影响阴道灌洗病人舒适度的相关因素及护理对策

[目的]了解影响阴道灌洗病人舒适度的相关因素,探讨舒适护理措施在阴道灌洗病人中的应用效果。[方法]应用自行设计的调查表对对照组60例阴道灌洗病人进行调查,分析影响其舒适度的相关因素,提出舒适护理对策;对干预组69例阴道灌洗病人实施相应的舒适护理对策。运用视觉模拟评分法对两组病人进行舒适度评价。[结果]影响阴道灌洗病人舒适度的相关因素有窥阴器在阴道内转动时疼痛、治疗室环境温度低等生理及环境因素,由于暴露生殖器官而产生羞愧感等不适、不了解阴道灌洗的治疗过程等心理因素,以及家庭成员不了解阴道灌洗相关知识等社会因素;干预组病人在接受系统的、有针对性的舒适护理措施后,其舒适度显著高于对照组。[结论]实施系统的舒适护理能显著提高阴道灌洗病人的舒适度。     

影响阴道灌洗病人舒适度的相关因素及护理对策

[目的]了解影响阴道灌洗病人舒适度的相关因素,探讨舒适护理措施在阴道灌洗病人中的应用效果。[方法]应用自行设计的调查表对对照组60例阴道灌洗病人进行调查,分析影响其舒适度的相关因素,提出舒适护理对策;对干预组69例阴道灌洗病人实施相应的舒适护理对策。运用视觉模拟评分法对两组病人进行舒适度评价。[结果]影响阴道灌洗病人舒适度的相关因素有窥阴器在阴道内转动时疼痛、治疗室环境温度低等生理及环境因素,由于暴露生殖器官而产生羞愧感等不适、不了解阴道灌洗的治疗过程等心理因素,以及家庭成员不了解阴道灌洗相关知识等社会因素;干预组病人在接受系统的、有针对性的舒适护理措施后,其舒适度显著高于对照组。[结论]实施系统的舒适护理能显著提高阴道灌洗病人的舒适度。     

扩阴器45°插入法在宫颈癌放疗患者阴道冲洗中的应用

目的探讨扩阴器45。插入法在阴道冲洗操作中的应用效果，以减轻宫颈癌放疗患者阴道冲洗的疼痛。方法选取30例宫颈癌放疗行阴道冲洗的患者，采用自身对照法，分别于第1，4，7天采用45。插入扩阴器，第2，5，8天采用90°，第3，6，9天采用180°插入扩阴器对其进行阴道冲洗，比较3种插入扩阴器方法患者的疼痛情况。结果采用45。插入扩阴器时，患者疼痛情况明显轻于90°及180°，差异均有统计学意义（X2分别为25．2，22．5，27．9；P〈0．01）。结论阴道冲洗时采用45°插入法插入扩阴器，可减轻患者疼痛感，提高患者舒适度。     

霉菌性阴道炎的特效治疗方法

霉菌性阴道炎是妇科常见病,临床治疗效果不佳,给患者带来痛苦。我院采用洗必泰治疗该病效果满意,现报告如下。用物:无菌手套1副,一次性窥阴器1个,无菌纱布(20 cm×30 cm)1块,无菌持物钳、无菌弯盘各1个,洗必泰棉球缸,0·1%~0.2%洗必泰20m l。方法:患者取膀胱截石位,用洗必泰棉球擦洗外阴及阴道,一次性窥阴器扩开阴道,将20m l洗必泰倒入无菌弯盘内,无菌纱布浸满洗必泰后塞入阴道,末端留于阴道口外。取出窥阴器,保留洗必泰纱布6~8h。优点:取材方便,操作简单,治疗效果好。霉菌性阴道炎的特效治疗方法@王月云$聊城市人民医院!山东聊城252000…     

不同温度灌洗液对经皮肾镜碎石取石术病人生命体征的影响

[目的]探讨不同温度灌洗液对经皮肾镜碎石取石术(PCNL)病人生命体征的影响。[方法]选取PCNL病人180例,按照随机数字表法分为室温组(A组)和加温组(B组、C组),灌洗液温度分别为A组21℃~24℃,B组30℃~34℃,C组36℃~38℃。比较3组病人灌洗前、灌洗后(30min、60min、90min)和手术结束时体温(直肠温度)、血压、心率和寒战发生率等指标。[结果]灌洗30min后B组和C组体温变化、心率异常和寒战发生率均低于A组(P<0.05)。C组与B组比较差异无统计学意义(P>0.05)。[结论]术中使用加温灌洗液可以有效保持病人体温、血压及心率的稳定,维持机体正常新陈代谢,越接近体温的灌洗液越有利于提高PCNL手术的安全性。     

改良阴道冲洗方法对阴道炎疗效的影响

[目的]探讨臭氧水阴道冲洗改良方法对治疗阴道炎疗效的影响。[方法]选择阴道炎病人370例,随机分为实验组190例和对照组180例。对照组用常规方法冲洗阴道后塞药治疗阴道炎,实验组采用臭氧水阴道冲洗改良方法彻底冲洗阴道后塞药治疗阴道炎,并实施护理干预,3d为1疗程。疗程结束后,比较两组病人冲洗时的舒适度、冲洗的效果、远期复发情况并进行评价。[结果]实验组病人的舒适度及冲洗效果明显高于对照组,远期复发率低于对照组P<0.05。[结论]阴道炎病人采用改良的冲洗方法及相应的护理干预,可减轻病人不适,缩短治疗时间,降低复发率,促进康复。     

多酶清洗剂处理时效性对窥阴器清洗效果的影响

[目的]探讨多酶清洗剂处理的时效性对妇科窥阴器清洗效果的影响,为推广窥阴器的高效清洗方法提供依据,预防医院感染的发生。[方法]将妇科门诊使用后的2450件窥阴器作为 A组,使用后2 h内进行多酶清洗剂的浸泡清洗;将妇科病房使用后的窥阴器1755件作为B组,使用后〉2 h进行多酶清洗剂的浸泡清洗。分别采用肉眼目测及借助光源放大镜检测方法判断清洗效果。[结果]肉眼目测合格率 A组为97.7%、B组为91.1%;镜检合格率 A组为95.7%、B组为86.7%。两组差异均有统计学意义（P〈0.05）。[结论]窥阴器使用后及时进行多酶清洗剂处理可以提高清洗质量。     

多酶清洗剂处理时效性对窥阴器清洗效果的影响

[目的]探讨多酶清洗剂处理的时效性对妇科窥阴器清洗效果的影响,为推广窥阴器的高效清洗方法提供依据,预防医院感染的发生。[方法]将妇科门诊使用后的2 450件窥阴器作为A组,使用后2h内进行多酶清洗剂的浸泡清洗;将妇科病房使用后的窥阴器1 755件作为B组,使用后2h进行多酶清洗剂的浸泡清洗。分别采用肉眼目测及借助光源放大镜检测方法判断清洗效果。[结果]肉眼目测合格率A组为97.7%、B组为91.1%;镜检合格率A组为95.7%、B组为86.7%。两组差异均有统计学意义(P0.05)。[结论]窥阴器使用后及时进行多酶清洗剂处理可以提高清洗质量。     

宫颈癌病人术前两种阴道准备方法的效果比较

[目的]比较宫颈癌病人术前两种阴道准备方法的效果。[方法]选择160例宫颈癌病人随机分为两组,实验组选用阴道擦洗加阴道填塞法,对照组实施常规的阴道灌洗法,比较两组阴道准备效果。[结果]两组阴道清洁、体温、阴道排液异味、术后第5天白细胞计数比较差异有统计学意义(P<0.05)。[结论]宫颈癌病人术前阴道准备选用阴道擦洗加阴道填塞法,能有效减少术后并发症发生率,提高护理效果。     

吸氧病人的舒适护理

[目的 ]提高吸氧病人的舒适度。 [方法 ]选择符合条件的长期吸氧病人 ,随机分为实验组及对照组 ,分别给予舒适吸氧法及常规吸氧法 ,并进行吸氧舒适度调查。 [结果 ]两组病人对吸氧的舒适度存在差异 (P <0 .0 1)。[结论 ]舒适吸氧法可提高病人吸氧的舒适度     

Methods of vaginal cuff closure during vaginal hysterectomy

Over a 2.8-year period, I did 112 vaginal hysterectomies using five different techniques of cuff closure to examine the preservation of vaginal length associated with each closure. I conclude that all five methods are acceptable as long as there is proper vault support. Morbidity was minimal, vaginal depth was retained, and there were no deaths.     

不同阴道冲洗时间对阴道洁净度的影响

妇科手术中,经腹子宫全切、经阴道子宫切除、尿漏修补、阴道壁修补及妇科恶性肿瘤手术均需阴道准备[1]。充分的术前阴道准备是保证手术顺利进行和预防术后逆行感染的重要措施之一[2]。对于术前阴道准备的方法不尽相同,回顾相关文献,大致可分为两类,即阴道擦洗和阴道冲洗。阴道冲洗的原理主要是     

经阴妇科手术两种阴道冲洗方法的临床对比研究

目的 通过对两种阴道冲洗方法的研究,选择一种科学、经济、实用的方法用于经阴妇科手术.方法 :选择2006年1月至12月经阴子宫切除、经阴子宫肌瘤剔除和经阴卵巢肿瘤摘除术420例,随机分实验组与对照组,分别采用碘伏阴道冲洗法与传统阴道冲洗法进行术前阴道冲洗,对冲洗前后细菌阳性率、不同时间细菌杀灭率、两组术后发热情况、感染率、阴道残端伤口愈合情况、两种方法所消耗时间及经济花费进行对比.结果 两种方法消毒前后细菌阳性率差异有显著性意义(P＜0.05),以消毒后3 min开始手术达到最佳的消毒效果.两组术后发热情况差异无显著性意义,两组术后阴道残端伤口愈合情况差异有显著性意义(P＜0.01),两组术后感染率差异有显著性意义(P＜0.05),消耗时间及病人花费实验组较对照组有明显降低.结论 碘伏阴道冲洗法与传统阴道冲洗法相比较,碘伏阴道冲洗法更科学、实用、经济,更具有临床可行性.     

Spontaneous vaginal delivery

Vaginal delivery is a natural process that usually does not require significant medical intervention. Management guided by current knowledge of the relevant screening tests and normal labor process can greatly increase the probability of an uncomplicated delivery and postpartum course. All women should be screened for group B streptococcus; women who test positive should be treated with antibiotics during labor. Routine human immunodeficiency virus screening of all pregnant women, and treatment with antiretroviral medication for those who test positive, can reduce perinatal transmission of the infection. Once a woman is in labor, management should focus on the goal of delivering a healthy newborn while minimizing discomfort and complications for the mother. In a patient who tests negative for group B streptococcus, delaying admission to the labor ward until she is in active labor decreases the number of possible medical interventions during labor and delivery. Once a patient has been admitted to the hospital, providing her with continuous emotional support can improve delivery outcomes and the birthing experience. Epidural analgesia is effective for pain control and should not be discontinued late in labor to reduce the need for operative vaginal delivery. Epidurals prolong labor, but do not increase the risk of cesarean delivery. Research has shown that labor may not progress as rapidly as historically reported; this should be considered before intervening for dystocia. Routine episiotomy increases morbidity and should be abandoned. Once the infant has been delivered, active management of the third stage of labor decreases the risk of postpartum hemorrhage.     

Abnormal vaginal bleeding

The complaint of abnormal vaginal bleeding in a non‐pregnant patient is not a common presentation to a general ED. However, the bleeding may in itself be significant or it may be a harbinger of serious underlying pathology. A systematic approach to diagnosis is required. An initial approach to vaginal bleeding can be to categorize the bleeding by the anatomical site. This article discusses some of the common causes of upper tract or uterine bleeding and outlines the basic approach to diagnosis and management.     

Laparoscopically-assisted vaginal hysterectomy

We report on our initial experience with laparoscopically-assisted vaginal hysterectomy. Seven patients aged 41 to 67 years were successfully treated with this new technique without significant morbidity and with the advantage of early discharge and return to full activity. We discuss the indications, technical details including preparation and positioning, and the shortcomings and problems encountered. It is concluded that laparoscopically-assisted vaginal hysterectomy may in the near future become a valid alternative to the conventional procedures in selected cases.     

Vacuum-assisted vaginal delivery

The second stage of labor is a dynamic event that may require assistance when maternal efforts fail to effect delivery or when there are nonreassuring fetal heart tones. Therefore, knowing how to perform an operative vaginal delivery with forceps or vacuum is vital for family physicians who provide maternity care. Vacuum is rapidly replacing forceps as the predominant instrument, but each has advantages and disadvantages, including increased risk of maternal trauma with forceps and increased risk of neonatal cephalohematoma with vacuum. Use of a second instrument if the first one fails is associated with worse outcomes. Routine episiotomy in operative vaginal delivery is no longer recommended. The "ABCDEFGHIJ" mnemonic can facilitate proper use and application of the vacuum device and minimize risks, and practicing the techniques on mannequins can provide an introduction to the skills of operative vaginal delivery.     

Total abdominal hysterectomy versus laparoscopically-assisted vaginal hysterectomy versus total vaginal hysterectomy

Introduction: While total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) are conventional procedures, we have actively introduced laparoscopically‐assisted vaginal hysterectomy (LAVH) since its advent. This study was the first attempt to retrospectively compare the surgical results, including invasiveness, among the three methods of performing a hysterectomy. Methods: The subjects included 1181 patients who underwent total hysterectomies (TAH, n=465; LAVH, n=629; TVH, n=87) due to uterine fibroids or uterine adenomyosis at our hospital between January 1995 and December 2009. The mean age, parity, weight of the removed uterus, operative time, blood loss, rates of intra‐ and post‐operative complications, length of post‐operative hospital stay, leukocyte count, and CRP and hemoglobin levels were compared. Results: The operative time was significantly longer in the LAVH group than the other two groups. Blood loss was significantly greater in the TAH group than the LAVH and TVA groups. The rates of intra‐ and post‐operative complications were significantly higher in the TAH group than the LAVH group. The CRP level and leukocyte count were significantly lower in the LAVH group than the TAH and TVH groups. Conclusion: LAVH can be applied to nulligravidas or patients with relatively large uteri and it is proved less invasive than TAH and TVH in this study. We recommend active application of LAVH.     

绝经后女性阴道微生态与阴道上皮内瘤变的相关性

目的:探讨绝经后女性阴道微生态与阴道上皮内瘤变(vaginal intraepithelial neoplasia, VaIN)的相关性,为绝经后女性VaIN的科学防治提供临床依据。方法:选择2020年5月至2020年8月复旦大学附属妇产科医院宫颈疾病诊疗中心经阴道镜检查、活组织检查和组织病理学诊断为VaIN的160例绝经后女性为病变组,另选同期常规体检的人乳头瘤病毒阴性且液基薄层细胞检测正常的健康绝经后女性志愿者50例为对照组,比较2组间阴道微生态的差异。结果:绝经后女性的阴道微生态普遍呈现失衡状态,多样性升高、密集度降低,过氧化氢阳性率明显升高,优势菌以革兰阳性短杆菌为主。病变组较对照组乳杆菌减少、多样性升高;两组白细胞酯酶阳性率、乙酰氨基葡萄糖苷酶阳性率、Nugent评分异常率差异均有统计学意义(P0.05)。Logistic回归分析结果表明,VaIN与白细胞酯酶阳性率、优势菌异常和多样性升高有关。白细胞酯酶阳性率的OR值为1.251(95%CI 1.101 4～1.421 1),优势菌异常的OR值1.242(95%CI 1.031 3～1.496 7),多样性降低的OR值为0.791(95%CI 0.672 5～0.931 1)。结论:绝经后女性阴道微生态的改变,尤其是白细胞酯酶阳性率、优势菌异常和多样性升高,与VaIN的发生发展密切相关。