产后腹痛属生理现象,一般不需治疗,但若腹痛加剧,难以忍受,影响产妇康复时应予治疗[1].中医学认为产后腹痛多因气血运行不畅所致,因此治疗应以活血化瘀、益气补血为主,用以缓解临床症状[2].中药督脉熏蒸疗法是利用中草药煎煮产生药气熏蒸,借热力和药力刺激督脉,使毛孔扩大,将人体内寒湿等病邪从毛孔透出体外,被广泛用于腰痛、慢性盆腔炎等疾病的治疗,但其在产后腹痛中的效果有待进一步验证[3].

目的 探讨督脉熏蒸疗法在自然分娩产妇早期康复中的应用效果.方法 选取2022年1月-2022年8月在嘉兴市妇幼保健院分娩的900例产妇为研究对象,按照随机抽签的方式分为了对照组A、对照组B及观察组,每组300例.对照组A按照产后常规管理,不予康复治疗;对照组B给予热敷、按摩等康复治疗干预;观察组给予督脉熏蒸疗法干预.比较3组产妇产后康复指标、子宫收缩疼痛程度、腰背疼痛程度、绒毛膜促性腺激素(HCG)及性激素[卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E2)],记录不良反应发生情况.结果 观察组产妇产后泌乳时间、总住院时间、HCG转阴时间及恶露消退时间均短于对照组A和对照组B,差异有统计学意义(P＜0.05).产后3d,观察组产妇子宫收缩程度和腰背疼痛程度明显低于对照组A和对照组B,差异有统计学意义(P＜0.05).产后3d,观察组产妇HCG水平低于对照组A和对照组B(P＜0.05).产后3 d,3组产妇FSH、LH及E2水平均明显降低,但观察组产妇FSH、LH及E2水平的降低幅度较小,FSH、LH及E2水平高于对照组A和对照组B(P＜0.05).3组产妇不良反应发生情况(0vs.1.3％vs.0.7％)比较差异无统计学意义(P＞0.05).结论 督脉熏蒸疗法在自然分娩产妇早期康复中的应用效果显著,有助于缓解产妇产后子宫收缩疼痛和腰背疼痛,促进产后快速康复.

目的 探讨"互联网+孕产妇群组"管理模式在门诊的应用效果.方法 选取 2020 年 11 月至 2021 年 4 月传统就诊模式期间的孕产妇与 2021 年 11 月至 2022 年 4 月"互联网+孕产妇群组"管理模式运行时就诊的孕产妇作为研究对象.比较两时间段候诊时间、预约就诊率、产科门诊孕产妇满意度与孕妇学校听课人数.结果 传统就诊模式下候诊时间为(30.00±5.24)min,预约就诊率为 73.2%,孕产妇满意度 89.5 分,孕妇学校听课数中位数为 500 人;"互联网+孕产妇群组"管理模式下候诊时间为(17.00±3.09)min,预约就诊率为 86.3%,孕产妇满意度 93.7 分,孕妇学校听课数中位数为665 人.结论 "互联网+孕产妇群组"管理模式能缩短候诊时间,提高门诊工作效率,提升门诊医疗服务质量.

目的:探讨耳穴贴压联合穴位按摩对剖宫产术后母婴分离乳汁分泌情况的影响.方法:选取我科2019年6月至12月未开展耳穴贴压和穴位按摩的剖宫产母婴分离患者48例为对照组,选取2020年1月至6月剖宫产母婴分离患者52例为观察组,对照组给予常规护理,观察组在对照组基础上给予耳穴贴压联合穴位按摩.比较两组临床疗效、泌乳情况、首次泌乳时间、产后3d、产后7d乳房胀痛疼痛评分.结果:观察组总有效率94.23％,较对照组72.92％更高,有显著性差异(P<0.05);观察组泌乳始动时间、首次泌乳时间、产后7d乳房胀痛疼痛评分均低于对照组;观察组产后24h、产后96h、产后7d的充足泌乳均高于对照组(P<0.05);结论:耳穴贴压联合穴位按摩可使泌乳启动时间提前,从而明显改善产妇的泌乳状况,减少产后乳房胀痛,提高充分泌乳的比例.

先天性心脏病(CHD)是最常见的出生缺陷,由于产前超声和产前诊断的不断发展,产前诊断出的CHD越来越多,到目前为止绝大多数CHD的病因尚不清楚.基因组技术的迅猛发展得以发现一部分CHD的遗传学病因,但是同时也发现了CHD遗传原因的复杂性.本综述将重点阐述CHD遗传病因的研究进展.

目的 探究产妇分娩时开展拉玛泽呼吸减痛分娩法的效果及意义.方法 45例产妇,根据其入院时间先后顺序分为对照组(23例)和观察组(22例).对照组产妇行常规分娩干预,观察组产妇行拉玛泽呼吸减痛分娩法.对两组产妇分娩疼痛情况、妊娠结局进行比较.结果 观察组产妇分娩疼痛情况明显优于对照组,差异具有统计学意义(P＜0.05).观察组产妇的剖宫产率18.18％显著低于对照组的56.52％,差异具有统计学意义(P＜0.05).观察组产妇的不良妊娠结局总发生率为9.09％,显著低于对照组的34.78％,差异具有统计学意义(P＜0.05).结论 拉玛泽呼吸减痛分娩法可有效缓解产妇分娩疼痛程度,减少不良妊娠结局发生率,对保证母婴安全具有重要作用,可在临床中推广应用.

目的 探讨助产士见面会对低危孕妇心理状态及分娩结局、满意度的影响.方法 该院门诊建卡并定期产检的低危孕妇, 随机分为试验组与对照组各50例.试验组除接受常规的产科门诊检查外, 孕32周开始还参加助产士见面会;对照组仅行常规产前门诊护理.比较两组不同时期的心理状态及分娩结局.结果 对照组分娩前的焦虑得分及剖宫产率均高于试验组, 差异有统计学意义(P<0.05) .结论 助产士见面会可降低产妇分娩前的紧张、焦虑程度, 提高自然分娩率及对护理的满意度.

目的 探究醋酸甲羟孕酮治疗非典型子宫内膜增生的临床疗效.方法 68例非典型子宫内膜增生患者,根据入院时间先后顺序分为对照组及观察组,各34例.对照组患者给予戊酸雌二醇治疗,观察组患者给予醋酸甲羟孕酮治疗,比较两组患者临床疗效及治疗前后月经失血图评分法(PBAC)及子宫内膜厚度.结果 治疗前,两组患者PBAC评分及子宫内膜厚度比较,差异无统计学意义(P>0.05);治疗后,观察组患者PBAC评分低于对照组,子宫内膜厚度小于对照组,差异具有统计学意义(P<0.05).观察组患者总有效率为94.12％,显著高于对照组的76.47％,差异具有统计学意义(P<0.05).结论 非典型子宫内膜增生患者行醋酸甲羟孕酮片治疗效果显著,可有效改善患者月经量过多情况,降低子宫内膜厚度,促进患者子宫功能恢复,值得在临床中推广应用.

目的 评估“袋鼠爸爸式护理”对剖宫产新生儿生长发育、生命体征等的影响.方法 将120例剖宫产新生儿按随机数字法分为观察组(“袋鼠爸爸式护理”)60例与对照组(常规护理)60例.评估两组新生儿的神经行为功能、身体发育(头围、体质量、身高的增长)、生命体征(心率、呼吸、血氧饱和度)、情感需求及总胆红素.结果 与护理前相比,两组新生儿的神经行为功能、身体发育、生命体征、情感需求均得到显著的改善(P均＜0.05);经过护理后,观察组神经行为功能、身体发育、生命体征、情感需求的改善明显优于对照组(P均＜0.05).结论 对剖宫产新生儿采用“袋鼠爸爸式护理”能促进其生长发育.

目的:针对产后尿潴留患者使用产后康复综合治疗仪的治疗效果进行研究分析.方法:选取增城区中新镇中心卫生院2016年2月至2017年12月收治的病例数共计180例,按照随机数字表法分为观察组(n=90)和对照组(n=90),对照组患者实施常规治疗,观察组患者使用产后康复综合治疗仪治疗,比较分析两组患者临床指标、治疗效果及不良反应发生率.结果:观察组患者在排尿初始时间和导尿例数均低于对照组,产后初始尿量高于对照组,组间比较,差异具有统计学意义(P＜0.05);观察组患者治疗总有效率为97.78％,对照组患者治疗总有效率为76.67％,观察组明显高于对照组,组间比较,差异具有统计学意义(P＜0.05);两组患者不良反应发生率,组间比较,差异无统计学意义(P＞0.05).结论:产后尿潴留患者使用产后康复综合治疗仪治疗效果显著,能够明显缩短排尿初始时间,提高产后初始尿量,安全性较高.

ObjectiveTo study the clinical effect of the Rivanol in combination with mifepristone on induced labor after cesarean Section in late pregnancy.MethodThe 80 women after cesarean section who need induced labor in late pregnancy were divided into observation group(40 cases) and control group(40 cases),the observation group were fi rstly given mifepristone to take orally,then the Rivanol was used for amniotic cavity injection,however the control group simply used the Rivanol to induce Labor.ResultThe observation group was better than the control group in the total labor time,duration of induction,placenta adhesion,defect of membranes and the amount of bleeding within 24 hours after Labor induction, the difference was statistically signifi cant(P<0.05 orP<0.01).ConclusionRivanol combined with mifepristone for labor induction of scarred uterus is an ideal,safe,effective method,can alleviate the pain of patients,is worthy of clinical application.

目的:探讨妇产科护理人员面对的职业危险因素,并探讨针对性的防范管理措施.方法:加强护理人员职业安全教育,提高自我保护意识;定制完善的防护制度,规范防范措施;营造护理安全文化,保证身心健康.结果:采取相应的防范措施,避免职业危险因素造成的伤害,保证护理人员身心安全.结论:充分了解妇产科护理人员临床工作中存在的职业危险因素,根据危险因素制定有效的防范措施,以保护护理人员免受危险因素损伤.

Obj ective To observe the effect of continuous epidural labor analgesia combined with nursing supports on puerpera.Methods By convenience sampling,450 cases were selected and equally divided into A,B,C three groups. Group A received continuous epidural labor analgesia combined with nursing supports including verbal communication, emotional support,Lamaze breath,and posture intervention.Group B received only epidural labor analgesia and other routine nursing.Group C was not received epidural labor analgesia in second stage until end and other routine nursing supports.Time of second stage of labor,delivery outcome,and the visual analog scale (VAS )pain scores at 1 .0 cm (T1),3.0 cm (T2),10.0 cm cervical dilation(T3),delivery (T4)and perineal trauma repair (T5)were recorded.Results There was no statistical significance of VAS scores in T1,T2 and T3 among three groups (all P>0.05).The VAS score in T4 and T5 of group A and B were significantly lower than group C (P<0.05).The duration of second stage of labor in group A and C were significantly shorter than group B (all P<0.01).The nature birth rate in group A was higher than group B and group C (all P<0.01).The analgesic satisfaction rate in group A and B were significantly higher than group C (all P<0.05).Conclusions Continuous epidural labor analgesia combined with nursing supports can promote nature birth,which is safe for mother and child.

目的：探讨改良连续性助产服务模式对降低无医学指征孕妇要求剖宫产（CDMR）的影响。方法选择2013年6月至2014年6月分娩的产妇509例，以产妇自愿为原则将产妇随机分为观察组255例与对照组254例。观察组产妇自孕28周起在整个围生期接受改良连续性助产服务，对照组接受常规的产前检查和护理。比较两组孕妇孕晚期选择分娩方式意向、实际分娩方式以及CDMR率。结果观察组孕37周分娩意向选择自然分娩、剖宫产和意向不定的比例分别为93.73％、4.71％和1.56％；而对照组分别为68.11％、20.87％和11.02％，与对照组比较，观察组孕妇选择剖宫产意向的比例下降明显（P<0.01）。实际分娩结局产妇剖宫产率及CDMR率观察组为21.18％、1.57％，对照组为40.55％、9.84％，两组产妇剖宫产率及CDMR率比较差异有统计学意（P<0.01）。结论改良连续性助产服务模式能使产妇更易接受自然分娩，有效降低CDMR，值得临床推广。

To explore the feasibility and effects of Cook balloon cervical dilator on full-term nulliparous parturients under epidural analgesia.The observation group (n =40) received Cook balloon cervical dilation under epidural analgesia.However, the control group (n =40) had no epidural analgesia.Latent phase of labor was shorter in observation group than that in control group [(198.7 ± 65.7) vs.(242.9 ± 78.9) min, P ＜0.05].And the incidence of cesarean section and perineal laceration was lower under epidural analgesia(8％ vs.15％, 45％ vs.50％ respectively).There were no effects on success rate of induced labor in neither group.Cook balloon could shorten latent phase of labor, relieve the pain of parturients and increase no infection rate [leukocyte count : (8.82 ± 2.74) × 109/L vs.(9.10 ± 3.06) × 109/L, C-reactive protein: (4.73 ±0.87) mg/L vs.(4.82 ±0.90) mg/L respectively].It is worth wider clinical popularization.

目的 探讨改良会阴麻醉预防无保护会阴助产会阴损伤的效果.方法 将400例自然分娩的单胎头位初产妇随机分为观察组和对照组各200例.对照组按无保护会阴助产法助产;观察组在无保护会阴助产前实施双侧阴部神经阻滞麻醉联合外阴多点麻醉.比较两组产妇会阴侧切率及会阴裂伤情况.结果 观察组产妇会阴完整率显著高于对照组、会阴侧切率显著低于对照组、会阴裂伤程度显著轻于对照组(均P＜0.01).结论 无保护会阴助产前实施改良会阴麻醉,可有效降低会阴侧切率和会阴裂伤程度.

Objective To explore the feasibility and effect of Cook balloon cervical dilator with epidural analgesia on full-term nulliparous parturients. Methods A total of 80 nulliparous parturients in Jinxing Maternity and Child Health Care Hospital from March 2013 to August 2014 were selected as study objects, and they were randomly divided into two groups, observation group (n=40) were received Cook balloon cervical dilator combined with epidural analgesia and control group (n=40) were received no epidural analgesia. The stage of labor, delivery outcome, parameters of hemody-namics, haemorrhage, Apgar scores of neonate and side effects were recorded. WBC and hypersensitive C-reactive pro-tein of puerperas prenatal and after delivery were measured and blood gas analysis of umbilical artery blood of new-borns was carried. Results Latent phase of lalor was shorter in observation group than in control group [(196.60±65.48) v s (242.80±78.62) min] (P< 0.01). Moreover, the pain was relieved obviously. There were no significant differences in other labor duration, delivery outcome, haemorrhage, and Apgar scores between two groups (P> 0.05). SBP, DBP, HR of two groups had statistically significant differences (P<0.05 or P<0.01); 0.5, 1, 2, 3, 4 h after given medicine and the end of delivery, VAS scores of the observation group were significantly lower than those of the control group, the differences were statistically significant (P< 0.05 or P< 0.01). Conclusion Cook balloon can shorten latent phase of lalour, relieve the pain of parturients and not increase infection rate, it is worth the clinical application.

Objective To explore the serum level of neuron towards axon guidance factor-1 (Netrin-1) in pregnancies complicated by fetal growth restriction(FGR),and investigate the mechanism of Netrin-1 in fetal growth restriction.Methods A total of 73 consecutive cases of pregnant women from June 2013 to June 2014 in our hospital were analyzed.The 28 pregnant women with fetal growth restriction diagnosed by ultrasonography were served as test group,among them 18 cases were in the midtrimester,10 cases in the third trimester.The corresponding 45 pregnant women were treated as control group,among them 10 cases were in the first-trimester,23 cases in the midtrimester and 12 cases in the third trimester.The serum levels of Netrin-1 were detected in all pregnant women and the fetal karyotype were analyzed in the corresponding fetus.Results There were 72 cases with normal karyotype,only one was 18 trisomy syndrome.The maternal serum level of Netrin-1 in normal early pregnancy,medium term pregnancy and term pregnancy were (220.25 ± 10.72)pg/ml,(23.10 ± 1.08) pg/ml and (1000.62 ± 98.14) pg/ml,respectively.The maternal serum level of Netrin-1 in medium term pregnancy and term pregnancy complicated by fetal growth restriction were (22.24 ± 0.96)pg/ml and (35.13 ± 0.96) pg/ml.Compared with the levels in the early pregnancy and medium term pregnancy,the maternal serum level of Netrin-1 in term pregnancy was higher(P ＜ 0.05),but there were no significant differences between the two groups with mediumterm pregnancy(P ＞ 0.05),and the maternal serum level of Netrin-1 in term pregnancy were decreased significantly than the normal term pregnancy (P ＜ 0.05).Conclusion The maternal serum level of Netrin-1 may be involved in the development of fetal growth restriction,especially in term pregnancy,and fetal chromosomal abnormalities maybe also take part in it.

“导乐”一词出自希腊文“Doula”，专司指导孕妇进行顺利自然地分娩，于1996年在美国最早开展。它体现了“以人为本”，以产妇为中心的人性化服务。旧的分娩模式把孕产妇患者化，把自然分娩过程医疗化，且阴道分娩产痛对于孕产妇来说又是一种持久而强烈的疼痛，同时对胎儿的过分担心，往往使产妇在阴道分娩过程中产生恐惧感等，导致产程延长，胎儿宫内窘迫，致使剖宫产率上升。我院在孕妇阴道分娩过程中，给予镇痛分娩使其在生理上减轻疼痛，导乐陪伴分娩在心理、精神等方面给予支持帮助，使产妇在安心，愉快中顺利完成阴道分娩。导乐陪伴联合镇痛分娩，两者有机结合在一起，相互作用，在改善分娩质量及减少产后并发症取得了较好疗效，现报道如下。