脐静脉推注缩宫素联合舌下含化卡孕栓对剖宫产产后出血的疗效观察

目的探讨缩宫素联合卡孕栓对剖宫产产后出血的疗效。方法将剖宫产的180例产妇随机分为两组。观察组104例在胎儿娩出后脐静脉给缩宫素20 U,同时产妇含舌下化卡孕栓1 mg;对照组76例在胎儿娩出后均子宫体注射缩宫素10 U,同时产妇舌下含化卡孕栓1 mg。比较不同时段剖宫产产后出血量,所获数据采用方差分析、t检验和X2检验。结果子宫收缩效果、止血效果、术中、术后及总出血量比较P均<0.005。结论剖宫产术中脐静脉推注缩宫素联合舌下含化卡孕栓,预防剖宫产术后出血效果显著。     

社区产后访视健康教育对母乳喂养的影响

目的:通过社区产后访视健康教育知识宣传让产妇和家属了解和接受母乳喂养知识和技能,提高母乳喂养率.方法:社区产后访视人员在产妇及新生儿出院后3天、28天各进行上门访视一次,先了解产妇及新生儿健康状况、母乳喂养知识了解程度和喂养技能掌握情况,再根据当前存在的问题给予纠正.对可能发生的问题给予预防措施指导.利用健康教育宣传母乳喂养知识,使产妇及家属了解和接受母乳喂养知识.结果:社区产后访视健康教育宣传指导使产妇及家属接受和正确实施母乳喂养,从而提高了母乳喂养率.结论:社区产后访视利用健康教育宣传和指导母乳喂养知识和技能对提高母乳喂养率有很大的促进作用.     

产后出血模拟实训在防治产后出血中的临床效果观察

目的评价产后出血模拟实训在防治产后出血中的临床效果及可行性。方法选取2018年开展产后出血模拟实训后收治的114例产后出血产妇为观察组,另选取2017年未开展演练时收治的72例产后出血产妇为对照组。比较两组产妇严重产后出血率、难治性产后出血率、产后出血量、用血量,并比较50例医务人员模拟实训前后考核成绩。结果观察组严重产后出血率1.8%、难治性产后出血率0均低于对照组的11.1%、5.6%;差异均有统计学意义(P<0.05);观察组产后出血量(535±10.5)ml、用血量(1000±102.3)ml均少于对照组的(750±11.3)、(1800±180.1)ml,差异均有统计学意义(P<0.05)。模拟实训后,50例医务人员理论知识、操作水平、应急能力、沟通能力、团队合作能力的考核成绩分别为(77±8.5)、(87±10.7)、(77±3.7)、(85±3.7)、(82±4.2)分,均高于模拟实训前的(65±6.5)、(66±8.4)、(60±1.2)、(70±4.5)、(65±1.2)分,差异均有统计学意义(P<0.05)。结论在产科针对产后出血开展模拟实训,可有效提高科医务人员的产科急重症理论知识、应急处理能力和团队协作能力,有效改善母婴结局。     

Brief postpartum separation from offspring promotes resilience to lipopolysaccharide challenge-induced anxiety and depressive-like behaviors and inhibits neuroinflammation in C57BL/6J dams

Emerging evidence indicates an important role for neuroinflammation in depression. Brief maternal separation promotes resilience to depression in offspring, but relatively little is known about the effects of different durations of postpartum separation (PS) from offspring on anxiety and depressive-like behaviors in dams following immune challenge. Lactating C57BL/6J mice were subjected to no separation (NPS), brief PS (15 min/day, PS15) or prolonged PS (180 min/day, PS180) from postpartum day (PPD) 1 to PPD21 and then injected with lipopolysaccharide (LPS). Behavioral tests, including the open field test (OFT) and forced swimming test (FST), were carried out at 24 h after the injection. LPS resulted in anxiety and depressive-like behaviors in NPS dams and activated ionized calcium-binding adaptor molecule (Iba1), an important biomarker of microglia, in the hippocampus. However, compared with NPS + LPS dams, PS15 + LPS dams spent significantly more time in the center of the OFT (anxiety-like behavior) and exhibited lower immobility time in the FST (depressive-like behavior), which indicated a phenomenon of resilience. Furthermore, the activation of neuroinflammation was inhibited in PS15 dams. Specifically, levels of the Iba1 mRNA and protein were decreased, while the mRNA expression of NLR family pyrin domain containing 3 (NLRP3) inflammasome/interleukin-18 (IL-18)/nuclear factor kappa-B (NF-κB) was decreased in the hippocampus. Furthermore, positive linear correlations were observed between microglial activation and LPS-induced depressive-like behaviors in dams. Collectively, the findings of this study confirm that brief PS from offspring promotes resilience to LPS immune challenge-induced behavioral deficits and inhibits neuroinflammation in dams separated from their offspring during lactation.     

Nocturnal cognitive hyperarousal,perinatal-focused rumination,and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression

ObjectivesThis prospective study explored associations among insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with depression.MethodsFrom late pregnancy through early postpartum, 39 depressed women completed 17 weekly surveys assessing SI, insomnia, depression, stress, and cognitive arousal.ResultsWomen with nocturnal cognitive hyperarousal at baseline, relative to those with low cognitive arousal, were at greater risk for new onset SI (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR = 5.66, p = 0.037) or perinatal-focused rumination (OR = 11.63, p = 0.018). Daytime perseverative thinking was not uniquely associated with SI.ConclusionsNocturnal cognitive arousal predicts the development of new onset SI, and perinatal-focused rumination is also uniquely associated with SI-risk in late pregnancy and early parenting. Critically, SI-risk is highest when perinatal women endorsed insomnia and high cognitive arousal at the same time. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.     

产后与非产后抑郁症患者失配性负波的对比研究

目的探讨产后抑郁症与非产后抑郁症患者失配性负波（MMN）的差异,为产后抑郁症的预防提供参考指标。方法选择2011年4月一2012年12月解放军第三医院精神科收治的24例产后抑郁症患者（产后组）和25例非产后抑郁症患者（非产后组）为研究对象,并检测其事件相关电位MMN,将其与26名健康志愿者（对照组）的结果进行比较。结果①与对照组相比,产后组、非产后组blMN潜伏期均显著延迟（t=2．84,5．26;P〈0．05）,波幅均显著降低（t=4．16,4．19;P〈0．01）;②与产后组相比,非产后组MMN潜伏期显著延迟,差异有统计学意义（t=3．63,P〈0．05）;两组波幅差异均无统计学意义。结论产后与非产后抑郁症患者信息自动加工功能均受损,非产后抑郁患者受损程度大于产后抑郁患者。提示产后与非产后抑郁症患者大脑对外界信息的自动加工采用不同的机制。     

产后抑郁症患者的述情障碍与抑郁症状的相关分析

目的探讨产后抑郁症患者的述情障碍与抑郁症状的相关性。方法采用汉密尔顿抑郁量表17项版本(HAMD-17)和多伦多述情障碍量表20项(TAS-20)对60例产后抑郁症患者和60例健康产妇进行评定。结果①产后抑郁症组患者TAS-20总分及3个因子分评分显著高于对照组,差异有统计学意义(t=31.294,21.450,10.006,26.053;P<0.01;);②TAS-20总分及3个因子分与HAMD-17总分、焦虑/躯体化因子(Hf1)、体重因子(Hf2)、认知障碍因子(Hf3)、阻滞因子(Hf4)呈显著正相关(r=0.273～0.638,P<0.01或0.05);睡眠障碍因子(Hf5)与TAS-20总分和3个因子分相关均不显著(r=-0.141～0.030,P>0.05)。结论产后抑郁症患者存在着明显的述情障碍;述情障碍与抑郁症状的严重程度呈显著正相关,产后抑郁症患者的述情障碍与抑郁症状相互影响;有述情障碍的产后抑郁症患者的功能性躯体不适症状更突出。     

产妇产后抑郁应用时机理论指导的持续性护理干预的研究

目的探究时机理论指导的持续性护理对产妇产后抑郁的干预效果。方法依照护理方法不同将2018年1月至2018年12月在本院分娩的60例产妇分为两组,对照组行常规护理,研究组在常规护理基础上行时机理论指导的持续性护理,组间对比干预前后抑郁发生率;使用抑郁自评量表(Self-rating depression scale,SDS)对产妇产后负性情绪改善情况进行评价;使用科室自制自理能力评价问卷对产妇产后自理能力进行评价。结果干预前组间产妇抑郁发生率及SDS评分无明显差异(P>0.05),干预1个月及干预2个月后研究组抑郁发生率及抑郁评分均低于对照组(P<0.05);研究组自理能力评分高于对照组(P>0.05)。结论产妇应用以时机理论为指导的持续性护理干预模式,可有效改善产后负性情绪,降低抑郁发生率,提高自我护理能力,增强干预效果,该模式具有较高临床实用价值。     

Postpartum depression: A systematic review of the genetics involved

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms “postpartum depression” and “genetics”. Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.     

子宫肌注欣母沛配合宫腔填塞术对剖宫产产后出血的止血效果观察

目的探讨子宫肌注欣母沛配合宫腔填塞术对剖宫产产后出血的止血效果。方法随机将90例剖宫产产后出血患者分为观察组和对照组,各45例。观察组实施子宫肌注欣母沛配合宫腔填塞术止血,对照组实施常规止血治疗。对2组止血效果及治疗后2 h和24 h内平均出血量进行统计。结果对照组有效率66.67%,观察组有效率88.89%,观察组高于对照组,2组比较,差异有统计学意义(P<0.05)。观察组2 h及24 h平均出血量少于对照组,2组比较,差异有统计学意义(P<0.05)。结论子宫肌注欣母沛联合宫腔填塞术治疗剖宫产产后出血具有较好的止血效果,方法简单方便,快捷有效,值得在临床上推广应用。