妇产科腹部术后切口感染危险因素分析与防治

目的发现妇产科腹部手术切口感染的危险因素以及相关的防治措施。方法通过规范分析和文献分析,找到妇产科腹部手术中切口感染的多种危险因素,并将这些因素进行综合分析。结果妇产科腹部手术的切口感染可能引起严重的并发症,不但会增加患者的痛苦,增加其住院的时间和经济负担,甚至还可能危及生命。结论全面的理清妇产科腹部术后切口感染的危险因素,并对其进行有效、科学的防治。     

妇科肿瘤术后发生血栓性疾病的临床护理

目的探讨妇科肿瘤患者术后发生血栓性疾病的临床护理。方法选持肿瘤手术后血栓性疾病患者13例,采用抗凝治疗,观察护理效果。结果 10例痊愈出院,3例死亡。结论妇科肿瘤患者术后出现血栓性疾病,除了加强抗凝治疗之外,还应做好临床药物的护理工作,这样才能提高患者治愈率。     

难治性妇产科大出血临床效果观察

目的探讨难治性妇产科大出血临床治疗。方法本次选择50例难治性大出血患者作研究对象,均为我院妇产科2009年1月—2014年1月收治,随机分组,就宫腔填塞（对照组,n=25）治疗与髂内动脉及子宫动脉结扎（观察组,n=25）治疗效果进行比较。结果观察组治疗过程中出血量明显少于对照组,阴道流血天数明显短于对照组,差异均有统计学意义（P〈0.05）。观察组子宫切除率为4%,明显低于对照组20%,观察组临床总有效率为96%,对照组为80%,差异均有统计学意义（P〈0.05）。结论采用髂内动脉结扎手术及子宫动脉结扎手术治疗难治性大出血,可取得显著效果,降低并发症率,保障手术成功实施,提高患者存活,使子宫切除率降低,改善和优化患者生存质量,有较高应用价值。     

七氟醚对肥胖患者行妇科腹腔镜手术苏醒质量的影响

目的探讨七氟醚对肥胖患者妇科腹腔镜手术术后苏醒质量的影响。方法妇科腹腔镜手术患者80例,根据疾病性质分为短时间手术组(S组)和长时间手术组(L组),再根据患者BMI分为两个亚组:标准体重组(S1组和L1组)和肥胖组(S2组和L2组)。术中麻醉维持采用静吸复合麻醉,根据血流动力学变化及时调整用药。分别记录患者第1次自主呼吸恢复时间、出现不自主体动时间、能听从指令睁眼时间、拔出气管导管时间。结果 L2组出现不自主体动时间与拔管时间长于L1组(P<0.05);L2组自主呼吸恢复时间与拔管时间长于S2组(P<0.05)。结论短时间手术时七氟醚对肥胖患者苏醒没有明显影响,长时间手术时七氟醚会延长肥胖患者的苏醒时间和拔管时间。     

舒芬与左布比卡因复合在妇科腹腔镜术后镇痛作用

目的:探讨舒芬太尼复合左布比卡因局部浸润在妇科腹腔镜手术后镇痛效果.方法:选择全麻腹腔镜下卵巢及子宫肌瘤手术患者120例(ASA Ⅰ～Ⅱ级)随机分为治疗组与对照组各60例,治疗组用0.05％舒芬太尼注射液15μg+0.25％左布比卡因75mg加生理盐水至30al,对照组0.05％舒芬太尼注射液15μg+生理盐水至30ml,手术结束术者在腹腔创面喷洒15ml,退出腔镜后在脐切口及下腹两个切口共三个切口每个部位注射5ml,两组注射方法相同.全麻药物均按体重给药并在一个时间点停药,记录停药后苏醒期反应、呼吸频率、血压、心率及疼痛反应和手术后1h、6h、12h、24h及48h的VAS评分.结果:治疗组苏醒期血压、心率与对照组比较差异有显著性P＜0.05,苏醒后安静无疼痛、在术后备时间点VAS评分较对照组差异有显著性P＜0.05.结论:舒芬太尼复合左布比卡因局部注射在妇科腹腔镜手术后具有良好的镇痛镇静效果及安全性.     

妇科住院患者医院感染病原菌特点及耐药性

目的:探讨妇科住院患者医院感染病原菌特点及耐药性,为临床合理用药提供依据。方法:对我院2009年1月～2011年12月妇科住院患者1215例,对送检标本采用自动微生物分析仪进行细菌鉴定和药敏分析,观察病原菌分布特点及耐药性。结果:医院感染113例,共培养分离出189株病原菌,其中革兰阴性菌(G-菌)108株,占57.14%,主要为大肠埃希氏菌、铜绿假单胞菌、肺炎克雷伯菌;革兰阳性菌(G+菌)61株,占32.28%,主要为金黄色葡萄球菌、表皮葡萄球菌,真菌20株,占10.58%,主要为白色假丝酵母菌13株,热带假丝酵母菌7株。革兰阴性杆菌对环丙沙星、阿米卡星、亚胺培南、阿奇霉素敏感率较高,对左氧氟沙星、头孢哌酮/舒巴坦中度敏感,其他药物呈不同态势耐药。革兰阳性杆菌对左氧氟沙星、环丙沙星、头孢哌酮/舒巴坦、万古霉素敏感率较高,其他药物呈不同态势耐药。结论:根据妇科住院患者病原菌分布特点和耐药性合理使用抗生素,能有效控制医院感染率。     

Large bowel injuries during gynecological laparoscopy

Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.     

超声造影在妇产科疾病诊断及治疗中的研究进展

随着超声造影剂的广泛应用和超声造影技术的不断发展,超声诊断成像成为了疾病诊断的主要手段之一。很多学者对其在妇产科的临床应用做了较深入地研究,包括超声造影在子宫肌瘤与腺肌瘤的鉴别诊断、子宫肌瘤介入治疗的效果评估、子宫内膜癌的诊断、卵巢良恶性肿瘤的鉴别诊断,以及子宫输卵管声学造影等方面的应用。本文就目前超声造影技术在上述几个方面的临床应用进展进行综述。     

妇产科手术护理中舒适护理的应用效果评价

目的：探讨妇产科手术护理中舒适护理的应用效果。方法选取我院妇产科在2012年4月至2013年4月收治的120例手术患者作为研究对象,随机均分为两组：A组患者实施常规护理,B组患者在A组患者的护理基础上,给予舒适护理。比较两组患者术后的并发症情况、疼痛情况及满意度情况。结果 B组患者的镇痛有效率（0～Ⅰ级）为95．0％,显著高于A组（76．7％）,P＜0．05;B组患者的护理满意度评分、护理质量评分均显著高于A组,P＜0．05;A组术后并发症发生率为13．3％,B组为5．0％,组间数据比较,差异有统计学意义,P＜0．05。结论对于妇产科手术患者,给予舒适护理,可有效缓解患者的生理疼痛,促进身心舒适,减少并发症的发生,提高患者的护理满意度,值得推广应用。     

Role of Three-Dimensional Ultrasound in Gynecology

Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.