目的 评价加速康复外科(ERAS)干预对剖宫产术后功能恢复的影响.方法 收集2021年9月1日至2022年9月1日在深圳市龙岗区妇幼保健院产科行剖宫产分娩的194例产妇为研究对象,采用前瞻性、随机单盲的研究方法,使用随机数表法将产妇随机分为快速康复组(ERAS组,96例)和常规组(98例).ERAS组给予跨越术前、术中和术后的综合干预措施;常规组给予常规围手术期干预措施.观察剖宫产围手术期的ERAS措施对产妇疼痛视觉模拟评分(VAS)、术后阿片类药物使用情况、胃肠道恢复情况、膀胱功能、首次下床活动时间、24 h阴道出血量等的影响.结果 ERAS组和常规组基线资料比较均无显著性差异(P＞0.05).ERAS组产妇剖宫产术后回病房0 h的VAS与常规组无显著性差异(P=0.546),但术后回病房4 h、12 h、16 h和24 h的VAS显著低于常规组(P均＜0.05).ERAS组术后需要联合使用舒芬太尼和地佐辛的比率显著低于常规组(29.2％vs.46.9％,P＜0.05).ERAS组术后首次进食流质时间[(2.6±1.1)h vs.(4.3±2.3)h]、进食半流质时间[(7.5±6.8)h vs.(20.5±15.0)h]、进食普食时间[(35.1±15.7)h vs.(41.4±13.2)h]、拔尿管时间[(9.8±5.1)h vs.(23.5±4.5)h]、拔尿管后首次排尿时间[(12.9±5.4)h vs.(25.9±4.3)h]及首次下床时间[(13.8±6.0)h vs.(26.8±6.7)h]均显著短于常规组(P＜0.01).两组的首次肛门排气时间及产后24h出血量均无显著性差异(P＞0.05).结论 ERAS干预应用于剖宫产孕妇围手术期,能够减轻产妇疼痛,具有阿片节省效应,还能有效缩短孕产妇空腹时间,促进膀胱功能恢复和产后尽早活动.

目的:研究快速康复途径(ERAS)应用于剖宫产围手术期对母婴结局的影响.方法:选择我院收治剖宫产孕妇240例作为研究对象,病例均选自2020年7月至2021年8月.采用单盲、随机分组原则将孕妇分成两组,对照组120例给予常规手术干预方法,试验组120例给予ERAS临床干预(快速康复组).比较术中出血量、胃肠功能恢复时间、平均住院时间、住院平均费用;同时比较两组产后抑郁评分、疼痛耐受情况,以及术后并发症.结果:试验组术中出血量少于对照组,术后肠鸣音恢复、术后排气时间短于对照组,平均住院时间、住院费用均少于对照组,差异有统计学意义(P<0.05);试验组孕妇产后抑郁SDS评分与疼痛VAS评分均少于对照组,差异有统计学意义(P<0.05);试验组术后并发症发生率1.67％低于对照组7.50％,差异有统计学意义(P<0.05).结论:在剖宫产围手术期临床干预中应用ERAS快速康复途径可改善母婴结局,值得应用.

AIMS Currently, there is no reliable method to effectively predict and diagnose early-onset preeclampsia (EOPE). microRNAs (miRs) are promising biomarkers for EOPE. This study investigated the role of miR-320a in EOPE. METHODS Expressions of miR-320a and insulin-like growth factor-1 receptor (IGF-1R) in serum of EOPE patients and normal pregnant women were detected. The clinical diagnostic efficacy of miR-320a and IGF-1R for EOPE was analyzed using receiver operating characteristic curve. The correlation between miR-320a expression and EOPE clinical indicators [mean arterial pressure (MAP), 24-h urinary protein excretion, serum creatinine (SCR), uric acid (UA), albumin (ALB) and platelet count] was analyzed. The correlation and binding relationship between miR-320a and IGF-1R was predicted and verified. RESULTS miR-320a was upregulated, and IGF-1R was downregulated in EOPE patients with their differential expressions more obvious in severe EOPE than mild EOPE. miR-320a and IGF-1R possessed potent clinical diagnostic efficacy for EOPE. miR-320a expression showed a positive correlation with MAP, 24-h urinary protein excretion, UA and SCR levels, and a negative correlation with ALB level and platelet count in EOPE patients. Moreover, miR-320a targeted IGF-1R. CONCLUSION We demonstrated that miR-320a was aberrantly elevated in EOPE and showed powerful clinical diagnostic efficacy for EOPE, which may be achieved by directly targeting IGF-1R. This study provided great reference values for EOPE early diagnosis and novel targets for EOPE treatment.

目的 观察产前检查在妊娠晚期胎盘早剥诊断中的临床效果.方法 100例妊娠晚期孕妇,均进行产前检查,随访3个月记录最终结果 并依此为金标准,观察产前检查及随访的最终胎盘早剥情况,并比较差异,计算产前检查胎盘早剥诊断准确率.结果100例孕妇经产前检查发现,有15例孕妇为胎盘早剥;随访3个月最终发现,有17例孕妇为胎盘早剥;产前检查与最终发现胎盘早剥情况比较差异无统计学意义(P>0.05).产前检查胎盘早剥诊断准确率为88.2％(15/17).结论 产前检查在妊娠晚期胎盘早剥诊断中应用价值较高,其可尽早发现、尽早诊治胎盘早剥现象,有效保障母婴安全,临床应用价值较高,值得临床推广.

目的:对比先兆流产治疗中地屈孕酮与黄体酮的应用效果.方法:选取2016年1月至2018年1月期间我院先兆流产60例患者(实施信封随机分组模式),对照组的30例患者进行黄体酮治疗,观察组的30例患者进行地屈孕酮治疗,随后对比两组患者治疗安全性、成功率、流产率、E2(雌二醇)、血HCG(人绒毛膜促性腺激素).结果:观察组患者的不良事件发生率、治疗成功率、流产率、血HCG、E2均优于对照组(P<0.05).结论:对先兆流产患者实施地屈孕酮效果更为显著.

Objective To investigate the relationship between random urinary albumin /creatinine ratio and hypertensive disorder complicating pregnancy (HDCP).Methods 132 cases of HDCP were selected from March 2015 to June 2017 in Shenzhen Longgang Women and Children Health Care Hospital.According to the clinical classification , they were divided into HDCP group , mild pre-eclampsia group and severe preeclampsia group.100 pregnant women with normal pregnancy were selected as the control group . Blood and urine samples of all pregnant women were collected.Blood routine parameters , coagulation function, blood lipid level, blood biochemical index , urine protein creatinine ratio and 24 h urine protein were measured and compared between the two groups. Spearman correlation analysis of the relationship between random urine albumin /creatinine ratio (ACR) and various blood and urine indicators, meanwhile, using ROC curve to analyze the diagnostic value of ACR for HDCP.Results Of the indexs of red blood cell (RBC), hemoglobin(HGB), hematocrit (HCT), platelet (PLT), triglyerude(TG), total cholesterol (TC),there were no significant difference between the two groups(P＞0.05).D-Dimer(DD),prothrombin time(PT),activation of partial thromboplastin time(APPT), blood urea nitrogen(BUN), creatinie(Cr), cystatin C(Cys C),fasting blood -glucose(FBG),glycated hemoglobin(GHB),uric acid (UA), insulin(INS),C-peptide, low density lipoprotein(LDL),apolipoprotein AⅠ(Apo AⅠ), apolipoprotein B(Apo B), 24 h urine protein quantitation and ACR of pregnancy hypertension group , mild preeclampsia group and severe preeclampsia group were significantly higher than the control group.Fibrinogen(Fib), total protein(TP), albumin(ALB),high density lipoprotein(HDL) were significantly lower than the control group, and the differences were statistically significant (P＜0.05).ACR was positively correlated with BUN , Cr, Cys C, UA, DD, LDL, Apo A I, Apo B, and 24 h urine protein, and negatively correlated with TP , ALB, and HDL.The best values for ACR in the diagnosis of pregnancy -induced hypertension, mild pre-eclampsia, and severe pre-eclampsia were 1.44 mg/mmoL, 10.48 mg/mmoL, and 39.84 mg/mmoL, respectively.Conclusion The changes of coagulation function , blood lipid level and hematuria biochemical index are related to the occurrence of HDCP.The ratio of random urine protein creatinine is significantly correlated with 24 h urine protein quantification, which can be used as an effective indicator for HDCP diagnosis.

目的:探讨对瘢痕子宫患者经阴道分娩加强产程管理的临床效果.方法:研究选择本院于2015年12月至2018年1月期间收治的300例瘢痕子宫阴道分娩产妇作为资料,随机分组各150例,对照组为常规产程监护,观察组加强产程管理,比较产程时间、出血量及住院时间等.结果:观察组产程、出血量、住院时间均显著低于对照组,P<0.05;两组分娩安全性无明显差异,P>0.05.结论:针对瘢痕子宫阴道分娩产妇加强产程管理可缩短产程时间,减少出血量及预防并发症发生,临床应用价值较高.

目的 评价不同缩宫药物联合应用预防前置胎盘产后出血临床疗效.方法 60例前置胎盘产妇,根据随机数字表法分为对照组和研究组,每组30例.对照组应用缩宫素联合卡前列素氨丁三醇注射液(商品名:欣母沛)预防,研究组应用缩宫素联合益母草预防.比较两组产后出血预防效果及并发症发生情况.结果 研究组产妇的总有效率100.0％ 显著高于对照组的83.3％,差异具有统计学意义(P<0.05).研究组并发症发生率6.7％ 低于对照组的26.7％,差异具有统计学意义(P<0.05).结论 在预防前置胎盘产后出血过程中联合应用缩宫素及益母草,效果显著,值得临床推广.

选取2015年1月~2016年5月我院妇产科收治的154例盆底功能障碍性疾病患者.随机分为对照组和观察组各77例.对照组患者给予Kegel运动康复疗法,观察组患者在对照组的基础上给予生物反馈电刺激,比较两组患者的盆底肌力和生活质量.结果治疗前,两组患者盆底肌力比较均无统计学差异(P>0.05),治疗后,观察组患者的盆底肌力明显改善,而对照组改善不明显,两组比较,差异具有统计学意义(P<0.05);两组患者治疗前SWLS评分比较无差异(P>0.05),治疗后,SWLS评分上升,观察组与对照组相比,SWLS评分均优于对照组(P<0.05).Kegel运动联合电刺激综合疗法可明显改善顺产后盆底功能障碍患者的盆底肌力,提高生活质量.

目的:探究生物反馈联合电刺激康复在增强盆底肌肉肌力及提高阴道紧缩度中的意义.方法:随机选取我院于2014年3月～2016年3月诊治的76例产妇,对其临床相关资料进行回顾性分析,将进行常规盆底康复训练的36例作为对照组,进行生物反馈和电刺激康复治疗的40例作为观察组,对两组的临床结果进行对比.结果:康复锻炼后,观察组盆底综合肌力情况较对照组明显改善(P＜0.05);在康复锻炼1、3个月时,观察组阴道肌电电压较对照组明显提高,夜尿次数较对照组明显减少(P＜0.05).结论:将生物反馈和电刺激康复治疗应用于产妇的产后盆底康复训练,可以明显提高产妇盆底肌肉的肌力,增加其阴道的紧缩度,值得临床应用及推广.

目的 探讨对产褥期营养保健宣教在产妇产后恢复中的作用.方法 采用随机抽样法,选取2015年1月～2016年4月于我院生产的产妇中210例作为研究对象,随机均分为观察组和对照组,各105例.对照组在产褥期进行常规护理干预,观察组在常规护理的基础上,给予营养保健宣教.记录并对比两组产妇在生产5d后产妇子宫底高度、恶露的排出量以及泌乳量;比较两组产妇在产褥期疾病的发生情况.结果 观察组生产后子宫底高度显著低于对照组,恶露排除量显著少于对照组,泌乳量显著多于对照组,差异有统计学意义(P＜0.05).观察组在产后出现抑郁、乳房疼痛以及感染等疾病的发生概率显著低于对照组(P＜0.05).结论 在产褥期对产妇进行合理的营养保健宣教,能够增加产妇对产褥期相关知识的认识,促进产妇产后的康复,减少产褥期疾病的发生概率,值得在临床中推广应用.