目的 分析瘢痕子宫剖宫产手术中采用腰-硬联合麻醉(CSEA)与连续硬膜外麻醉(CEA)的效果,为优化麻醉方案提供参考.方法 选取2018年1月至12月秦皇岛军工医院收治的100例瘢痕子宫剖宫产手术患者,将其纳入对照组,另选取2019年1月至12月400例瘢痕子宫剖宫产手术患者,将其纳入观察组进行回顾性分析.对照组患者实施CEA麻醉,观察组患者实施CSEA麻醉,分析两组患者麻醉效果.结果 观察组患者感觉阻滞持续时间、最大感觉阻滞平面、最大感觉阻滞时间优于对照组(P<0.05);观察组患者切皮、娩出胎儿、手术结束等3个时间点视觉模拟评分(VAS)低于对照组(P<0.05);观察组患者手术时间、麻醉起效时间、新生儿娩出时间短于对照组(P<0.05);观察组患者切皮、娩出胎儿、手术结束时平均动脉压(MAP)、心率(HR)低于对照组,动脉血氧饱和度(SpO2)高于对照组(P<0.05);两组新生儿Apgar评分、断脐时间比较,差异无统计学意义(P>0.05).结论 瘢痕子宫剖宫产手术中采用CSEA麻醉效果更加显著,具有起效迅速、阻滞完善等优势,值得临床应用.

目的 探讨不同给药方式对瘢痕子宫剖宫产产妇麻醉效果的影响,为优化麻醉方案提供参考.方法 选取2010年1月至2021年12月秦皇岛军工医院收治的92例瘢痕子宫剖宫产产妇为研究对象进行回顾性分析,所有产妇均采取腰-硬联合麻醉,根据腰椎间隙蛛网膜下腔内不同的给药方式分为常规组(布比卡因单向注射)和试验组(布比卡因双向注射),各46例.比较两组产妇麻醉前(T0)、麻醉后改平卧位即刻(T1)、麻醉后5?min(T2)、麻醉后15?min(T3)及手术结束时(T4)等节点血流动力学指标变化情况;比较两组产妇麻醉效果、围术期指标、麻黄碱使用情况、不良反应发生率及1?min、5?min新生儿阿氏(Apgar)评分情况.结果 试验组产妇在T1时舒张压(DBP)及心率(HR)波动幅度均水平明显低于常规组(P<0.05);试验组产妇术前及术后每节段阻滞平面均低于常规组,剖宫产手术时间、术中出血量及术中补液量均少于常规组(P<0.05);试验组产妇麻黄碱使用率及不良反应发生率显著低于常规组(P<0.05);试验组新生儿1?min内Apgar评分高于常规组(P<0.05).结论 腰-硬联合麻醉中选用布比卡因双向注射给药方式,能够稳定瘢痕子宫剖宫产产妇的血流动力学,提升麻醉效果,改善围术期指标,减少不良反应发生率及麻黄碱使用率,且对新生儿影响小,安全可靠.

目的 探讨双侧子宫动脉灌注甲氨蝶呤及平阳霉素治疗剖宫产瘢痕妊娠(CSP)的临床疗效,以及对阴道出血情况的影响.方法 选取秦皇岛军工医院2018年5月至2020年1月收治的CSP孕妇102例,随机分为观察组和对照组,各51例.两组患者均予注射用甲氨蝶呤,观察组患者加用注射用盐酸平阳霉素,均双侧子宫动脉灌注给药,每日1次,治疗1周.结果 观察组总有效率为92.16％,显著高于对照组的76.47％(P<0.05);观察组患者在治疗后的第1,3,6,12天的β-人绒毛膜促性腺激素(β-HCG)水平均显著低于对照组(P<0.05);治疗期间,观察组患者的阴道出血量显著少于对照组,出血停止时间显著短于对照组(P<0.05);随访期间,观察组患者的孕囊消失时间、β-HCG复常时间、月经复常时间均显著短于对照组(P<0.05);观察组与对照组不良反应发生率相当(13.73％比9.80％,P=0.290>0.05).结论 甲氨蝶呤联合平阳霉素双侧子宫动脉灌注治疗CSP,能迅速降低患者的β-HCG水平,减少阴道出血,改善预后.

目的 研究米非司酮联合双侧子宫动脉灌注甲氨蝶呤(MTX)治疗剖宫产瘢痕妊娠(CSP)的临床疗效,以及对血β-人绒毛膜促性腺激素(β-HCG)水平的影响.方法 选取秦皇岛军工医院2018年1月至2019年1月收治的CSP患者74例,按随机数字表法分为对照组和治疗组,各37例.两组患者均口服米非司酮片,并超声引导下清宫,治疗组患者加用双侧子宫动脉灌注MTX.结果 治疗组有效率为91.89％,显著高于对照组的67.57％(P<0.05);治疗组患者清宫术时间、β-HCG转阴时间、孕囊消失时间、月经恢复时间和住院时间均显著短于对照组(P<0.05);治疗组患者术后的β-HCG水平显著低于对照组,孕酮、雌二醇、黄体生成素、卵泡刺激素水平均显著高于对照组(P<0.05);治疗组不良反应发生率为5.41％,显著低于对照组的24.32％(P<0.05).结论 米非司酮联合双侧子宫动脉灌注MTX治疗CSP,可缩短清宫术时间和β-HCG转阴时间,改善β-HCG水平,且对性激素水平无明显不良影响.

Objective To investigate the value of laparoscopic bilateral uterine artery occlusion combined with hysteroscopic resection in the treatment of cesarean scar pregnancy ( CSP ) . Methods A total of 62 patients with CSP were admitted to this hospital from January 2013 to May 2015.Transvaginal ultrasound was performed for primary screening , and pelvic MRI for diagnosis. Uterine arteries were separated and coagulated during laparoscopic surgery , followed by hysteroscopic surgery .The postoperative serum hCG level tests and ultrasonography examinations were conducted for evaluating the surgical outcomes . Results The procedure was successfully completed under laparoscopy and hysteroscopy without surgical complications or conversions to open surgery in all the cases.The median blood loss was 30 ml (P25:20 ml, P75:100 ml).In 4 patients the intraoperative bleeding reached 600, 600, 800, and 800 ml, respectively, due to large lesions, with blood transfusions requirement in 3 patients.One patient received secondary hysteroscopy due to unsatisfied hCG decrease .The serum hCG levels dropped to normal in 4-75 d (30.9 ±16.9 d) after operation. The menstuation cycles recovered to normal in 20-75 d (34.8 ±11.4 d).During follow-ups for 4-32 months (15.8 ±8.0 months) in 62 cases, 5 patients had subsequent pregnancy , 4 of which had full-term pregnancy and 1 of which experienced CSP again and received hysteroscopic removal of pregnancy . Conclusion Laparoscopic bilateral uterine artery coagulation and hysteroscopic removal of pregnancy is an ideal choice for the treatment of CSP with good outcomes .

Objective To observe the effects of tonifying kidney and spleen herbs on body mass and sex hor-mone levels in perimenopause and menopause women with obesity, and to study the relativity between body mass in-dex ( BMI) and sex hormone levels. Methods 120 perimenopause and menopause women with obesity who had physical examination in our hospital were divided into two groups.60 cases in treatment group were received oral toni-fying kidney and spleen herbs, the control group received no treatment.The body mass, BMI, waist circumference, hip circumference, waist-hip ratio and the level of serum estradiol ( E2 ) , follicle-stimulating hormone ( FSH) and luteinizing hormone ( LH) were compared in two groups.Results After treatment in treatment group, BMI and waist-hip ratio were decreased compared with those in before treatment ( P <0.01, P <0.05), and the improvement was more significant compared with that in control group at the same period ( P <0.01) .The level of E2 after treat-ment in treatment group was significantly increased compared with that in before treatment ( P <0.01), the level of FSH and LH were decreased ( P <0.01), and the improvement was more significant compared with that in control group at the same period ( P <0.01).Conclusion Tonifying kidney and spleen herbs can decrease the BMI and waist-hip ratio in perimenopause and menopause women with obesity, improve the level of sex hormone.

目的：探讨妊娠期糖尿病的诊断及治疗时机对妊娠结局的影响。方法将200例妊娠期糖尿病患者根据诊断及治疗时间分为试验组和对照组各100例。试验组患者于妊娠32周前确诊为妊娠期糖尿病并及时治疗；对照组患者于妊娠32周后（包括32周）确诊并予以治疗。2组患者措施一致，结合对症治疗和整体护理，比较2组患者治疗效果、妊娠结局及并发症情况。结果治疗后2组患者血糖各项指标均有不同程度下降，且试验组指标下降幅度均大于对照组，差异均有统计学意义（ P＜0．05）。试验组自然顺产率高于对照组，分娩并发症较对照组显著降低，差异均有统计学意义（ P＜0．05）。结论妊娠期糖尿病的早期诊断和治疗有助于患者血糖水平控制，提高自然顺产率，降低分娩并发症和分娩不良结局的发生率。

目的：探讨妊娠不同时期给予胰岛素治疗对妊娠期糖尿病（GDM）患者分娩结局的影响。方法选取该院2012年1月-2014年3月收治的 GDM 患者200例，按治疗时期分为妊娠中期组和妊娠晚期组各100例。对所有患者进行常规治疗和护理，分别在妊娠中期、晚期患者给予相应胰岛素治疗。治疗后密切随访观察，比较2组患者血糖水平及不良分娩结局发生情况。结果妊娠中期组空腹血糖、餐后2h 血糖低于妊娠晚期组，酮症酸中毒患者和妊高征患者的比例均低于妊娠晚期组，差异均有统计学意义（P ﹤0.05）。2组妊娠孕周、胎盘早剥率、不良围生儿率、巨大儿以及围生儿出生体质量方面差异有统计学意义（ P ﹤0.05）。结论 GDM 患者应早期给予胰岛素治疗，可更有效地降低血糖，减少不良分娩结局的发生。