目的 探讨梅毒感染产妇血清快速血浆反应素环状卡片试验(RPR)滴度对乳汁中梅毒特异性抗体阳性率的影响.方法 选择2016年1月1日-2017年12月31日在天津市第二人民医院分娩的、并且产后进行乳汁梅毒特异性抗体检测的梅毒产妇共360例,按入院时RPR滴度分两组,即RPR高滴度组(RPR≥1∶4)和RPR低滴度组(RPR＜1∶4).利用梅毒螺旋体免疫吸附试验法(ELISA法)检测产后乳汁中的梅毒特异性抗体.分析两组血液及乳汁的化验结果,了解孕期血清RPR及驱梅治疗对乳汁梅毒抗体的影响.结果 360例产妇中,RPR高滴度组170例,乳汁梅毒特异性抗体ELISA阳性者1 14例;RPR低滴度组190例,乳汁梅毒特异性抗体ELISA阳性者63例,两组之间比较差异有统计学意义(x2=41.261,P＜0.01).另外,在高滴度组的170例产妇中,有79例孕期驱梅治疗后RPR滴度下降达到4倍或以上(治疗有效组),其中56例产后化验乳汁梅毒抗体ELISA阳性(阳性率70.89％);剩下91例孕期驱梅治疗后RPR滴度下降不足4倍(治疗无效组),此91例产后化验乳汁梅毒抗体ELISA均阳性(阳性率100.00％).两组比较差异有统计学意义(x2=30.642,P＜0.01).结论 血清RPR滴度高的梅毒产妇,乳汁梅毒特异性抗体阳性的概率较高;孕期驱梅治疗对降低乳汁中梅毒螺旋体抗体阳性率有一定影响.

梅毒是由梅毒螺旋体感染引起的一种可以造成机体多脏器损伤的性传播疾病,对人体危害很大,甚至可以导致患者丧失劳动力,并留下终身的印记,给患者身心均造成很大创伤.国家取消强制婚检以后,由于人们缺乏足够的性教育知识、患者刻意隐瞒病情,导致梅毒等性传播疾病感染人群逐渐增多,先天梅毒的发病率也明显增多.梅毒螺旋体可以通过胎盘感染胎儿,造成流产、死胎、早产、死产、胎儿畸形、先天性梅毒儿等.先天性梅毒会给未来一代人的身体健康造成严重危害,控制及减少先天性梅毒的形势非常严峻.该文通过对近几年关于先天性梅毒临床表现、先天性梅毒预防、妊娠期梅毒螺旋体检测、妊娠期梅毒驱梅治疗、先天性梅毒诊断、先天性梅毒治疗、先天性梅毒再发等方面研究进行综述,为减少梅毒对胎儿健康的损害,提高国民身体素质提供有力的理论依据.

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 study nosocomial infection(NI) and antibiotic usage in a three level of first-class infectious disease hospital. METHODS The point-prevalence survey of NI in all hospitalized patients at one day in the fourth quarter was made from 2007 to 2009. RESULTS The prevalence rates of NI were individually 4.35%,3.50% and 2.17%.The common NI sites were upper respiratory tract,intraabdominal cavity and lower respiratory tract.No statistically difference was found between strength changes of immunodeficiency,urinary catheter,peripheral and central venous catheter.9 strains of pathogenic bacteria were found through delivering samples including 5 strains of gram-positive bacteria and 4 strains of gram-negative bacteria.Antibiotics utilization rate was decreased in 3 years(P=0.058),mostly for one couplet medicine.16 in 21 cases of NI were on antibiotics,and all for one. CONCLUSION The prevalence of NI and antibiotics utilization rate are both decreasing.The most common NI sites are respiratory system and intraabdominal cavity.

[Objective]Through the retrospective study on short PR interval ECG of the end stage pregnant women with HBV carrier,to disclose its pathogenesis and clinical significance.[Methods]1859 the end stage pregnant women with HBV carrier,divided into two groups,according to age and HBV-DNA,respectively,and then statistic total incidence rate of short PR interval,incidence rate of every group as well as the recovery after parturition. [Results]Total incidence rate of short PR interval was 6.29%.There was no significance between the compared groups,respectively.The recovery rate was about 93%3 days to 2 months after parturition.[Conclusion] There were no relations between the incidence of short PR interval ECG and age,HBV-DNA of the end stage pregnant women with HBV carrier.Short PR interval ECG of the end stage pregnant women with HBV carrier was a functional change and need no special treatment.

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.

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.