妊娠晚期孕妇配偶父胎依恋现状与影响因素调查分析

目的:了解妊娠晚期孕妇配偶父胎依恋现状并分析其影响因素。方法:便利抽取南京某三级甲等妇幼保健院妊娠晚期住院孕妇配偶117人为研究对象,采用中文版父胎依恋量表(PAAS)进行问卷调查。结果:共回收有效问卷115份。孕妇配偶PAAS量表得分为37～74(57.30±9.32)分,其中依恋质量维度得分为(33.79±5.14)分,依恋强度维度得分为(19.58±4.05)分。计划内怀孕、第1个孩子、夫妻同住是影响父胎依恋主要影响因素(P<0.05)。结论:妊娠晚期孕妇配偶父胎依恋程度偏低,需引起医护人员重视。产前及时给予评价、指导与支持,帮助其适应角色改变,为建立良好的亲子依恋关系打好基础。     

长春瑞滨单药与联合铂类一线治疗老年晚期非小细胞肺癌临床观察

目的观察长春瑞滨单药和长春瑞滨联合顺铂一线治疗老年晚期非小细胞肺癌的疗效和毒性反应。方法 44例晚期非小细胞肺癌,其中21例予长春瑞滨25mg/m2,第1.8天给药,每21天为1周期,23例予长春瑞滨联合顺铂,长春瑞滨25mg/m2,第1,8天,顺铂25mg/m2第1～3天,随访至进展后患者死亡。结果单药组CR、PR、SD、PD、总有效率,1年生存率分别为0%,28.6%,38.1%,33.3%,37.5%和43.6%。联合组CR、PR、SD、PD、总有效率,1年生存率分别为4.3%,26.0%,34.8%,30.1%和47.5%。两者之间无统计学差异;不良反应以粒细胞减少,消化道反应,口腔黏膜炎为主,两者之间对比差异有统计学意义(P<0.05)。结论应用单药长春瑞滨一线治疗老年晚期非小细胞肺癌不仅疗效与长春瑞滨联合顺铂方案大致相同且患者有良好的耐受性,因不良反应稍多,因引起重视。     

音乐疗法对第一产程的影响

目的：探讨音乐疗法对第一产程的影响。方法将92例临产的初产妇按随机分为观察组和对照组各46例,对照组按常规护理,观察组在此基础上接受音乐疗法。观察两组疼痛程度、第一产程时间、产妇焦虑、抑郁评分。结果观察组第一产程阵痛比对照组缓和,第一产程时间明显短于对照组, SAS、SDS评分与对照组比较明显下降,差异有统计学意义（均P〈0.05）。结论音乐疗法可缓解分娩过程中的疼痛,缩短第一产程时间,缓解产妇焦虑、抑郁情绪,减轻产妇的痛苦。     

First trimester serum inhibin A in normal pregnant women

Objectives To establish reference ranges for maternal serum inhibin A in normal first trimester pregnant women. Materials and methods This was a cross-sectional study. We measured maternal serum inhibin A in normal pregnant women gestation age between 6⁺⁰ and 14⁺⁶ weeks using the enzyme-linked immunosorbent assay (ELISA) method. Maternal serum inhibin A was analyzed according to gestational ages (GA). Results Serum of 300 pregnancies was analyzed and the outcome demonstrated the median of maternal serum inhibin A according to gestational age. The levels of maternal serum inhibin A during the 6⁰–6⁺⁶ week of gestations are lowest when compared with other gestational age. The levels of maternal serum inhibin A during 9⁰–9⁺⁶ week of gestations are maximal. Maternal serum inhibin A then declined until 14 weeks of gestation. Conclusion Serum inhibin A can be measured during the first trimester of pregnancy by using the recent ELISA technique. Our reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome in threatened abortion.     

Caesarean delivery at full cervical dilatation versus caesarean delivery in the first stage of labour: comparison of maternal and perinatal morbidity

OBJECTIVE: To compare perinatal and maternal morbidity associated with caesarean sections performed in the first with that performed in the second stages of labour. PATIENTS AND METHODS: Comparative analyses between nulliparous women with singleton term pregnancies who had a caesarean section in the first stage of labour and those who had a second stage caesarean section were completed using standard statistical methods. A subgroup analysis, according to indication for caesarean section, was also performed. RESULTS: Of 627 women, 81% had caesarean delivery in the first stage and 19% had caesarean delivery in the second stage of labour. Women undergoing caesarean delivery at full cervical dilatation were 1.9 times more likely to have an augmented labour (95% CI 1.2-3.4, P < 0.001) and 2.8 times more likely to have epidural anaesthesia in labour (95% CI 1.5-5.2, P < 0.001) than those in the first stage. Compared with caesarean delivery in the first stage of labour, women undergoing caesarean delivery at full cervical dilatation were 4.6 times more likely to have composite intraoperative complications (95% CI 2.7-7.9, P < 0.001), 3.1 times more likely to have blood loss greater than 1,000 ml (95% CI 1.3-7.4, P = 0.01), and 2.9 times more likely to have a blood transfusion (95% CI 1.5-5.6, P < 0.001). The risk of neonatal morbidity was higher in first stage caesareans when they were performed for presumed fetal compromise (66.3 vs. 26.3%, P = 0.002), and lower when they were performed for failure to progress (18.4 vs. 42%, P = 0.02). CONCLUSION: Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.     

对公众开展院前急救知识教育的探讨

目的使公众掌握院前急救基本知识,发挥“第一目击者”作用。方法采用在日常急救中宣教,开设院前急救知识讲座,举办院前急救知识培训班,跟新闻媒体合作,举办急救栏目等方式,因人施教。结果93％学员认为接受院前急救教育对他们今后一旦发生的灾害和危重病现场有帮助,培训考核的学员一次通过者占90％,未通过者经强化训练补考后全部通过。结论对公众进行院前急救教育十分必要且可行,方式具有多样性,培训内容设置上重点应该是通气、止血、包扎、固定和搬运,以及心肺复苏术。重视跟政府各部门的合作,借助行政干预手段,是普及公众急救知识的一个好方法。     

2型糖尿病一级亲属糖耐量正常者血糖、血脂、CRP检测及意义

目的探讨2型糖尿病（T2DM）一级亲属糖耐量正常者血糖、血脂和c反应蛋白（CRP）的变化，了解T2DM自然病程中一些早期生理改变，提出预防措施．方法选择T2DM一级亲属糖耐量正常者（93名）为试验组，3代无糖尿病家族史健康者（93名）为对照组，对2组的体重指数（BMI）、糖化血红蛋白（HbA1C）、口服葡萄糖耐量试验（OGGT）葡萄糖、血脂、CRP观测指标进行比较分析．结果T2DM一级亲属糖耐量正常者与3代无糖尿病家族史的健康者BMI、OGGT试验的30、60、120min血糖及OGTT葡萄糖曲线下面积（GluAUC）、甘油三脂（TG）、CRP比较差异有显著意义．结论T2DM一级亲属糖耐量正常者已存在血糖、血脂、CRP潜在或异常的变化，在糖耐量正常阶段就应该采取糖尿病的综合预防措施，这有助于预防或延缓T2DM的发生．     

泰州市乡村医生现场急救知识和技能掌握现状分析

目的了解泰州市乡村医生现场急救知识和技能掌握现状,为政府在农村建立急救网络提供依据。方法采取随机抽样,以问卷形式对泰州市1 120名乡村医生进行调查。结果 1 120名调查对象中,男655名,女465名;年龄27～64岁。仅21.2%掌握第一目击者的含义,18.8%掌握黄金4分钟,29.6%掌握心肺复苏原理,39.1%掌握心搏、呼吸骤停的判断。心肺复苏及止血、包扎、搬运、骨折固定四大技术掌握率分别为41.2%及41.0%、41.2%、41.0%、39.4%。近5年内未参加急救知识培训者118名(10.5%),既往培训≥2次者727名(64.9%),参加急救知识培训的时间≥1周者731名(65.2%),愿意再参加急救培训者992名(82.4%)。最想学的急救项目前5项分别为:心肺复苏、固定术、搬运术、包扎术、内科急症的急救。结论乡村医生需要急救理论和技能的培训,急救培训的重点是急救素质的提高、急救技能的规范和急救知识的更新。     

首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历,为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE数据库,检索时限均从建库至2021年7月31日,使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献,并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献,提炼出60个研究结果,整理成8个类别,得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化,营造患者及家属无障碍化就医环境;关注家庭照顾者早期心理健康的干预,满足其社会支持的需要,提高该类人群应激应对能力,促进照顾者心理康复。     

首诊高血压住院患者心理分析及护理对策

目的分析首诊高血压住院患者的心理状态,并探讨护理对策。方法选择2011年3月至2013年2月我院首诊高血压患者360例,随机分为观察组和对照组各180例。两组患者均接受药物治疗和常规护理,观察组同时接受心理护理。比较护理干预前后患者心理状态的变化和两纽的活疗效果。结果与护理干预前比较,干预后两纽患者的SAS评分、SDS评分均有所下降．观察组下降幅度明显大于对照组,差异具有统计学意义（P〈0．05）。对比两组降压效果发现,观察组总有效率明显高于对照组．差异具有统计学意义（P〈0．05）。结论首诊高血压患者多存在一定程度的焦虑、抑郁等不良情绪．在住院治疗过程中加强对患者的心理疏导和健康教育,有助于缓解其不良情绪,提高治疗依从性,对降压药物的效果起到良好的促进作用。