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宫角妊娠治疗方法的探讨 总被引:1,自引:0,他引:1
目的 总结分析宫角妊娠的不同治疗方法,提出最佳治疗方案。方法 分析1998年1月1日至2004年12月31日收治的60例宫角妊娠病人的临床资料、超声及病理结果。将治疗方法归纳为5组:第1组B超直视下刮宫;第2组B超直视下刮宫联合宫颈注射MTX;第3组B超直视下刮宫失败,剖腹行患侧宫角切除手术;第4组B超直视下刮宫失败,腹腔镜下行患侧宫角切除或刮宫联合宫角部注射MTX手术;第5组口服杀胚胎中药保守治疗。结果 第1组23例;第2组9例;第3组18例;第4组8例;第5组2例。从1998-2004年宫角妊娠的例数呈逐年增加的趋势。腹腔镜已成功用于宫角妊娠的手术治疗;B超下刮宫及联合MTX治愈的比例有呈逐年增加的趋势。发生在右侧的例数明显多于左侧的例数。结论 宫角妊娠根据病情的不同可以采取多种治疗方法。应根据患者的不同病情采取损伤最小、恢复最快、预后最好的治疗方案。发生腹腔内出血的病例以行开腹手术为宜。血HCG值明显低于相应孕周的病例可住院口服杀胚胎中药。B超下刮宫在保留了患者解剖结构的完整性的同时避免了手术后的粘连。B超下刮宫联合MTX宫颈注射,提高了保守治疗的成功率,但治疗时间长,宜用腹腔镜手术代替。超声直视下刮宫失败或合并具有剖腹指征的病例行腹腔镜治疗是最佳选择。 相似文献
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目的 观察静脉用尼卡地平治疗孕期高血压急症的降压效果及对母婴的安全性。方法 观察16例妊娠期高血压急症病人接受静点尼卡地平治疗,心电监护仪观察24h动态血压、心率并评价其稳定性,电子监护仪监测胎心率用药前后变化,B超测定脐动脉血流S/D值并对新生儿进行Apgar评分、出生体重及新生儿预后的分析,了解其安全性。结果 全部患者静点尼卡地平后5~40min内血压可降至预期血压(140~150/90~100)mmHg,并能保持血压平稳。血压下降初始可伴心率加快,但多无症状,2h内即恢复。治疗前后胎心监护、胎儿脐血流无明显改变。结论 尼卡地平用于重度妊高症降压治疗是有效的,可平稳维持血压,未发现有严重不良反应,对胎儿安全性与其他钙拮抗剂相似。 相似文献
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剖宫产率升高及指征的变化分析 总被引:1,自引:0,他引:1
目的分析剖宫产率升高及指征变化的原因,并制定出相应的对策。方法采用回顾性分析的方法,对我院2000年1月至2004年12月住院分娩产妇的剖宫产病例进行分析。结果剖宫产率逐年升高,剖宫产指征中社会因素所占比例明显增高。结论社会因素是剖宫产率升高的主要原因,降低剖宫产率关键是减少社会因素,加强宣传剖宫产术的适应症及并发症,开展无痛分娩。 相似文献
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背景:缺氧血性脑病(hypoxic-ischemic encephalopathy,HIE)是新生儿死亡和致残的重要原因之一,但其发病机制仍不十分清楚。目的:研究HIE患儿血浆神经肽Y与神经降压素(neurotensin,NT)变化及其对脑血流动学的影响,以探讨HIE的发病机制,为进一步改善HIE的预后提供理论依据。设计:非随机对照的实验研究。地点、对象和方法:研究对象来源于首都医科大学附属北京妇产医院,用放射免疫法检测40例HIE患儿及40例正常新生儿脐血及生后1,3和7d血浆神经肽Y与NT的动态变化,由北京东亚免疫技术研究所负责检测。同时于生后24h内静脉取血后即刻应用彩色脉冲多普勒超声检测其大脑中动脉的血流动学变化,包括收缩期峰值流速、舒张期末血流速度、时间平均流速、波动指数与阻力指数等。主要观察指标:HIE患儿血浆神经肽Y、血浆NT的动态变化,脑血流动力学变化并与正常新生儿比较;不同程度HIE第1天血浆神经肽Y、NT水平比较。结果:HIE患儿脐血与生后第1天外周血神经肽Y显著高于正常新生儿,分别为(615.5&;#177;130.7),(355.9&;#177;57.4)ng/L和(199.1&;#177;63.2),(214.4&;#177;58.0)ng/L(t=7.22,4.68,P&;lt;0.01),至生后第3天时降至正常对照组水平,分别为(251.1&;#177;69.9)和(232.5&;#177;85.5)ng/L(P&;gt;0.05)。而脐血与外周血NT在生后1周内均显著高于正常新生儿(t=6.61~9.66,P&;lt;0.01)。多普勒超声检测显示HIE患儿脑血流速度减慢,阻力指数增大或减小。直线相关分析显示与神经肽Y呈正相关(r=0.540,P&;lt;0.01)、与NT呈负相关(r=-0.688,P&;lt;0.01)。结论:新生儿窒息后血浆神经肽Y与NT通过调节脑血流动学变化而参与HIE的发病机制,为寻求HIE新的干预措施改善预后提供了理论依据。 相似文献
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翟桂荣 《中华临床医师杂志(电子版)》2008,2(1):15-18
妊娠合并子宫肌瘤属高危妊娠,临床上并不罕见,占妊娠的0.03%~1.1%,子宫肌瘤患者中的发病率为0.5%~1%。妊娠合并子宫肌瘤者并发症发生率高达10%~30%。近年来由于晚婚、高龄分娩者增多以及超声技术在产科领域的广泛应用和诊断技术的提高,其发生率呈上升趋势。本文就妊娠与子宫肌瘤之间的相互影响以及妊娠各期子宫肌瘤的处理阐述如下。 相似文献
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Objective: To compare the efficacy and safety of carbetocin and oxytocin in the prevention of postpartum hemorrhage after selective caesarean section. Methods: Two hundred and sixteen pregnant women who were going to deliver by caesarean section were randomly divided into two paralleled and controlled groups, of which the oxytocin group(group A) contained 105 women and the carbetocin group(group B) 111 women. 20 IU of oxytocin was administrated during operation for both groups, 10 IU directly into uterus and 10 IU intravenously. When the operation was over, 20 IU of oxytocin was dripped for group A lasting for 8 hours, while for group B 100μg of carbetocin was immediately injected intravenously for 1 minute. Blood loss as well as hemoglobin alteration was measured for the comparison of the effect of the two drugs. Blood biochemical indicators were introduced for the evaluation of the safety of carbetocin including the function of liver and kidney and the fasting glucose.Results: No significant difference was revealed between the two groups concerning the postpartum hemorrhage within 24 hours, the postpartum hemorrhage incidence and the changes of hemoglobin. There was no significant difference in the change of liver and kidney function, fasting glucose and electrolyte changes as well.Conclusions: Carbetocin has a similar effect and safety of oxytocin in controlling the blood loss of selective caesarean section. 相似文献
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To investigate the safety of electroacupuncture plus oxytocin for uterine contraction of puerperants. Methods: 276 puerperants with difficult labor were randomly divided into a medication group, treated with intravenous dripping of oxytocin, and an acupuncture plus medication group, in the medication group, intravenous dripping of oxytocin was given, and in the other group, acupuncture at bilateral Hegu (LI 4) was added. Heart rate, respiratory frequency, blood pressure of puerperants, fetal heart rate and birth process were observed. Results: During laboring, the indices observed, including heart rate, respiratory frequency, blood pressure, fetal heart rate and birth process, were all in normal range in all of the 276 cases, with better effects in acupuncture plus medication Group M. Conclusions: Electroacupuncture at bilateral Hegu (LI 4) plus intravenous dripping of oxytocin can intensify the uterine contraction, shorten the birth process to avoid probable systemic exhaustion due to excessive consumption, and with no side effects on life signs of the puernerants and newborns. 相似文献
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目的研究针刺膻中穴治疗产后缺乳的临床作用,为确定腧穴主治提供临床依据。方法采用多中心单盲随机对照研究方法,将276例乳汁不足的产妇随机分为针刺组与中药组,连续治疗3天,观察乳房充盈程度、泌乳量、泌乳素及新生儿体重、人工喂养次数和容量、婴儿小便次数、哭闹时间长短等指标,对照比较治疗产后缺乳的临床疗效。结果针刺组与中药组均能有效改善缺乳状态,乳房充盈程度、泌乳量及新生儿体重、人工喂养次数和容量、婴儿小便次数等治疗前后比较差异均有统计学意义,两组之间比较差异无统计学意义。针刺组治疗前后泌乳素无差异,中药组治疗前后泌乳素有差异。结论针刺膻中穴能有效促进乳汁的分泌。 相似文献