深圳市坪山区人民医院

An 84-year-old female patient was admitted with “unconsciousness for 7 hours” by flat car and was given imipenem/cilastatin sodium 1 g, q12h, intravenous antiinfective therapy for septic shock.Before medication, the patient′s white blood cell count was 7.16×10~9/L and platelet count was 253.00×10~9/L;after 3 days of medication, the patient′s white blood cell count was 1.78×10~9/L and platelet count was 37.00×10~9/L.After imipenem/cilastatin sodium were stopped, recombinant human granulocyte stimulating factor injection 150 μg was given subcutaneously, and one therapeutic dose of platelet was given.After treatment, the white blood cell count increased to 12.81×10~9/L and platelet count increased to 175.00×10~9/L.This case suggests that imipenem/cilastatin sodium should be used with caution in elderly patients and surveillance should be strengthened during treatment.

Objective:To explore the correlation between different degrees of placental abruption and coagulation function indicators.Methods:Seventy-two pregnant women with placental abruption admitted to Pingshan District People's Hospital from January 2019 to September 2021 were collected as an observation group, with an age of (28.67±3.05) years and a gestation period of (33.69±1.35) weeks. According to the severity of placental abruption, they were divided into a mild group (42 cases) and a severe group (30 cases). During the same period, 72 healthy pregnant women were collected as a reference group, with an age of (28.56±3.11) years and a gestation period of (33.42±1.23) weeks. The prothrombin times (PT), activated partial thromboplastin times (APTT), and thrombin times (TT) and levels of fibrinogen (FIB) and D-Dimer (D-D) were compared between the control group and the observation group. The coagulation function indicators and adverse pregnant outcomes were compared between the mild group and the severe group. The efficiencies of the coagulation indicators in predicting different degrees of placental abruption were analyzed. The t test, ANOVA, and χ2 test were used. The areas (AUC) under the receiver operating characteristic curves (ROC) were used to evaluate the prediction efficiencies. Results:The PT and D-D levels in the observation group were higher than those in the reference group [(14.22±1.54) s vs. (9.11±0.45) s and (4.46±1.37) μg/L vs. (0.34±0.10) μg/L], with statistical differences ( t=27.026 and 25.450, both P<0.001). The FIB level of the observation group was lower than that of the reference group [(3.46±0.42) g/L vs. (4.52±0.97) g/L], with a statistical difference ( t=8.509, P<0.001). There were no statistical differences in APTT and TT between the observation group and the reference group (both P>0.05). The D-D level in the severe group was higher than that in the mild group [(5.88±1.73) μg/L vs. (3.05±1.01) μg/L], with a statistical difference ( t=8.734, P<0.001); the FIB level in the severe group was lower than that in the mild group [(3.00±0.26) g/L vs. (3.93±0.59) g/L], with a statistical difference ( t=8.079, P<0.001). There were no statistical differences in PT, APTT, and TT between the mild group and the severe group (all P>0.05). The AUC's of FIB and D-D in the prediction of mild and severe placental abruption were 0.630 and 0.609, respectively; the sensitivity and specificity of FIB combined with D-D in predicting mild and severe placental abruption were 87.99% and 86.59%, and the AUC was 0.897, which were better than FIB or D-D alone. By DeLong test, the AUC of the combined prediction was better than those of FIB and D-D, with statistical differences ( Z=2.983 and 2.784, both P<0.001). The incidence of adverse pregnancy outcomes in the severe group was higher than that in the mild group [70.00% (21/30) vs. 30.95% (13/42)], with a statistical difference ( χ2=30.501, P<0.001). Conclusions:The maternal and fetal outcomes of placental abruption are closely related to the severity of placental abruption, and the decrease of FIB level and increase of D-D level in pregnant women with placental abruption are closely related to the severity of placental abruption. The combination of FIB and D-D is effective in predicting the severity of placental abruption.

Objective To analyze the effect of acupoint massage nursing combined with AIDET communication on pain relief in the intervention of postpartum women with contraction pain. Methods 60 cases of parturient in our hospital from Jan 2020 to Aug 2022 were divided into control group and observation group according to random number table method. The control group received routine nursing, and the observation group received acupoint massage nursing combined with AIDET communication. VAS score, SAS score, PSQI score, nursing satisfaction, pain related biochemical indexes were compared and analyzed. Results Nursing satisfaction of observation group was higher than control group (P<0.05). VAS scores, SAS scores and PSQI scores of the observation group were better than those of the control group (P<0.05). The levels of pain related biochemical indices (serum PGE2 and SP) in the observation group were lower than those in the control group (P<0.05). Conclusion The implementation of acupoint massage nursing combined with AIDET communication intervention can relieve uterine pain, improve the quality of life, relieve bad mood and improve nursing satisfaction.