胎盘早剥胎心监护的图形分析

目的分析胎盘早剥异常胎心监护图形特征,总结图像规律,以提高早期诊治胎盘早剥的能力。 方法选取2015年1月至2019年11月中山大学附属第一医院产科收治的胎盘早剥且胎心监护异常的56例病例,按出现胎心监护异常时临产情况分为已临产组(25例)和未临产组(31例),并对其胎心监护图形等资料进行分析;按胎盘早剥产前诊断与漏诊分为产前诊断组(30例)和产前漏诊组(26例),对其胎心监护异常的类型进行比较。 结果胎盘早剥常见的胎心监护异常类型为无加速、微小变异、变异减速及宫缩波异常。微小变异在胎盘早剥未临产组胎监异常类型所占比例(51.6%)明显高于临产组(8%),两组差异有统计学意义(χ²＝12.07,P<0.01);延长减速在未临产组胎监异常类型所占比例(6.5%)明显低于临产组(48%),两组差异有统计学意义(χ²＝12.74,P<0.01)。宫缩波异常在产前诊断组胎监异常类型所占比例(50%)明显高于产前漏诊组(3.8%),两组差异有统计学意义(χ²＝14.54,P<0.01);变异减速在产前漏诊组胎监异常类型所占比例(46.2%)明显高于产前诊断组(16.7%),两组差异有统计学意义(χ²＝5.73,P＝0.02)。 结论准确判读胎心监护图形,有助于早期发现胎盘早剥。当胎心监护出现微小变异、延长减速或宫缩波异常时,需警惕胎盘早剥的发生。     

Puerperal ventral epidural hematoma after epidural labor analgesia

Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3 000 obstetric patients. Neuraxial hematoma after obstetric epidural analgesia or anesthesia is extremely rare.We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment. We reviewed the epidemiology, clinical manifestations and treatment options for this rare complication.     

能量平台中结扎束在阴式子宫全切手术中的应用

目的探讨Force Triad能量平台中血管结扎闭合系统（结扎束）在阴式子宫全切术（Transvaginal total hysterectomy,TVH）中的应用价值。方法 2013年4~12月住院患者60例,随机分成观察组（ligasuren血管闭合系统组）与对照组（传统手术组）,比较两组间在手术时间、术中出血量、术后排气时间、术后发热时间、术后离床活动时间以及平均住院天数等情况。结果观察组手术时间、术中出血量、术后离床活动时间及平均住院时间明显少于开腹手术组（P〈0.05）,差异有统计学意义;术后排气时间、术后发热时间差异均无显著性（P〉0.05）。结论 Ligasuren血管闭合系统在阴式子宫全切手术的应用方面有一定的优势,可以更有效地闭合血管,减少出血量及缩短手术时间,减少术后并发症等优点,值得推广。     

Periurethral collagen implant: Ultrasound assessment and prediction of outcome

The objective of this study was to identify sonographic parameters that could predict sucessful outcome in women after periurethral collagen implant. Thirty-one women with a diagnosis of stress urinary incontinence with intrinsic sphincteric deficiency underwent one periurethral collagen implant between January and December 1994. Three months after the procedure ultrasound evaluation was performed using a 5 MHz probe placed at the vaginal introitus. Subjective assessment and cough stress test were used to measure outcomes. Twenty-five women were available for evaluation 1 year after the procedure. A successful outcome was found in 18 of the 25 women subjectively (72%) and in 16 objectively (64%). A distance of the collagen from the bladder neck of less than 7 mm was found to be associated with a positive outcome. This threshold was found to have a sensitivity of 83.3%, specificity of 85.7%, a positive predictive value of 93.7% and a negative predictive value of 66.6%.     

Investigation of Unplanned Absenteeism of Nurses Working in a University Hospital: Cross-Sectional Study

AimThis study aimed to determine the tendencies and causes of unplanned absenteeism of nurses and the experiences of clinical nurse managers on this subject.BackgroundAbsenteeism is a common way for an employee to distance themselves from their job. Unplanned absence is defined as the employee's inability to come to work without the employer's consent.MethodsIn the retrospective analysis of the archived data on nurse absenteeism, a qualitative interview technique was used in the data collected from nurse unit managers using the quantitative method, semistructured interview form.ResultsChildren's problems, special reasons, and medical diseases are among the most common reasons for nurses' unplanned absenteeism. As per the nurses in charge, the tendency of unplanned absenteeism in their units is not high; in addition, motivation can reduce the tendency of unplanned absenteeism.ConclusionsIt was emphasized that in absentee management, interteam communication and regulations aimed at increasing the employee's motivation in the work environment are important. Clinical manager nurses can reduce the frequency of unplanned absenteeism by determining the factors that push nurses working in the clinic to unplanned absenteeism for motivational reasons. This study will guide the preparation of programs to improve the causes of unplanned absences in their clinics.     

电子阴道镜在宫颈疾病诊断中的临床应用

目的探讨电子阴道镜在宫颈疾病诊断中的应用价值、临床意义及应用体会。方法收集我院2001年~2004年妇产科240例宫颈疾病患者,进行阴道镜检查并行宫颈活检组织学检查,结果进行回顾性分析、比较和总结。结果①电子阴道镜在诊断宫颈病变中敏感度为80.4%,特异度为87.8%,假阴性率(漏诊率)为4.3%,阳性预测值为83.9%;②阴道镜图像与组织学结果相比:醋白上皮符合率为66.7%,二联征符合率为77.8%,三联征符合率100%,可疑宫颈癌符合率100%;③宫颈疾病在年龄分布上,其中以30~39岁发病者所占比例最大(46.5%),为CIN发病高峰年龄。结论电子阴道镜检查技术诊断宫颈疾病结果准确可靠,有一定的应用价值,特别对CIN的早期诊断、早期治疗及降低宫颈癌的发生率有重要的指导意义。     

Cerebral perfusion pressure,and not cerebral blood flow,may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis

OBJECTIVE: The relationship between cerebral perfusion pressure (CPP) and cerebral blood flow is unclear in preeclampsia. Our objective was to clarify this issue by comparing normal pregnant women to those with mild and severe preeclampsia. STUDY DESIGN: Patients with mild (n = 72) and severe (n = 120) preeclampsia underwent transcranial Doppler (TCD) imaging of the maternal middle cerebral artery (MCA). At the same time, blood pressure was taken with a Dinamap monitor (Dinamap; Criticon Inc, Tampa, Fla). CPP, resistance area product (RAP), and the cerebral flow index (CFI) were calculated by standard formulas. Data were plotted on normative curves for pregnancy (5% and 95%) and compared by chi(2) and Mann-Whitney U tests. RESULTS: CFI is usually normal in both severe (75%) and mild (72%) cases. If CFI is abnormal in severe cases, it may be either increased (14%) or decreased (10%), although in mild cases almost all abnormal CFI (25%) is lower than normal. In those cases with low or normal CFI, severe cases are associated with a significantly higher CPP, RAP, and MAP than mild cases (P <.05), although the CFI is not significantly different. A significant proportion of severe cases have high CPP (52%), whereas in mild cases the CPP is almost always normal (87%). Overall, in severe cases the RAP is abnormally high, although it is within the normal range in mild cases. CONCLUSIONS: One of the fundamental differences between mild and severe cases relates to the degree of cerebral perfusion pressure that the MCAs are subjected to. Because most preeclamptic women, regardless of degree of severity, have a normal CFI, it appears that autoregulation is generally intact. Because women with severe cases are more prone to cerebral catastrophe than those with mild preeclampsia, uncontrolled CPP may cause barotrauma and vessel damage, leading to hypertensive encephalopathy and overperfusion injury. Therapeutic strategies that ensure reduction of the CPP with maintenance of the CFI seem most likely to prevent the cerebral injuries (overperfusion or underperfusion) that cause seizures or death in women with preeclampsia.