119例出生低体重儿母婴情况分析

出生体重过低是造成围产儿死亡的主要原因之一。要降低围产儿死亡率,必须降低低体重儿出生率。本文通过对119例出生低体重儿母婴情况临床分析,探讨发病因素。造成出生体重过低的原因有早产、妊高征、胎膜早破、双胎、畸形儿及造成胎盘功能不全的各种因素。故应加强围产期保健。对于危险因素应早发现,早治疗,以便减少低体重儿出生率。     

集束化护理在低龄低体重室间隔缺损患儿微创封堵术围术期中的应用观察

目的?探讨集束化护理干预在低龄低体重室间隔缺损患儿微创手术围术期中的应用效果。方法?选择本院2016年1月～2018年12月施行微创封堵术治疗的60 例低龄低体重室间隔缺损患儿开展前瞻性研究，按照随机数字表法分为对照组与观察组各30 例，对照组施行常规围术期护理干预，观察组施行集束化护理干预，比较患儿术后并发症发生率、术后治疗时间，并比较家属疾病不确定感评分、负性情绪评分、护理满意度。结果?观察组患儿的术后并发症总发生率较对照组更低（P＜0.05），其术后ICU 监护时间、术后住院时间均较对照组缩短（P＜0.05）。护理后，观察组家属的疾病不确定感评分、SAS 评分、SDS 评分均较对照组更低（P＜0.05），其护理总满意率较对照组更高（P＜0.05）。结论 集束化护理干预可减少低龄低体重室间隔缺损患儿微创封堵术后的并发症，使患儿顺利度过手术危险期，还可减轻患儿家属的疾病不确定感和负性情绪，提高其护理满意度。     

床旁微创小切口钛夹闭合早产儿动脉导管110例临床分析

目的 探讨床旁微创小切口钛夹闭合早产儿动脉导管的临床疗效.方法 将2010年1月至2013年1月收治100例患儿分为两组:A组:体质量≥1.5 kg的早产儿动脉导管未闭(PDA)71例;B组:体质量＜1.5 kg的低体质量早产儿PDA 29例.所有手术均在新生儿监护室床旁进行.患儿气管插管呼吸机辅助呼吸,体位呈右侧卧位.左侧肩胛下角下2～3肋间横行小切口,长约1.5 ～2.5 cm.使用两个钛夹分别钳夹PDA早产儿.结果 99例痊愈出院,1例死亡.2例术后超声发现残余分流,1例患儿术后第5天发现伤口感染,经静脉使用抗生素后伤口痊愈.A组与B组相比术后并发症发生率和病死率差异无统计学意义(P＞0.05).多数患儿术后由于血流动力学和肺部状况迅速改善,顺利脱离呼吸机.B组术后呼吸机辅助时间(12.6±7.5)d和术后住院时间(21.0±15.4)d明显长于A组[(9.6±4.2)d与(12.0±10.8)d],两组差异有统计学意义(t值分别为7.35,9.12,P均＜0.05).结论 (1)利用床旁微创小切口钛夹闭合动脉导管治疗早产儿PDA是一种可行的治疗方法;(2)低体质量早产儿对手术创伤耐受能力较差,该手术方式作为一种微创、简单的方法尤其适合低体质量早产儿PDA的治疗.     

One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II-mesh in Lichtenstein hernioplasty

A standard polypropylene mesh used in Lichtenstein’s operation induces a strong foreign tissue reaction with potential harmful effects. A mesh with less polypropylene could possibly be beneficial. Six hundred men with primary unilateral inguinal hernias were randomised to Lichtenstein’s operation using a Prolene- or Vypro II-mesh in six centres. The patients were blinded to which mesh they received. A validated questionnaire assessing recurrence and pain along with SF-36 Health Survey was sent after 1 year to all patients and a selected group was clinically examined. Of the 591 operated patients, 526 (89.0%) returned the questionnaire. 188 patients had some complaints or sensations of which 111 patients were clinically examined. The mean follow-up time was 13.6 (SD. 4.0) months. The incidence of hernia recurrence (four vs. four patients) and neuralgia (three vs. four patients) did not differ between Prolene and Vypro II-groups, respectively. One Vypro II-patient was re-operated due to neuralgia. There was no difference in the SF-36 scores. The results of Lichtenstein’s operation with either Prolene or Vypro II do not seem to differ significantly.     

不同时间窗降纤与抗凝治疗急性脑梗死疗效分析

目的　评价不同时间窗降纤、抗凝治疗急性脑梗死的疗效及不良反应。方法　发病在24h内的急性脑梗死患者180例随机分为降纤组(A组)、抗凝组(B组)和对照组(C组);分别给予降纤酶(第1天10U和第3、5天各5U)、低分子量肝素(4 100U腹壁皮下注射, 1日两次,连用10d)、低分子右旋糖酐500ml加丹参24g静脉滴注,每日1次, 10d为1疗程治疗。结果　发病时间≤6h者,欧洲中风神经功能量表评分抗凝组比降纤组高(P<0. 05); 6h后至24h,抗凝组均比降纤组低(P<0. 05);日常生活能力评分无明显差异(P>0. 05),且均无不良反应。结论　发病时间≤6h应用抗凝治疗急性脑梗死效果较好,而在6h后至24h,则降纤效果显著。     

以家庭为中心的协同护理对低出生体重早产儿照顾者出院准备度的影响

目的 探讨以家庭为中心的协同护理对低出生体重早产儿照顾者出院准备度的影响。方法 选取2019年1月-2020年1月笔者所在医院收治的低出生体重早产儿38例为对照组,2020年2月-2021年6月笔者所在医院收治的低出生体重早产儿39例为观察组。对照组采用常规护理,观察组采用以家庭为中心的协同护理,比较2组照顾者出院准备度、照护应对能力和出院3个月内早产儿的再入院率。结果 干预后,观察组出院准备度得分、应对能力得分均高于对照组（P<0.05）;患儿再入院率低于对照组（P=0.01）。结论 以家庭为中心的协同护理可以提高照顾者的出院准备度和早产儿照顾应对能力,降低患儿再入院率。     

10kg及以下体重婴幼儿心脏直视术后呼吸机使用时间相关因素分析

目的探讨≤10 kg体重婴幼儿心脏直视术后呼吸机使用时间的相关因素。方法从2005年3月-2011年6月,选择纳入接受心脏直视手术的体重≤10 kg的先天性心脏病婴幼儿,分析各项围术期指标与术后呼吸机使用时间的关系,讨论该类婴幼儿术后呼吸机使用时间决策。结果共纳入体重≤10 kg的婴幼儿42例,呼吸机使用时间(42.74±52.55)h,中位数20.88 h;发现术后2 h入量(mL/kg),术后4、8、16 h总入量(mL/kg)与术后呼吸机使用时间相关(P<0.05),术后呼吸机使用时间与患儿ICU入住时间约成线性相关(P<0.05)。结论影响低体重婴幼儿心脏直视术后呼吸机使用时间是术后液体管理,实施"限制性液体管理"治疗策略可能会促进患儿的术后快速康复。术后液体管理如何具体影响患儿呼吸机使用时间,影响患儿的预后,尚需进一步研究。     

Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37–91). Anterior, posterior and anterior–posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10–19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.     

亚高原地区低体重儿胎盘绒毛结构的观察研究

目的：探讨亚高原妇女缺氧对胎儿胎盘绒毛组织结构的影响；方法：收集单胎活产分娩低体重儿胎盘50例为观察组，正常体重儿的胎盘50例为对照组；取胎盘部1cm 3块10％甲醛固定，石蜡块切片，HE染色光镜观察四项指标；结果：合体结节：低体重儿47％，对照组39.1%％(P＜0．01)；血管合体膜：低体重儿12．4％，对照组16．2％(P＜0．01)；毛细血管：低体重儿11．9％，对照组8．4％(P＜0．01)；纤维素样坏死：低体重儿4．2％，对照组3．5％(P＜0．01)；结论：低体重儿合体细胞结节、毛细血管和纤维素样坏死明显增多，血管合体膜减少。高原缺氧影响胎盘绒毛结构，是低体重儿的重要发病原因之一。     

Safety of deep venous thrombosis prophylaxis with low-molecular-weight heparin in brain surgery. Prospective study on 746 patients

BACKGROUND: Pharmacologic prophylaxis of deep vein thrombosis for intracranial surgery is still a controversial matter due to the concern of possible increased risk of postoperative hemorrhage. The objective of this prospective study was to assess the safety of the deep vein thrombosis prophylaxis protocol applied in our neurosurgical unit. METHODS: This is a prospective clinical trial on 746 consecutive patients undergoing intracranial surgery during a 30-month period managed by our deep vein thrombosis prophylaxis protocol. All patients were managed with elastic stockings, perioperative mechanical pneumatic sequential compression leg device, and 3500 units (daily) of sodium Tinzaparin starting from the first postoperative day. In those patients who were considered to be at higher risk to develop deep vein thrombosis, the dose of heparin was doubled and was started in the preoperative period. RESULTS: Eight (1.07%) significant postoperative hemorrhages were recorded among 746 procedures, 6 (0.8%) of those occurred among patients undergoing major cranial procedures. Clinical evidence of deep vein thrombosis was present in 3 patients (0.4%). One patient (0.13%) died of fatal PE 2 months after surgery. CONCLUSION: The results of this study show the safety of our deep vein thrombosis prevention protocol in patients undergoing intracranial neurosurgical operation.