目的 探讨运动-饮食综合干预联合硝苯地平和依诺肝素钠对重度子痫前期孕妇胎盘生长因子(placental growth factor,PLGF)、同型半胱氨酸(homocysteine,Hcy)和血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响.方法 选取2018年6月至2020年6月首都医科大学宣武医院收治的200例重度子痫前期孕妇为研究对象,采用随机数字表法将其纳入观察组和对照组,每组各100例.两组孕妇均给予常规综合治疗、硝苯地平片口服和依诺肝素钠皮下注射,观察组孕妇在此基础上联合运动-饮食综合干预.比较两组孕妇治疗前后血清PLGF、Hcy、VEGF、尿蛋白水平、血压、凝血功能指标、妊娠结局和治疗效果.结果 治疗7 d后,两组孕妇血清PLGF、VEGF水平均显著高于本组治疗前(均P<0.05),凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)均显著长于本组治疗前(均P<0.05),血清Hcy、尿蛋白、血红蛋白(hemoglobin,Hb)水平、收缩压、舒张压、血小板(platelet,PLT)均显著低于本组治疗前(均P<0.05).观察组孕妇治疗7 d后血清PLGF、VEGF水平均显著高于对照组(均P<0.05),PT、APTT均显著长于对照组(均P<0.05),血清Hcy、尿蛋白、Hb水平、收缩压、舒张压、PLT均显著低于对照组(均P<0.05).观察组孕妇治疗总有效率显著高于对照组(P<0.05),终止妊娠孕周显著长于对照组(P<0.05),新生儿体重显著大于对照组(P<0.05),不良妊娠结局发生率显著低于对照组(P<0.05).结论 运动-饮食综合干预联合硝苯地平和依诺肝素钠能够改善重度子痫前期孕妇PLGF、Hcy、VEGF水平和凝血功能,降低血压,延长期待治疗时间,改善妊娠结局.

With the implementation of the comprehensive two child policy,maternal care in general hospital has increased rapidly.Furthermore,the proportion of critical maternal care with complications is obviously rising.The emergency care is the important parts of providing critical maternal care.Based on the analysis of maternal emergency care,triage process in emergency care is continuously optimized to strengthen risk management,quality control and performance management.By full use the advantages of disciplines and the optimized triage process,the maternal mortality rate and disabled rate is considered to be decreased.

目的:探讨妊娠相关脑卒中的发病原因、临床表现、母婴结局、治疗及预防措施.方法:回顾性分析2001年1月-2013年12月我院共收治的妊娠相关脑卒中39例患者的临床资料.结果:39例患者中,发生在妊娠期21例,产褥期18例.经电子计算机断层扫描(CT)、磁共振成像(MRI)、磁共振动脉血管造影(MRA)、磁共振脑静脉血管成像(MRV)、数字减影血管造影术(DSA)和腰椎穿刺等检查明确诊断,诊断出血性脑卒中7例,脑梗死3例,脑静脉窦血栓(CVST)29例,均给予相应的抢救及治疗.16例早期、中期妊娠患者行人工流产术或利凡诺羊膜腔内注射穿刺引产终止妊娠,5例患者行剖宫产终止妊娠.患者治愈出院15例,6例死亡,14例遗留不同程度的肢体活动障碍或语言障碍,家属放弃治疗出院4例.结论:妊娠相关脑卒中危险因素主要包括子痫前期、心源性栓塞、脑血管畸形、脑动脉瘤、水电解质紊乱等代谢障碍性疾病及产褥感染等.其发病急、病死率高,故需提高对本病的认识,定期产前检查,及时发现高危因素,早诊断及时治疗,选择适当的时机及方式终止妊娠是改善妊娠相关脑卒中患者预后的关键.

Objective To retrospectively analyze safety and feasibility of the suction curettage in the treatment of endogenous scar pregnancy guided with ultrasound. Methods We included sixty-eight patients diagnosed as endogenous cesarean scar pregnancy at Xuanwu Hospital,Capital Medical University in the past five years.Forty-six patients treated with suction curettage guided with ultrasound,another twenty-two patients treated with hysteroscopy.We compared the outcomes of the two groups with success rate,the bleeding volume,time for β-hCG returning to normal,and the total cost of inpatient. Results Of the forty-six patients underwent curettage guided with ultrasound,forty-four patients achieved success,another two failed.The success rate was 95.7%.Of the twenty-two patients treated with hysteroscopy,one failed,and the remaining twenty-one were successful.The success rate was 95.5%.Average blood loss during suction curettage was (89.4 ±58.3)ml,while the hysteroscopy group was (1 75.1 ±69.3)ml.Mean time for achieving a normalβ-hCG level was (58.0 ±21 .2)days for the suction curettage group,and (46.2 ±1 2.4)days for the hysteroscopy group. Total cost of inpatient was (1 545.3 ±437.2)yuan for the suction curettage group,and (5 893.0 ±1 785.4 )yuan for the hysteroscopy group.We found no statistically significant difference in the success rate between the two groups.Compared with hysteroscopy group,the suction curettage group had less blood loss,shorter operation time,lower cost of inpatient,but longer time for serum β-hCG returning normal levels. Conclusion Suction curettage guided by ultrasound is a safe and effective method,with low damage and cost.

Objective:To access the effectiveness and safety of intravaginal misoprostol following mifepristone administration to terminate 14-20weeks gestation.Methods: Eighty patients requesting legal termination of pregnancy at gestational between 14 to 20 weeks were from the Xuan Wu Hospital of capital University of medical of science between January 2012 and December 2012. They were divided randomly into two groups. Both 40 women (experimental group) and 40 women (control group) received 50mg of oral mifepristone every 12h for three times. Then, the experimental group was given 200μg misoprostol intravaginal at 7am on the third day and the control group received intra-amniotic injection of rivanol.Results: Comparing with intra-amniotic injection of rivanol, the combination of mifepristone and misoprostol intravaginally has higher success rate, lower tissue residue rate and curettage of uterus, shorter labor and less hemorrhage, the difference were statistically significant. As to the side effects, nausea, vomiting are statistically significant.Conclusion: It is a safe and effective method for mifepristone and vaginal misoprostol to termination of mid-pregnancy.