目的 构建妊娠中晚期妇女缺铁性贫血(iron deficiency anemia,IDA)预测模型,并建立个体预测IDA发生风险的列线图模型.方法 选取2018年5月-2019年11月在本院妇产科进行产检的431例妊娠中晚期妇女,均进行血常规和血清铁检测,根据有无IDA分为IDA组与非IDA组.对两组各项因素进行比较,采用多因素logistic回归分析妊娠中晚期女性发生IDA的危险因素,并采用R软件建立预测发生的列线图模型,采用ROC曲线分析列线图模型对妊娠中晚期女性发生IDA的预测效率.结果 431例妊娠中晚期女性发生IDA有83例(19.26％);经单因素分析显示,年龄、月经济收入、孕周、初次月经年龄、孕期含铁食物摄入频次、补充铁剂频次、是否定期复查血常规与妊娠中晚期妇女IDA的发生有关(x2/P=5.964/0.015、11.183/0.001、7.336/0.007、7.907/0.005、12.911/0.011、14.202/0.001、4.901/0.027);logistics回归分析显示,孕周(Waldx2=5.891,P=0.015,OR=1.931,95％CI: 1.135～3.285)、孕期含铁食物摄入频次少(Waldx2=4.410,P=0.036, OR=3.044,95％CI: 1.077～8.603)、未定期复查血常规(Waldx2=4.997,P=0.025,OR=3.552,95％CI:1.169～ 10.793)是妊娠中晚期妇女发生IDA的危险因素,月经济收入高(Waldx2=6.285,P=0.012,OR=0.334,95％CI:0.141 ～ 0.787)、补充铁剂频次多(Waldx2=5.370,P=0.020,OR=0.314,95％CI:0.118～0.837)是其保护因素;ROC曲线显示列线图模型预测IDA发生的曲线下面积为0.714,截断点为0.226,预测灵敏度与特异度分别为74.00％、90.00％.结论 月经济收入低、孕周、孕期含铁食物摄入频次少、补充铁剂频次少、未定期复查血常规是妊娠中晚期妇女发生IDA的危险因素,而利用上述因素构建模型可为妊娠中晚期妇女IDA发生风险的预测及防护性措施的制定提供参考依据.

目的:分析针药结合治疗子宫内膜异位症(endometriosis,EM)的临床疗效.方法:选取EM患者87例,随机分为中药口服组、中药口服+中药灌肠组和针药结合组,每组29例,共治疗3个月经周期,观察3组临床疗效及后穹窿触痛结节的变化,比较治疗前及停药后1、2、3个月经周期的痛经评分.结果:针药结合组总有效率显著高于中药口服组(P<0.05),略高于中药口服+中药灌肠组(P>0.05).针药结合组后穹窿触痛结节改善情况明显优于中药口服组(P<0.05),略优于中药口服+中药灌肠组(P>0.05).停药后1、2、3个月经周期,3组痛经评分较治疗前明显减少(P<0.01);针药结合组停药后1、2个月经周期痛经评分显著低于其余两组,且中药口服+中药灌肠组显著低于中药口服组(P<0.05).结论:针药结合可有效缓解EM患者的疼痛程度,疗效优于单纯中药治疗.

Objective:To explore the feasibility of reasonable preventive application of antibiotics in patients with C-reactive protein (CRP)-guided premature rupture of fetal membrane (PROM).Methods:A total of 138 patients with PROM who were not in la-bor with rupture of fetal membrane <12 h on admission were selected to detect the level of serum CRP.Patients with CRP >8 mg/L were randomly divided into group A (n=34)and group B (n=36),while those with CRP <8 mg/L into group C (n=42)and group D (n=26).Groups A and C received preventive application of antibiotics,while groups B and D did not.All groups delivered within 24 h after rupture of membrane.The rate of histological chorioamnionitis,and the changes of serum CRP level,proclacitonin (PCT)lev-el,white blood cell count (WBC),interleukin (IL)-6 level and IL-8 level on admission and after delivery were observed in all groups. Results:The rate of histological chorioamnionitis was 94.44% (34/36)in group B,evidently higher than the 26.92% (7/26)in group D and 41.18% (14/34)in group A,the difference was statistically significant (P<0.01).But there was no significant differ-ence between groups C and D in the rate of histological chorioamnionitis (P>0.05 ).After delivery,serum CRP level,PCT level and WBC were markedly higher in all groups than those on admission,and the differences were significant (P<0.05),which were notably higher in group B than those in the rest groups,the difference was statistically significant (P<0.01).The levels of serum IL-6 and IL-8 decreased in both groups A and C after delivery than those on admission,the difference was statistically significant (P<0.01 ),but increased prominently in group B than that on admission,the difference was statistically significant (P<0.01).Conclusion:Increase of CRP level has obvious association with the occurrence of histological chorioamnionitis,but whether using antibiotics has insignificant in-fluence on the rate of histological chorioamnionitis,and the changes of postnatal serum CRP,PCT and WBC in patients with normal CRP level.As to patients with increased CRP,preventive application of antibiotics can effectively reduce the rate of histological chorioamnio-nitis and inhibit the increase of postnatal serum CRP,PCT and WBC as well as anti-inflammatory cytokines IL-6 and IL-8 levels to some extent.

Objective To analyze the effect of quantification health education for gestational diabetes mellitus ( Gestational Diabetes Mellitus, GDM) . Methods The 140 cases of gestational diabetes mellitus who in our hospital from 2011 August to 2012 May treated were randomly divided into random health education group ( 70 cases) and quan-tification health education group ( 70 cases) , the results of two modes after education were analyzed. Results All the patients were elevated in mastering knowledge of the disease after the education and controlled the blood sugar bet-ter. The quantification health education group was superior to the random group in the rate of the mastering knowledge, controlling blood sugar and satisfaction of the patients ( P<0. 05 ) . Conclusions The quantification health education can obviously help improving the GDM patients knowing better of their disease and controlling better their blood sug-ar. The quantification health education is worth using widely in the clinical practice.

目的:通过对产后出血高危人群采取针对性护理干预并评价其效果.方法:对2011年1月1日～2012年12月31日在我院分娩的35667例产妇产后出血发生率及产后出血发生原因进行分析,以2011年产妇为对照组,2012年产妇为对照组,制定针对性护理干预措施,对干预组进行综合性护理措施,比较两组产妇产后出血发生率.结果:2011年产妇产后出血发生率为0.92％,2012年产妇产后出血发生率为0.50％,2012年产妇产后出血发生率低于2011年(x2=22.45,P=0.000),产后出血最常见原因为宫缩乏力66.3％,其次是胎盘因素20.49,产道损伤3.3％,凝血功能障碍1.1％.结论:加强对早期产后出血高危因素的识别及早期预测,制定针对性的护理措施对于孕产妇保健非常有重要.

Objective To investigate the clinical efficacy of fire needling in treating endometriosis.Method Fifty-eight endometriosis patients were randomly allocated to treatment and control groups. The treatment group received fire needling at specific points. The treatment was given at one week before menstruation until the end of it, twice a week, three months as a course. The control group took gestrinone 2.5 mg from the first day of menstruation, twice a week, for three consecutive months. The therapeutic effects were evaluated in both groups at three months after the end of treatment.Result The cure rate and the efficacy rate were significantly higher in the treatment group than in the control group (P<0.05). The pregnancy rate was also higher in the treatment group than in the control group (P<0.05).Conclusion Fire needling treatment for endometriosis has the advantages of good therapeutic effect, high cure rate and no influence on pregnancy.

阴道出血是早期先兆流产的常见症状，但本患者阴道反复大量出血，伴大血块，经中西药给予肌注大剂量的黄体酮针，间断静滴间苯三酚注射液、止血敏、止血芳酸（以下简称止血合剂），配合中药汤剂寿胎丸加减治疗后，效果不理想。后加用红参，阿胶颗粒益气养血治疗后，症状逐渐好转，阴道出血停止。表明补气养血摄血在气血虚弱型先兆流产患者中应用的必要性。

Objective To study the differential expression of matrix metalloproteinase-9(MMP-9) and tissue inhibitors of metalloproteinase-1(TIMP-1) in serum and decidua tissue from missed abortion and normal first trimester pregnancy,and to explore their function in early pregnancy .Methods The expression of MMP-9,TIMP-1 in serum was determined using enzyme-linked immunosorbent assay ( ELISA) ,and in decidua by immunohistochemical method . Results The MMP-9 serum level from missed abortion women was higher than that from normal first trimester preg -nancy women [(154.60 ±28.69)ng/mL vs.(135.75 ±18.35)ng/mL,t=3.50,P=0.001].The TIMP-1 serum level from missed abortion women was lower than that from normal first trimester pregnancy women [(253.03 ± 29.90)ng/mL vs.(323.15 ±33.62) ng/mL,t=9.86,P=0.000].The MMP-9 positive expression rate in decidua tissue was higher in missed abortion women than that in normal first trimester pregnancy women (82.5%vs.42.5%,χ2 =13.65,P=0.000).The TIMP-1 positive expression rate in decidua tissue was lower in missed abortion women than that in normal first trimester pregnancy women (87.5%vs.62.5%,χ2 =6.67,P=0.010).Conclusion The expression of MMP-9 and TIMP-1 in serum and decidua may be assosiated with missed abortion .

目的 探讨全程护理干预对预防产后抑郁的效果,为促进产妇心理健康调试提供参考依据.方法 以2012年1月1日-12月31日期间在我院进行产检并承诺在我院进行分娩的孕妇为研究对象,利用爱丁堡产后抑郁量表(EPDS)对产妇进行产前及产后第7天、第42天抑郁状态的测定,对产前有抑郁情绪的对象进行全程护理或常规护理,比较两种护理效果的差别.结果 通过全程干预护理可以减轻产后抑郁的发生,干预组产后第7天和第42天抑郁率均较对照组低,差异有统计学意义(P＜0.01).结论 全程护理干预能够为产妇提供科学、有效的健康知识和指导,有助于降低产后抑郁的发生,改善产妇负性情绪.

Objective: To understand the present stage of breast feeding on the post parturm mothers who delivery in our hospital,analysis the influential factors why the rate of breat feeding keep still low.Methods:The data were from the same questionnaire answered by the post partum mothers who were visited and the Purperas who come back to hospitalto have a health examination in 42 days after delivery.To analyze and compare awareness of the situation of maternal breast-feeding of different delivery modes,the impact of breast-feeding factors and feeding patterns.Results: The knowledge on breast-feeding of vaginal delivery puerpera was less than cesarean section.Main factors affecting breast-feeding were posture,painn,and so on,these was difference between vaginal delivery and cesarean section.The breast feeding rate of caesarean purpers was obvious lower than the purperas who through vagina give birth to baby.Conclusions:Mother milk's includes various nourishment that an infant need,it is the infant's most ideal food;Breast feeding can promote mother baby's affection,lower mother and baby's fall ill rate.Therefore,we must persist in initiating the breast feeding actively,raise the rate of breast feeding and promote the mother and baby's mind and body to develop.

目的探讨中药泡浴加晒太阳对新生儿黄疸的防治临床疗效。方法新生儿出生第三天跟踪监测黄疸,将960例随机分为四组,一组为晒太阳组,一组为中药泡浴组,一组中药泡浴加晒太阳联合组,一组对照组,比较四组黄疸的发生率及黄疸住院率。结果联合组黄疸的发生率、黄疸持续时间及住院率最低,中药泡浴及晒太阳组次之,两者取得同样的效果,两组黄疸的发生率、黄疸持续时间及住院率无明显差异,而对照组的黄疸发生率、黄疸持续时间及住院率最高。