宫内外复合妊娠27例临床分析

目的 提高宫内外复合妊娠（HP）的诊治水平.方法 对27例HP患者的临床资料作回顾性分析.结果 27例患者中自然妊娠10例,试管妊娠17例.有异位妊娠史5例,有盆腔、输卵管手术史22例.宫内单活胎25例,双活胎1例,宫内孕卵停育1例.停经时间39～67 d：有腹痛病史11例,阴道流血病史14例,失血性休克2例.血绒毛膜促性腺激素（HCG）为（44 714.40±237.2） IU/L.B超检查示附件区异常回声团块（3.35±0.32）个.患者均于腹腔镜下行异位妊娠病灶切除术,术后均行保胎治疗.术后随访,22例足月妊娠分娩,2例继续妊娠,3例终止妊娠,其中2例因孕卵停育终止妊娠,1例自行放弃妊娠.结论 临床对停经后有腹痛、阴道流血、尿HCG阳性的患者,尤其是使用促排卵药物及体外受精一胚胎移植术后的患者应特别注意HP的发生,阴道B超及血HCG检查有助于HP的诊断.HP一旦确诊,应立即行腹腔镜手术;术后注意保胎治疗,可获得较好的妊娠结局.     

剖宫产瘢痕妊娠17例的诊治分析

目的探讨适宜剖宫产瘢痕妊娠（ CSP ）的治疗方案。方法回顾性分析该院17例CSP患者的临床特点。结果17例患者均有停经史,10例患者均有停经后阴道流血史;3例在确诊前行人工流产,2例行药物流产,此5例患者均因术后阴道流血淋漓不净而入院治疗;5例入院诊断明确。本组17例全部治愈出院,住院时间平均（5.6＆#177;1.1）d。结论 CSP临床易误诊,对有剖宫产手术史的患者,应结合临床症状、体征和辅助检查作出早期诊断,根据患者实际情况予以不同的治疗方案。     

输卵管性不孕患者宫、腹腔镜手术后妊娠率影响因素分析

目的 探讨影响输卵管性不孕患者宫、腹腔镜手术后妊娠率的相关因素.方法 对236例输卵管性不孕患者于气静联合麻醉下行宫、腹腔镜手术治疗,术毕均用0.9％氯化钠溶液充分冲洗盆腔.术后24h常规使用抗生素预防感染.术后1～24个月电话随访妊娠情况,比较原发性不孕与继发性不孕者的妊娠率,观察盆腔手术史、输卵管妊娠史、人工流产史、输卵管妊娠史、输卵管柔软程度和盆腔粘连程度对妊娠率的影响.结果 236例患者中术后妊娠120例,未妊娠116例,总妊娠率50.85％,1 a内妊娠率41.10％,1～2a内妊娠率16.55％.原发性不孕与继发性不孕者术后妊娠率分别为47.42％、53.24％,二者比较,P＞0.05;有、无盆腔手术史者术后妊娠率分别为49.06％、54.55％,二者比较,P＞0.05;有、无输卵管妊娠史者术后妊娠率分别为44.83％、56.67％,二者比较,P＜0.05;有、无人工流产史者术后妊娠率分别为45.61％、55.74％,二者比较,P＜0.05.术前HSG检查显示输卵管柔软者术后妊娠率59.84％,欠柔软者46.75％,僵硬者29.73％,妊娠率两两比较,P均＜0.05.腹腔镜下盆腔粘连轻度者术后妊娠率58.09％,中度者47.06％,重度者28.13％,妊娠率两两比较,P均＜0.05.Logistic回归分析示输卵管妊娠史、输卵管柔软程度和盆腔粘连程度与术后妊娠率有关.结论 输卵管妊娠史、输卵管柔软程度、盆腔粘连程度三者可能是输卵管性不孕患者行宫、腹腔镜手术后妊娠率的影响因素.     

体外受精和胚胎移植后妊娠合并急性粟粒性肺结核的临床特点

目的总结体外受精和胚胎移植（IVF-ET）后妊娠发生急性粟粒性肺结核的临床特点。方法回顾性分析2001年1月至2005年12月在浙江大学医学院附属妇产科医院生殖中心接受IVF-ET后妊娠并发粟粒性肺结核的6例临床资料。结果IVF-ET后妊娠并发粟粒性肺结核患者的临床表现多不典型，以发热为主要表现，呼吸道症状隐匿。胸部影像学表现以粟粒性结节和浸润性改变为主。平均于移植后53．2d发病，1例人工流产终止妊娠，其余5例均在发病后2～4周内发生自然流产。结论发热为急性粟粒性肺结核的主要临床表现，IVF-ET后妊娠发生粟粒性肺结核的妊娠结局差，对抗炎治疗无效的发热患者应警惕肺结核，尽早行结核病的相关检查。     

初治涂阳肺结核治愈后近期复发预测模型

目的建立初治涂阳肺结核治愈后近期复发的预测模型。方法采用前瞻性追踪研究方法,对2005年1月1日—2006年12月31日广州市初治涂阳肺结核治愈停药的3 293例患者进行2年随访研究,从临床因素、社会因素探讨影响初治涂阳肺结核治愈后复发的相关因素,建立近期复发的logistic回归模型。结果初治涂阳肺结核治愈后细菌学复发率为4.6%。近期复发预测模型:logitP=-9.546+0.586X1+1.959X6+1.449X10+1.118X15+1.027X16+1.525X18+0.674X22+2.042X23,经评价预测效果较好。结论预测模型的建立为减少肺结核复发提供了科学循证依据,能为结核病疫情控制给予针对性指导。     

肺结核病人的健康教育

肺结核病人在急性发作住院治疗一段时间病情稳定后,大多数时间是出院后在家继续治疗,因此,做好肺结核病住院期间和出院后的健康教育对彻底治愈肺结核,减少复发,提高生活质量具有重要意义。1住院期间的宣教1.1心理方面:结核病有慢性、传染性、易复发性的特点,病人常表现为孤独寂     

探究糖尿病继发肺结核患者血糖控制及抗结核的临床效果和影响因素

目的探讨分析糖尿病继发肺结核患者采用不同降糖方案的血糖控制效果,并分析治疗影响因素。方法筛选该院2018年7月—2019年11月收治的2型糖尿病并继发肺结核的患者共52例,随机分为胰岛素组和口服药组,每组26例,治疗后按治愈与否分组,治愈组共41例,未治愈组共11例,分析临床效果和相关的影响因素。结果胰岛素组患者餐前、餐后平均血糖和平均血糖波动幅度较口服药组控制效果较好,胰岛素组抗结核治愈率为88.46%,高于口服药组治愈率且对比差异有统计学意义(P0.05);治愈组与未治愈组患者在年龄、吸烟史、糖尿病病程时间、慢性肺病史方面比较差异有统计学意义(P0.05)。结论胰岛素给药比常规口服药物治疗所得的血糖控制效果及抗结核治疗效果较好,而年龄、吸烟史、糖尿病病程时间、慢性肺病史是影响抗结核治疗效果的相关因素。     

影响肺结核治愈的原因分析与探讨

目的分析影响肺结核患者治愈的因素,为提高肺结核治愈率提供依据。方法收集2007～2012年甘肃省民乐县新涂阳肺结核患者治愈情况的相关信息并进行调查分析。结果共调查新涂阳患者490例,治愈393例,治愈率80．2％,半年后复发97例,复发率19．8％;复发组在就诊前结核病防治知识知晓率（55．7％）低于治愈组（76．0％）;复发组接受综合医院治疗大于1个月者比率（18．5％）,明显高于治愈组（6．3％）;复发组及时转诊（7日内）到位率（14．4％）,明显低于治愈组（93．6％）;复发组患者规则治疗依从性比率（5．3％）明显低于治愈组（79．2％）。结论患者对结核病防治知识知晓率、病后及时转诊到位率、接受规范治疗率低是影响肺结核治愈的主要原因,应加强宣传力度,建立健全转诊审批制度,强化督导管理,给予结核病患者早期、及时、全程、规范的治疗,提高治愈率。     

体外受精——胚胎移植后异位妊娠相关因素分析

目的探讨体外受精-胚胎移植（IVF—ET）后异位妊娠发生的相关因素。方法分析比较IVF-ET后15例异位妊娠（观察组）、90例宫内妊娠（对照组）患者的临床资料。结果观察组有异位妊娠史8例（53．33％）;宫腔内环境不良者3例（20％）,对照组分别为13例（14．44％）、0例,两组比较,P〈0．05。结论IVF-ET后异位妊娠发生与既往有异位妊娠史、宫腔内环境不良有关。     

24例妊娠合并肺结核临床及影像特点

目的分析妊娠合并肺结核的临床及影像特点。方法对24例明确诊断妊娠合并肺结核的住院患者进行回顾性分析。结果全身中毒症状明显,X线及CT主要特点：（1)病变多数为两侧多叶分布;（2)病变形态以斑片状、片状实变、空洞及结节为主要表现,且多种病变同时出现。急性、亚急性血行播散肺结核占20.8%,痰菌阳性率42. 1%,延误诊断率54. 1%。结论妊娠加重了肺结核,应提高对妊娠合并肺结核的认识,提高早期诊断率。     

38例妊娠合并结核病误诊原因分析

目的分析和探讨妊娠合并结核病误诊原因,提高对妊娠合并结核病的认识,防止误诊后导致严重后果。方法对38例临床诊断妊娠合并结核病的临床资料及误诊情况进行分析。结果 38例患者平均误诊时间26.8天,患者中农村妇女24例（63.2%）,综合医院就诊33例（86.8%）,发病一周就诊率仅18.4%,发病三周内行X线检查仅23.7%,PPD／痰菌阴性误诊18例（47.3%）误诊疾病中上呼吸道感染（44.7%）、产褥感染（21%）。结论妊娠合并结核病平均误诊时间较长,农村妇女对此病认识不够及心理顾虑、未及时X线等检查、PPD／痰菌等检查阴性是误诊常见原因。上呼吸道感染、产褥感染是常见误诊疾病。     

妊娠合并肺结核68例临床分析并文献复习

目的分析妊娠合并肺结核的临床特点。方法对我科诊治的妊娠期、产褥期合并肺结核68例进行回顾性分析。结果妊娠早、中期及产后(产褥期、流产后)1个月内发病者居多,分别占30.9%及64.7%,且全身中毒症状者明显,痰菌阳性率高,合并肺外结核者多(尤其是结核性脑膜炎占23.5%),急性血行播散性肺结核占41.2%。结论妊娠及分娩是已婚妇女易患结核病的重要诱因,应予重视。     

The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis

Whether or not pregnant women with a previous episode of venous thromboembolism (VTE) should receive antithrombotic prophylaxis is a matter of debate. In order to estimate the rate of recurrent deep venous thrombosis (DVT) or pulmonary embolism (PE) during pregnancy and puerperium we retrospectively investigated a cohort of 1104 women with previous VTE; after a single DVT or isolated PE, 88 of them became pregnant at least once without receiving antithrombotic prophylaxis. Overall, 155 pregnancies and 120 puerperium periods without prophylaxis were recorded. There were nine recurrences during pregnancy and 10 during puerperium, with a rate of 5.8% [95% confidence interval (CI) 3.0-10.6] and 8.3% (95%CI 4.5-14.6) respectively. In pregnancy, the rate of recurrence was 7.5% (95%CI 4.0-13.7) if the first VTE was unprovoked, related to pregnancy or to oral contraceptive use, whereas no recurrence occurred if the first VTE was related to other transient risk factors. In puerperium, the rate of recurrence was 15.5% (95%CI 7.7-28.7) in women with a pregnancy-related first VTE, with a risk 3.9-times higher than in the remaining women. Inherited thrombophilia was not associated with a statistically significant increase in risk of recurrence in pregnancy or in puerperium, yet the rate of recurrence in puerperium was 14.2% (95%CI 5.7-31.4) in overall carriers of factor V Leiden and 30% (95%CI 10.7-60.3) in carriers with a pregnancy-related first VTE, with a risk 6.8 times higher than in women without thrombophilia and with a non pregnancy-related first VTE.     

布加综合征与妊娠

布加综合征是一种少见的肝脏疾病,其与妊娠之间相互影响。系统论述了布加综合征与妊娠的关系,并指出了在疾病诊断和治疗中的注意事项。其一,妊娠是布加综合征的危险因素。对于妊娠期间出现门静脉高压和(或)下腔静脉高压表现的患者,应高度怀疑合并布加综合征。其二,布加综合征患者妊娠具有一定的风险。经治疗病情稳定的患者可以妊娠,但孕期和产后须严密监查,以防止血栓复发。其三,布加综合征可导致女性不孕。原因不明的不孕患者应行腹部超声及CT检查,以排除布加综合征的可能。     

脊柱结核内固定术后复发探讨（附23例报告）

目的 探讨脊柱结核内固定术后复发原因及处理方法。方法 回顾性分析23例脊柱结核内固定术患者的发病及治疗经过以及复发后的表现和再治疗经过。重新调整抗结核药物治疗，并且用药时间为18～30个月；19例行手术病灶清除术及重新植骨，其中2例内固定物取出1例重新行内固定手术；4例单纯行瘘管清创换药。结果 23例患者19例治愈，术后安置病灶引流管相应延长到3-14天；2例耐药术后又瘘管形成，经局部换药及调整结核药物治疗，2年后痊愈，平均用药时间增加6～12个月；2例内固定取出后绝对卧床6～8个月。结论 脊柱结核内固定术后复发是严重的并发症，它影响结核的治疗和预后以及结核的播散问题；规范抗结核治疗和正确的手术时机和方法的选择应引起高度重视；及时调整抗结核药物治疗及瘘管换药和局部结核病灶的进一步清除是治愈结核复发的关键；内固定物取出不是治愈结核的关键条件。     

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Intended and unintended pregnancies occur frequently among human immunodeficiency virus (HIV)-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1–5.7). Younger age (odds ratio [OR]?=?1.07, 95% confidence interval [CI]: 1.04–1.11 per one year decrease in age), hospitalization during the index pregnancy or up to six months post-partum [OR?=?2.0, 95% CI: 1.2–3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion; OR?=?3.4, 95% CI: 1.4–8.4) were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (vs. prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p?相似文献   

Serum proinsulin in normal and gestational diabetic pregnancy

Summary The concentration of proinsulin-like components (PLC) in serum has been determined by gel filtration on samples obtained from eight normal pregnant women and eight nonobese gestational diabetics. The normal women were investigated early in pregnancy and all subjects were investigated in mid pregnancy, late pregnancy, and postpartum. At each occasion, samples were obtained after an overnight fast and after glucose ingestion. In both groups, the concentration of PLC in serum after overnight fast rose with gestation as well as after glucose ingestion, but there were no significant differences between mean levels of PLC of the normals and the gestational diabetics. With gestation, serum insulin rose in parallel with PLC in either group. The proportion of total insulin immunoreactivity composed by PLC thus remained constant and, furthermore, the proportions of PLC in gestation were equal to those observed postpartum. Four to six weeks after delivery, the basal concentration of PLC in serum was higher in the gestational diabetics than in the normals, whereas the concentrations of insulin were equal. Since the biological potency of proinsulin is much less than that of insulin, the results exclude the possibility that the decrease of glucose tolerance in normal pregnant women and gestational diabetics is due to an increased concentration of proinsulin in serum.     

The effect of pregnancy on the epilepsies: a study of 37 pregnancies

Abstract Background: Although studies have assessed the effect of pregnancy on epilepsy, usually the types of epilepsy are not differentiated and most have not included a control group, despite the natural history of epilepsy including fluctuations in seizure frequency. Aims: To assess the effect of pregnancy on seizure frequency and compare this with changes in seizure frequency in non-pregnant patients. In addition, the relationship between seizure frequency during pregnancy and epilepsy type, seizure frequency prior to pregnancy and duration of epilepsy will be assessed. Methods: Seizure frequency was assessed retrospectively in 37 pregnancies from 24 women by comparing the seizure number for the nine-month period prior to pregnancy with the number during the pregnancy. An increase in frequency was defined as a 50% or greater increase in the number of seizures. Twenty-four non-pregnant women, matched for age and epilepsy type, were included to assess fluctuations in control. Results: In 41% of pregnant women, there was an increase in seizure frequency, in 51% no change and in 8% improvement. In the control group, 24% had an increase, 65% no change and 11% improvement. There was no correlation between seizure frequency during pregnancy and epilepsy type and seizure frequency prior to pregnancy, but those with longer duration of epilepsy were more likely to deteriorate (p < 0.05). Alterations in anticonvulsants to reduce the risk of teratogenicity was a common identifiable cause of deterioration in control. Conclusions: Significant random fluctuations in epileptic control occur, but pregnancy may have a deleterious effect on epilepsy, particularly when appropriate therapy is withdrawn to reduce teratogenicity.     

Frequency of previous tuberculosis history in patients with and without active tuberculosis admitted to our hospital in 1980-83 and in 1997-99

To study recurrence rate over a long period after recovery from previous tuberculosis history, we examined the frequency of previous tuberculosis history in patients who were admitted to our hospital in 1980-83 and in 1997-99 and the comparison was made between cases with and without culture-positive tuberculosis. The tuberculosis groups comprised of 297 patients in 1980-83 and 688 patients in 1997-99. The non-tuberculosis groups (control groups) comprised of 373 patients in 1980-83 and 1092 patients in 1997-99 with non-tuberculosis diseases other than the tuberculosis-related diseases such as non-tuberculosis mycobacteriosis, pulmonary aspergillosis, bronchiectasis, chronic bronchitis and tuberculosis sequelae. The patients with viral chronic hepatitis previously operated and transfused were also excluded as they might be operated because of pulmonary tuberculosis in the era of surgical treatment for tuberculosis. In both tuberculosis and control groups, they had previous tuberculosis history most frequently when they were twenties. In the control groups, the frequency of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39, 40-49 were 15/84 (17.9%), 22/93 (23.7%), 11/77 (14.3%) and 3/43 (7.0%), respectively, and those admitted in 1997-99 were 11/70 (15.7%), 30/231 (13.0%), 28/288 (9.7%), and 10/230 (4.3%), respectively. In these 4 birth year groups, frequency of previous tuberculosis history among cases admitted in 1997-99 were significantly lower than that admitted in 1980-83 (p < 0.05, one-sided paired t-test), and the fact suggests that persons with tuberculosis history died earlier than those without it. In the tuberculosis groups, the frequencies of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39 and 40-49 were 20/35 (57.1%), 31/58 (53.4%), 19/48 (39.6%), and 11/53 (20.8%), respectively, and those among cases admitted in 1997-99 were 30/99 (30.3%), 58/125 (46.4%), 22/102 (21.6%) and 17/136 (12.5%), respectively. The frequency of previous tuberculosis history among cases admitted in 1997-99 was significantly lower than that admitted in 1980-83 (p < 0.01) as was the case in the control groups. As recurrence within 5 years had occurred in only 4 out of 113 tuberculosis patients (3.5%) in the above-mentioned 4 birth year groups, almost all tuberculosis patients were assumed to have recovered completely from previous tuberculosis. Comparison between the recurrence rate from previous tuberculosis and the incidence rate from the remotely infected persons without previous tuberculosis history in the same birth year group can be done by calculating the prevalence of tuberculosis infection for each birth year group using a model of annual risk of tuberculosis infection appropriate for Japanese. The ratios between the recurrence rate from previous tuberculosis patients and the incidence rate from remotely infected persons without previous tuberculosis history were 4.71, 2.33, 1.78 and 1.11 in 1980-83 and 1.84, 3.99, 1.80 and 1.11 in 1997-99 for groups born in 1910-19, 20-29, 30-39 and 40-49, respectively. The ratio did not change systematically with time in these groups, indicating the recurrence rate did not change with time more than ten years after recovery from previous tuberculosis. The ratio was about 3 for groups born in 1910-19 and 20-29 and 1 for group born in 1940-49. Almost all patients born in 1940-49 could receive chemotherapy for tuberculosis in their twenties, while most of the patients born in 1910-29 could not. Therefore, the above-mentioned fact may reflect the recurrence rate of patients treated successfully with chemotherapy is almost the same as the incidence rate from remotely infected persons, while that the recurrence rate from previous tuberculosis patients spontaneously recovered is 3 times higher than the incidence rate from remotely infected persons.