剖宫产术后PCEA产妇产褥恢复的早期观察

目的：研究硬膜外病人自控镇痛（PCEA）对剖宫产产妇产褥恢复的影响。方法：选取无内外科合并症及产科严重并发症的剖宫产产妇80例，随机分为两组：40例硬膜外病人自控镇痛为研究组，40例肌注盐酸哌替啶为对照组。观察两组产妇镇痛效果、子宫复旧及泌乳情况，分析比较两组产妇术后72h内子宫宫底高度、开始泌乳时间及乳汁满足婴儿需要时间。结果：术后2组产妇子宫复旧差异无统计学意义，而研究组开始泌乳时间及满足婴儿需要时间比对照组短（P＜0.05)。结论：剖宫产术后应用PCEA不影响产妇产褥早期子宫复旧，且可促进泌乳功能，有利于母乳喂养。     

Ultrasound and Doppler assessment of uterus during puerperium after normal delivery

Abstract

Objective: To describe the biometric and morphological characteristics of the uterus through ultrasound (US) and Doppler on the uterine arteries in the initial and late puerperium after normal delivery.

Methods: This was a prospective longitudinal study on full-term singleton pregnancies without complications. The patients were divided into two groups: 31 primiparous and 28 multiparous women. Two US exams were carried out with Doppler evaluation: firstly, within the initial 48?h; and secondly, between 31 and 50 days after childbirth. The US assessed the position and biometry of the uterus, appearance of the myometrium, measurement and content of the uterine cavity, and Doppler velocimetry indices of uterine arteries. To compare the groups at the two times, the paired Student t-test, Fisher’s exact test and chi-square test were used.

Results: In the initial puerperium, the position of the uterus was retroversion (98.3%); the appearance of the myometrium was heterogeneous (96.6%); the uterine cavity was filled with some type of material (72.9%). After the 30th day, a position was anteversion (74.6%); the appearance of the myometrium was homogeneous (91.5%); and the uterine cavity was empty (81.3%). There was an evolution in the pulsatility index between the two US exams, with an increase of 52.03% among the primiparous and 53.13% among the multiparous for the right uterine artery.

Conclusion: Significant changes were observed in the morphological and biometric characteristics of the uteruses evaluated through US, as well as in the uterine arteries Doppler, between the initial and late puerperium.     

孕产期保健宣教对产褥期妇女饮食及行为影响

目的 通过比较干预组和对照组产褥期妇女不同休养方式对健康的影响,分析不同饮食、行为与健康的关系。方法 于2010年9月在宁夏银川市社区和海原县乡村随机抽取800 名在妇幼保健机构建有孕期保健卡、身体健康的孕晚期妇女(均为怀孕37 周即将分娩的妇女)作为研究对象,于产前和产后住院期间在干预组对象中进行多种形式营养卫生宣教,对照组不采取干预措施,但仍与干预组接受相同的常规保健服务。结果 干预组对象营养保健知识水平有明显提高,如城市、农村干预组对象认为鸡肉比鸡汤更有营养分别占45.90%和50.00%,认为产妇居室可以开窗通风分别占93.44%和71.21%;干预组对象第2、4 周洗澡、洗头等行为的发生率均高于对照组,差异有统计学意义(P<0.05);干预组便秘、痔疮、腰背痛等疾病的患病率分别为18.03%、11.48%、21.31%,均低于对照组(P<0.01)。结论 采用多种形式的卫生保健宣教方法能有效提高妇女营养保健知识水平从而改善妇女产褥期饮食、行为及健康状况。     

孕产期心身障碍临床路径(2020修订版)

在生物-心理-社会医学模式下,孕产期心身障碍(PPPSD)是指孕产妇集心理-妊娠期生理-社会因素的“心-身”作用,或集妊娠期生理、病理危险因素的“身-心”作用,或二者共存相互作用,导致的个体躯体功能障碍。孕产妇发生PPPSD,可严重影响产科医疗质量,对孕产妇、胎儿及新生儿健康造成极大危害。全国孕产妇心身健康门诊总课题组(以下简称为“总课题组”)对PPPSD的病因、发病机制、诊断、治疗、预后及康复等进行研究,并制定PPPSD临床诊疗系统及相应规范和标准,创建孕产妇心身健康门诊医疗服务模式,在全国不同民族与不同经济和文化特点地区的各级综合性医院围生保健中心或产科、妇幼保健院(中心)、社区卫生服务中心设立门诊研究基地,持续开展PPPSD相关全国多中心临床研究。总课题组自2015年制订《孕产期心身障碍临床路径》后,根据临床实践,不断进行修订、完善,并陆续发布2016修订版、2017修订版、2018修订版PPPSD临床路径。随着总课题组对PPPSD理论研究的不断深入,并结合全国多中心临床研究大样本数据的统计分析结果,再于《孕产期心身障碍临床路径(2018修订版)》基础上进行修订、完善,推出基于围生保健中心和产科的《孕产期心身障碍诊疗临床路径(2020修订版)》,为临床规范诊疗PPPSD提供标准。     

Narcolepsy with cataplexy and pregnancy: a case–control study

This was a retrospective case–control study in 25 patients with narcolepsy with cataplexy and 75 women in the control group. Patients completed the questionnaire by Maurovich‐Horvat et al. (J. Sleep Res., 2013, 22: 496–512). We personally interviewed 25 patients with narcolepsy with cataplexy using the administered questionnaire regarding conception, pregnancy, delivery, perinatal and breastfeeding periods. Patients with narcolepsy with cataplexy reported 59 pregnancies versus 164 in the control group. In 16 cases (27.1%), a disease before pregnancy was present compared with eight cases (4.9%) in the control group (P < 0.001); among them, extrinsic asthma was reported 11 times in the narcolepsy with cataplexy group (P < 0.005). Patients with narcolepsy with cataplexy more often had a single pregnancy compared with controls (P < 0.05). Gestational diabetes was more frequent in patients with narcolepsy with cataplexy (P < 0.05). Induced deliveries were higher in controls (P < 0.009). No differences were found between the groups in terms of duration of pregnancies and complications during and after delivery, as during the puerperium. Neonates from patients had heavier birth weight (P < 0.015). The breastfeeding period was longer in patients (P < 0.01). Modafinil and methylphenidate were the drugs administered in six pregnancies. No significant differences in depression during pregnancy and during puerperium were found between patients and controls. This is the first case–control study in women with narcolepsy with cataplexy related to pregnancy, delivery, childbirth and puerperium. Data suggest that patients have pregnancy outcomes similar to controls. The prevalence of gestational diabetes was higher in women with narcolepsy with cataplexy. Caesarean sections, complications during delivery and normal perinatal period for infants were similar in both groups. Breastfeeding was longer in patients.     

产后多瘀的血液流变和微循环研究

作者进行了４０例晚期孕妇（３６—４０周）和产妇产褥初期血瘀的血 液流变性和微循环观察，结果发现晚期孕妇和产妇产褥初期的血液粘滞性、聚集性 和凝固性均增强，血液流变学１２项指标均与健康对照组呈显著性差异（Ｐ＜０．０１）。 晚期孕妇微循环加权积分值 ２．１９士 ０．５４．呈轻度微循环障碍，而产妇产褥初 期加权分值３．５２士１．４４，呈明显微循环障碍，结果为不后多瘀提供了客观的生理 病理依据，并进一步分析了其改变机理．提示探索恰当的方法，改善血液流变性、微 循循环状况，是提高生理复原，减少多虚多瘀并发症的可行途径．     

Tumor necrosis factor-alpha in gestation and puerperium of women with gestational hypertension and pre-eclampsia

PROBLEM: High plasma levels of tumor necrosis factor-alpha (TNF-alpha) in pregnant women have been associated with the pathogenesis of pre-eclampsia (PE). This study evaluated TNF-alpha plasma levels and monocyte production in gestational hypertension (GH) and PE during gestation and at puerperium. METHOD OF STUDY: This study included 128 women, of whom 20 were non-pregnant (NP) normotensive (NT), and 108 were pregnant: 36 NT, 27 with GH, and 45 with PE. Peripheral blood plasma was used for TNF-alpha and uric acid determination. TNF-alpha was determined in plasma and lipopolysaccharide (LPS)-stimulated and non-stimulated monocyte supernatants by L929 bioassay. RESULTS: Tumor necrosis factor-alpha and uric acid plasma levels were higher in PE than in GH pregnancies. In both hypertensive groups, these parameters positively correlated and were significantly more elevated than in NT and NP women. TNF-alpha plasma levels and monocyte production were higher in hypertensive than in NT women during gestation, and significantly decreased at puerperium. Although decreased, TNF-alpha release in LPS-stimulated PE monocytes, was still significantly higher than in the other pregnant groups. CONCLUSION: In vivo monocyte activation in GH and PE pregnant women was characterized by in vitro TNF-alpha production. The fact that higher circulating concentrations of TNF-alpha and uric acid were observed in PE than in GH suggests an association with disease severity.     

《妇人大全良方》产后门护理思想与现代医学辨析

文章分析了《妇人大全良方》记载的有关产后调护的原始资料,通过与现代产后调护思想进行辨析,提取其中值得发扬继承之处,同时纠正其中的不足。     

从“治未病”理论谈中国特色“坐月子”

中国特色＂坐月子＂的习俗流传至今有其特殊的价值,作者认为中国特色＂坐月子＂是对＂治未病＂理论的实践和应用。主要从中医学的＂治未病＂理论角度对中国特色＂坐月子＂分析和总结,从而有利于中国特色＂坐月子＂更科学地推广和应用。     

孕产期健康教育与产褥期母婴保健知识及护理能力关系探究

目的对孕产期妇女进行健康教育后其产褥期母婴保健知识的了解情况和护理能力的变化情况进行分析。方法抽取2008年4月～2011年4月来本院进行孕期保健护理的104例孕产期妇女的资料,将其分为A、B两组,平均每组52例。A组孕妇在孕产期进行系统的健康教育;B组孕妇进行非系统健康教育。采用问卷调查的形式,对两组孕妇的产褥期母婴保健知识的了解情况和护理能力的变化情况进行调查分析。结果 A组孕妇的产褥期母婴保健知识的了解情况和自我护理能力均明显优于B组孕妇,且差异有统计学意义（P〈0.05）。结论对孕产期妇女采用系统的健康教育方案,可以使孕妇对产褥期母婴保健知识的了解更加透彻,可以使其产褥期的自我护理能力明显提高,应将其作为今后对该类孕妇进行孕产期保健教育的常规项目。