膀胱容量测定联合计划饮水用于宫颈癌术后膀胱功能训练的效果观察

目的观察膀胱容量测定联合计划饮水用于宫颈癌术后膀胱功能训练的临床效果。方法选取拟行宫颈癌根治术患者80例,术前行膀胱容量测定,了解膀胱类型,制定饮水及排尿计划,术后第8天开始计划饮水,术后第10天开始膀胱功能训练,3 d后拔除留置导尿管,观察膀胱功能恢复情况。结果 80例患者术前残余尿量为（76.34±24.40）ml,术后为（74.90±26.83）ml,手术前后残余尿量比较差异无统计学意义（P〉0.05）;术前平衡膀胱率为97.50%,术后为91.25%,手术前后平衡膀胱率比较差异无统计学意义（P〉0.05）;术后出现尿潴留3例（3.75%）,排尿困难4例（5.00%）。结论膀胱容量测定联合计划饮水能有效促进宫颈癌术后膀胱功能恢复。     

B超监视下宫腔镜电切术治疗子宫纵隔的探讨

目的:探讨B超监视下宫腔镜电切术治疗子宫纵隔的价值。方法:在B超监视下,对26例子宫纵隔患者行宫腔镜子宫纵隔切开术。结果:26例手术均顺利,手术时间平均为30(15～40)min,出血量平均为15(10～20)mL,住院时间平均为3(1～5)d,无并发症出现。术后随访,宫腔形态正常,无粘连积血,自然流产率由术前的90.2%下降至术后的6.7%,足月分娩率由术前的3.9%上升至术后的73.3%,无分娩并发症发生。结论:B超监视下行宫腔镜子宫纵隔切开术是一种安全、有效、经济、简便的治疗方法,可作为首选的治疗方案。     

电子病案系统的动态质量管理

目的加强对动态病案质量的数字化审核和过程质量控制。方法1．增加动态监控功能,提高电子病案质量;2．完善电子病案的三级医师检审监控设置;3．完善电子病案模板的管理监控;4．完善电子病案质控管理模块;5．加强电子病案归档监控。结果对运转中病案规范操作流程、监控环节质量提出了计算机信息化的实现方案。结论电子病案系统的完善和改进,有效提高了动态病历质量和病案管理质量。     

腹腔镜下子宫切除术不同术式的临床应用

目的探讨4种不同途径腹腔镜下子宫切除术的临床应用。方法回顾性分析208例腹腔镜子宫切除术患者的临床资料,其中腹腔镜辅助阴式子宫切除术（LAVH）83例、腹腔镜下全子宫切除术（TLH）64例、腹腔镜下筋膜内子宫切除术（CISH）35例、腹腔镜下子宫次全切除术（LSH）26例,比较各组患者术中及术后的情况。结果平均手术时间LAVH组（115．60±22．81）min,TLH组（135．36±28．11）min,CISH组（103．69±19．18）min,LSH组（84．23±18．42）min,术中出血量LAVH组（130．44±27．35）组ml,TLH组（143．55±29．86）ml,CISH组（103．84±31．72）ml,LSH组（80．29±21．41）ml,LSH组与其它组比较,差异均有统计学意义（P〈O．051。结论不同途径腹腔镜子宫切除术各有优势,且互不能完全替代,应根据患者的情况、手术医生的技术水准、医院的条件等综合考虑。     

从98例未婚异位妊娠谈青少年生殖健康教育的必要性

目的　了解未婚异位妊娠的发病情况 ,以探索应对措施。方法　对 2 0 0 2年 1月～ 2 0 0 3年 12月收治的 98例未婚异位妊娠病例作回顾性调查。结果　 16～ 2 2岁年龄段占婚前异位妊娠总数的 5 2 0 % ,待业人员占 4 4 9% ,初中文化程度占 5 6 1% ,外省籍流动人员占 6 8 3% ,居住城郊占 6 2 2 %。有次数不等人流史占 4 4 9% ,曾有宫外孕史占 4 1% ,已行双侧输卵管切除占 2 0 % ,已行单侧输卵管切除占 5 5 1% ,因输卵管阻塞行通水术占 2 8 6 %。结论　加强青少年的生殖健康教育 ,增强保健及自我保护意识 ,杜绝婚前性行为 ,可有效预防异位妊娠的发生。     

产科子宫切除26例分析

目的探讨产科子宫切除的发生率、指征及降低产科子宫切除的可能性。方法回顾性分析1996年1月~2004年12月间所做的产科子宫切除26例。结果产科子宫切除的发生率为0.12%,其中剖宫产子宫切除发生率显著高于阴道分娩者。产科子宫切除的原因依次有胎盘因素(胎盘植入、胎盘早剥)、子宫破裂、宫缩乏力、羊水栓塞、妊娠合并肿瘤、阔韧带血肿。结论做好围产期保健工作,防治产科的严重并发症,降低剖宫产率可减少产科子宫切除的发生。     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

目的 探讨不同剂量肺表面活性物质(PS)替代治疗早产儿肺透明膜病(HMD)与发生支气管肺发育不良(BPD)的关系.方法 将2005年1月至2007年12月入住本院新生儿科并出现生后进行性呼吸困难且胸片提示考虑诊断为HMD的403例早产儿,依据家属经济条件使用旨剂PS情况分三组进行前瞻性的临床对照研究:低剂量PS组(L-PS组,剂量≤100 mg/kg,n=188)、高剂量PS组(H-PS组,剂量>100mg/kg,n=94)和未使用PS组(N-PS组, n=121);采用自身对照和组间比较观察PS治疗6 h后患儿吸氧浓度(FiO2)、肺部氧合功能,以及三组问观察总氧疗时间、机械通气时间、再次插管机械通气率、住院时间和BPD发生情况.结果 与N-PS组患儿比较,在给予Ps治疗6 h后,L-PS组和H-PS组两组患儿的FiO2,OI明显降低,PO2和a/A PO2比值均明显升高(P<0.05);氧疗时间和机械通气时间均明显缩短,较少发生再次插管机械通气(P<0.05);且以H-PS组患儿改变显著,差异均具有统计学意义(P<0.05).H-PS组患儿BPD发生(11例,11.7%)明显低于N-PS组(29例,24.0%),差异具有统计学意义(F1-3=4.267,P=0.006);L-PS组BPD发牛(34例,18.1%)虽然低于N-PS组,但差异无统计学意义(F1-2=1.354,P=0.062).结论 PS替代治疗能有效地改善肺部氧合功能,减少机械通气时间和再次插管机械通气发生率,且以大剂量(>100mg/kg)的效果更明显,并能有效地预防BPD的发生.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.