagnostic accuracy of preoperative serum levels of the CA125 and CA19-9, ultrasound findings and menopausal status, and RMI IV were calculated for prediction of discrimination between BOTs and benign adnexal masses and the results were compared. Results: The RMI IV was the best method for discrimination between BOTs and benign adnexal masses and was more accurate than the other parameters. When Receiver Operator Characteristic area under the curves for menopausal status was analyzed, serum CA 125 and CA19-9 level, ultrasound score, RMI IV(CA125), and RMI IV(CA19-9) were, 0.580, 0.625, 0.548, 0.694, 0.734 and 0.711, respectively. The best RMI IV cut-off was found to be 200 for discrimination of benign and BOT lesions. In the RMI formulation, replacing CA125 with CA19-9 didn’t affect RMI IV sensitivity and specificity for discrimination. Conclusion: Compared to ultrasound, menopausal status, CA-125, CA19-9, the RMI IV was found to be the best predictive method for differentiation of BOTs from benign adnexal masses. RMI IV cut–off value of 200 is suitable for differentiation of benign and BOT’s.     

Determining the contribution of asphyxia to brain damage in the neonate

Studies in the research laboratory have demonstrated the complex relationship between fetal and newborn asphyxia and brain damage, a balance between the degree, duration and nature of the asphyxia and the quality of the cardiovascular compensatory response. Clinical studies would support the contention that the human fetus and newborn behave in a similar manner. An accurate diagnosis of asphyxia requires a blood gas and acid base assessment. The clinical classification of fetal asphyxia is based on a measure of metabolic acidosis to confirm that fetal asphyxia has occurred and the expression of neonatal encephalopathy and other organ system complications to express the severity of the asphyxia. The prevalence of fetal asphyxia at delivery is at term, 25 per 1000 live births of whom 15% are moderate or severe; and in the preterm, 73 per 1000 live births of whom 50% are moderate or severe. It remains to be determined how often the asphyxia recognized at delivery may have been present before the onset of labor. There is a growing body of indirect and direct evidence to support the contention that antepartum fetal asphyxia is important in the occurrence of brain damage. Although much of the brain damage observed in the newborn reflects events that occurred before delivery, newborn asphyxia and hypotension, particularly in the preterm newborn, may contribute to the brain damage accounting for deficits in surviving children.