目的 观察液氮冷冻孕妇宫颈尖锐湿疣的疗效及对分娩结局的影响,旨在为患者提供安全有效的治疗方法.方法 选取2016年12月-2018年10月嘉兴市妇幼保健院收治并确诊的宫颈尖锐湿疣孕妇106例为研究对象,分为对照组和观察组,每组53例.对照组予以聚甲酚磺醛溶液治疗,观察组予以液氮冷冻治疗,治疗结束后评估两组疗效及分娩结局.结果 观察组痊愈率(79.25％)明显高于对照组(39.62％),差异有统计学意义(P＜0.05);对照组复发率(22.64％)明显高于观察组(5.66％),差异有统计学意义(P＜0.05);观察组剖宫产率(18.87％)明显低于对照组(58.49％),自然分娩率(81.13％)明显高于对照组(22.64％),两组分娩结局比较差异均有统计学意义(均P＜0.05);对照组新生儿窒息率(13.21％)、胎儿宫内感染发生率(16.98％)明显高于观察组(1.89％、3.77％),差异均有统计学意义(均P＜0.05);观察组新生儿Apgar评分(8.92±2.05)分明显高于对照组(6.17±1.24)分,差异有统计学意义(P＜0.05);两组好转率(32.08％ vs.20.75％)、胎膜早破发生率(13.21％ vs.5.66％)比较差异均无统计学意义(均P＞0.05);观察组不良反应发生率(13.21％)与对照组(7.55％)比较差异无统计学意义(P＞0.05).结论 液氮冷冻法治疗孕妇宫颈尖锐湿疣,有助于提高患者治愈率,降低复发率,有效改善孕妇分娩结局及新生儿状况,安全性高,值得临床推广应用.

Objective: To explore the application value of multiple disciplinary team Enhanced recovery after surgery (MDT-ERAS) in cesarean section and evaluate its health economic benefits. Methods: A total of 572 cases of pregnant women undergoing cesarean section in obstetrics department of Jiaxing Maternity and Child Health Care Hospital from March 2018 to March 2019 were selected and randomly divided into experimental group and control group, 286 cases in each group. The control group was treated with traditional rehabilitation mode, and the experimental group was treated with MDT-ERAS intervention to compare the difference of rehabilitation index and health economics index between the two groups, and to evaluate the application value and health economics benefit of MDT-ERAS. Results: The VAS scores of the two groups at 1 day after operation were higher than those at the time of returning to the ward after operation(1.81±0.40 VS. 1.58±0.39, 3.78±0.89 VS. 3.22±0.83, all P<0.05). The VAS scores at 2 days and 3 days after operation were lower than those at the time of returning to the ward(0.58±0.09 VS. 1.58±0.39, 1.02±0.15 VS. 1.58±0.39; 1.88±0.37 VS. 3.22±0.83, 2.67±0.44 VS. 3.22±0.83, all P<0.05). The VAS scores of the experimental group at each time point after operation were lower than those of the control group(1.58±0.39 VS. 3.22±0.83, 1.81±0.40 VS. 3.78±0.89, 1.02±0.15 VS. 2.67±0.44, 0.58±0.09 VS. 1.88±0.37), and these differences were statistically significant (P<0.05). The anal exhaust time, indwelling catheterization time, first time out of bed and first time eating time of the experimental group were lower than those of the control group, with statistical significance (P<0.05). Postpartum hemorrhage rate and neonatal milk addition rate in the experimental group were significantly lower than those in the control group (all P<0.05). The hospitalization time and hospitalization expenses of the experimental group were lower than those of the control group(all P<0.05), and the health economics benefit of the experimental group was significantly higher than that of the latter (P<0.05). Conclusion: MDT-ERAS can effectively improve the recovery rate of the parturient after cesarean section, ensure the analgesic effect and improve the maternal and infant outcomes, and has higher health and economic benefits, which is worthy of promotion.

目的 分析剖宫产后瘢痕子宫再次妊娠分娩方式的临床选择及安全性.方法 选取2016年7月-2018年1月该院收治的剖宫产后瘢痕子宫再次妊娠产妇110例为研究对象,分析剖宫产后瘢痕子宫再次妊娠产妇分娩方式的选择情况,比较不同分娩方式产妇的分娩结局(包括住院天数、平均出血量、初次母乳喂养时间、新生儿Apgar评分)及并发症发生情况.结果 110例产妇中有38例阴道分娩、72例剖宫产分娩(包括19例阴道试产失败转为剖宫产).阴道分娩组产妇住院天数、平均出血量、初次母乳喂养时间均小于剖宫产组,差异均有统计学意义(均P＜0.05).两组新生儿Apgar评分比较,差异无统计学意义(P＞0.05).阴道分娩组产妇并发症总发生率低于剖宫产组,差异有统计学意义(P＜0.05).结论 剖宫产后瘢痕子宫再次妊娠分娩方式的选择应该在密切监测产程、严格掌握经阴道分娩指征的前提下进行,经阴道分娩安全可行.

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 观察妊娠期糖尿病患者会阴无保护改良产钳助产法对母儿临床结局的影响.方法 选取2014年10月~2016年9月于嘉兴市妇幼保健院采用会阴无保护改良产钳助产法终止妊娠的的23例妊娠期糖尿病产妇为研究组,取同期采用传统产钳接生法的23例妊娠期糖尿病产妇作为对照组,回顾性分析两组临床资料,比较两组产妇新生儿窒息率,产妇产后出血、会阴Ⅱ度、Ⅲ度裂伤、产后抗生素使用率、产后尿储留、产后l~2d会阴水肿疼痛发生率、产后平均住院时间及住院费用等.结果 两组新生儿窒息率无明显差异,两组产妇会阴Ⅱ度、Ⅲ度裂伤、产后尿储留及产后1~2d会阴水肿疼痛发生率亦无明显差异;但研究组产后出血、产后抗生素使用率、产后平均住院时间及住院费用均显著少于对照组(P均<0.05).结论 会阴无保护改良产钳助产法简化了操作流程,但减少了妊娠期糖尿病母婴并发症,并有利于产后恢复,值得临床推广.

目的 探讨剖宫产术后出血患者经不同给药方案治疗后收缩压(SBP)、舒张压(DBP)、心率(HR)变化及临床意义.方法 选取我院2015年1～12月行子宫下段剖宫产术的60例足月妊娠孕妇,按给药治疗方式不同分为对照组和观察组各30例.其中对照组患者使用缩宫素宫体注射治疗,观察组患者行卡前列素氨丁三醇宫体注射治疗.观察两组患者给药后10 min较给药前SBP、DBP、HR的变化情况以及产中、产后2h和产后24h的出血量及不良反应发生率.结果 两组患者用药10 min后与用药前相比,SBP、DBP及HR均明显升高,差异有统计学意义(P＜0.05).与对照组比较,观察组患者SBP、DBP及HR升高更为显著,差异有统计学意义(P＜0.05).两组患者出血量比较,观察组患者于产中、产后2h及产后24 h出血量均显著低于对照组,差异有统计学意义(P＜0.05).两组患者的不良反应情况比较差异无统计学意义(P＞0.05).结论 卡前列素氨丁三醇治疗剖宫产术后出血可积极改善患者SBP、DBP及HR等生理指标,减少产后出血量,具有积极的临床意义.