目的探讨硬膜外自控镇痛(PCEA)在自然分娩过程中的镇痛效果及对孕妇产程、血液中缩宫素水平和新生儿的影响。方法选择2018年6月-2019年1月在我院产科要求自然分娩的符合要求的孕妇,根据分娩过程中是否镇痛分为观察组(行PCEA)和对照组(未行PCEA)。分别于宫口开大于3 cm时(T1)、T1后60 min时(T2)采集孕妇肘静脉血,检测血浆中缩宫素水平,计算两个时间点缩宫素浓度的差值;同时记录两组孕妇T2时的疼痛视觉模拟评分(VAS评分)、第一与二产程时间、新生儿1 min和5 min Apgar评分。结果两组孕妇血液中缩宫素水平差值比较,差异有显著性(t=11.34,P<0.01);观察组第一、二产程时间长于对照组,差异均有统计学意义(t=6.69,7.44,P<0.05);T2时,两组孕妇VAS评分差异显著性(t=10.57,P<0.01);两组新生儿出生后1 min和5 min Apgar评分差异无统计学意义(P>0.05)。结论PCEA在自然分娩中的镇痛效果显著,对新生儿无不良影响,PCEA可能抑制孕妇血液中缩宫素的分泌并使第一、二产程延长。
分析青岛大学附属医院收治的1例妊娠期D-二聚体显著升高孕妇的临床资料并进行文献复习,探讨孕期高D-二聚体预防不良妊娠结局的临床管理和决策方法。方法:回顾性分析2024年01月04日青岛大学附属医院收治的1例孕37 + 2周D-二聚体显著升高孕妇的病例资料,并复习国内外相关文献,分析孕期高D-二聚体产生原因、可能发生的不良妊娠结局及预防措施。结果:患者入院后完善相关辅助检查,予抗凝治疗,监测胎心、胎动变化,后D-二聚体逐渐下降并维持稳定,于孕39周经剖宫产终止妊娠。术后产妇及新生儿病情稳定。新生儿生后Apgar评分1、5分钟均10分,产妇宫缩好,阴道流血少,术后恢复良好出院。出院后新生儿生长发育与同龄儿无明显差异。通过复习国内外文献资料,了解妊娠期及产褥期D-二聚体区间及高D-二聚体孕妇不良妊娠结局预防措施。The clinical data of a pregnant woman with a significant increase in D-dimer during pregnancy admitted to the Affiliated Hospital of Qingdao University were analyzed and the literature was reviewed to explore the clinical management and decision-making methods of high D-dimer during pregnancy to prevent adverse pregnancy outcomes. Methods: The case data of a pregnant woman with a significant increase in D-dimer at 37 + 2 weeks gestation admitted to the Affiliated Hospital of Qingdao University on January 04, 2024 were retrospectively analyzed, and relevant literature at home and abroad were reviewed to analyze the causes of high D-dimer during pregnancy, possible adverse pregnancy outcomes and preventive measures. Results: After admission, the relevant auxiliary examination was completed, anticoagulant treatment was given, fetal heart rate and fetal movement were monitored, D-dimer gradually decreased and remained stable, and pregnancy was terminated by cesarean section at 39 weeks of gestation. The condition of the mother and newborn was stable after the operation.
妊娠期糖尿病(gestational diabetes mellitus, GDM)是在妊娠期发生或首次发现的不同程度的糖耐量异常,是一种葡萄糖利用障碍性疾病。在我国,使用世卫组织标准,GDM的流行率为5%~9%;使用我国最新诊断标准,GDM的发病率约为18%~20%。近年来,GDM的发病率不断升高,对母儿健康造成了巨大影响。目前对GDM的发病机制尚无定论,可能与胰岛素抵抗和β细胞功能障碍有关。此外,也有研究表明,免疫因素、肠道菌群紊乱、炎症反应、脂肪因子等与GDM的发生存在相关性,但多为回顾性研究,相关证据并不充分。遗传因素、肥胖、多囊卵巢综合征病史、不良孕产史等也是GDM的危险因素。本文主要对妊娠期糖尿病的危险因素和发病机制作出总结,从而进一步对妊娠期糖尿病的发病机制、管理和治疗寻找新的思路。Gestational diabetes mellitus (GDM) is an abnormal glucose tolerance of varying degrees that occurs or is first detected during pregnancy and is a disorder of glucose utilization. In our country, using WHO standards, the prevalence of GDM is 5%~9%;Using the latest diagnostic criteria in China, the incidence of GDM is about 18%~20%. In recent years, the incidence of GDM has been increasing, which has caused great impact on the health of mother and child. At present, the pathogenesis of GDM is still inconclusive, which may be related to insulin resistance and β cell dysfunction. In addition, studies have also shown that immune factors, intestinal flora disorders, inflammatory responses, and adipokines are correlated with the occurrence of GDM, but most of them are retrospective studies and the relevant evidence is insufficient. Genetic factors, obesity, history of polycystic ovary syndrome, and adverse pregnancy history are also risk factors for GDM. This article mainly summarizes the risk factors and pathogenesis of gestational diabetes, so as to further find new ideas for the pathogenesis, management and treatment of gestational
