目的 探讨静脉滴注青霉素钠治疗妊娠合并梅毒对妊娠结局及新生儿感染的影响.方法 选择天津市第二人民医院妇产科2012年10月至2013年6月收治的妊娠合并梅毒患者109例,根据孕期治疗情况,将患者分为孕早期治疗组(44例)、孕中晚期治疗组(47例)和未治疗组(18例).采用x2检验比较各组的妊娠结局、新生儿感染情况.结果 孕期监测RPR,Ⅰ、Ⅱ期梅毒RPR下降明显,隐性梅毒下降缓慢.早产、流产及死胎等不良妊娠结局的发生率在孕早期治疗组、孕中晚期治疗组及未治疗组分别为0％,17.02％和44.44％.新生儿的感染率分别为0％,14.29％和76.92％,经统计学处理差异有统计学意义.新生儿经治疗后,严密随访,RPR均于6～12个月转为阴性.结论 及早、规范、足量的抗梅毒治疗是改善妊娠结局、新生儿预后及降低先天梅毒发生率的关键.

目的:探讨乙肝免疫球蛋白(HBIg)联合替比夫定对乙肝表面抗原(HBsAg)阳性孕妇母婴传播的阻断效果.方法:根据自愿原则将该院产科门诊收集的330例HBsAg阳性、HBV-DNA定量≥1×106 copies/ml孕妇分为研究组(246例)和对照组(84例),研究组孕妇分别于孕第28、32、36周注射200 IU HBIg,同时口服替比夫定至分娩,对照组孕妇仅注射HBIg,未口服替比夫定.两组新生儿均出生后注射200 IU HBIg,分别于出生后6h、第1个月、第6个月注射乙肝疫苗10 μg,比较两组新生儿出生后及出生1年后的免疫学指标差异.结果:对两组新生儿的出生体重、身长、1 min Apgar、性别等指标情况进行统计分析差异无统计学意义(P＞0.05),研究组新生儿的宫内感染率为6.1％显著低于对照组的16.67％ (x2 =8.727,P=0.003),研究组新生儿的HBV-DNA阳性率为1.22％显著低于对照组的11.9％(x2=18.893,P=0.000),研究组新生儿的HBsAb阳性率为22.36％显著高于对照组的4.76％(x2=13.205,P=0.000),研究组的HBsAb阳转率为95.8％显著高于对照组的87.5％(x2=6.281,P=0.012).结论:HBIg联合替比夫定能够有效阻断高病毒载量HBsAg阳性孕妇的母婴传播.

OBJECTIVE:To determine the effective dose of hepatitis B immunoglobulin (HBIG) for clearing maternally-transmitted hepatitis B virus (HBV) from a newborn.METHODS:Full-term neonates born to HBV-infected mothers were tested for hepatitis B surface antigen (HBsAg) and HBV DNA in venous blood, Individuals with positive results within two hours after birth were selected for study, and divided among two treatment groups: research group receiving HBIG continually adjusted to quantitative levels of neonatal HBsAg and HBV DNA levels; control group receiving standard HBIG 200IU dose. All neonates were also treated with 10 micrograms of recombinant vaccine. The decreases in HBsAg and HBV DNA over 12 months were comparatively analyzed between the two treatment groups.RESULTS:The two treatment groups (HBIG adjusted vs. standard) were statistically similar in Apgar score (9.38+/-0.49 vs. 9.37+/-0.48), neonate body weight (3458.67+/-374.93 vs. 3558.61+/-322.85 g), maternal age (26.33+/-3.63 vs. 25.33+/-3.03), and initial HBsAg and HBV DNA levels (rank sum test Z = 1.381, and Z = 0.700, respectively) (all, P more than 0.05). Successful clearance of HBV infection within 12 months was achieved in significantly more neonates in the HBIG adjusted therapy group than in the standard therapy group (82.8% vs. 57.4%; x2 = 9.696, P less than 0.05).CONCLUSION:Adjusting the neonatal HBIG dose according to HBsAg and HBV DNA levels can improve the success rate of clearing maternally-transmitted HBV.

目的提高以头孢唑啉为主短程策略预防剖宫产手术部位感染的实施情况。方法制定有循证基础的以一代头孢菌素为主短程预防剖宫产手术部位感染抗菌药物预防性使用指南(以下简称《指南》)。2009年9月～2011年8月对某院妇产科全部剖宫产病例进行前瞻性手术部位感染监测,并每月对围手术期预防性抗生素使用情况进行反馈。自2010年3月～2010年8月进行干预。结果干预前、干预中、干预后预防剖宫产手术部位感染的抗菌药物使用对《指南》的依从率逐步提高,分别为20.80%,63.34%,90.91%,P<0.001;手术部位感染分别为0.73%(2/274),1.06%(3/284),0.00%(0/550),P<0.01;抗菌药物费用下降,分别为83.36(48.6,145.80),6.30(2.10,72.90),2.10(2.10,6.30)元,P<0.001。结论对短程应用以头孢唑啉为主预防剖宫产术后感染指南的依从性在干预下明显提高,安全经济。

Objective: To evaluate the effect of short-term prophylactic antibiotics (24 h) on prevention maternal/neonatal infectious morbidity of cesarean section in patients with pelvic inflammatory disease (PID). Methods: Two hundred and twenty-seven patients with PID were collected from patients with cesarean section. Patients were divided into 2 groups according to the short-term prophylaxis (24 hours, n=109) or long-term prophylaxis (48 hours, n=118). It was compared between the two groups including maternal trimester, body mass index, white blood cell count before surgery primipara,premature rupture of membranes,pregnancy-induced hypertension syndrome and surgical site infection(SSI),postoperative endometritis,puerperal morbidity,hemogram,frequency and cost of antibiotic defined daily dose(DDDs), neonatal score and infection. Results: There were no significant differences in the basic data, before operation, duration of surgery and blood loss during surgery between two groups (P 0.05). Also there were no significant differences in the incidence of SSI, endometritis, puerperal morbidity and hemogram between two groups (P 0.05). It was found that the DDDs of short-term antibiotic prophylaxis strategy was 1/7 DDDs of long-term one (P 0.01), but no significant difference was found in the neonatal score and infection between two groups (P 0.05). Conclusion: The effect of short-term (24 hours) prophylaxis by cefazolin or combined with metronidazole was equivalent to the long-term strategies ( 48 h) in pelvic inflammatory diseases, with a decreased antibiotic usage and cost.

OBJECTIVE To evaluate the clinical effect on prophylactic antibiotics in cesarean delivery.METHODS The intervention including evidence-based guideline of prophylactic use of antimicrobial for cesarean section single-dose of the first generation cephalosporins at cord clamping was performed to increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction.A retrospective investigation of antimicrobial consumption,endometritis,surgical site infections(SSIs)and postoperative incidence between the pre and post operation were performed randomly to comparison of the intervention.RESULTS The SSIs rates before and after the intervention were 1.54%,and the incidence rates of post intervention were 3.08% and 2.31%,respectively.There was about 90% cost reduction in prophylactic antimicrobial use on average per cesarean section after the intervention(RMB 179.79±51.79 to RMB 14.96±15.19,P=0.00).CONCLUSION The intervention of the first generation of cephalosporins by single-dose use administrated after cord clamping is safe and more unexpensive compared with the previous stractegy of third generation of cephalosporin plus metronidazde long use.

目的 探讨HBV感染母亲所产婴儿HBV感染情况以及生后免疫效果.方法 以新生儿出生2 h内静脉血定量检测HBsAg作为新生儿HBV感染指标,治疗组新生儿在出生后0、1、4、6个月使用重组乙型肝炎疫苗(酵母)各一次,每次10 μg,乙型肝炎免疫球蛋白用量根据新生儿出生后即刻检测结果而定,使新生儿体内的抗-HBs水平达到500～600 U/L,6个月龄评价疗效;与以未针对性免疫的6个月龄婴儿作为对照组进行比较.结果 治疗组共纳入1 460例婴儿,189例出生后感染,6个月龄时15例HBV阳性,占1.0%;对照组共纳入653例,6个月龄时64例HBV阳性,占9.8%(P＜0.01).结论 生后免疫在阻断HBV母婴传播方面有一定意义.

Objective: In order to cut off validly HBV from mother to new born, it is divided into different types according to the embryo acquired HBV-markers and HBV DNA degrees. Methods: HBV-markers and HBV DNA were tested for 831 new born within 2 hours from 825 HBsAg positive mothers and divided into 5 types in order to run several immunity methods of HBIG(hepatitis B immunity globulin ) and hepatitis B vaccine. Six hundred and sixty five new born as a treatment group and control group of 166 were retested in 7～8 month old. Results: The immunity effect were significant different between the treatment and control groups(P 0.05). Conclusion: The effect of running immunity according different types is better than the traditional immunity. It is an important step to prevent HBV from morthers to their infants effectively.

Objective:To explore the spread pathway, relative factors, and treatment of HBV intrauterine infection of HBV during pregnancy.Methods:Serous HBV -markers and HBV-DNA were detected in 498 newborns whose mothers' HBsAg were positive. According to the results of HBV-DNA and the use of HBIG, the pregnant women were divided into 4 groups.Results:The intrauterine infection of HBV was 39.6%in 283 pregnant women with HBV-DNA positive, and 13.5%in 215 pregnant women with HBV-DNA negative. There was a significant difference between two groups. There was no correlation in the use of HBIG. Conclusion: The intrauterine infection is relative to HBV-DNA positive.There is no effect with the use of HBIG to prevent HBV infection during pregnancy.

Objective:To explore the effective method for the treatment of chronic hepatitis B.Methods:Thirty_six chronic hepatitis B patients with a family history of chronic hepatitis B were treated with interferon_γ(IFN_γ)for3months,and38chronic hepatitis B patients without the treatment of IFN_γas control.Results:HA,LN,IV_C,and PcIII significantly decreased in IFN_γtreatment group.There was a significant difference in HbeAg and HBV_DNA negative change,levels decrease,improving rate of A/G,reducing diameter of portal,and the recurrent rate of chronic hepatitis B between two groups(P0.05).Conclusion:Interferon_γis an effective drug in treating chronic hepatitis B.