目的 分析中山市博爱医院妊娠合并哮喘急性发作患者相关危险因素。方法 选取2019年7月—2021年2月中山市博爱医院收治100例的妊娠合并哮喘患者作为研究对象,将100例妊娠合并患者分为哮喘急性发作组(n=46)与未发作组(n=54),采用多因素Logistic回归分析进行调查分析。结果 100例患者中发作人数为46例,占46.0%。Logistic回归分析显示孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的危险因素(P<0.05)。发作组剖宫产率发生率、住院时间以及并发症发生率均高于未发作组,差异有统计学意义(P<0.05)。结论 孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的独立危险因素,应对此类患者给予高度重视。

Objective To analyze the risk factors of pregnancy complicated with acute attack of asthma in Zhongshan Bo'ai Hospital.Methods A total of 100 patients with pregnancy complicated with asthma treated in Zhongshan Bo'ai Hospital from July 2019 to February 2021 were selected as the research objects.Patients were divided into acute attack group (n=46) and no attack group (n=54).Multivariate logistic regression analysis was used for investigation and analysis.Results The patient number of attack was 46,accounting for 46.0%. The incidence of cesarean section,length of hospital stay and complications in the attack group were higher than those in the no attack group,and the difference was statistically significant (P<0.05).Conclusions Gestational age,use of asthma drugs,anxiety and IL-17 level were independent risk factors for pregnancy complicated with acute attack of asthma.Great attention should be paid to these patients.

目的 分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇接受胰岛素治疗对妊娠结局的影响及安全性。方法 将2018年7月—2020年7月接诊且行常规治疗的50例GDM孕妇作为对照组,将同期接诊且在对照组基础上行胰岛素治疗的50例GDM孕妇作为观察组,对组间血糖控制效果、生活质量(SF-36)、治疗效果、不良妊娠结局、不良反应展开分析。结果 (1)组间血糖指标在治疗前无明显差异(P＞0.05);治疗后,观察组血糖控制效果优于对照组(P<0.05);(2)观察组SF-36评分高于对照组,且治疗效果(96.00%)优于对照组(82.00%,P<0.05);(3)观察组出现3例不良妊娠结局(6.00%),对照组出现11例不良妊娠结局(22.00%,P<0.05);(4)观察组发生3例不良反应(6.00%),对照组发生2例不良反应(4.00%,P＞0.05)。结论 对GDM孕妇实施胰岛素治疗,可以改善孕妇血糖水平,减少不良妊娠结局,提高孕妇生活质量,安全可靠,值得推广。

Objective To analyze the effect and safety of insulin therapy on pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 50 pregnant women with GDM who received conventional treatment from July 2018 to July 2020 were induded in the control group, and 50 pregnant women with GDM who received insulin treatment on the basis of the control group were induded in the observation group. Results (1) There was no significant difference in blood glucose index between two groups before treatment(P＞ 0.05); after treatment, the blood glucose control effect of the observation group was better than that of the control group(P<0.05); (2) SF-36 score of the observation group was higher than that of the control group, and the treatment effect (96.00%) was better than that of the control group (82.00%,P<0.05); (3) there were 3 cases of adverse pregnancy outcomes (6.00%) in the observation group and 11 cases (22.00%) in the control group; (4) there were 3 cases of adverse reactions (6.00%) in the observation group and 2 cases (4.00%) in the control group(P＞ 0.05). Conclusion Insulin therapy for pregnant women with GDM could improve the blood glucose level of pregnant women, reduced adverse pregnancy outcomes, improved the quality of life of pregnant women, which is safe and reliable, and is worthy of promotion.

目的 研究妊娠早期低血压对子宫动脉血流的影响。方法 前瞻性连续收集2020年9月—2021年3月在广州市妇女儿童医疗中心行产前检查的早孕期正常单胎妊娠孕妇,分为两组:低血压组(43人)及正常血压组(73人),分别监测两组孕妇的双侧子宫动脉血流搏动指数 (pulse index,PI)及收缩期峰值 (peak systolic velocity,PSV),并比较两组间PI及PSV是否有统计学差异。结果 双侧子宫动脉血流PI与平均动脉压呈线性正相关关系(P＜0.05)。低血压组双侧子宫动脉PI低于正常血压组,差异有统计学意义(P＜0.05),低血压组右侧子宫动脉PSV低于正常血压组,差异有统计学意义(P＜0.05),左侧子宫动脉PSV两组间无差异(P＞0.05)。结论 低血压孕妇子宫动脉血流动力学参数异常降低,临床应重视妊娠期低血压孕妇子宫动脉血流动力学异常者的围产期管理。

Objective To study the relationship between early pregnancy hypotension and uterine artery blood flow. Methods We prospectively and consecutively selected pregnant women with normal singleton pregnancy in early pregnancy for this study from September 2020 to March 2021 in Guangzhou Women and Children's Medical Center. According to the blood pressure, they were divided into hypotension group (n=43) and normal blood pressure group (n=73). We monitored the pulse index (PI) and peak systolic velocity (PSV) of bilateral uterine artery blood flow, then compared the PI and PSV between the two groups. Results There was a positive linear correlation between PI and mean arterial pressure (P＜0.05). The PI of bilateral uterine arteries in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of right uterine artery in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of left uterine artery in hypotension group was not different from that in normal blood pressure group (P＞0.05). Conclusion Uterine artery hemodynamic parameters of hypotensive pregnant women decreased abnormally, so attention should be paid to the perinatal management of pregnant women with abnormal uterine artery hemodynamics.

目的 探讨影响孕晚期死胎伴胎动减少延迟就诊的临床因素,加强围产期宣教。方法 回顾性分析2017年1月—2019年10月广州市妇女儿童医疗中心住院分娩的孕晚期(孕周≥28周)单胎死胎病例的相关临床资料。结果 在79例死胎中,有59例(74.68%)孕妇感知胎动减少,但只有27人(45.76%)在感知胎动减少后24小时内就诊。妊娠未合并胎儿生长受限可能会导致延迟就诊(P=0.03<0.1)。结论 胎动减少和死胎发生密切相关,但大部分孕妇可能会出现延迟就诊。加强孕期产检,规范孕期宣教,尤其是合并胎儿生长受限等高危妊娠时的孕期严密监测,强调胎动的重要性,在感知胎动减少后强调早期就诊,有助于减少孕晚期死胎风险。

Objective To explore the clinical factors that affect the consultation time of stillbirth after perceptive reduction of fetal movement in the third trimester of pregnancy, and to strengthen the perinatal education. Methods A retrospective analysis of single stillbirth in late pregnancy (gestational weeks≥ 28 weeks) in Guangzhou Women and Children's Medical Center from January 2017 to October 2019 was taken, and the relevant clinical data were summarized and evaluated. Results Out of 79 stillbirth cases, 59 (74.68%) cases had decreased fetal motility. Only 27 pregnant women (45.76%) visited the doctor in 24 hours after they perceived the reduction of fetal movement. Pregnancy without fetal growth restriction may lead to delayed consultation (P=0.03<0.1). Conclusion Perception of decreased fetal movement is closely related to the occurrence of stillbirth, but most pregnant women may have delayed visits. To strengthen the prenatal examination, standardize the propaganda and education during pregnancy, especially the close monitoring of high-risk pregnancy such as fetal growth restriction, emphasize the importance of fetal movement, and emphasize the early consultation after perceiving the reduction of fetal movement, are helpful to reduce the risk of stillbirth in late pregnancy.

目的 探讨子午流注开穴法对薄型子宫内膜患者妊娠结局的影响。方法 将同期在门诊行B超监测排卵、指导受孕的薄型子宫内膜患者80例随机分为两组,每组各40例,观察组采用子午流注开穴法及药物治疗,对照组则单纯给予药物治疗。比较两组治疗前后的子宫内膜厚度、子宫内膜形态、子宫内膜血流搏动指数(PI)、血流阻力指数(RI)及临床妊娠率(PR)。结果 两组治疗后子宫内膜厚度与同组治疗前均有不同程度的改善(P<0.05),治疗后子宫内膜厚度两组间比较差异有统计学意义(P<0.05)。观察组治疗后A型子宫内膜的比例较治疗前增加,差异有统计学意义(P<0.05);与对照组比较,差异有统计学意义(P<0.05)。观察组临床妊娠率为27.5%,对照组临床妊娠率为10%,两组相比较差异有统计学意义(P<0.05)。结论 子午流注开穴法在薄型子宫内膜患者中的应用有效促进子宫内膜容受性的建立,从而改善其妊娠结局。

Objective To explore the effects of selection points by earth meridian ebb-flowing rule on infertile women suffering from thin endometrium. Methods 80 patients with thin endometrium who were monitored ovulation and guided pregnancy under B-mode ultrasound were randomly divided to two groups: the observation group and the control group, 40 patients for each group. The observation group was treated with selection points by earth meridian ebb-flowing rule and medication, while the control group was treated with medication only. The endometrial thickness, endometrial morphology, endometrial blood flow Pulsation Index (PI), Resistance Index (RI) and Clinical Pregnancy Rate (PR) before and after treatment were compared between the two groups. Results After treatment, the endometrial thickness was improved in both groups, which was statistical significant between the two groups(P<0.05). The proportion of type A endometrium in the observation group was increased compared with that before treatment and the control group, the difference was statistical significant(P<0.05). The clinical pregnancy rate was 27.5% in the observation group and 10% in the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusion The application of selection points by earth meridian ebb-flowing rule in patients with thin endometrium may effectively promote the establishment of endometrial receptivity and improve the pregnancy outcome.

目的 我们探讨2019年6月—2020年1月复发性流产夫妇男性患者精浆弹性蛋白酶同精液参数及DNA碎片率的可能关系。方法 研究对象纳入80例复发性流产的男性患者及25例因女方输卵管因素行IVF-ET正常生育的男性患者。精液标本用来进行精浆弹性蛋白酶、精液常规分析、精子核染色质分析及精子形态学等参数分析。结果 结果表明同正常生育男性相比,复发性流产的弹性蛋白酶是增高(P=0.010)。我们将复发性流产男性患者分为正常组(<600 ng/mL)及异常组(≥600 ng/mL)。结果表明异常组患者的精子前向运动比例(P=0.002)及正常形态百分率(P=0.009)均降低,而精子DNA碎片率(P=0.002)增高。Spearman相关性分析发现精浆弹性蛋白酶同精子前向运动比例(r=-0.43,P<0.001)及正常形态百分率(r=-0.39,P<0.001)负相关,而同精子DNA碎片率(r=0.36,P=0.001)正相关。结论 精浆弹性蛋白酶可能影响复发性流产男性患者的精子活力、形态及DNA碎片率。复发性流产男性患者的生殖道隐性感染值得重视,其相关临床探讨性值得深入研究。

Objective Our study is aim to investigate the possible relationship of seminal elastase, on semen parameters and DNA fragmentation in male patients of recurrent pregnancy loss (RPL) between June 2019 and January 2020. Methods The patients included 80 male patients of RPL couple and 25 male patients from couples with clinical pregnancy through in vitro fertilization due to the female tubal factor. The semen samples were used to determine the seminal elastase, computed assisted semen analysis, sperm dispersion test and sperm morphology analysis. Results Compared to the control group, the levels of seminal elastase was increased in the RPL group. The RPL group was divided into the normal group (Elastase<600 ng/mL) and abnormal group (Elastase ≤ 600 ng/mL).The abnormal group exhibited the lower percentage of progressive sperm (P=0.002) and normal morphology (P=0.009),but higher precentage of DNA fragmentation (P=0.002). Meanwhile, the seminal elastase was positively associated with DNA fragmentation (r=0.36,P=0.001), but was inversely associated with the sperm motility (r=-0.43,P<0.001) and normal morphology (r=-0.39,P<0.001). Conclusion Our study may unveil the possible effects of the seminal elastase on the semen parameters and DNA fragmentation in the male patients of RPL couples. Further studies should put more emphasis on the silent genital tract inflammation of the patients.

目的 比较细胞因子TGF-β、IL-10、TNF-α、Th17在不同妊娠结局的妊娠期亚临床甲减孕妇血清中的差异,探索细胞因子在不同妊娠结局中的作用。方法 随机选择2018年1月—2018年12月在我院就诊的66例确诊为因妊娠期亚临床甲减而出现不良妊娠结局的孕妇与同期妊娠结局正常的66例孕妇进行病例对照研究,比较不同妊娠结局孕妇的血清TGF-β、IL-10、TNF-α、Th17的差异;结果 ① 亚临床甲减组的TPOAb、TgAb、TRAb阳性率高于正常妊娠组,同时TNF-α、Th17均高于正常妊娠组,而TGF-β、IL-10均低于正常妊娠组,差异有统计学意义(P<0.05)。② 因子分析发现:在TPOAb、TgAb、TRAb、TGF-β、IL-10、TNF-α、Th17七个影响妊娠期亚临床甲减不良妊娠结局的相关因素中,TGF-β、IL-10、TNF-α、Th17在第1影响因子,特征值达2.347;TPOAb、TgAb、TRAb是次要影响因子,特征值为1.162。结论 TGF-β、IL-10、TNF-α、Th17与妊娠期亚临床甲状腺功能减退症的不良妊娠结局有密切关系,TGF-β、IL-10、TNF-α、Th17是影响妊娠期亚临床甲减不良妊娠结局的主要因子;TPOAb、TgAb、TRAb是影响妊娠期亚临床甲减不良妊娠结局的次要因子。

Objective To compare the serum levels of TGF-β, IL-10, TNF-α and Th17 in pregnant women with subclinical hypothyroidism in different pregnancy outcomes. Methods A case-control study was conducted in 66 pregnant women with adverse pregnancy outcomes due to subclinical hypothyroidism during pregnancy and 66 pregnant women with normal pregnancy outcomes during the same period. The differences of serum TGF-β, IL-10, TNF-α and Th17 among pregnant women with different pregnancy outcomes were compared. Results ①The positive rates of TPOAb, TgAb and TRAb in subclinical hypothyroidism group were higher than those in normal pregnancy group, and TNF-α and Th17 were higher than those in normal pregnancy group, while TGF-βand IL-10 were lower than those in normal pregnancy group (P<0.05). ②Factor analysis found that TPOAb, TgAb, TRAb, TGF-β, IL-10, TNF-α and Th17 were the factors related to adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy. TGF-β, IL-10, TNF-α and Th17 were the main influencing factors with a characteristic value of 2.347; TPOAb, TgAb and TRAb were the second influencing factors,with a characteristic value of 1.162. Conclusion ①TGF-β, IL-10, TNF-α, Th17 are closely related to the occurrence and pregnancy outcome of subclinical hypothyroidism in pregnancy. ②TGF-β, IL-10, TNF-α and Th17 are the main factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy;TPOAb, TgAb and TRAb are the secondary factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy,

目的 针对剖宫产术后瘢痕子宫妊娠早产进行阴道分娩方法的研究,并比较其可行性与安全性。方法 选择 2015年5月—2017年4月在来我科室采用经阴道分娩法进行分娩的瘢痕子宫妊娠早产(28～37周)患者96例为研究对象,设为观察组。同时按照随机分组法选择同时间段来我院就诊的非瘢痕子宫妊娠早产经阴道分娩的患者96例作为对照组A组,瘢痕子宫妊娠早产行剖宫产分娩的患者96例作为对照组B组。对三组患者的产妇分娩情况和新生儿出生后的情况进行比较分析。结果 观察组与对照组A在产住院天数、产程时间、出血量、新生儿窒息发生等产妇术中情况及新生儿情况的比较没有差异(P＞0. 05) 。观察组与对照组B在产后在住院天数、住院花费、出血量等方面进行比较,两组的差异有统计学意义(P＜0.05)。在发生产褥感染、进行输血的病例数、子宫切除例数、新生儿Apgar评分、新生儿并发症等新生儿情况的比较同样没有统计学差异(P＞0.05)。结论 瘢痕子宫妊娠早产患者采用经阴道分娩法进行分娩产后并发症少、新生儿出生后情况较好、母婴妊娠结局良好,是一种可行性好、安全性高的分娩手段。

目的 通过比较二胎孕妇和初产孕妇心电图变化探讨其对妊娠结局的影响。方法 随机选取300例孕妇,其中150例二胎孕妇为观察组,150例初产孕妇为对照组。观察2组孕妇异常心电图的类型及发生率,分析异常心电图与妊娠结局的关系。结果 初产孕妇组异常心电图35例,心电图异常发生率为23.3%,二胎孕妇组异常心电图50例,心电图异常发生率为33.3%,两组心电图异常发生率差别有统计学意义(P<0.05)。二胎孕妇组窦性心动过速、室性早搏及ST-T改变的发生率显著高于初产孕妇组,差异有统计学意义(P<0.05)。二胎孕妇心电图异常组的剖宫产率和早产率均高于二胎孕妇心电图正常组、初产孕妇心电图正常组,差别有统计学意义(P>0.05)。结论 二胎孕妇易合并心电图异常改变,心电图异常会增加剖宫产和早产的发生率,临床医生在诊治此类患者时应提高警惕。

Objective To observe the relationship between electrocardiogram(ECG) and pregnancy outcomes of the second pregnant women. Methods Pregnant women were divided into two groups by parity history: the second pregnancy group and the Primipara group. The incidence of abnormal electrocardiogram was recorded, then the pregnancy outcome including the delivery mode and the premature birth rate were followed up. Results The incidence of abnormal ECG in the second pregnancy group was significantly higher than that in primipara group(P<0.05) and the incidences of Nodal tachycardia, Premature ventricular contraction, ST-T changes in the group of the second pregnancy were higher than that in the group of Primipara (P<0.05). The incidence of cesarean delivery and premature birth in the second pregnancy group with abnormal ECG group was significantly higher than that in pregnant women with normal ECG group (P<0.05). Conclusion The second pregnant women are more likely to have ECG abnormality, the pregnant women with abnormal ECG are easily suffer from cesarean delivery and premature birth.

目的 探究以临床护理路径为主的健康教育在二胎异位妊娠患者中的应用效果。方法 选取2016年1月—2017年6月收治的80例二胎异位妊娠患者,随机分为实验组40例和对照组40例,实验组:实施以临床护理路径为主的健康教育,对照组以常规指导,比较两组临床效果。结果 实验组患者在健康教育知晓率、护理满意率方面与对照组比较,有差异(P<0.05);实验组在住院时间、住院费用及并发症发生率方面与对照组比较(P<0.05),观察组焦虑评分与抑郁评分均低于对照组(P<0.05)。结论 二胎异位妊娠患者运用临床护理路径进行健康教育,可有效提高患者对于异位妊娠疾病的了解程度,提高治疗护理依从性,促进患者早日康复出院,提高护理满意度,值得推广普及。

Objective To study the effect of applying clinical nursing pathway on health education of second womb ectopic pregnancy and explore more effective health education modes. Methods 80 patients with second-trimester ectopic pregnancy were randomly divided into experimental group (40 cases) and control group (40 cases). The experimental group was given health education through clinical nursing pathway. The control group was given routine guidance. We compared the effects of health education in two groups. Results 40 patients in the experimental group were compared with the 40 patients in the control group in terms of awareness rate of health education and satisfaction rate of care, P<0.05; the experimental group was compared with the control group in terms of length of stay, hospitalization costs, and complication rate, P<0.05 The anxiety scores and depression scores in the observation group were lower than those in the control group, P<0.05. There was a statistical difference between the two groups. Conclusions Applying clinical nursing pathway on health education of second womb ectopic pregnancy patients may effectively improve patients' understanding of ectopic pregnancy diseases, improve compliance of nursing care, facilitate patients to be discharged and improve satisfaction of nursing satisfaction, clinical care services in the popularization.