目的：讨论剖宫产瘢痕妊娠的早期正确诊断方法和适当的治疗措施。方法：回顾性分析我院35例剖宫产瘢痕妊娠病例的临床表现、超声影像和治疗方法。结果：33例病例经血βhCG测定、B超或彩超确诊，2例行清宫术或诊刮术时发生大出血，后经彩超修正诊断。31例接受药物、清宫等保守性治疗，4例接受介入治疗，所有病例均好转或痊愈。结论：广大临床医师对剖宫产瘢痕妊娠认识的提高，以及超声检查技术的发展，使早期明确诊断和成功保守治疗该病成为可能。
Objective To assess the efficacy and safety of chewing gum in promoting bowel recovery after cesarean section. Methods Such databases as The Cochrane Library, MEDLINE, EMbase and CBM were searched from their establishment to 2010 to include the randomized controlled trials (RCTs) of comparing chewing gum with other procedures for promoting postoperative bowel function after cesarean section. The risks of bias in the included studies were evaluated at randomization, allocation concealment, blinding, completeness of outcomes, and selective reporting. Meta-analyses were performed by RevMan 5.0.22 software. Results Three RCTs involving 745 participants were included. The results of meta-analyses showed chewing gum after cesarean section significantly shortened the time before getting the first postoperative flatus (MD= –6.54, 95%CI –7.82 to –5.27, Plt;0.000 01), reduced the risks of postoperative ileus (RR=0.54, 95%CI 0.34 to 0.87, P=0.01) and possibly shortened the length of hospital stay (MD= –0.21, 95%CI –0.39 to –0.03, P=0.02) compared with blank control. Currently, no adequate data supported the safety of chewing gum after cesarean section. Conclusion Chewing gum after cesarean section can promote the postoperative bowel recovery, and reduce the odds of postoperative ileus. However, more high quality RCTs are required for lack of included studies and poor quality of methodology.
Objective To compare the outcome of uterine exteriorisation repair with in situ in caesarean section. Methods A randomized controlled trial with 220 cases were recruited. Woman with term singleton pregnancy underwent caesarean section and without severe complication were randomly allocated to the two groups (112 cases in exteriorisation group and 108 cases in situ group). Women in treatment group received exteriorisation when the uterus was sutured, While others had the uterus repaired in situ as control. Main outcome measures included perioperative haemodynamic parameters, loss of blood, changes in haemoglobin concentration, duration of operation, postoperative pain score and febrile days, gastrointestinal discomforts and function recovery as well as postoperative maternal morbidity.Data were analyzed by SPSS 11.0. Results Haemoglobin concentration dropped in both groups after caesarean section, and the drops in control group was significantly higher than that of treatment group (t=-2.902, P=0.004). In both groups, pulse before operation was markedly higher than when suturing the uterus and postoperation (Plt;0.05), but no difference was observed between the two groups. Systolic blood pressure of treatment group was lower than that of control group before operation, when suturing the uterus and after operation (F=5.246, P=0.022), but there was no difference among these 3 time points within the group. Onset of flatus was earlier in control group than in treatment group (t=5.567, P=0.000). No difference was identified between the two groups when receiving the different suturing methods. No severe maternal morbidity was observed.Conclusions Uterine exteriorisation and in situ repair have similar effects on intra- and postoperative outcomes. In routine process.
目的 探讨子宫动脉化疗栓塞在剖宫产术后子宫切口妊娠治疗中的可行性和安全性。 方法 回顾分析2006年7月－2011年3月收治的152例剖宫产切口瘢痕妊娠行介入治疗的病例资料。 结果 152例子宫动脉化疗栓塞操作均成功。阴道大出血或不规则出血均得到有效控制。人绒毛膜促性腺激素β亚型较术前下降，差异有统计学意义（Z=−9.295，P=0.000），术后2～22 d行清宫术，术中失血3～100 mL，平均27 mL。3例行子宫切除术，子宫切除率2%。1例发生栓子脱落导致左下肢胫前动脉栓塞并发症。 结论 子宫动脉化疗栓塞治疗剖宫产术后切口妊娠可有效控制大出血、降低清宫风险、降低子宫切除风险，是治疗切口妊娠的有效可行方法之一。
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。
【作者简介】〖KG2〗〖HTSS〗蒋青(1963-),女,四川遂宁人,主管护师,硕士,Email:jq0987@yahoo.cn
【摘要】 目的 观察小剂量氯胺酮在健忘镇痛麻醉辅助局部麻醉（局麻）剖宫产中的应用。方法 选择1200例剖宫产的孕妇,随机分为单纯局麻组(L组)、氟芬强化局麻组(F组)和健忘镇痛麻醉组(J组),每组400例。L组单纯局麻;F组局麻术中辅以氟哌利多500 mg,芬太尼015 mg;J组在F组基础上辅以氯胺酮,观察各组患者麻醉诱导至胎儿娩出时间;新生儿1、5 min Apgar评分;手术中血压相对于基础值的波动情况;手术中及手术后出血情况及麻醉满意度。 结果 J组与L组和F组比较,胎儿娩出时间无显著差别;Apgar评分提高;手术中孕妇血压波动不明显;手术中及手术后出血量无明显增加,麻醉满意度明显提高。 结论 由小剂量氯胺酮辅助实施的健忘镇痛麻醉在局麻剖宫产中优于单纯局麻和氟芬强化局麻,在剖宫产中尤其急诊剖宫产中值得推广。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
【摘要】 目的 探讨延期妊娠的结局及防治。 方法 回顾性分析2008年6月-2009年6月收治的1 157例延期妊娠临床资料，根据妊娠时段分A、B、C三组，A组449例，妊娠40+1~40+3周；B组358例，妊娠40+4~40+6周；C组350例，妊娠41~41+6周。比较各组羊水粪染发生率，剖宫产率，新生儿转归情况。 结果 随妊娠时段的延长，羊水粪染发生率，剖宫产率具有统计学意义的变化（Plt;0.05）。新生儿评分低，转专科治疗的新生儿增多。 结论 延期妊娠为高危妊娠，应加强监护及检测手段，适时终止妊娠。【Abstract】 Objective To explore the outcome of prolonged pregnancy and treatment. Methods Clinical data of 1 157 cases of prolonged pregnancy were retrospectively analyzed during June 2008 to June 2009.They were divided into three groups according to the time of pregnancy.Group A: 449 cases, pregnant age 40+1 - 40+3 week; Group B:358 cases, pregnant age 40+4 - 40+6 weeks; Group C:350 cases, pregnant age 41 - 41+6 weeks. The incidence of amniotic fluid turbidity, the rate of cesarean section and the neonatal prognosis were compared among three groups. Results With the extension of time of pregnancy, the incidence of amniotic fluid turbidity and the rate of cesarean section were statistically different among three groups (Plt;0.05), neonatal score was low, and the number of cases who needed specialist treatment increased. Conclusion Prolonged pregnancy is a high-risk pregnancy.The monitoring and detection means for prolonged pregnancy should be strengthened.Termination of pregnancy should be considered if necessary.