目的 比较妊娠晚期和产后6周的盆底表面肌电值,探讨产科因素的相关影响.方法 选择2016年11月至2017年1月于我院建档产检的单胎妊娠且既往无盆底功能障碍性疾病(PFD)的女性为研究对象(共162例),分别于妊娠晚期(妊娠36～38周)、产后(分娩后6周)进行盆底肌电值检测.并根据不同年龄(≥35岁、<35岁)、体重指数(BMI)(≥28 kg/m2、<28 kg/m2)、新生儿体重(>3500 g、≤3500 g)、产次(初产、经产)进行分组,比较各组的盆底肌电参数.结果 162例产妇妊娠晚期和产后6周的盆底表面肌电平均值与参考值比较均有明显变化;妊娠晚期的快肌上升时间、慢肌变异系数显著高于产后6周,慢肌平均值显著低于产后6周(P<0.05).分析年龄、BMI、新生儿体重、产次对盆底功能的影响发现,高龄组的慢肌平均值显著低于非高龄组,肥胖组的慢肌平均值显著高于非肥胖组(P<0.05).结论 妊娠和分娩是影响盆底肌功能的因素之一,妊娠晚期盆底功能较产后6周更差;年龄和BMI对妊娠晚期盆底肌功能有一定影响,但仍然存在争议.

目的探讨不同分娩方式对产后早期盆底功能的影响。方法选取2016年10月-2017年3月于我院建档产检的110例产妇为研究对象,按照分娩方式的不同分为阴道分娩组（n=77）和选择性剖宫产组（n=33）,其中阴道分娩组按照是否侧切分为会阴侧切组（n=47）和非会阴侧切组（n=30）,比较产妇分娩前后盆底功能。结果与阴道分娩组比较,选择性剖宫产组分娩后快肌分、慢肌平均值、慢肌分均上升;而两组快肌最大值、上升时间、恢复时间、慢肌变异性差异无统计学意义。阴道分娩组中,侧切组和非侧切组各项盆底指标差异均无统计学意义。结论选择性剖宫产对早期盆底功能的影响较阴道分娩小,会阴侧切无法减轻分娩对产后早期盆底功能的影响。

目的 主要分析在外周静脉留置针管理中落实精细节管理对病人堵管、静脉炎发生几率、药液渗出情况、留置时间以及满意度指标的影响.方法 本次探讨的病人为到我院接受医治且均属于外周静脉留置针病人,收集的起止时间为:2017年7月份,终止时间2018年5月份.从该时间段中抽取患者人数176例,将上述病人均落实例数对等处理.其中88例病人通过常规性安全管理方案护理(为参照组),余下的88例病人在上述护理的条件下落实细节管理方案(为精细组).分析落实不同的管理后病人病人堵管、静脉炎发生几率、药液渗出情况、留置时间以及病人(家属)满意度指标的变化情况.结果 精细组病人出现堵管的病例为3例,发生概率为3.14％、静脉炎的发生概率4.55％、药液渗出发生概率3.14％,明显低于参照组病人的相关指标,P<0.05.在病人满意度指标对比中,精细组病人的满意度评分为(94.7±2.0)分,高于参照组的相关指标,P<0.05.精细组病人的留置时间(81.6±3.4)小时,高于参照组(57.7±5.7)小时,P<0.05.结论 在外周静脉留置针护理管理中落实精细化管理后能明显的减少静脉炎、堵管以及药液渗出的发生几率,与此同时还能显著的提升病人的满意值以及留置时间.

患儿男，生后1 h，主因“发现先天性完全性房室传导阻滞”于2016年4月入住清华大学第一附属医院心脏小儿科。母亲孕25周时发现胎儿心率慢，超声检查提示胎儿房室传导阻滞，孕35周超声提示胎儿完全性房室传导阻滞（心房率135次／min，心室率44次／min），全心扩大，心胸比例0．7，左室舒张末内径20 mm，射血分数59％，心脏结构未见异常。胎儿期生长发育尚正常，胎龄36周剖宫产出生，出生体重为2．5 kg，1、5、10 min Apgar评分分别为9、9、10分。为行“起搏治疗”收入我科。患儿为第2胎第2产，其姐姐（12岁）体健，出生史及既往史无特殊，母亲（43岁）和父亲（44岁）既往体健，否认晕厥、猝死家族史，母亲自身抗体谱［抗核抗体、干燥综合征（ SS ）－A、SS－B、双链DNA （ dsDNA ）抗体、抗心磷脂抗体等］阴性。

Objective To explore the prognosis of children under different modes of delivery in the oli?gohydramnios patients,in order to reduce unnecessary cesarean section rate. Methods One hundred and forty?eight cases of oligohydramnios from September 2013 to October 2015 in the First Affiliated Hospital of Tsinghua University were reviewed,including 74 cases of vaginal delivery,54 cases of vaginal delivery group,20 cases for fetal heart abnormalities in the induction of labor or labor in the process or abortion failure emergency caesarean&nbsp;birth operation( pilot transfer of emergency cesarean section delivery group);direct line selective cesarean section in 74 cases. The delivery surround unripe ending of three kinds of delivery mode was compared,and gestational weeks,estate, cervical score, maximal amniotic fluid dark area vertical depth ( AFV), amniotic fluid index ( AFI) ,fetal size,water treatment and abortion case of the vaginal delivery and emergency caesarean birth were statistically compared. Results Both fetal heart abnormality and amniotic fluid of third degree incidence of trial production of emergency cesarean section group was 80. 00%( 16/20) ,of vaginal delivery group was respectively 11. 11%( 6/54) ,29. 63 ( 16/54) ,and of selective cesarean section delivery group was 0 and 9. 50%( 7/74) re?spectively,the difference between the 3 groups was statistically significant( P<0. 05) . The gestational age of vagi?nal trial production successfully delivery group and transfer of emergency cesarean section production group was respectively (39. 33+0. 13),(40. 20+0. 2) weeks, the parity was 0 were 45 cases,20 cases respectively,the parity was 1 were 9 cases,0 case respectively;AFV was ( 2. 14+0. 06) cm,( 1. 86+0. 08) cm respectively;the water treatment rates were 66. 67%( 36/74) and 30%( 6/20) respectively;the difference between the two groups was statistically significant(P<0. 05). Induction:in vaginal delivery group,there were 24 cases of spontaneous labor without induction,12 cases treated with misoprostol for cervical mature after vaginal delivery,12 cases of contraction oxytocin induction of labor with vaginal delivery,6 cases of misoprostol for cervical ripening after va?ginal delivery;in emergency cesarean section group,there were 2 cases of natural labor,8 cases of oxytocin,miso?prostol after oxytocin in 10 cases. There was significant difference between the two groups ( P<0. 001 ) . Conclusion Low risk pregnancy, fetal reserve ability of oligohydramnios in vaginal delivery is feasible. Water treatment,gestational age < 40 weeks, the parity more than 1 times,AFV>2 cm,the high rate of abortion sensi?tive pregnant women with high rate of vaginal delivery.

Objective To probe the application effect of ethinylestradiol cyproterone(diane-35)combined with metformin therapeutic in PCOS. Methods 70 cases of PCOS were randomly divided into control group and observation group of 35 cases. Compared the levels of TC,HDL-C,LDL-C, T,LH/FSH before and past treatment.ResultsAfter treatment,the BMI,LH/FSH and T levels of the two groups were significantly decreased (P<0.05). The BMI of the observation group was significantly lower than that of the control group(P<0.05). The TG had no changes(P>0.05). The level of LDL-C in the observation group was significantly lower than that in the observation group(P<0.05),and the level of HDL-C in the observation group was significantly higher than that in the control group(P<0.05),the LD L-C in observation was levels(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion Diane-35 combined with metformin in the treatment of PCOS can reconcile sex hormone levels,improve lipid metabolism,with a more comprehensive treatment.

Objective To discuss and validate which method is more effectiveness for central placenta previa through analysing the clinical outcomes of the management of hemorrhage between uterine packing and stitching hemo-stasis during cesarean section.Methods 48 pregnant women with central placenta previa was conducted in this ret-rospective study,which were all cesarean section delivery.These patients were divided into two groups.24 patients with uterine packing with gauze in the control of massive hemorrhage during cesarean section were indetified,other-wise,the other 24 patients were conducted with sewing and ligation uterine.And then,the effectiveness and outcomes were compared.Results These all patients were alive and keep the uterus.The average estimated blood loss of the stiching group was (554 ±327)mL,obviously less than the uterine packing group,which was (828 ±584)mL,and the difference was statisatically significant (t =6.689,P<0.01 ).The rate of blood transfusion during operation was 8.33% (2/24)in the group of stiching,and was 50.0%(12/24)in the uterine packing group(P<0.05).Similar-ly,the operation time of the stiching hemostasis group,which was (48.9 ±10.0)min,was evidently shorter than (68.3 ±13.3)min of the other group(t=8.126,P<0.01).The two groups had no significant difference in therate of primary healing of incision,postoperative fever and admission time(P>0.05).Conclusion The uterine stiching is an effective,rapid and simple technique in the control of hemorrhage of central placenta previa.

Objective To study the effect of nourishing Yin and moistening intestines oral liquid on intestinal function recovery after cesarean section.Methods 100 delivery women with cesarean section in The First Affiliated Hospital of Tsinghua University were divided into the observation group(n=60) and control group(n=40).The cases in the observation group were given nourishing Yin and moistening intestines oral liquid orally 6h after cesarean section, while cases in the control group were not.The first anal exhaust time, first defecation time, abdominal pain, wound pain, nausea and vomiting were observed.Results The postoperative first anal exhaust time and first defecation time in the observation group were (30.13 ±14.24)h, (41.23 ±13.11)h respectively, which were significantly shorter than those in the control group (P<0.05).The incidence of postoperative abdominal pain and wound pain in the observation group were 3.33%, 36.67%respectively, which were significantly less than those in the control group (P<0.05). The difference in the incidence of postoperative nausea and vomiting between the two groups had no statistical significance (P>0.05). Conclusion Taking nourishing Yin and moistening intestines oral liquid orally early after cesarean section can reduce the anal exhaust time and defecation time and promote the recovery of intestinal function.

目的:探讨绒毛膜羊膜炎严重程度对自发性早产的影响。方法:收集我院产科单胎自发性早产病例96例,另随机选取足月分娩64例。分娩后胎盘送病理组织学分析有无绒毛膜羊膜炎及其严重程度。结果:自发性早产绒毛膜羊膜炎发生率及中重度感染发生率均明显高于足月分娩,破膜至分娩时间及羊水性状与绒毛膜羊膜炎严重程度呈显著正相关。结论:宫内感染是自发性早产的重要原因。胎膜早破后长时间保胎治疗可以导致或加重绒毛膜羊膜炎。

In order to investigate whether IgG isotype β2-GPI-dependent autoimmune antibody may have an etiological diagnostic value to spontaneous abortion. 59 patients with spontaneous abortion were selected as investigative group,and other 29 normal parturients were selected as control group.Conclusions show that β2-GPI-dependent autoimmune antibody used together can improve the sensitivity of diagnosis of spontaneous abortion .The specificity of β2-GPI-dependent aCL is more higher than aCL , which are more accurate methods.

子宫肌瘤是女性生殖器中最常见的良性肿瘤,大约20%～25%育龄妇女患有该肿瘤[1].子宫肌瘤切除术可以保留患者生育能力及保证器官的完整性,但术后又有复发风险.现结合临床资料对子宫肌瘤切除术后复发情况进行分析.

Objective:To evaluate the cause of abdomen cavity adhesions after caesarean section, and to reduce the risk of adhesions by improving the operation methods.Methods:140 cases of abdomen cavity adhesions women who had a second caesarean section between March 1996 to August 2005 were studied retrospectively.Results:34 cases(94.4%) developed abdomen cavity adhesions in the new mode caesarean section group, while 70 cases(67.3%) in midline incision group. This difference was statistically significant (P< 0.01). New mode caesarean section was associated with more extensive adhesions of abdomen wall and abdomen cavity than midline incision, which were statistically significant too (P< 0.05,P<0.01). Less serious degree of adhesions did not differ between the two groups (P>0.05). There was no statistically significant association between abdomen cavity adhesions and the time interval of repeat operation.Conclusion:New mode caesarean section is associated with higher rate and more serious degree of abdomen cavity adhesions.

近年来,由于妇女不断推迟受孕年龄,导致未孕妇女患有子宫肌瘤的人数不断增加,其中一部分患者合并不孕、妊娠丢失、不规则阴道流血等症状,为保留其生育能力,行子宫肌瘤切除术,对这部分患者术后生育能力进行分析.

目的探讨胎膜早破的分娩方式及早期干预效果。方法对2004年1月1日至2005年12月31日在我院住院分娩的1979例产妇资料进行回顾性分析。结果初产妇胎膜早破的发生率较经产妇明显增高（P＜0.01）,胎膜早破组早产发生率高（P＜0.01）,两组分娩方式比较无差异（P＞0.05）,胎膜早破组手术指征中头盆不称的发生率明显高于对照组（P＜0.01）,两组新生儿窒息、产后出血及产妇感染的发生率均无明显差异（P＞0.05）。结论对胎膜早破患者预防性使用抗生素、适时终止妊娠等积极干预措施,可以减少母儿并发症发生。

目的探讨β2糖蛋白I（β2GPI）相关抗磷脂抗体对于妊娠丢失免疫因素病因的诊断价值。方法通过酶联免疫吸附试验检测59名妊娠丢失患者（实验组）及29名正常妊娠分娩者（对照组）的血清中抗心磷脂抗体（aCL）、β2GPI依赖性aCL、β2-GPI依赖性抗磷脂酰丝氨酸抗体（aPS）及β2GPI非依赖性aCL的IgG水平。结果（1）自然流产史组β2GPI依赖性aPS的阳性率高于对照组（P＜0.05）,死胎史组β2GPI依赖性aCL和aCL的阳性率均高于对照组（P＜0.05）;（2）不同自然流产次数组β2GPI依赖性aPS阳性率均高于对照组（P＜0.05）;（3）各种抗体对于诊断妊娠丢失的敏感性及特异性比较aCL的敏感性最高,为45.3%;β2GPI依赖性aPS和β2GPI依赖性aCL的特异性均为100.0%;（4）各种aPL交叉阳性情况β2GPI依赖性aPS与β2GPI依赖性aCL的交叉阳性率最高,为33.3%,β2GPI依赖性aPS与β2GPI非依赖性aCL交叉阳性率最低,为7.7%。结论β2GPI依赖性aPS与自然流产有关,β2GPI依赖性aCL和aCL与死胎有关,联合检测能增加妊娠丢失患者免疫因素病因诊断的敏感性。β2GPI依赖性aPS及β2GPI依赖性aCL的特异性最高,是诊断妊娠丢失较准确的指标。β2GPI依赖性aPS出现于一次自然流产史组,有统计学意义,其阳性率与流产次数无关。

抗磷脂抗体(antiphospholipid antibodies,aPL)是一族能与多种阴性磷脂、磷脂连接蛋白或两者形成的复合物结合的抗体,包括抗心磷脂抗体(anticardiolipin antibodies,aCL)、狼疮抗凝抗体(Lupus anticoagulant,LA)、抗磷脂酰丝氨酸抗体、抗磷脂酰胆碱抗体等.1975年,Nisson等首次报道了aPL与妊娠丢失有关.近年来,国内外对两者的关系进行了大量研究,也随之出现了许多争论.本文将从aPL影响妊娠丢失的致病机制、临床诊断及治疗方法等方面的进展进行阐述.

早产的发生率约为10%,除先天畸型外,75%新生儿死亡原因为早产所致的呼吸窘迫综合征(Respiratory distress syndrome,RDS).目前产前糖皮质激素用于预防早产儿RDS已在临床上广泛应用,大大降低新生儿的发病率和死亡率.自1972年在人类应用以来,许多临床实验逐渐证实了糖皮质激素对降低早产儿呼吸窘迫综合征的发生率和死亡率具有积极作用[1].

近年来,输卵管妊娠(简称TP)的发生率呈上升趋势.在TP的众多病因中,性传播疾病所致输卵管炎症占重要地位.目前,沙眼衣原体(简称CT)已逐渐成为常见的性传播疾病的感染源,它与TP的关系逐渐被重视.为寻求降低TP发病率的方法和途径,本文对CT与TP之间的关系进行了综述.

良性勃勒纳氏瘤(Brenner tumor),又称良性卵巢纤维上皮瘤,是一种较少见的卵巢上皮性肿瘤,术前诊断率低,我科1990年-2002年间共收治8例良性Brenner tumor患者,现结合患者资料探讨该肿瘤的临床特征及内分泌功能,以提高对该肿瘤的认识.