目的 探讨妊娠期糖尿病(GDM)合并乙肝表面抗原(HBsAg)阳性孕妇的妊娠结局影响因素及对新生儿乙型肝炎病毒(HBV)感染的影响.方法 选取2020年3月—2022年3月在温州市中心医院就诊的60例GDM合并HBsAg阳性孕妇为观察组,同期选取60例单纯GDM孕妇作为对照组.比较两组孕妇临床信息、肝功能指标以及不良妊娠结局的发生情况,采用logistic回归模型分析GDM合并HBsAg阳性孕妇妊娠结局的影响因素.结果 观察组孕妇丙氨酸转氨酶(ALT)[(16.13±3.52)U/L vs.(11.48±2.71)U/L]、天门冬氨酸转氨酶(AST)[(23.27±7.03)U/L vs.(17.36±5.42)U/L]、总胆红素[(8.80±2.09)μmol/L vs.(7.23±1.71)μmol/L]、总胆汁酸[(4.07±1.53)μmol/L vs.(2.38±0.94)μmol/L]水平均显著高于对照组,差异均有统计学意义(均P＜0.05).观察组孕妇不良妊娠结局总发生率为60.0％,高于对照组的38.3％,差异有统计学意义(P＜0.05).logistic 回归分析结果显示,年龄≥35 岁(OR=2.015,95％CI:1.264～5.872)、ALT 升高(OR=4.316,95％CI:2.326～9.714)、AST 升高(OR=4.998,95％CI:2.649～11.347)、总胆汁酸升高(OR=2.235,95％CI:1.307～5.133)、HBsAg阳性(OR=6.340,95％CI:3.209～15.479)是导致不良妊娠结局的独立危险因素(P＜0.05).观察组新生儿HBsAg阳性率(20.0％ vs. 0)、HBV感染率(11.7％ vs. 0)均显著高于对照组,差异有统计学意义(P＜0.05).结论 GDM孕妇合并HBsAg阳性可增加不良妊娠结局的发生风险和新生儿HBV感染率,高龄、肝功能异常及HBsAg阳性是导致不良妊娠结局的影响因素.

院内感染是指住院患者在医院内获得新的微生物引起的感染,包括在住院期间发生的感染和在医院内获得出院后发生的感染,但不包括入院前已开始或入院时已处于潜伏期的感染.产科一直是医院感染的高发科室,产科患者正经历妊娠、分娩及产褥,各种有创操作对身体的打击加上产后照顾新生儿,导致休息不足、抵抗力下降,即使本身无原发病,也非常容易受到感染.鉴于此,本文通过分析我院产科2018年6月至2020年12月住院期间发生医院感染患者的病例资料,了解其感染特点,以期针对各环节制定预防措施,减少医院感染的发生,更好地为母婴健康保驾护航.

胎母输血综合征是发生在产科的一种少见疾病,主要是某种原因导致胎儿血液通过胎盘时发生出血,其血液通过绒毛间隙进入母体血循环,引起胎儿贫血或母体溶血性输血反应的一组症候群[1].该病发病隐匿,临床表现不典型,缺乏特异性及灵敏性均高的诊断方法,产前明确诊断困难,围产儿病死率高.现通过对我院2017年1月至2020年3月胎母输血综合征11例进行回顾性分析,分析临床表现、胎心监护、实验室辅助检查及新生儿预后,探讨临床特点,以期早期诊断,降低围产儿并发症发生率及死亡率.

目的 探讨孕妇维生素D受体(VDR)基因FokⅠ位点多态性与脐血25-羟维生素D的关系.方法 选取2017年6月至2019年5月在温州市中心医院产检的846例孕妇为研究对象,均为单胎.采用PCR-焦磷酸遗传分析技术检测孕晚期孕妇血液中VDR基因FokⅠ位点多态性;ELISA法检测孕晚期孕妇血清及新生儿脐血25-羟维生素D水平.分析两者的关系.结果 846例孕妇中,VDR基因Fok I位点TC基因型386例,占45.63％,该基因型组孕妇血清25-羟维生素D水平为(45.32±9.17)nmol/L,脐血25-羟维生素D水平为(45.51±9.70)nmol/L;TT基因型组为206例,占24.35％,血清25-羟维生素D水平为(39.31±11.91)nmol/L,脐血25-羟维生素D水平为(38.81±10.53)nmol/L;CC基因型组为254例,占30.02％,血清25羟维生素D水平为(55.53±12.51)nmol/L,脐血25-羟维生素D水平为(55.92±11.79)nmol/L.VDR基因TT型的孕妇血清及脐血25-羟维生素D水平

目的 探讨产前超声筛查胎儿骨骼畸形与染色体微阵列分析特征的相关性. 方法 回顾性分析2019年1～10月于我院进行超声筛查确诊胎儿骨骼畸形的的孕妇病历资料64例.所有孕妇均进行染色体核型分析结果正常后行 CMA检查.根据 CMA分析的拷贝数变异(CNVs)结果将所有患者分为致病性(pCNVs)、良性 CNVs 和临床意义不明性(Vous)3种类型,比较3种类型患者的基本资料及超声检查结果,统计分析 CMA结果的影响因素. 结果 所有患者均不同程度存在 CNVs,CNVs 个数范围1～7个,平均 CNVs 个数(3.47±1.04)个,CNVs 片段大小0.17～5.73Mb,平均大小(3.94±1.98)Mb.其中13例患者检出 pCNVs,10例患者检出 Vous,41例患者检出良性 CNVs.相较于良性 CNVs患者,心/胸比增大和股骨长/腹围比减小是 pCNVs 患者的独立影响因素(P＜0.05). 结论 骨骼畸形胎儿超声产前筛查与 CMA检查特征存在显著相关性,可以将二者结合运用于骨骼发育异常的产前检查中,有助于进一步明确诊断结果.

目的:探讨内皮克隆形成细胞对妊娠期糖尿病(GDM)孕妇发生早产的影响机制,分析环状RNA Amotl-1与内皮克隆形成细胞关系.方法:分别选取早产的GDM孕妇及健康孕妇,收集血样内皮克隆形成细胞,通过小管形成和划痕实验实验,观察环状RNA Amotl-1与内皮克隆形成细胞的关联性.结果:早产的GDM孕妇内皮克隆形成细胞(99.2％)多于健康孕妇(35.7％);小管形式实验小管长度,si RNA转染组(105.17±1.34μm)、质粒转染组(151.62±2.51μm)和空白对照组(98.56±3.71μm)存在差异(P＜0.05).细胞划痕平面迁移实验迁移率,RNA-环状RNAAmotl-1质粒近100％、si RNA为55.9％、对照组为5.2％.结论:环状RNA Amotl-1通过对内皮克隆形成细胞的促进调控GDM孕妇早产的发生和发展.

目的 了解胎儿畸形的发生率、发生顺位,探讨胎儿畸形发生的相关因素,为预防胎儿畸形的临床咨询提供依据.方法 回顾分析2017年1月至12月份在本院因胎儿畸形而引产的425例孕妇的病历资料,同时随机抽取425例于同期分娩正常新生儿的产妇为对照组,通过出生缺陷报告卡和电话随访获得相关信息进行统计分析.结果 425例胎儿畸形引产中超声异常为254例,占59.76％,染色体异常为132例,占31.05％,超声及染色体均异常为37例,占8.7％,另有两例因中重度地中海贫血引产.在染色体异常的孕妇中,≥40岁的孕妇异常率最高10.10％,≥35 ～ 40岁的孕妇异常率次之2.58％,不同年龄段之间差异具有统计学意义(P＜0.05).病例组与对照组在高龄、服用叶酸、不良孕产史、不良工作环境、吸烟及是否正规产检方面的差异具有统计学意义.胎儿超声畸形中以多系统畸形比例最高,中枢神经系统畸形居第二位,心脏畸形居第三位.结论 高龄是胎儿染色体异常的高危因素,不良孕产史、吸烟、高龄及不良工作环境是胎儿出生缺陷的高危因素.要重视出生缺陷的一级预防,孕早期服用叶酸,正规产前检查,及早发现胎儿畸形,适时选择性终止妊娠,避免给社会和家庭造成严重的负担.

目的:探讨高危孕妇不同产前诊断指征与羊水细胞异常核型发生频率及类型的关系.方法:回顾性分析4943例因不同高危因素在温州市中心医院行产前诊断的孕妇临床病例资料.结果:检出异常核型182例,异常检出率为3.68％.无创DNA高风险组异常率最高(为90.47％),另有12例因无创DNA提示性染色体异常行羊水穿刺后提示异常率为75.00％,超声异常组的异常率为7.61％,高龄组异常率为3.43％,唐氏筛查21-三体高风险组异常率为3.09％,唐氏筛查18-三体高风险组异常率为2.28％,不良孕产史组异常率为0.37％.无创DNA高风险组的染色体异常率最高,其次是超声异常组.结论:无创DNA不能完全代替羊水细胞核型分析,羊水细胞核型分析仍是检测胎儿染色体异常的金标准;高龄孕妇胎儿染色体容易突变,建议直接行产前诊断,对有超声异常或者高龄者建议加做基因芯片.

Objective To explore the relationship between serum retinol binding protein 4 and serum Lipasin levels and vascular complications in gestational diabetes mellitus(GDM).Methods From Jan.2016 to Jan.2018,80 pregnant women with gestational diabetes diagnosed as GDM in Wenzhou Central Hospital of Zhejiang Province were selected as the study group.They were divided into two groups according to whether they had vascular lesions.Group A included patients with gestational diabetes mellitus complicated with vascular complications and group B included patients without vascular complications.Forty healthy pregnant women were selected as the control group(group C).The levels of fasting plasma glucose (FPG),fasting serum insulin (FINS),homeostatic model assessment of insulin resistance (HOMA-IR),serum retinol binding protein 4 (RBP4) and serum Lipasin were compared among three groups of pregnant women.The vascular complications of GDM were analyzed.Results The levels of FPG,FINS and HOMA-IR in gestational diabetes mellitus pregnant women were higher than those in healthy pregnant women (P＜0.05),and those in group A were higher than those in group B (P＜0.05).The levels of RBP4 and Lipasin in serum of pregnant women with GDM were higher than those of healthy pregnant women (P＜0.05),and those of group A were higher than those of group B (P＜0.05).Spearman univariate correlation analysis showed that serum RBP4 levels were positively correlated with FPG and FINS(P＜0.05),and serum Lipasin levels were positively correlated with FPG and FINS (P＜0.05).Logistic regression analysis showed that the levels of FPG,FINS,RBP4 and Lipasin increased,which were independent risk factors for diabetic retinopathy (P＜0.05).Conclusion In GDM with vascular complications,the serum RBP4 and Lipasin levels are higher,which are independent risk factors for vascular complications in GDM,and may participate in the occurrence and development of vascular complications in gestational diabetes mellitus.

目的探讨孕妇保健操对初产妇负性情绪及分娩结局的影响.方法2016年2月至2017年5月在该院定期产检的初产妇260人,按是否自愿行孕妇保健操,将未做操的130例设为对照组,自愿练习并每日做操直到临产的130人设为观察组.两组均行常规产检和孕期保健.观察两组负性情绪、分娩方式、孕期体重增长、分娩时BMI及巨大儿发生率.结果观察组焦虑自评量表及抑郁自评量表得分均低于对照组,自然分娩率高于对照组,孕期体重增长及分娩时BMI小于对照组,巨大儿发生率低于对照组;差异均有统计学意义(P<0.05).结论孕妇保健操能减轻初产妇负性情绪,促进孕期体重合理增长,控制分娩时BMI,提高自然分娩率,减少巨大儿发生.

目的 探讨产科护士角色扮演对孕产妇住院体验的影响.方法选择本院产科护士82名作为研究对象,随机分为对照组和体验组,每组各41名,对照组采用常规在职培训管理,体验组采用角色扮演,比较分析两组干预后各相关指标.结果体验组产科护士医患关系认知的各维度评分(除医患关系总体认识外)、孕产妇住院体验满意度的各维度评分均显著高于对照组(p<0.05);体验组孕产妇满意率(95.7％)明显高于对照组(x2=5.890,p=0.015),投诉率(1.7％)明显低于对照组(x2=4.403,p=0.036),差异具有统计学意义.结论角色扮演可增强产科护士的医患关系认知水平,减少投诉率,提高产科孕产妇住院满意度.

目的 通过检测妊娠期糖尿病(GDM)及正常妊娠妇女妊娠早期、健康未孕妇女的血清Betatrophin水平,了解不同代谢状态下血清Betatrophin水平的变化,探讨Betatrophin与糖脂代谢指标、胰岛素抵抗等的相关性,及其与GDM发病的相关性.方法 选择产科门诊进行定期产前检查并在本院分娩的孕妇作为研究对象,均于孕7～13周首次来院进行早期唐氏综合征血清筛查同时预留空腹血标本.根据妊娠24～28周75 g葡萄糖耐量试验(OGTT)结果选取诊断为GDM的孕妇43例,随机选取同期匹配的糖耐量正常孕妇46例为NGT组,另选取健康未孕育龄妇女37例作为正常对照组(NC组),比较3组血清Betatrophin水平和糖脂代谢指标.结果 GDM组及NGT组妊娠早期血清Betatrophin水平均显著高于NC组(P＜0.05);GDM组血清Betatrophin水平显著高于NGT组(P＜ 0.01).Betatrophin与孕期体质量增加量、TG、新生儿出生体重呈正相关(r=0.673、0.658、0.532,均P＜ 0.05).Logistic回归分析显示血清Betatrophin水平是GDM独立危险因素.ROC曲线分析显示血清Betatrophin水平曲线下面积(AUC)为0.772(95％CI:0.677～0.867,P＜0.05);以246.08 pg/ml为界值,GDM的灵敏度为87.1％,特异度为61.9％,阳性预测值为52.9％,阴性预测值为90.7％.结论 孕早期血清Betatrophin升高与GDM发病相关,孕早期高水平的Betatrophin将增加GDM的发病风险,通过对孕早期血清Betatrophin的监测,可以为预测及预防GDM的发生提供依据.

目的:了解温州市5家三甲综合医院助产士核心胜任力状况及其影响因素.方法:采用助产士核心胜任力量表对215名助产士进行调查.结果:温州市5家三甲综合医院助产士核心胜任力最低分为2.18分,最高分为4.70分,平均分为(4.18±0.42)分;不同年龄、婚姻、编制、职称、职务、助产工作年限、助产培训时间、参加学历继续教育、参与教学的助产士核心胜任力总分比较,差异均有统计学意义(P＜0.05),不同学历的助产士核心胜任力总分比较,差异无统计学意义(P＞0.05);多元线性回归分析显示:年龄、婚姻、职称、职务、助产工作年限、助产培训时间等是助产士核心胜任力的影响因素(P＜0.05).结论:温州市5家三甲综合医院助产士核心胜任力属于中等水平,应针对影响助产士核心胜任力的因素,实施针对性的培训和管理,提高助产士的核心胜任力水平.

Objective To explore the relationship between serum adiponectin (APN) concentration and insulin resistance(IR) in elderly pregnancy patients(GDM) with gestational diabetes mellitus.Methods Data of 120 cases of elderly pregnancy patients with gestational diabetes mellitus admitted from Jan.2011 to Dec.2016 were retrospective analyzed.The relationship between serum APN concentration and IR was assayed.Healthy subjects and normal pregnancy patients in our Department were taken as the control.Results The concentration of APN was lower while the CysC,BNP,IGF1,IGF2 and IGFIR were higher in elderly pregnancy patients with gestational diabetes mellitus than those in the control group with a significant difference (P＜0.05).At the same time,Spearman analysis results showed that the serum APN was negatively related with IR while CysC,BNP,IGF1,IGF2 and IGFIR were positively related with IR (P＜0.05).Conclusion Theserumconcentrationofadiponectin and visfatin were negatively related with insulin resistance in elderly pregnancy patients with GDM.

Objective To investigate the clinical value of HPV L1 capsid protein detection combined with cytology in the screening of cervical lesions.Methods Totally 420 cervical exfoliative cytology specimens were collected from November 2014 to November 2016 in Wenzhou Central Hospital.Cytology and expression of HPV L1 capsid protein in these specimens were detected by liquid based cytology test (TCT) and immunocytochemistry,respectively.Furthermore,these results were compared with cervical biopsy which was considered as golden standard.Results In these 420 cases,10 cases (2.38％) were positive for TCT alone,15 cases (3.57％) were positive in HPV L1 capsid protein detection alone.Among them,6 cases (1.43％) were both positive in TCT and HPV L1 capsid protein.Cervical biopsy was performed in patients with positive TCT or HPV L1 capsid protein and 160 patients with both negative detection,and result of biopsy was taken as standard.The sensitivity of TCT was 38.89％ (7/18) and the specificity was 97.95％ (143/146).The sensitivity of HPV L1 protein was 55.56％ (10/18) and the specificity was 96.58％ (141/146).The sensitivity of combined detection of two methods was 94.44％ (17/18),which showed significant difference (P ＜ 0.05),while the specificity was 94.52％ (138/146),which was not statistically different (P ＞ 0.05).Conclusion In the clinical screening of cervical lesions,HPV L1 capsid protein combined with TCT,which showing higher sensitivity and specificity can combine the advantages of these two methods,and complement the insufficiency of each other.They can improve the diagnosis accuracy of cervical lesions,which is worthy of clinical application.

目的 研究亚临床甲状腺功能减退(Subclinical hypothyroidism,SCH)对子痫前期(Preeclampsia,PE)发病及妊娠结局的影响.方法 选取经甲状腺功能筛查诊断为SCH的妊娠妇女339例(SCH组)和正常妊娠妇女1460例(对照组),比较二组子痫前期(PE)的发病率,促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)的水平,每组再分为PE组及正常妊娠组,比较各组妊娠结局.结果 SCH组PE发生率显著高于对照组(P＜0.01);SCH组TSH水平高于对照组,FT4水平、TPOAb阳性率低于对照组,差异均有统计学意义(P＜0.01).SCH组流产、早产率高于对照组,各组的PE组亦高于正常妊娠组,差异均有统计学意义(P＜0.05).结论 SCH会增加PE发病风险,对妊娠不良结局存在影响,SCH合并PE对不良妊娠结局的影响高于单一疾病.

OBJECTIVE To explore the clinical characteristics of nosocomial infections and species ,distribution , and drug resistance of pathogens in department of obstetrics so as to provide guidance for prevention and treatment of the nosocomial infections in the department of obstetrics .METHODS The clinical data of 1 850 puerpera who gave birth in the department of obstetrics from May 2014 to May 2015 were retrospectively analyzed ,then the in‐cidence of nosocomial infections ,infection site ,distribution and drug resistance of pathogens were recorded ,and the statistical analysis of data was performed with the use of SPSS 19 .0 software .RESULTS The nosocomial infec‐tions occurred in 31 of 1 850 puerpera ,with the infection rate 1 .7% ,and 11 patients had upper respiratory tract infections ,accounting for 35 .5% .A total of 47 strains of pathogens were isolated ,of which 44 .7% (21 strains ) were gram‐negative bacteria ,38 .3% (18 strains) were gram‐positive bacteria ,and 17 .0% (8 strains) were fungi . The drug resistance rates of the gram‐negative bacteria to imipenem ,meropenem ,and ciprofloxacin were less than 25 .0% ,while the drug resistance rates to the rest of antibiotics were more than 50 .0% .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing the nosocomial infections in the department of obstetrics .It is of great significance to understand the characteristics of nosocomial infections and drug resistance of pathogens and put forward targeted intervention measures so as to improve the prognosis of the puerpera and neonates .

目的：比较瘢痕子宫与非指征剖宫产孕妇产后并发症发生情况。方法回顾性分析200例剖宫产分娩产妇的临床资料，包括瘢痕子宫妊娠与非指征剖宫产各100例，分析统计产后并发症发生情况。结果瘢痕子宫组盆腔粘连、胎盘植入、子宫破裂、产后出血均高于非指征组（ P＜0．05或P＜0．01），两组切口愈合延迟、产褥期感染发生率差异比较无统计学意义（ P＞0．05）。结论瘢痕子宫妊娠剖宫产并发症显著多于非指征剖宫产。

目的：分析正常孕妇不同孕期血脂水平对胎儿生长发育的影响。方法跟踪随访310例孕周在24～28周的健康孕妇，分别于孕24～28周、孕37～42周临产前测定血总胆固醇（ TC）、甘油三酯（ TG）、低密度脂蛋白-胆固醇（ LDL-C）、高密度脂蛋白-胆固醇（ HDL-C），分析新生儿体格测量指标与孕妇不同孕期血脂测定值的相关性。结果孕24～28周与孕37～42周临产前母血血脂TC、TG、LDL-C均有差异，且后者TC、TG、LDL-C水平较前者显著升高（P＜0．05）。孕24～28周，母血TG与新生儿出生体质量、腹围呈正相关；孕37～42周临产前母血TC与新生儿出生体质量呈正相关，TG与新生儿出生体质量、腹围呈正相关（均P＜0．05）。结论正常孕妇孕晚期血脂较孕中期上升（ HDL-C除外），母血血脂与胎儿生长发育有一定关系。

Objective To evaluate the effect of early gastrointestinal nutrition combined with parenteral nutrition on extrauterine growth of small-for-gestational-age (SGA) infants.Methods From 2011 to 2014, totally 90 cases of SGA infants born in Wenzhou Central Hospital were selected, and they were divided into four groups according to gestational age and birth weight: ≥37 weeks group ( n=12 ) , <37 weeks group (n=78),≥2.5 kg group (n=36) and <2.5 kg group (n=54), respectively.All of them received early enteral nutrition combined with parenteral nutrition support.Biochemical indicators, body weight, head circumference and the time return to birth weight were determined.The incidence of extrauterine growth retardation ( EUGR) was recorded and the feeding tolerance of infants was assessed. Results There were no significant differences in TBIL, CH, TG, BUN, head circumference and weight gain between two groups with different birth weight (t value was 9.009, 9.435, 9.221, 9.758, 10.297 and 9.502, respectively, all P>0.05).The time return to birth weight reduced ( t=6.663,P<0.05) and the incidence of URGR decreased in≥2.5kg group, and the differences were significant (χ2 =5.632,P<0.05).The differences in biochemical indicators (TBIL,CH,TG,BUN) and the incidence of EUGR were not significant between groups with different gestational age (t value was 11.039, 11.445, 10.280 and 10.775, respectively, χ2 =11.457,all P>0.05).Compared with <37 weeks group, the increasing of head circumference and body weight was faster and the time return to birth weight reduced in≥37 weeks group.The differences were significant (t value was 5.647, 4.090 and 3.677, respectively, all P<0.05). No feeding intolerance was found in any cases.Conclusion Early enteral nutrition combined with parenteral nutrition support is helpful to improve the growth and development of SGA.