连续硬膜外自控镇痛在孕中期妊娠引产中的应用

目的：探讨连续硬膜外自控镇痛方式在孕中期妊娠引产中的麻醉效果。方法：对在本院接受治疗的76例引产产妇资料进行分析,将这些产妇（根据产妇引产的日期,单、双）分两组,每组38例。对照组产妇采用传统方法进行麻醉,试验组产妇采用连续硬膜外自控镇痛方式进行麻醉,比较两组患者的麻醉效果。结果：试验组镇痛起效时间为（7.4±1.6）min,长于对照组的（3.9±0.6）min,比较差异有统计学意义（P〈0.01）;两组产妇产程和出血比较差异无统计学意义（P〈0.05）;试验组无产妇出现不良反应和并发症,对照组有3例产妇发生不良反应,主要表现为呕吐、恶心等症状,发生率为7.9%。结论：临床上,孕中期妊娠引产中使用连续硬膜外自控镇痛方式临床效果较好,能够有效的缓解产妇的疼痛,减少对胎儿出生后的影响,值得在临床上推广使用。     

持续静脉镇痛应用于中期妊娠引产分娩镇痛的护理研究

目的 通过对中期妊娠引产孕妇应用持续静脉镇痛进行分娩镇痛,观察其对产程及相关并发症的影响,探讨安全、有效的护理方法.方法 选择16～27 w因各种原因需要终止妊娠的孕妇226例.按孕妇要求随机分为镇痛组与对照组.镇痛组孕妇专人守护,宫颈评分≥7分时行持续静脉分娩镇痛,对照组不采用任何镇痛方法,给予常规护理.观察两组孕妇的产程时间,Mulleetr镇痛强度评分,血氧饱和度及产时出血量,分析其镇痛效果.结果 通过对观察指标进行两样本t检验,两组在产程时间、镇痛强度评分差异有统计学意义（p＜0.05）,血氧饱和度、产时出血量两组无统计学差异（p＞0.05）.结论 持续静脉镇痛应用于中期妊娠引产分娩镇痛效果显著,专人守护,把握镇痛最佳时机,实施个性化的护理是中期妊娠引产持续静脉分娩镇痛成功及取得最佳疗效的重要保证.     

笑气用于102例中期妊娠引产镇痛效果分析

国内外学者围绕足月妊娠分娩镇痛，进行了深入研究并取得了满意效果。而中期妊娠引产分娩的疼痛不亚于足月分娩。但其未引起足够重视。本院自2002年2月将笑气用于中期妊娠分娩镇痛。取得满意效果。现报告如下。     

自控硬膜外镇痛用于分娩镇痛的临床研究

目的探讨全程病人自控硬膜外镇痛(PCEA)用于分娩镇痛以及对产程及分娩结局的影响。方法产妇分为镇痛组和对照组,每组120例,镇痛组产妇进入活跃期后采用病人自控硬膜外镇痛,对照组不采用镇痛分娩。结果应用病人自控硬膜外镇痛(PCEA)的产妇的血压、脉搏、呼吸、产后出血,新生儿Apgar's评分与对照组无显著性差异。镇痛效果确切,还可一定程度上减少剖宫产率。结论全程PCEA用于分娩镇痛效果满意,对母婴均无明显不良影响,安全可靠。     

中期妊娠引产部分胎盘植入1例

<正> 资料:患者,女,38岁,G3P1,置宫内节育器14年。因停经4个月确诊为中孕18周~+。于2001年7月4日在外院行利凡诺腔内引产术,7月5日21:40自娩一死婴,脐带自然断裂,25分钟后因胎盘未娩出行刮宫术,探官腔13cm,卵圆钳夹取,感胎盘与宫腔粘连较紧,仅刮出少许内膜组织约20克,同时取     

自控硬膜外镇痛用于分娩镇痛的临床研究

目的探讨全程病人自控硬膜外镇痛（PCEA）用于分娩镇痛以及对产程及分娩结局的影响。方法产妇分为镇痛组和对照组,每组120例,镇痛组产妇进入活跃期后采用病人自控硬膜外镇痛,对照组不采用镇痛分娩。结果应用病人自控硬膜外镇痛（PCEA）的产妇的血压、脉搏、呼吸、产后出血,新生儿Apgar’s评分与对照组无显著性差异。镇痛效果确切,还可一定程度上减少剖宫产率。结论全程PCEA用于分娩镇痛效果满意,对母婴均无明显不良影响,安全可靠。     

硬膜外自控镇痛用于分娩镇痛的临床观察

椎管内神经阻滞被认为是目前最佳的分娩镇痛方法。我院近年来使用病人自控硬膜外镇痛（PECA）行分娩镇痛105例。观察其镇痛效果及其对产妇和胎儿的影响。现报告如下。     

浅谈中期妊娠引产的护理

中期妊娠引产是为了中断妊娠而不得已采取的措施.笔者所在计划生育服务站通常采用利凡诺羊膜腔内注射,加口服米非司酮加米索前列醇联合用药,取得了较好效果,但在引产过程中加强观察及护理仍是十分必要的.     

妊娠中期引产的药物使用

妊娠中期引产是终止妊娠的一种主要手段，其中药物引产应用最多，近来，联合用药的使用大大提高了药物中期引产的成功率，并提高了患者的耐受性，减少并发症的产生。其中，米非司酮联合利凡诺、米索前列醇等，针对各个环节满足分娩的必要条件，有效宫缩、宫颈软化、宫口扩张，妊娠中期引产效果显著。     

剖宫产术后硬膜外自控镇痛的疗效观察

目的:探讨剖宫产术后应用硬膜外自控镇痛泵镇痛的疗效。方法:随机抽取剖宫产术后应用镇痛泵的初产妇60例为观察组,选取同期未使用者60例为对照组。结果:观察组镇痛有效率为98.33%,对照组有效率为13.33%。两组比较差异极为显著,P<0.005。观察组产妇24h内开始泌乳的例数、哺乳的次数明显多于对照组,P<0.05,差异显著。观察组产妇24h内肛门排气的例数明显多于对照组,P<0.05,差异显著。观察组恶心、呕吐发生率低,两组比较,P<0.05,差异显著。结论:剖宫产术后应用硬膜外自控镇痛泵镇痛是一种安全有效的措施。     

不同时期终止妊娠对妊娠期糖尿病患者妊娠结局的影响

目的:探讨不同时期终止妊娠对妊娠期糖尿病妊娠结局的影响。方法:对215例住院分娩的妊娠期糖尿病患者的临床资料进行回顾性分析,根据不同分娩时期分成3组,Ⅰ组妊娠28～36周末,Ⅱ组妊娠37～39周末,Ⅲ组妊娠≥40周。对3组母婴并发症进行统计分析,包括围生儿病率、围生儿死亡率、巨大儿、妊娠高血压病、剖宫产率、产后出血发生情况。结果:妊娠37～39周末终止妊娠母婴并发症发生率较低(P<0.05);37周后终止妊娠,巨大儿发生率明显增加(P<0.05);40周以后终止妊娠妊娠高血压病发生率明显高于其他组;血糖控制满意孕妇(128例)与不满意孕妇(87例)比较,有较好的妊娠结局。结论:①对于妊娠期糖尿病患者,血糖控制水平是决定终止妊娠时期的关键因素,严格控制血糖可改善妊娠结局。②妊娠37～39周末终止妊娠可以降低母婴的并发症。     

200例中孕引产的临床观察

目的探讨中孕引产对象在行羊膜腔注药前服用米非司酮的可行性和必要性。方法收集笔者所在计划生育服务站的临床实例，分为原始组和对照组，对照组在经腹壁行羊膜腔穿刺注人依沙丫啶100mg前，空腹分服米非司酮150mg。结果对照组的流产时间明显短于原始组，且无明显的副作用，其他指标无显著差异。结论对于中孕引产对象，在行羊膜腔注入依沙丫啶前分服米非司酮100mg可明显缩短流产时间，深受引产对象欢迎，其可行性是肯定的，值得广大基层计划生育服务站同仁们参考。     

早孕合并子宫肌瘤人工流产术临床分析

目的:探讨早孕合并子宫肌瘤患者终止妊娠方式、手术并发症的预防和处理。方法:回顾性分析212例早孕合并子宫肌瘤终止妊娠患者的临床资料。结果:203例行电吸术及钳刮术,2例出血较多,为合并肌壁间肌瘤,直径>5cm。9例行药物流产术,顺利排出胎囊,排出时间平均136min。出血未超过月经量。结论:早孕合并较小子宫肌瘤病例(肌瘤结节<5cm),或者肌瘤位于浆膜下者,手术难度及风险较小。合并多发性、肌壁间子宫肌瘤,以及直径≥5cm的子宫肌瘤患者,人工流产手术并发症的发生率均明显增高。早孕合并子宫肌瘤行药物流产是可行、有效的,在药流过程中,严密观察、及时处理,可减少并发症的发生率。     

Mifepristone and prostaglandin for termination of pregnancy: contraindications for use, reasons and rationale

Drug therapies are usually contraindicated in specific patient populations where evidence suggests that administration may result in a serious reaction or may seriously and negatively alter the risk benefit of treatment. There are few absolute contraindications to licensed regimens of mifepristone and prostaglandin for termination of pregnancy. However, those that are specified on "summary of product characteristics" [product labeling (PL)] differ from country to country. Differences reflect the dynamic environment of emerging scientific evidence, local experience and guidelines, and local regulatory processes, which all influence the resultant PL. The reasons and rationale for specific contraindications for mifepristone and prostaglandin for the termination of pregnancy are detailed, and the reasons for the differences between PL in different countries are explained.     

人工流产后生殖支原体感染与盆腔炎的相关性分析

目的 分析人工流产(TOP)后生殖支原体(Mg)感染与盆腔炎(PID)的相关性,为临床预防和治疗流产后PID提供参考.方法 以2007年3月-2012年3月医院收治的TOP患者为对象,筛查Mg和沙眼衣原体(CT)感染情况,单纯Mg感染的患者作为感染组,Mg和CT检测均阴性患者作为对照组;剔除发生CT感染的病例、随访资料不完整、患生殖器畸形和急、慢性疾病的病例;术后对所有患者随访6周,观察其术后PID的发病情况,分析Mg感染与人工流产术后PID发病率的相关性.结果 5年中共收集984例患者,其中Mg感染110例,感染率为11.18％,CT感染51例感染率为5.18％,同时感染Mg和CT的患者6例,感染率为0.61％,20～30岁年龄段感染率显著高于其他年龄段(P＜0.01);随访发现Mg感染患者中出现PID共有15例,发病率为13.63％,而未感染患者中诊断为PID共有17例,发病率为3.53％;通过logistic回归分析可见总体在流产患者中Mg感染与PID的发病率差异有统计学意义(OR 6.29,95％CI1.56～25.2),在药物流产患者中Mg感染与PID的发病率差异无统计学意义(OR 8.68,95％CI0.58～14.84),在手术流产患者中Mg感染与PID的发病率显著相关(OR 5.78,95％CI 1.02～32.80),手术流产后盆腔炎的发病率显著高于药物流产(P＜0.01).结论 Mg感染与手术流产后PID的发病率有显著相关性,推荐对手术流产患者进行Mg感染筛查并进行治疗,预防术后PID的发生.     

Contraceptive practice before and after termination of pregnancy: a prospective study

This study is part of a larger prospective research program focusing on termination of pregnancy (TOP). One hundred and three women requesting TOP were interviewed before the intervention and 6 months later using open and closed questions and psychological tests. This paper focuses on contraceptive practices before and after abortion. The analysis took into account specific aspects of contraceptive practices and patients' behaviors. The aims were to assess: the level of women's knowledge and practice of contraception at the time of request for a TOP; the behavioral modifications following professional counseling 6 months after TOP; the influence of psychological and sexual factors, and those linked to the women's use of contraception. Most women (n = 101) had already used recommended contraception. During the cycle that had resulted in pregnancy, more than half (n = 58) had used recommended contraception and one third had not used any contraception. Six months later, 86 women used recommended contraception, and 17 did not. The majority of women reported changes in their contraceptive methods (n = 82). Most changes were within recommended methods. The women (n = 10) who continued to practice unprotected intercourse post-TOP were slightly older, satisfied with their sexual relations with their partner, often involved in a long-term and good relationship. During post-TOP period, it is essential to take into account the psychological dynamics involved in the choice of contraceptive methods. Counseling should emphasize not only protection against an unwanted pregnancy but also protection against sexually transmitted diseases, which is often perceived as a less important issue following TOP.     

Emergency contraception: knowledge and use among Danish women requesting termination of pregnancy

The aim of this study was to describe knowledge about and use of emergency contraception (EC) among Danish women requesting termination of pregnancy. The study included 1514 women (response rate 83.7%) referred during the period August 2000 to May 2001. Sufficient knowledge of EC was defined as knowledge about both the correct time limit and where to acquire the EC. We found adequate knowledge in 44.7%. These women were typically younger, better educated and more often singles, nulliparae, and users of contraception. No relation was found to the type of contraception used or to previous terminations of pregnancies. EC was used in the actual pregnancy by 6.6% and 24.1% had used it previously. Actual or formers users were characterized in the same way. The general knowledge about EC has not improved significantly during the last few years and there is still need for information about the correct use of EC.