跟踪式护理对冠脉内支架植入术患者术后康复结局的影响

目的 探讨跟踪式综合康复护理模式对冠脉内支架植入术患者术后康复结局的影响.方法 选取128例冠脉内支架植入术患者,按照人院日期分为两组,研究组62例采用跟踪式综合康复护理模式,常规护理组66例给予常规治疗及护理,比较两组患者术后康复结局.结果 干预后,两组患者治疗后的血压及血脂水平均低于治疗前,且跟踪护理组患者治疗后水平改善均优于常规组,差异有统计学意义(P＜0.05);跟踪护理组患者运动耐受强度、胸闷发作频率、射血分数恢复情况均优于常规护理组,差异有统计学意义(P＜0.05).结论 跟踪式综合康复护理模式能有效改善冠脉内支架植入术患者的心脏康复功能,建议推广和应用.     

26卷11期疑难病案

患者34岁,G2P0,因停经38周,胎动减少2+小时,于2009年4月13日11时急诊入院.平素月经规则,曾行人工流产1次,末次月经2008年7月20日,预产期2009年4月27日.     

妊娠期肝内胆汁淤积症发生死胎的临床因素分析

Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.     

产科面临的挑战

围产医学建立初期的目标是降低孕产妇和围产儿的死亡率,中期又强调降低母亲和孩子围产病率和远期的致伤率,减少盆底的损伤、张力性尿失禁、尿瘘及粪瘘等的发生,远期注重孕产妇的心理对健康的影响.现今,最终的目标是提高人口素质,但面临的问题太多.     

中晚期妊娠合并卵巢囊肿相关急腹症的诊治

卵巢囊肿相关急腹症或称卵巢囊肿意外(Ovarian cyst'accident',OCA)是常见的妇科急腹症之一,包括卵巢囊肿蒂扭转、破裂和出血[1].OCA可引起突发性剧烈腹痛,孕妇比非孕期妇女更易发生OCA,所以准确及时地诊断和选择合适的治疗手段是改善妊娠合并OCA孕妇预后的关键.     

重度子痫前期并发胸腹腔积液15例临床分析

目的:探讨重度子痫前期并发胸腹腔积液的临床特点和救治方法.方法:回顾性分析我院2005年1月至2006年11月重度子痫前期并发胸腹腔积液患者15例的临床病例资料.结果:15例患者均有不同程度的高血压、低蛋白血症的表现,合并胸腔积液多表现为胸闷、呼吸困难和血氧饱和度下降;2例压迫症状严重的患者入院后及时剖宫产结束分娩,另13例经治疗后平均延长孕周4.5±1.5天;15例患者经治疗后,胸腹腔积液于术后5～12天内逐渐消失,术后12天左右出院.15例共分娩16例新生儿,死亡1例,其余近期预后好.结论:重度子痫前期并发胸腹腔积液患者病情极其严重,应及早发现并进行解痉、纠正低蛋白血症、降压和支持等综合治疗,适时终止妊娠是唯一有效控制病情的方法.     

双胎输血综合征的诊断和治疗进展

双胎输血综合征(TTIS)是双胎妊娠的一种严重的并发症，有较高的围产儿死亡率和新生儿神经发育异常率。其病因主要是遗传基因的异常。主要死因是早产。早期诊断，恰当分级，合理评估并选择适宜的治疗方式能延长妊娠周，改善围产儿预后。选择性胎儿镜下激光凝固吻合血管是有较好发展前景的治疗方法。     

华蟾素注射液体外对小鼠脾淋巴细胞功能影响的研究

目的观察华蟾素注射液对小鼠脾淋巴细胞增殖、活化的影响,探讨其对免疫系统调节的作用,为阐明其免疫作用机制提供药理学依据。方法无菌分离小鼠脾淋巴细胞,制备淋巴细胞悬液,按临床给药量设置华蟾素注射液不同浓度组给药。MTT法分别检测刀豆蛋白A(Con A)刺激和脂多糖(LPS)刺激的小鼠脾淋巴细胞增殖;用华蟾素注射液预孵育淋巴细胞6 h,分别加入Con A或LPS诱导淋巴细胞活化,利用流式细胞仪通过Aimplex对细胞上清液进行GM-CSF、TNF-α,IFN-γ,IL-1α,IL-2,IL-6,IL-10细胞因子检测,评价其免疫效果。结果华蟾素注射液7.82mg/ml、15.63 mg/ml和31.25 mg/ml浓度组与Con A协同刺激淋巴细胞增殖。1.96 mg/ml和62.50 mg/ml浓度组与LPS协同抑制细胞增殖。华蟾素注射液可促进TNF-α和IL-6分泌,一定程度抑制IFN-γ和GM-CSF分泌,与不同刺激剂作用可不同程度促进或抑制IL-2、IL-1α和IL-10的分泌。结论华蟾素注射液可一定程度促进B淋巴细胞增殖,但对体液免疫的作用效果和作用机制还有待进一步研究。     

第146例 惑妊娠-高血压-低血钾

病例摘要 患者女,33岁,因停经24+周,眼花3 d,头痛伴血压升高1 d人院.有低血钾史3年,血钾波动于2.4～2.6 mmol/L,自服氯化钾10～20 ml,3 7欠/d,未正规诊治.