《傅青主女科》带下病浅谈

《傅青主女科》论述带下之病位、病因、病机及分型辨治,因带下色、质、气味不同,分为白、青、黄、黑、赤带,分别创完带汤、逍遥散、易黄汤、利火汤、清肝止淋汤;傅青主辨证详明、立法严谨、说理透彻、用药精当,对后世中医妇科影响深远,对治疗带下病颇具参考价值,值得潜心研究。     

罗哌卡因腰-硬膜外联合麻醉在妇科手术中应用效果的临床观察

目的:观察罗哌卡因腰-硬膜外联合麻醉在常规妇科手术中的效果及安全性。方法:将56例妇科开腹手术患者随机均分为2组,分别采用布比卡因及罗哌卡因腰-硬膜外联合麻醉,比较2组患者术中生命体征、视觉模拟(VAS)评分和Bromage评分变化,以及不良反应。结果:2组在麻醉后5min心率及布比卡因组在麻醉后5min平均动脉压与麻醉前比较,差异均有统计学意义(P<0.05),2组麻醉后30min和手术结束时VAS评分低于麻醉后5min,Bromage评分高于麻醉后5min(P<0.05);麻醉后30min及手术结束后,罗哌卡因组Bromage评分低于布比卡因组,罗哌卡因组低血压、心率减慢、恶心呕吐和胸闷出现率均明显低于布比卡因组(P<0.05)。结论:与布比卡因比较,罗哌卡因用于妇科开腹手术效果确切,是一种可行的麻醉方法。     

妇产科教学中注重七年制学生临床思维能力的培养

为了实现对七年制医学生的教育目标,我们把培养学生的临床思维能力作为妇产科教学的重点,改革出科考试形式,注重临床实践能力的考核、培养学生循证医学的思维方法,取得了良好的效果。     

Sexual function after sacrospinous fixation for vaginal vault prolapse: bad or mad?

Background  The main indication for sacrospinous ligament suspension is to correct either total procidentia, a posthysterectomy vaginal vault prolapse with an associated weak cardinal uterosacral ligament complex, or a posthysterectomy enterocele. This study aimed to evaluate sexual function and anatomic outcome for patients after sacrospinous ligament suspension. Methods  For this study, 52 patients who had undergone sacrospinous ligament fixation during the preceding 5 years were asked to complete the Female Sexual Function Index (FSFI) questionnaire. The patients were vaginally examined using the ICS POP score, and the results were compared with their preoperative status. For statistical analysis, GraphPad for Windows, version 4.0, was used. Results  The 52 patients were examined during a follow-up period of 38 months. No major intraoperative complications were noted. Recurrence of symptomatic apical descent was noted in 6% of the patients and de novo prolapse in 13.5%. Only one patient was symptomatic. Three patients experienced de novo dyspareunia, which resolved in two cases after stitch removal. Sexual function was good, rating higher than three points for each of the domains including satisfaction, lubrication, desire, orgasm, and pain. Conclusion  Sacrospinous ligament fixation still is a valuable option for the treatment of vaginal vault prolapse. Sexual function is satisfactory, with few cases of de novo dyspareunia.     

压力和容量通气模式对肥胖患者腹腔镜手术中呼吸功能的影响

目的 观察肥胖患者行妇科腹腔镜手术时,两种不同的机械通气模式对患者血流动力学、呼吸力学、动脉氧合的影响. 方法 选择40例行妇科腹腔镜手术的肥胖患者,按数字表法随机分为压力控制通气组(pressure-controlled ventilation,PCV)和容量控制通气组(volume-controlled yentilation,VCV),每组20例.两组患者均实施全凭静脉麻醉方案,分别采用不同的通气模式,维持呼气末二氧化碳分压(end-tial carbon dioxide partial pressure,PETCO2)在35 mm Hg～45 mm Hg(1 mm Hg=0.133kPa)之间.分别于麻醉前5 min(T0)、气腹开始前5 min(T1)、气腹后30min(T2)、气腹解除后5 min(T3)、拔除气管导管时(T4),采集动脉血行血气分析,监测和计算血流动力学指标、血气分析指标、呼吸力学指标. 结果 ①在T1、T2、T3 PCV组的PaO2、氧合指数(oxygenation index,OI)(分别为460±78、453±83、463±95)均高于VCV组(P<0.05);PCV组的肺泡动脉血氧分压差(A-aDO2)(分别为74±25、80±30、82±26)、呼吸指数(respiratory index,RI)(分别为0.32±0.08、0.33±0.10、0.34±0.13)明显低于VCV组(P<0.05).②与T0比较,两组在T2、T3、T4 PaCO2明显升高、pH值明显下降(P<0.05);与VCV组比较,PCV组在各时点差异无统计学意义.③与VCV组比较,PCV组在T2气道峰压Ppeak(27.8±1.6)较低(P<0.05). 结论 PCV在肥胖患者的妇科腹腔镜手术麻醉中改善通气与血流比例,促进气体交换.     

Human papilloma virus (HPV)-associated gynecological alteration in mothers of children with recurrent respiratory papillomatosis during long-term observation

BACKGROUND: Human papilloma virus (HPV) is one of the most frequently observed sexually transmitted infections. The study' purpose was to investigate the relation between a mother's gynecological history and the local status of her child with recurrent respiratory papillomatosis (RRP). METHODS: Forty-two patients enrolled in a prospective multicenter study between 1983 and 1990. The study included patients with juvenile-onset and adult-onset RRP. All patients underwent surgery and treatment with alpha-interferon. Thirty-eight patients were followed up until 31.01.2006. Twenty-five mothers of these patients participated in a parallel prospective study of genital HPV infection. In 1989-1990, all received a routine gynecological examination, an expanded colposcopy, a Pap smear, and a cervical biopsy. The mothers were followed up until February 2006. RESULTS: 74% of patients with RRP were the first-born children. Five (20%) mothers had condylomata acuminata, newly diagnosed during pregnancy. Indicators of HPV infection such as koilocytes, koilocytotic dysplasia and condyloma acuminatum were revealed cytologically in 17% of cases and histologically in 71.4% of cases. Six (24%) of mothers had had a hysterectomy. HPV type 11 was prevalent in the children of mothers who had had a hysterectomy. Among the patients with juvenile-onset RRP, the death rate from squamous cell carcinoma of the lung was significantly higher in those patients whose mothers had a hysterectomy (p=0.028). CONCLUSIONS: Mothers of patients with RRP demonstrated cytological and histological indicators of HPV infection in the genital tract. An adverse outcome of the disease in the child was associated with adverse gynecological history in the mother.     

Improved modeling of clinical data with kernel methods

Objective

Despite the rise of high-throughput technologies, clinical data such as age, gender and medical history guide clinical management for most diseases and examinations. To improve clinical management, available patient information should be fully exploited. This requires appropriate modeling of relevant parameters.

Methods

When kernel methods are used, traditional kernel functions such as the linear kernel are often applied to the set of clinical parameters. These kernel functions, however, have their disadvantages due to the specific characteristics of clinical data, being a mix of variable types with each variable its own range. We propose a new kernel function specifically adapted to the characteristics of clinical data.

Results

The clinical kernel function provides a better representation of patients’ similarity by equalizing the influence of all variables and taking into account the range r of the variables. Moreover, it is robust with respect to changes in r. Incorporated in a least squares support vector machine, the new kernel function results in significantly improved diagnosis, prognosis and prediction of therapy response. This is illustrated on four clinical data sets within gynecology, with an average increase in test area under the ROC curve (AUC) of 0.023, 0.021, 0.122 and 0.019, respectively. Moreover, when combining clinical parameters and expression data in three case studies on breast cancer, results improved overall with use of the new kernel function and when considering both data types in a weighted fashion, with a larger weight assigned to the clinical parameters. The increase in AUC with respect to a standard kernel function and/or unweighted data combination was maximum 0.127, 0.042 and 0.118 for the three case studies.

Conclusion

For clinical data consisting of variables of different types, the proposed kernel function - which takes into account the type and range of each variable - has shown to be a better alternative for linear and non-linear classification problems.     

妇产科急危重症患者的院前急救及护理

目的探讨妇产科急危重症患者的院前急救及护理的方法,为今后应用提供临床依据。方法本次研究选择我院2010年3月至2012年2月收治的妇产科急危重症患者128例的临床资料,对其救护过程、效果进行分析进行回顾性分析,总结妇产科急危重症患者的院前急救及护理的方法和经验。结果选取128例妇产科急危重症患者抢救成功126例,死亡2例,抢救成功率98.4%。结论妇产科急危重症患者的院前急救及护理应做到:出诊速度快,在路途中尽量了解患者的症状,并制订有效、准确的治疗方案;对每一种可能出现的并发症制订相应的救护流程,并让医护人员熟记于心;全面提高医护人员的综合素质,从而提高急危重症孕产妇的抢就成功率。     

北京市20家医院2008-2011年妇产科局部麻醉药处方情况分析

目的:研究北京市20家医院2008-2011年妇产科局麻药处方情况。方法:对北京市20家医院2008-2011年妇产科局麻药处方进行统计分析。结果:北京市20家医院2008-2011年妇产科局麻药处方按药品名称、给药途径、单价、医保范畴、来源统计结果见正文。结论:利多卡因注射剂在是妇产科局麻药的使用上占主导地位。局麻药的使用与多种因素有关。     

不同给药途径治疗滴虫性阴道炎的临床观察

目的探讨局部给药与口服给药治疗滴虫性阴道炎的临床疗效。方法将100例滴虫性阴道炎患者随机分为观察组及对照组各50例,观察比较两组的临床疗效。结果观察组和对照组的总有效率分别为94．00％和72．00％,两组比较差异有统计学意义（P〈0．05）。观察组患者的临床症状治疗后改善明显（P均〈0．05）;对照组患者的临床症状治疗后也改善明显（P均〈0．05）;观察组治疗后与对照组治疗后比较,观察组显著优于对照组（P〈0．05）。对照组不良反应发生率19／50（38．00％）;观察组不良反应发生率9／50（18．00％）,两组有显著性差异（P〈0．05）。结论局部用药治疗滴虫性阴道炎疗效好,具有显效快、疗效强、不良反应少等优点,值得在临床上推广和应用。