棋牌大全下载安装

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                              • 当前位置: 代写一篇论文多少钱 > 医学论文 > 瘢痕子宫实施阴道分娩的可行性与安全性

                                瘢痕子宫实施阴道分娩的可行性与安全性

                                时间:2018-12-18 10:27作者:秦海霞
                                本文导读:这是一篇关于瘢痕子宫实施阴道分娩的可行性与安全性的文章,瘢痕子宫是产科临床常见的问题,主要由剖宫产史造成[1],其他少见的包括子宫肌瘤剔除术史、子宫穿孔史、子宫破裂史。由于我国的高剖宫产率和人口政策的改变,瘢痕子宫再妊娠率明显增多并面临分娩方式的选择。

                                  摘    要:棋牌大全下载安装 目的 探讨瘢痕子宫再妊娠经阴道分娩的可行性以及注意事项。方法 收集某院产科2018年1月~2018年12月收治的146例瘢痕子宫再妊娠经阴道试产的孕妇(研究组),随机选择同期收治的146例非瘢痕子宫经阴道试产孕妇(对照组)的临床资料。比较两组分娩产妇的分娩结果。结果 研究组产妇146例,其中试产成功132例,成功率为90%,与对照组比较,产程时间、产时出血量、新生儿的Apgar评分、新生儿体重、产妇住院时间都没有显着性差异(P> 0.05)。结论 只要选择合适试产条件、做好孕期教育和产程中各注意事项,多数瘢痕子宫产妇是可以经阴道安全分娩的。

                                  关键词:棋牌大全下载安装 瘢痕子宫; 阴道分娩; 剖宫产术后阴道试产;

                                  瘢痕子宫是产科临床常见的问题,主要由剖宫产史造成[1],其他少见的包括子宫肌瘤剔除术史、子宫穿孔史、子宫破裂史。由于我国的高剖宫产率和人口政策的改变,瘢痕子宫再妊娠率明显增多并面临分娩方式的选择[2]。既往多数产妇和家属选择了再次剖宫产,但这增加了产时出血、盆腔粘连、感染、切口愈合不良以及远期并发症如瘢痕妊娠、凶险性前置胎盘等。近年来,瘢痕子宫再妊娠经阴道分娩问题成为研究热点,妇产科学者长期探究后认为,选择剖宫产术后阴道试产(Trial of labor after cesarean,TOLAC)是瘢痕子宫再次妊娠的一种安全分娩方式[3]。本文回顾分析了我院产科于2018年1月~2018年12月收治的146例由前次剖宫产造成的瘢痕子宫经阴道试产者的临床资料,随机选择同期收治的非瘢痕子宫经阴道试产者146例进行比较,分析探讨瘢痕子宫实施阴道分娩的可行性与安全性,体会如下。
                                 

                                瘢痕子宫实施阴道分娩的可行性与安全性
                                 

                                  1、 资料与方法

                                  1.1、 一般资料

                                  XUANZE2018NIAN1YUE~2018NIAN12YUEZAIWOYUANCHANKEZHUYUANFENMIAN,JINGGUOZHIQINGTONGYI,YUANYIXUANZEJINGYINDAOSHICHANDEBANHENZIGONGDANTAI、TOUWEI、WUYINDAOFENMIANJINJIZHENGDEYUNFU146LI(JUNWEIPOUGONGCHANSHUHOU)WEIYANJIUZU,SHANGCIPOUGONGCHANZHIZHENG:WUMINGQUEPOUGONGCHANZHIZHENGDE72LI,QIZHONG56LISHUSHEHUIYINSU(YUNFUBENRENYAOQIU),LINGWAI16LIYUANYINBUMING;QIDAIRAOJING2ZHOU5LI;TAIERJIONGPO18LI;YANGSHUIGUOSHAO11LI;TUNWEI12LI;TAIMOZAOPO6LI;JUDAER5LI;SHICHANSHIBAI6LI,RENSHENQIGANNEIDANZHIYUJIZHENG3LI;FUHEYINSU8LI。QIZHONG10LIQIANCIPOUGONGCHANSHIGONGKOUDA3~4 cm,4LIYOUJINGYINDAOFENMIANSHI。SUIJIXUANZETONGQIZAIWOYUANDAICHANDETONGYIJINGYINDAOSHICHANDECHUCHANFU146LIZUOWEIDUIZHAOZU,LIANGZUZAINIANLING、SHENGAO、YUNZHOUDENGFANGMIANWUMINGXIANCHAYI(P>0.05),YOUKEBIXING,JIANBIAO1。

                                  表1:产妇一般情况及新生儿体重比较
                                表1:产妇一般情况及新生儿体重比较

                                  1.2、 方法

                                  YUNQIJIANCHA:YUNQIYOUGAONIANZIZHUZHIYISHIHUOZHEFUZHURENYISHIXIANGXIXUNWENBINGSHI,PAICHUJINJIZHENGHOU,ZHUDONGXIANGQIXUANCHUANBANHENZIGONGJINGYINDAOFENMIANDEKENENGXINGHEANQUANXING,ZHUFUQIYANGEKONGZHITIZHONG、DINGQICHANJIAN、DUOYUNDONG、JIANDINGXINNIANBINGQUDEJIASHUZHICHI。TONGGUOYUNFUXUEXIAO、JIANLIQQGONGYIQUN,DAILINGYUNFUXUEXIYUNQIHEFENMIANDEZHISHI,LEJIEBANHENZIGONGSHIKEYIJINGYINDAOFENMIANDE,RANGYIXIECHENGGONGSHIXIANBANHENZIGONGJINGYINDAOFENMIANZHEDECHANFUXIEXIAXINDETIHUIGONGQITAYUNFUCANKAOXUEXI。

                                棋牌大全下载安装   RENSHENZUYUE:ZAICIPINGGUQISHIFOUFUHETIAOJIAN:(1)QIANCIPOUGONGCHANWEIZIGONGXIADUANPOUGONGCHAN,SHUZHONGQIEKOUWUYANLIE,SHUHOUWUZIGONGQIEKOUYUHEBULIANG;(2)CICIFENMIANJUQIANCISHOUSHUDA2NIANJIYISHANG;(3)BCHAOTISHIBANHENLIANXUXINGLIANGHAO,WUMINGXIANQUESUN,DUIYUBANHENHOUDUWUYANGEXIANZHI;(4)DANTAITOUWEI,WUMINGXIANTOUPENBUCHENG,FEIJUDAER,DANDUIYUSHENCAIGAODAZHE,TAIERTIZHONGKESHIDANGFANGKUAN;(5)CHANFUJIJIASHUZHIQINGTONGYI。

                                棋牌大全下载安装   FENMIANQI:JINLIANGZIRANLINCHANHOURUYUAN、XUANCHUANZUGUOYIXUEDE“SHUI、RENTONG、MANLINPEN”LIUZIZHENYAN、JINLIANGSHAOGANYU、CHANCHENGZHONGZIYOUTIWEI、ZHUANRENJIANHUJISHILEJIEYOUWUZIGONGXIADUANYATONGHETAIXINYICHANG,RUYOUXIANZHAOZIGONGPOLIE、TAIERJIONGPO、NANCHANQINGXIANGDENGJISHIPOUGONGCHAN,BENYUANCHANFANGSHEYOUSHOUSHUJIAN,MAZUISHI24XIAOSHIJINZHU,JUBEIJINJIPOUGONGCHANTIAOJIAN。

                                  1.3、 观察指标

                                棋牌大全下载安装   GUANCHAJILULIANGZUJINGYINDAOFENMIANCHENGGONGLV、CHANCHENGSHIJIAN、CHANHOUCHUXUE、XINSHENGERAPgarPINGFEN、XINSHENGERTIZHONG、HUIYINCEQIELV、ZHUYUANSHIJIAN。

                                  1.4、 统计学方法

                                  CAIYONGSPSS 19.0SHUJUTONGJIRUANJIANJINXINGSHUJUCHULI,JILIANGZILIAOYI(JUNSHU±BIAOZHUNCHA)BIAOSHI,CAIYONGtJIANYAN;JISHUZILIAOYIBAIFENLVBIAOSHI,CAIYONGχ2JIANYAN。YIP<0.05WEICHAYIYOUTONGJIXUEYIYI。

                                  2、 结果

                                棋牌大全下载安装   146LIBANHENZIGONGJINGGUOZHIQINGTONGYIHOUJINRUYINDAOSHICHAN,QIZHONG98%ZIRANLINCHANRUYUAN,JIN3LIYINRENSHEN41+4ZHOULINCHANQIANRENGONGPOMOJIAJINGDICUICHANSUGANYU;LINCHANHOU3LIXINGRENGONGPOMO,6LISHIYONGSUOGONGSU,42LISHIYONGDAOLEFENMIANZHENTONGYI,5LISHIYONGYINGMOWAIFENMIANZHENTONG。RENGONGGANYULV8%,ZHENTONGLV32%。

                                棋牌大全下载安装   132LICHENGGONGFENMIAN,CHENGGONGLV90%,ZHONGZHUANPOUGONGCHANDE13LI:QIZHONG6LIYINWEITAIERJIONGPOZHONGZHUANPOUGONGCHAN;2LISHICHANZHIGONGKOU3 cmHOUCHANFUBENRENBUNENGNAISHOUGONGSUOTONGJIANJUEFANGQISHICHAN,ZHUANWEIPOUGONGCHAN;3LICHIXUXINGZHENHOUWEI、XIANLUXIAJIANGTINGZHIZHONGZHUANPOU;1LIRENSHEN41ZHOUHOUJIHUAFENMIANLIANGTIANWUMINGXIANJINZHANHOUFANGQI;1LIRENSHEN36ZHOU、TAIMOZAOPOSHICHANSHIBAIZHUANPOUGONGCHAN。

                                棋牌大全下载安装   FENXIDUIBILIANGZUYINDAOFENMIANCHENGGONGLV、CHANCHENGSHIJIAN、CHANHOUCHUXUE、XINSHENGERAPgarPINGFEN、XINSHENGERTIZHONG、ZHUYUANSHIJIANWUMINGXIANCHAYI,JIANBIAO2。

                                  3、 讨论

                                  3.1、 瘢痕子宫经阴道分娩可行性和安全性

                                  CHANKEYANJIUZHEDUIYUBANHENZIGONGZAIRENSHENFENMIANSHIDEFENMIANFANGSHIXUANZEYIZHICUNZAIZHENGYI,DADUOSHUYUNFUHEYIYUANJUNRENWEIBANHENZIGONGYINDAOFENMIANFENGXIANTAIDAERZAICIXUANZEPOUGONGCHAN[4]。ZAIWOGUO,GENGSHIYINWEIJUGAOBUXIADEPOUGONGCHANLVERZAOCHENGLEDALIANGDEBANHENZIGONG,ERDANGQIANYIHUANGUANXIJINZHANGJIEHEYIXIESHEHUIRENWENYINSU,YIHUANSHUANGFANGJUNGUODUFANGDALEZIGONGPOLIEWENTI,PUBIANDEDUIBANHENZIGONGJINGYINDAOFENMIANJIESHOUCHENGDUDI。

                                  ZI2010NIANZHONGGUOFUYOUBAOJIANXIEHUIQIDONG“CUJINZIRANFENMIAN,BAOZHANGMUYINGJIANKANG”YILAI,CHANKEYIHUYIJIYUNCHANFUDEDAOZHENGQUEDEXUANCHUANJIAOYU,YIJIERHAIZHENGCEDEZHUJIANFANGKAI,YUELAIYUEDUODEBANHENZIGONGYUNFUXIWANGSHIXIANJINGYINDAOFENMIAN。YUELAIYUEDUODECHANKERENYUANFAXIANPOUGONGCHANSHUBINGBUSHIYINDAOSHUNCHANDEJINJIZHENG,ZAICHANFUDADAOYINDAOFENMIANTIAOJIANDEQIANTIXIASHIKEYIXUANZEYINDAOSHICHANDE[5]。BENZUYANJIUZILIAODECHENGGONGLV90%,MEIYOUFASHENGZIGONGPOLIE、CHANHOUCHUXUEDENGYANZHONGBINGFAZHENG,YUDUIZHAOZUDEFENMIANCHENGGONGLV、CHANCHENGSHIJIAN、CHANHOUCHUXUE、XINSHENGERAPgarPINGFEN、XINSHENGERTIZHONG、ZHUYUANSHIJIANDENGGUANCHAZHIBIAOWUMINGXIANCHAYI,ZHEIXIEDOUCHONGFENSHUOMINGLEBANHENZIGONGJINGYINDAOFENMIANDEKEXINGXINGHEANQUANXING。

                                  3.2、 疤痕子宫再次妊娠孕期健康教育的重要性

                                棋牌大全下载安装   JINXIENIANLAI,RENMENZHUJIANRENSHIDAOJINGSHENXINLIYINSUZAIFENMIANGUOCHENGZHONGDEZHONGYAOXING。JUBAODAO,YUNQIJIANKANGJIAOYUYOULIYUZENGJIAPOUGONGCHANZAICIRENSHENCHANFUDEZIRANFENMIANZHISHI,CUJINZIRANFENMIAN,JIANGDIPOUGONGCHANLV[6]。BENZUYANJIUZILIAOJUNYOUGAONIANZICHANKEYISHIJINXINGYUNQIJIANKANGJIAOYU,CHULECHANGGUICHANQIANJIANCHA,HAITONGGUOYUNFUXUEXIAO、JIANLIQQQUNSUISHIBAOCHILIANXI,DAILINGYUNFUXUEXIYUNQIHEFENMIANDEZHISHI,LEJIEBANHENZIGONGJINGYINDAOFENMIANDEKENENGXINGHEANQUANXING,RANGCHENGGONGSHIXIANBAHENZIGONGJINGYINDAOFENMIANZHEDECHANFUXIEXIAXINDETIHUIGONGQITAYUNFUXUEXI。HENDUODEYUNCHANFUTANYAN,YIQIANJIESHOUDEGUANNIANDOUSHI“YICIPOU,CICIPOU”,RUGUOBUSHIJINGGUOXUEXI,BUKENENGXUANZEJINGYINDAOFENMIAN。YUNFUYINDAOFENMIANJUEXINDUINENGFOUSHUNLIFENMIANYOUZHONGYAODEYINGXIANG[7]。BENZUYANJIUZILIAOCHENGGONGLV90%,JIN2LIBUNENGNAISHOUGONGSUOTONG,FANGQILESHICHAN。ZHEIXIEJUNSHUOMINGLEYUNQIJIANKANGJIAOYUDEZHONGYAOXING,RANGCHANFUZHUNBEIHAOJIANDINGDEXINNIANYOULIYUCHENGGONGDEYINDAOFENMIAN。

                                  3.3、 关于监测疤痕厚度的意义

                                  HENDUOYIYUANBABANHENHOUDUJIANCEZUOWEICHANGGUIJIANCHAXIANGMU,GUIDINGBANHENHOUDU≥2~3 mmSHIBAHENZIGONGJINGYINDAOFENMIANDEBIBEITIAOJIANZHIYI。SHIZHISHANG,BANHENHOUDUCELIANGSHANGWUGUIFANXINGDETONGYICELIANGBIAOZHUN,ERQIESHOUDAOHENDUOYINSUYINGXIANG,BIRUBANGGUANGCHONGYINGDU、CELIANGWEIZHI、CELIANGCISHU、CHAOSHENGCELIANGFANGFA[2]。CIWAI,ZIGONGXIADUANHOUDUHAIYUCAICHAOKEYISHENGDEJISHU、JINGYANDENGYOUGUAN。BENZUYANJIUZILIAOWEIYANGEYAOQIUBAHENHOUDU,ZHIYAOQIUBANHENJICENGLIANXUXINGLIANGHAO,CHENGGONGJINGYINDAOFENMIANDE90LIZHONGBAHENZUIBO1.0 mm,ZUIHOU6.5mm,BAHENHOUDU1.0~1.9 mm 33LI,≥2 mm 62LI,YINERBCHAOJIANCEBANHENHOUDUKEKAOXINGJIAOCHA。

                                  表2:两组产妇分娩情况比较(n=146)
                                表2:两组产妇分娩情况比较(n=146)

                                  3.4、 提高瘢痕子宫经阴道分娩成功率和安全性的体会

                                棋牌大全下载安装   (1)XIANGXIDECAIJIBINGSHI,PAICHUZIGONGTIBUPOUGONGCHAN、QIANCIZIGONGQIEKOUYANLIEHUOYUHEBULIANG,LIANGCIFENMIANJIANGE2NIANYISHANG。(2)YUNQIJIAOYUYOUQIZHONGYAO,BENZUYANJIUZILIAOJUNYOUJUBEIFENGFUJINGYANDEGAONIANZIYISHIJINXINGXUANCHUANJIAOYU,XIANGYUNFUHEJIASHUSHUOMINGBANHENZIGONGJINGYINDAOFENMIANDEKEXINGXINGHEANQUANXING,YUNQITONGGUOGEZHONGXINGSHIRUYUNFUXUEXIAO、QQQUNDENGXUANCHUANRUHETIGAOTOLACDECHENGGONGLV。(3)YUNQIKONGZHITIZHONG,DUOYUNDONG,JINLIANGBAOCHIFENMIANSHITAIERDAXIAOSHIZHONG。DUOSHUWENXIANJUNTICHUTOLACDETAIERTIZHONGYAOQIUBUCHAOGUO3 500~4 000g,DANBENZUZILIAODUIBUFENSHENCAIGAODAZHEFANGKUANLETAIERTIZHONGBIAOZHUN,CHENGGONGFENMIANDE132LIZHONGYOU6LIJUDAER;(4)YOUGUANLINCHUANGYANJIUBIAOMING,ZAIDUIHUANZHEDEGEXIANGZHIZHENGQINGKUANGZUODAOZHENGQUEPINGGUDEQINGKUANGXIA,HUANZHEFENMIANCHENGGONGDEJILVJIANGHUICHUXIANXIANGYINGDEZENGZHANG[8]。BENYANJIUZILIAOYUNWANQIJUNYOUGAONIANZIYISHIZONGHEPINGGU,JIEHEYUNFUSHENCAIPAICHUMINGXIANDETOUPENBUCHENGJIQITABUSHIYIYINDAOFENMIANQINGKUANG。(5)JINLIANGZIRANLINCHANRUYUAN,SHAOGANYU,BENZUYANJIUZILIAO98%ZIRANLINCHANHOURUYUAN。(6)CHANCHENGZHONGYOUJINGYANDEZHUCHANSHIYIDUIYIGUANCHA,CHANFANGJUBEIJINJIPOUGONGCHANTIAOJIAN,ZENGJIATAIXINJIANHU,YIDANYOUTAIXINYICHANG、JIXINGFAZUOXINGDEBANHENYATONG、XUENIAO、CHANFUDIXUEYAYUNJUEDENGZIGONGPOLIEZHENGZHAOJINJIPOUGONGCHAN[9,10]。

                                  ZONGSHANGSUOSHU,BANHENZIGONGZAIRENSHENYUNFU,ZHIYAOZHANGWOHAOZHIZHENG,ZUOHAOYUNQIJIAOYU、SHULIFENMIANXINXIN、JIAQIANGCHANCHENGJIANHU、TUANDUIXIEZUOJUBEIJINJIPOUGONGCHANTIAOJIAN,XUANZEJINGYINDAOFENMIANSHIANQUANKEXINGDE。

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