联合干预治疗剖宫产产后出血的临床疗效分析

目的分析宫腔填纱配合米索前列醇局部给药治疗剖宫产产后出血临床疗效。方法选取我院收治的90例剖宫产产后出血患者的资料,其入院时间为2018年1月—2019年6月。按照其入院时间的先后来进行分组—对照组(n=45,常规治疗干预)和观察组(n=45,采取宫腔填纱配合米索前列醇局部给药治疗)。对两组患者不同时间点的出血状况进行统计,且观察其血红蛋白水平治疗前后的变化。结果在两组产后2 h、24 h、48 h出血量上比较,观察组低于对照组,差异具有统计学意义(P<0.05);在治疗前,两组患者的血红蛋白水平差异无统计学意义(P>0.05);在治疗后,观察组优于对照组(P<0.05)。结论宫腔填纱配合米索前列醇局部给药治疗剖宫产产后出血的疗效显著。     

Obstetric emergencies

For more than 60 years the Confidential Enquiry into Maternal Deaths triennial reports and later reports from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have helped build a picture of maternity care within the UK highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner.     

腹壁切口子宫内膜异位症 32 例临床分析

目的探讨腹壁切口子宫内膜异位症（abdominalincisionendometriosis，AIEM）的临床特点，为临床诊断、治疗和预防提供依据。方法回顾性分析2000年1月至2012年12月我院收治的32例AIEM患者的临床资料。32例均采取手术治疗彻底切除病灶，治疗3～6月观察临床疗效并随访。结果AIEM多发生在术后1—7年，在腹壁原切口疤痕的不同部位可触及不规则结节或肿块，超声声像特征多为实质性低回声团块。病灶外观呈暗红色或紫蓝色，甚至黑色，直径1．0。5．0cm。术后随访5年，所有患者周期性腹痛症状消失，腹壁包块无1例复发，治疗效果满意。结论手术彻底切除病灶是治疗腹壁切口AIEM的有效方法，是预防其术后复发的关键措施。只要病灶彻底清除，术中、术后均不需要药物治疗。     

不同方法应用欣母沛预防剖宫产产后出血的疗效比较

目的：探讨肌注与宫体注射欣母沛两种方法预防剖宫产产后出血的疗效。方法：78例剖宫产产妇分别予以肌肉及宫体注射欣母沛,观察两组患者的出血量、临床疗效、不良情绪以及生活质量。结果：两组术后2 h出血量比较差异无统计学意义（P〉0.05）;术后24 h出血量比较,观察组优于对照组,差异具有统计学意义（P〈0.05）。观察组有效率为82.05%,对照组为79.49%,两组比较差异无统计学意义（P〉0.05）。观察组产妇的HAMD、HAMA总分及各因子得分均低于对照组,差异具有统计学意义（P〈0.05）。患者均无失访现象,观察组患者的生活质量指标PF、RP、RE得分均高于对照组,差异具有统计学意义（P〈0.01）。结论：两种方法对于预防剖宫产产后出血效果相当,但肌肉注射欣母沛对于降低24 h内产妇出血效果更佳,且更利于改善产妇的不良情绪,提高生活质量。     

Failure of communication: a patient’s story

The first author, a patient who underwent elective caesarean section and felt pain necessitating conversion to general anaesthesia, describes the experience with particular reference to the perceived poor communication between her and her anaesthetist. This extended from the preoperative visit to the information provided to her general practitioner after discharge. She makes several suggestions which would have made her experience, and those of other patients in similar circumstances, less traumatic. The second author, who had no involvement in events and works in a different Trust, comments upon the events from the perspective of an obstetric anaesthetist.     

心理疗法对孕妇选择剖宫产的影响

目的：探讨心理疗法对孕妇选择剖宫产的影响。方法：通过调查2010年1～12月的剖宫产原因，建立心理疗法干预措施模型，从宣传正确的分娩观点，消除两种分娩方式相关知识盲区；树立对产程中疼痛的正确认识；普及科学备孕待产，减低因孕期知识匮乏引起的胎儿问题等多类型的病例，并提高医院医疗水平和配套设备，给予孕妇及家属硬件和软件上的信任感，消除对产程安全的疑虑，调节整个孕期的心理状态，影响选择剖宫产的原因。结果：该院整体剖宫产率整体水平下降，孕妇选择剖宫产原因中涉及个人社会心理因素下降明显。结论：心理疗法通过调节孕妇及家属心理状态，有效降低个人及社会心理因素引起的剖宫产。     

卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果比较

目的:比较卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果。方法:选取122例剖宫产高危产妇为研究对象,按照随机数字表法分为观察组与对照组各61例。两组均行剖宫产手术,胎儿娩出后,对照组给予缩宫素治疗,观察组给予卡贝缩宫素治疗,比较两组术中、产后2、24 h出血量,产后加用前列素氨丁三醇率,凝血功能指标[纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)]水平,心率,血压,血红蛋白水平和不良反应发生率。结果:观察组术中、产后2、24 h出血量均低于对照组,差异有统计学意义(P<0.05);观察组加用卡前列素氨丁三醇率为4.92%(3/61),明显低于对照组的16.39%(10/61),差异有统计学意义(P<0.05);术后,两组FIB、D-D水平均高于术前,且观察组高于对照组,两组PT、APTT均短于术前,且观察组短于对照组,差异有统计学意义(P<0.05);术后,两组血红蛋白水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05);手术前后,两组心率、血压和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:卡贝缩宫素治疗剖宫产高危产妇可减少出血量和加用卡前列素氨丁三醇率,提高其术后血红蛋白水平,以及改善凝血功能指标,效果优于缩宫素。     

Utility of teledermatopathology for intraoperative margin assessment of melanoma in situ,lentigo maligna type: A 6 year community practice experience

BackgroundAchieving negative margins for melanoma in situ, lentigo maligna type can be challenging, particularly on cosmetically sensitive areas.ObjectiveTo assess the utility of intraoperative frozen section margin assessment using a teledermatopathology system in the treatment of head and neck lentigo maligna.Methods and materialsOver a 6 year period, 96 patients with lentigo maligna had surgical excisions. The margins were assessed intraoperatively with frozen sections prepared in the manner used in Mohs surgery. The surgeon guided the frozen section slides around the margin while a dermatopathologist assessed the margin remotely.ResultsIn 2/96 (2.1%) cases, the safety margin was positive (frozen sections were false negative). In 1 further case (1%) there was a recurrence of the melanoma 13 months following the excision.ConclusionThe described method is effective in treating melanoma in situ, lentigo maligna type with clearance rates similar to previous studies for Mohs surgery.     

2014-2018年某院剖宫产率及剖宫产指征的变化情况分析

目的分析我院2014-2018年剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的策略和措施。方法回顾性分析2014年1月至2018年12月于我院行剖宫产分娩的42385例产妇的临床资料,分析其剖宫产率及主要剖宫产指征。结果2016年的剖宫产率均低于2014年、2015年、2017年、2018年,差异具有统计学意义(P<0.05)。瘢痕子宫在二胎政策开放后所占比例明显增加;羊水过少及相对头盆不称所占比例呈现逐年下降的趋势。2014-2018年,母体因素所占比例均最高,胎儿因素及头盆因素所占比例逐年下降。另外,社会因素在二胎生育政策开放后仍呈上升趋势。结论2016年剖宫产率明显下降,瘢痕子宫在二胎政策开放后所占比例明显增加。临床需提高剖宫产术后再次妊娠阴道试产的比例、提高助产技术水平、发挥营养门诊及助产士门诊的作用、提高产科医生对胎心监护的正确解读以降低剖宫产率。