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Effect of Nursing Intervention on Exclusive Breastfeeding after Hysterotokotomy

【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

双胎妊娠临床结局分析

【摘要】 目的 探讨双胎妊娠剖宫产指征构成比、临床处理与妊娠结局的关系。 方法 对2000年1月-2009年8月321例双胎妊娠的临床资料进行回顾分析。 结果 ①A组第1胎儿为头位，191例双胎妊娠剖宫产指征首位为社会因素，其次为妊娠并发（合并）症、瘢痕子宫；B组第1胎儿为非头位，65例双胎妊娠剖宫产指征首位为单纯臀位因素（包括肩先露），其次为妊娠并发（合并）症、瘢痕子宫。②平均分娩孕周（36±4）周，剖宫产256例占79.75%， 经阴道分娩65例占20.25%。③剖宫产组新生儿体重≥2 500 g者高于阴道分娩组；两组第1胎儿新生儿窒息率比较无差异，第2胎儿经阴道分娩者新生儿窒息率明显高于剖宫产术者。校正孕周影响后，不同分娩方式间新生儿评分无差异。④lt;33孕周的双胎妊娠以阴道分娩为主，占83.33%；≥33孕周的双胎妊娠剖宫产率明显高于阴道产率。不同分娩方式的产后出血率无差异。 结论 双胎妊娠不是剖宫产的手术指征，孕期须加强监护管理，正确选择双胎妊娠的分娩方式，将有助于降低剖宫产率及新生儿窒息率。

自控静脉镇痛在剖宫产产妇术后镇痛中的效果评价

目的观察自控静脉镇痛（PCIA）在剖宫产产妇术后镇痛中的效果。 方法选取2013年6月－12月行剖宫产且术后疼痛视觉模拟评分（VAS）＞4分需进行药物止痛产妇79例，其中自愿选取肌肉注射哌替啶镇痛的29例产妇纳入对照组，其余50例采用PCIA（舒芬太尼150μg+托烷司琼5 mg+生理盐水共150 mL）镇痛方式的产妇纳入观察组，分别在术后2、4、6、12、24 h对两组产妇疼痛程度、24 h睡眠质量、不良反应、镇痛满意度进行比较。 结果两组产妇术后不同时点的疼痛程度，24 h睡眠质量、不良反应比较，观察组优于对照组，差异有统计学意义（P＜0.05），观察组镇痛满意率优于对照组，差异有统计学意义（P＜0.05）。 结论PCIA能长久持续地减轻剖宫产产妇术后的疼痛，有效提高产妇术后睡眠质量，降低不良反应。

剖宫产术中去氧肾上腺素与麦角新碱合用致急性头痛一例

Comparison of Three Therapeutic Strategies for Cesarean Scar Pregnancy

ObjectiveTo compare the curative effect of three therapeutic strategies for cesarean scar pregnancy (CSP). MethodsBetween January 2009 and December 2013, 208 patients with CSP underwent intramuscular methotrexate alone (group A, n=72), transvaginal ultrasound monitoring after embryo sac strangulation after injection of methotrexate (group B, n=70) and uterine arterial chemoembolization therapy monitoring after hysteroscopy surgery (group C, n=66). We studied their clinical data retrospectively. The preoperative treatment interval, the hospitalization days, intraoperative bleeding, time of blood β-HCG to normal level and hospitalization costs were compared between the groups. ResultsThe preoperative treatment interval, hospitalization days, intraoperative bleeding, and time of blood β-HCG to normal level of group C were significantly better than those of group A and B (P<0.05), while the hospitalization cost of the three groups were not statistically signficant (P>0.05). ConclusionAs a treatment for CSP, uterine artery chemoembolization is a safe and effective method, and it has the advantages of short hospitalization time, less intraoperative bleeding and high fertility preservation. It is worth application in clinical medicine.

剖宫产术后宫底免盐袋加压对产妇出血量及舒适度的影响

目的探讨剖宫产术后宫底免盐袋加压对产妇出血量及舒适度的影响。 方法将2012年7月－12月行剖宫产手术的正常初产妇122例随机分为2组，观察组（n=60）术毕不给予盐袋加压，对照组（n=62）常规在宫底部加压1 kg的盐袋，持续6 h，两组其他治疗、护理措施相同。记录两组产妇术后6 h内阴道出血量和呕吐次数，肛门排气时间及产妇主观舒适度。 结果两组产妇术后6 h内阴道出血量[（167.23±31.65）、（178.75±37.42）mL；t=1.833，P=0.069）和呕吐次数（Z=-0.740，P=0.459）比较，差异无统计学意义；观察组主观舒适度明显高于对照组（Z=-4.353，P=0.000）；观察组肛门排气时间[（14.45±4.55）d]比对照组[（21.95±6.06）d]明显缩短（t’=-7.747，P=0.000）。 结论剖宫产术后如未发生产后大出血，宫底免盐袋加压治疗可增加产妇舒适度，促进肠功能的恢复。

Therapeutic effect of methotrexate combined with hysteroscopy in the treatment of endogenous cesarean scar pregnancy

Objective To explore the clinical effect of intramuscular injection of methotrexate on hysteroscopic treatment of endogenous cesarean scar pregnancy (CSP). Methods A prospective analysis was conducted on 94 patients diagnosed with endogenous CSP who visited the Department of Gynecology in Liuzhou Workers’ Hospital between January 2013 and January 2018, and they were randomly divided into two groups, the intramuscular injection of methotrexate followed by hysteroscopic surgery group (the methotrexate group, n=39) and the direct hysteroscopic surgery group (the non-methotrexate group, n=55). The operation time, intraoperative blood loss, surgical complications, length of hospital stay, hospitalization expenses, the recovery time of blood human chorionic gonadotropin (HCG) and treatment outcomes of the two groups were compared. The normally distributed data were expressed as mean±standard deviation, and the non-normally distributed data were expressed as median (lower quartile, upper quartile). Results There was no statistically significant difference in age, gestational sac diameter, uterine scar thickness, number of cesarean sections, time from cesarean section to present, time of menopause, or preoperative blood HCG value between the two groups (P>0.05). There was no statistically significant difference in intraoperative blood loss [75 (35, 120) vs. 65 (35, 130) mL, P=0.821], incidence of complications (5.1% vs. 5.5%, P=1.000), postoperative blood HCG recovery time [(5.22±2.17) vs. (4.96±1.81) weeks, P=0.559] or the effective rate of treatment (94.9% vs. 90.9%, P=0.747) between the two groups. The methotrexate group had longer operation time [43 (34, 55) vs. 32 (28, 35) min, P=0.001], longer length of hospital stay [(10.89±1.42) vs. (5.82±1.47) d, P<0.001], and higher hospitalization cost [(8596.46±3336.59) vs. (7058.84±2638.49) yuan, P=0.014]. Conclusion For patients with endogenous CSP, intramuscular injection of methotrexate before hysteroscopic surgery is not necessary, for it has no significant impact on the treatment effect, instead, it may prolong the operation time and length of hospital stay, and increase the hospitalization cost.

The effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes

Objective To discuss the effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. Methods A total of 50 patients scheduled for selective cesarean section under combined spinal and epidural anesthesia were selected as the study subjects between July 2015 and June 2016. They were randomly allocated into two groups with 25 in each. Group CII underwent continuous phenylephrine infusion [0.5 μg/(kg·min)] immediately after anesthesia to adjust the blood pressure, while group CON accepted single-dose phenylephrine injection (50 μg) after anesthesia when systolic pressure was lower than 90 mm Hg (1 mm Hg=0.133 kPa) or when the decrease of mean arterial pressure (MAP) was higher than 20% of the base value. The infusion of phenylephrine was stopped after the fetus was taken out. MAP, cardiac output, cardiac index (CI) at the time when the patient went into the delivery room (T1), before anesthesia (T2), 1 minute after anesthesia (T3), 3 minutes after anesthesia (T4), 10 minutes after anesthesia (T5), and delivery (T6) were recorded. Blood gas analysis of fetal umbilical arterial blood was carried out and neonatal Apgar score was recorded. Results Hemodynamics was more stable in group CII compared with group CON. Heart rate at T4 and T5, and cardiac output at T5 and T6 in group CON were significantly lower than those in group CII (P<0.05). The neonatal umbilical arterial blood pH value, base excess and HCO3－ were all significantly lower, while partial pressure of carbon dioxide was significantly higher in group CON than group CII (P<0.05). Conclusion Compared with single-dose phenylephrine injection, continuous phenylephrine infusion has more stable hemodynamics, and exert less effect on maternal and infant outcomes for patients undergoing cesarean section under combined spinal and epidural anesthesia.

Effect of Postoperative Patient-Controlled Epidural Analgesia with Different Doses of Sufentanil after Cesarean Section

【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组，术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼；B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼；C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼，观察三组患者的术后镇痛效果（视觉模拟法评分，即VAS评分）及不良反应。 结果 A组VAS评分高于B组和C组，B组VAS评分高于C组（Plt;0.05）。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异（Pgt;0.05）。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小，患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.

Clinical Results of Vaginal Birth after Cesarean

ObjectiveTo investigate the factors affecting the results of vaginal birth after cesarean (VBAC). MethodsWe retrospectively analyzed the data from 80 pregnant women of prior cesarean section with intention of vaginal delivery between October 2012 and July 2013. According to the final way of delivery, the 80 women were divided into two groups, the VBAC group (40 cases) and repeated cesarean section (RCS) group (40 cases). The clinical characteristics of the two groups were compared and further multi-variant analysis was conducted. Besides, 40 women with successful repeated vaginal delivery were included as controls. The delivery time and bleeding volume were compared between the VBAC group and the control group. ResultsThe three determinant factors associated with the present VBAC were: Arrested labor as the indication of prior cesarean section [OR=1.601, 95%CI (1.025, 2.469), P=0.04], Bishop Score [OR=3.757, 95%CI (1.437, 8.772), P=0.01] and infant weight [OR=1.391, 95%CI (1.124, 2.583), P=0.03]. The VBAC group presented a higher Episiotomy rate than the RCS group. No significant difference was found between the VBAC and the control group regarding the delivery time [(6.71±2.94) vs. (5.88±2.47) hours, P=0.176] and bleeding volume [(259.13± 75.31) vs. (230.36±67.44) mL, P=0.076]. ConclusionVBAC presents a better and faster recovery with a shorter hospital stay. But the indication of VBAC should be strictly followed to ensure the safety of both mothers and babies.