目的 探讨子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用。方法 选择2020年1月—2021年12月在中山市中医院分娩的剖宫产术后再次妊娠经阴道分娩（VBAC）产妇作为研究对象。根据纳入和排除标准,共纳入子宫破裂的VBAC产妇32例、非子宫破裂的VBAC产妇90例。通过住院病历信息系统查询研究对象的基本信息及其在妊娠晚期（≥37周）用B超对研究对象行子宫瘢痕厚度和弹性的测量结果,采用受试者工作特征曲线（ROC）曲线分析子宫瘢痕厚度和弹性SI值对子宫破裂的预测作用。结果 子宫破裂组中年龄>35岁、妊娠>2次、与上次剖宫产间隔<2年、新生儿体质量≥3 kg、单层缝合者的比例高于非子宫破裂组（P<0.05）。122例产妇子宫瘢痕厚度的均值为（3.42±0.49）mm,SI的均值为（2.57±0.45）。ROC曲线分析结果显示：子宫瘢痕厚度单独预测子宫破裂的曲线下面积（AUC）为0.805（95%CI：0.730~0.880,P<0.05）,cut off值为3.05 mm,灵敏度为0.726,特异度为0.910,约登指数为0.636;子宫瘢痕SI单独预测子宫破裂的AUC为0.730（95%CI：0.635~0.824,P<0.05）,cut off值为2.11,灵敏度为0.767,特异度为0.781,约登指数为0.548;子宫瘢痕厚度联合预测子宫破裂的AUC为0.874（95%CI：0.812~0.937,P<0.01）,灵敏度为0.875,特异度为0.811,约登指数为0.686。子宫瘢痕厚度结合子宫瘢痕SI值预测子宫破裂的AUC高于单独使用子宫瘢痕厚度（Z=7.611,P=0.041）和子宫瘢痕SI值（Z=25.864,P=0.025）。结论 子宫瘢痕的超声弹性成像SI值联合子宫厚度可有效提高超声对于VBAC产妇子宫破裂的预测效能,具有一定的应用意义。

Objective To study the application of ultrasound elasticity imaging combined thickness analysis of uterine scar in predicting uterine rupture in women pregnant after cesarean section．Methods Pregnant women with vaginal birth after cesarean（VBAC）from January 2020 to December 2021 in Zhongshan Hospital of Traditional Chinese Medicine were selected as the research subjects．A total of 32 VBAC parturients with uterine rupture and 90 VBAC parturients without uterine rupture were included according to the inclusion and exclusion criteria．The basic information of the subjects was queried through the medical record information system of the hospital．In the third trimester（≥37 weeks）,the thickness and elasticity of uterine scar were measured by ultrasound,and the predictive effect of uterine scar thickness and elastic SI value on uterine rupture was analyzed by ROC curve．Results Chi-square test showed that the incidence of uterine rupture was higher in patients with age>35 years,pregnancy>2 times,interval from last cesarean section<2 years,newborn weight≥3kg,and the proportion of uterine rupture in single suture was higher than that in double suture（P<0.05）．The mean uterine scar thickness of 122 subjects was（3.42±0.49）mm,and the mean SI was（2.57±0.45）．The area under curve（AUC）of uterine scar thickness alone for predicting uterine rupture was 0.805（95%CI：0.730-0.880,P<0.05）,the cut off value was 3.05 mm,the sensitivity was 0.726,the specificity was 0.910,and the Youden coefficient was 0.636 by ROC curve analysis．The AUC of uterine scar SI alone for predicting uterine rupture was 0.730（95%CI：0.635-0.824,P<0.05）,the cut off value was 2.11,the sensitivity was 0.767,the specificity was 0.781,and the Youden coefficient was 0.548 by ROC curve analysis．The AUC of uterine scar thickness combination for predicting uterine rupture was 0.874（95%CI：0.812-0.937,P<0.01）,the sensitivity was 0.875,the specificity was 0.811,and the Youden coefficient was 0.686 by ROC curve analysis．The AUC predicted by uterine scar thickness combined with uterine scar SI value was higher than that predicted by uterine scar thickness alone（Z=7.611,P=0.041）and uterine scar SI value（Z=25.864,P=0.025）．Conclusions Elastic SI value of ultrasound imaging of uterine scar combined with uterine thickness can effectively improve the prediction efficiency of ultrasound for VBAC maternal uterine rupture,which has certain application significance,but further demonstration is still needed．

目的 观察父亲参与的早期母婴皮肤接触(SSC)对顺产初产妇的新生儿应激反应及生命体征的影响,为进一步优化“新生儿早期基本保健(EENC)”技术的临床实施建议提供实验依据。方法 使用随机数字表选取2017年2月—2021年5月期间,在深圳市福田区妇幼保健院产科分娩的1 986例顺产初产妇及新生儿作为研究对象。其中638例新生儿(共同参与组)实施了父亲参与的早期SSC,467例新生儿(SSC组)实施了早期母婴SSC,881例新生儿(对照组)实施了常规新生儿处理。观察3组新生儿的唾液皮质醇水平、体温和低温发生率、心率以及啼哭时间的差异,探讨父亲参与的早期母婴SSC在临床实施的可行性。结果 ① 3组新生儿出生30 min、60 min、90 min、180 min时,任意2组唾液皮质醇水平比较,差异均有统计学意义(均P<0.01);出生120 min时,共同参与组与对照组、SSC组与对照组比较,差异均有统计学意义(均P<0.01)。② 3组新生儿出生30 min、60 min时,共同参与组与对照组,SSC组与对照组的体温、低温发生率比较,差异均有统计学意义(均P<0.01);出生90 min时,任意2组体温比较,差异均有统计学意义(均P<0.01),共同参与组与对照组,SSC组与对照组的低温发生率比较,差异均有统计学意义(均P<0.01);出生120 min、180 min时,任意2组的体温与低温发生率比较,差异均有统计学意义(均P<0.01)。③ 3组新生儿出生30 min、60 min、90 min时,共同参与组与对照组,SSC组与对照组的心率比较,差异均有统计学意义(均P<0.01)。出生120 min、180 min时,任意2组比较,差异均有统计学意义(均P<0.01)。④ 3组新生儿出生0～30 min、30～60 min、60～90 min时间段,共同参与组与对照组,SSC组与对照组的啼哭时间比较,差异均有统计学意义(均P<0.01)。出生90～120 min、120～180 min时间段:任意2组的啼哭时间比较,差异均有统计学意义(均P<0.01)。结论 早期母婴SSC和父亲参与的早期母婴SSC均能降低顺产初产妇的新生儿唾液皮质醇水平,维持恒定的体温和心率,减少低温发生率和啼哭时间。相比较而言,父亲参与的早期母婴SSC是一种更科学、更有利于降低新生儿应激反应及维护其生命体征的护理模式。

Objective To observe the effect of father's participation in early maternal skin to skin contact (SSC) on primiparas' neonatal stress response and vital signs, so as to provide experimental basis for further optimizing the clinical implementation of “early essential newborn care (EENC)” technology. Methods The random number table was used to select 1 986 primiparas with their newborns who gave birth in Shenzhen Futian District Maternity and Child Healthcare Hospital from February 2017 to may 2021. Among them, 638 newborns (co-participation group) implemented early SSC with father participation, 467 newborns (SSC group) implemented early maternal and infant SSC, 881 newborns (control group) were treated with routine neonatal treatment. To observe the differences of salivary cortisol level, mean body temperature, incidence of hypothermia, heart rate and crying time among the newborns of three groups and to explore the feasibility of early mother and infant SSC with father participation in clinical implementation. Results ①There were significant differences in newborn salivary cortisol levels between any two groups at 30 min, 60 min, 90 min and 180 min after birth (all P<0.01). At 120 min after birth, there were significant differences between the co-participation group and the control group, SSC group and the control group (all P<0.01). ②At 30 min and 60 min after birth, there were significant differences in body temperature and the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 90 min after birth, there were significant differences in body temperature between any two groups (all P<0.01). There were significant differences in the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). There were significant differences in body temperature and the incidence of hypothermia between any two groups at 120 min and 180 min (all P<0.01). ③At 30 min, 60 min and 90 min after birth, there were significant differences in heart rate between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 120 min and 180 min after birth, there were significant differences between any two groups (all P<0.01). ④There were significant differences in the crying time of newborns in the three groups at 0-30 min, 30-60 min and 60-90 min, between the co-participation group and the control group, and between the SSC group and control group (all P<0.01). There were significant differences in crying time between any two groups at 90-120 min and 120-180 min after birth (all P<0.01). Conclusions Early maternal and infant SSC and early maternal and infant SSC participated by father could reduce the salivary cortisol level of primipara newborn, maintain constant body temperature and heart rate,also reduce the incidence of hypothermia and crying time. In comparison, the early maternal and infant SSC with father participation was a more scientific and conducive nursing model to reduce neonatal stress response and maintain their vital signs.

目的 探讨双侧会阴神经阻滞麻醉配合综合护理在降低单胎初产妇顺产会阴侧切率中的应用效果。方法 选取2019年7月—2019年12月在我院经阴道分娩的顺产初产妇110例为研究对象,按照随机数字表法分成两组,每组各55例,所选产妇对照组产妇给予常规护理模式,给予局部浸润麻,观察组产妇在对照组基础上采用综合护理模式,给予双侧会阴神经阻滞麻醉,比较两组产妇会阴侧切情况、会阴裂伤情况、产程持续时间、VAS评分、新生儿Apgar评分、依从性情况及护理效果等相关指标。结果 和对照组相比,观察组患者会阴侧切发生率少于对照组(P＜0.05),第一、第二产程时间短于对照组(P＜0.05);同对照组相比,观察组产妇在VAS评分、依从性及满意度指标均优于对照组(P＜0.05),而新生儿窒息、产后出血发生情况比较差异无统计学意义(P＞0.05)。结论 双侧会阴神经阻滞麻醉配合综合护理可以有效降低初产妇会阴侧切的发生率,减轻分娩时的疼痛,缩短产程,提高产妇依从性及满意度,具有较高的临床推广价值。

Objective To explore the effect of bilateral perineum nerve block anesthesia combined with comprehensive nursing in reducing the rate of perineum side cutting of primipara. Methods 110 primiparas who delivered vaginally in our hospital from July 2019 to December 2019 were selected as the research objects. According to the random number table method, they were divided into two groups, 55 in each group. The control group was given the routine nursing mode and local infiltration anesthesia. The observation group was given the comprehensive nursing mode and bilateral perineum nerve block anesthesia on the basis of the control group. The perineum side cutting status, perineum laceration, duration of labor, VAS score, Apgar score, compliance and nursing effect of the two groups were compared. Results Compared with the control group, the incidence of perineum side cutting was lower in the observation group than that in the control group (P<0.05).The first and second stages of labor were shorter in the observation group than the control group (P<0.05); compared with the control group, the VAS score, compliance and satisfaction index were better in the observation group than the control group (P<0.05), but there was no significant difference in neonatal asphyxia and postpartum hemorrhage (P>0.05). Conclusion Bilateral perineum nerve block anesthesia combined with comprehensive nursing may effectively reduce the incidence of perineum lateral incision of primipara, reduce the pain during delivery, shorten the labor process, improve the compliance and satisfaction of parturients, and has a high clinical value.

目的 观察腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果。方法 在2016年12月-2017年12月间,选取我院收治的80例高危产妇作为观察对象,均择期行剖宫产手术,依照随机数字表法分为观察组、对照组,每组产妇各40例。剖宫产手术的麻醉方式为,观察组采取双侧腹横肌平面阻滞后,七氟醚吸入诱导插入喉罩,对照组采取腰硬联合麻醉。观察比较两组的生命体征、手术持续时间、麻醉并发症发生率、新生儿Apgar 评分。结果 ①观察组T1~T3时段的平均动脉压、心率均低于对照组,（P<0.05）,有统计学意义。②观察组手术持续时间、麻醉并发症发生率、新生儿Apgar 评分与对照组比较,无差异,（P>0.05）。结论 腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果较好,对产妇和胎儿影响小,麻醉平稳、苏醒快,麻醉风险低,值得应用。

目的 分析于剖宫产产妇围手术期实施针对性护理对其切口感染率及不良情绪的影响。方法 选取2015年6月—2016年4月于我院择期行剖宫产术的102例产妇,通过随机数表法分为观察组与对照组,各51例。给予对照组常规护理,在此基础上观察组给予针对性护理干预。对比两组术后恢复情况、护理前后疼痛评分(VAS)、抑郁评分(SDS)及焦虑评分(SAS)变化情况,并统计两组并发症发生率、护理满意度。结果 观察组肛门排气时间、切口愈合时间、24 h睡眠时间、住院时间、下床活动时间均少于对照组,差异有统计学意义(P＜0.05);护理前两组SAS评分、SDS评分、VAS评分间无明显差异(P＞0.05),经护理干预,观察组SAS评分、SDS评分、VAS评分低于对照组,差异有统计学意义(P＜0.05);两组切口感染率、并发症发生率(1.96%、7.84%)低于对照组(15.69%、31.37%),差异有统计学意义(P＜0.05);两组护理满意度对比,观察组(98.04%)高于对照组(82.35%),差异有统计学意义(P＜0.05)。结论 给予剖宫产围术期产妇针对性护理疗效确切,可缓解不良情绪,减轻疼痛感,促使机体功能及早康复,减少切口感染与并发症发生。

目的 探讨标准化沟通模式在重症孕产妇院前转运前评估与交接环节中的应用效果。方法 设计转运前标准化沟通信息登记表,用以标准化转运前评估与交接环节,护士按照登记表中的项目逐条交接,对方未交代的项目护士进行主动评估,并将结果登记并汇报接诊医生。结果 运用标准化沟通模式后,有效缩短了转诊的通话时间和抵院后的处理时间,护士评估信息的错漏率由13.84%降低至4.23%,交接不清导致的不良事件发生率由7.41%降至1.21%,并在改善母婴结局等方面均取得较好效果。结论 SBAR 沟通模式在重症孕产妇孕前转运的评估和交接环节中保证了重要信息的准确传递,为重症孕产妇的救治争取宝贵时间,值得临床上推广应用。

Objective To explore the application effects of SBAR (situation, background, assessment and recommendation) communication mode in the transfer of critically ill obstetric women. Methods A transfer from based on SBAR communication mode was designed and used to assess the psychological status and illness condition of critically ill obstetric women. Results After the application of SBAR communication transfer model, the communication time and hospital action time were both shortened and the occurrence of transfer problems decreased,while the pregnancy outcomes were improved (P＜0.05). Conclusion Applying SBAR communication mode in the transfer of critically ill obstetric women is helpful to reduce the transfer time and the occurrence of transfer problems,and improve the quality of patient handover.

目的 研究限制会阴切开及会阴不同切口对产妇产后出血、疼痛及性功能的影响。方法 选取我院2012年4月—2013年4月头位自然分娩产妇480例,抽签随机分为三组,每组160例,实施限制会阴切开的为限制组,实施会阴侧切的为侧切组,实施会阴正中切开的为正切组,比较三组产妇产后2 h出血量、产后住院时间、产妇会阴阴道裂伤率、产后疼痛程度和性功能满意程度。结果 产后2 h产妇出血量限制组(203.65±76.68)mL较侧切组(241.41±80.63)mL和正切组(239.15±85.19)mL少(P＜0.05);侧切组(1.64±0.87)d产后住院时间较限制组(1.37±0.64)d较长(P＜0.05);限制组会阴Ⅰ/Ⅱ°裂伤率为86.25%较侧切组1.25%和正切组6.88%较高(P＜0.05);侧切组2.50%和正切组3.13%会阴Ⅲ/Ⅳ°裂伤较限制组0%较高(P＜0.05);女性性功能指数限制组(22.69±2.65)分较侧切组(19.12±2.05)分与正切组(18.96±2.16)分较高(P＜0.05)。结论 实施限制会阴切开的产妇术后出血量少,会阴重度裂伤率低,保证了会阴完整性,产后性功能满意度高,值得临床上应用推广。

目的 对比观察罗哌卡因及布比卡因应用于患有妊娠期高血压的产妇行剖宫产时腰麻联合硬膜外麻醉的临床效果。方法 将103例择期行剖宫产手术的妊娠期高血压患者随机分为罗哌卡因组51例及布比卡因组52例分别采用对应药物进行麻醉,研究两组阻滞效果、心血管系统变化情况及不良反应发生情况。结果 两组间麻醉镇痛效果及优良率比较,差异没有统计学意义(P>0.05)。罗哌卡因组感觉及运动阻滞起效时间较布比卡因组长,运动阻滞恢复时间较布比卡因组短(P<0.05)。心血管系统变化情况比较,麻醉5min、10min时两组收缩压及平均动脉压均降低,但布比卡因组波动更大,两组间比较差异显著(P<0.05),心率及血氧饱和度比较无差异(P>0.05)。罗哌卡因组不良反应出现时间较布比卡因组晚,同时其不良反应发生率较布比卡因组低(χ²=4.1599,P<0.05)。结论 罗哌卡因及布比卡因在阻滞时间上略有差异,麻醉镇痛效果相当,但鉴于妊高症产妇本身心血管系统存在基础问题,运用罗哌卡因对心血管系统的影响较小,安全性更高,更值得推荐使用。

       目的   探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法   选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果   高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论   高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。

       Objective  To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods  From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results  The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions  Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．

        目的   对入住重症监护病房（ICU）重症孕产妇患者的病种特征和住院费用进行分析。方法   从医院信息管理系统中搜索2009—2019年广州市某省级重症孕产妇救治中心ICU的重症孕产妇住院病例，对病例资料进行描述性流行病学分析。结果  2009—2019年该救治中心ICU共收治重症孕产妇1 616例，病种排名前五位依次为心血管疾病430例（26.61%）、血液及造血器官疾病310例（19.18%）、妊娠期特定并发疾病287例（17.76%）、消化系统疾病218例（13.49%）、呼吸系统疾病110例（6.81%）。患者经济负担中位数排名前五位依次为肌肉骨骼系统和结缔组织疾病（62 252.60元）、消化系统疾病（61 684.41元）、感染性疾病（42 945.70元）、血液及造血器官疾病（40 403.52元）、神经系统疾病（40 055.93元）。结论   入住ICU内的重症孕产妇以心血管疾病、血液及造血器官疾病为主，经济学分析表明肌肉骨骼系统和结缔组织疾病造成的经济损失较大。

       Objective  To analyze the disease characteristics and hospitalization expenses of  severe maternal patients in intensive care unit（ICU）．Methods  Hospitalized cases of severe maternal disease in  ICU of a provincial critical care center in Guangzhou from 2009 to 2019 were searched from the hospital information management system，and case data was analyzed by descriptive epidemiology．Results  From 2009 to 2019，a total of  1616 critically ill maternal  patients  received intensive care treatment at this center．The predominant diseases observed were cardiovascular disorders（26.61%），blood and hematopoietic organ diseases（19.18%），specific pregnancy-related complications（17.76%），gastrointestinal ailments（13.49%），and respiratory disorders（6.81%）．Among the top five patient groups，the median economic burden was the highest in musculoskeletal system and connective tissue diseases（62 252.600 yuan），followed by digestive system diseases（61 684.410 yuan），infectious diseases（42 945.700 yuan），blood and hematopoietic organ diseases（40 403.515 yuan），and nervous system disorders（40 055.930 yuan）Furthermore，a discernible correlation between hospitalization cost and length of stay was identified．Conclusions  Cardiovascular diseases and disorders of blood and hematopoietic organs are the primary causes for maternal admissions to ICU．Economic analysis shows that musculoskeletal system and connective tissues diseases cause bigger economic loss ．