Objective To explore the effect of different pre-labor position for premature rupture of membrane (PROM) after 37 weeks with vertex and engaged presentation on the maternal and neonatal outcomes. Methods A total of 120 women over 37 weeks PROM with single fetus in vertex presentation and engaged head were randomly allocated into two groups. The trial group (60 women) received no limit of movement after hospitalization and before labor while the control group (60 women) adapted lateral and supine position alternatively with hip-up. Labor process and neonatal outcomes were observed and recorded. SPSS 13.0 software was adopted to analyze the data. Results Compared with the control group, the trial group had higher rate of normal birth (70% vs. 46.7%, χ2=6.72, P=0.01), shorter first and second stage of labor (t=2.11, P=0.039; t=2.75, P=0.007), fewer incidence of dysuria during labor (χ2=8.11, P=0.0041), and less amount of amniotic fluid (107±55 mL vs. 248±42 mL, t=4.188, P=0.000 1). Conclusion For PROM over 37 weeks pregnancy with single vertex presentation and engaged head, no limit on the position before labor is safe and feasible, and it can improvie spontaneous delivery rate, shorten labor process, decrease amount of amniotic fluid, and eliminate the incidence of dysuria. It is worth to be popularized in the clinic.
摘要:目的:减少胎膜早破患者产科并发症的发生。方法:将我院于2005年1月至2006年12月收治的217例胎膜早破的患者设为对照组，将2007年1月~2008年12月收治的248例胎膜早破的患者设为观察组。对照组采用教科书上传统的方法进行护理,观察组正确地判断胎膜早破,胎儿宫内状况评估,产前选择正确的卧位,加强对产前、产时、产后规范的监护,积极预防感染等措施。结果:积极的医疗处理有效地减少了产后出血,胎儿宫内窘迫,切口感染的发生。结论:对胎膜早破的患者,尽早地采取正确、有效的护理干预措施,能减少产科并发症的发生,保障母儿的健康。Abstract: Objective: To reduce maternal obstetrics complications of premature rupture of membranes occurred. Methods: From in January 2005 to December 2006, treated 217 cases of premature rupture of membranes in pregnant women as control group, from January 2007 to December 2008 treated 248 cases of premature rupture of membranes as observation group. The control group used the traditional textbook approach to care. The observation group to determine the correct premature rupture of membranes, fetal assessment, pregnant women to choose the correct prelying, strengthen the preproduction, the postnatal care norms positive measures such as the prevention of infection. Results:The suitable medication and nursing procedure could effectively reduce postpartum hemorrhage, fetal distress, the occurrence of incision infection. Conclusion: The maternal premature rupture of membranes, as soon as possible to take the correct and effective nursing interventions can reduce the incidence of obstetric complications to protect the health of mothers and infants.
ObjectiveTo study the mechanisms of spontaneous rupture of hepatocellular carcinoma and the treatments in the acute phase and the second phase after hemostasis. MethodsRelated domestic and foreign literatures were reviewed. ResultsThe mechanism of spontaneous rupture of hepatocellular carcinoma was still not quite clear. In China, spontaneous rupture of hepatocellular carcinoma was closely related with hepatitis B virus infection. Immune complex deposition in vessel wall led to the injuries of small arteries and bleeding. Treatments included conservative therapy, surgical intervention （lobectomy of liver, hepatic artery ligation, packing, and suturing), transarteial embolization, other medications (percutaneous ethanol injection, radiofrequency ablation, bio-immunotherapy). ConclusionTransarterial embolization has been shown to be highly effective in achieving immediate hemostasis, and can be used as the basis of phase two comprehensive treatment.
Objective To evaluate the role of CT in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma. MethodsTwenty preoperative CT scans and clinical data were obtained in 20 patients who subsequently had bowel ruptures verified surgically. CT findings were analyzed retrospectively in these patients. Retrospective interpretation was made by consensus of at least two radiologists. ResultsTwenty cases of CT scan showed intraperitoneal fluid (18 cases), pneumoperitoneum (18 cases), extravasations of gastrointestinal tract contents (2 cases), bowel wall findings (14 cases) and mesenteric injury (15 cases). Conclusion CT is fast, sensitive and noninvasive in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma.
In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
To comprehend the present situation in diagnosis and treatment of traunatic hepatorrhexis in this country,693 patients with traumatic rupture of the liver in 31 hospitals where to be located in Sichuan,Zhejiang,Guizhou,Yunnan,Fujian,Heilongjiang,Gguangxi and Hebei province in this country were collected through questionnaire and analysed.The data showed that male to female ratio was 4.17 to 1,with an average of 39.3 years.Closed injury accounted for 74.5% and 53.9 percent of them were injured in traffic accident.47.4% of the patients were admitted to the hospital within 4 hours after injury.Hemorrhagic shock was present high up to 61.9%.During exploratory laparotomy,hematoperitoneum was greater than 1000ml accounted for 61.5%,injury to the right lobe of liver 70.0%,and hepatorrexis associated with other organs and tissues injuries were 19.8%.45.5% of the patients was in third degree or more according to the AAST classificatino.All of the patients were treated by surgery,83.7% percent of them with debridement and suture and omentum packing for hemostasis,49 patients undergone partial hepatectomy.The postoperative complication rate was 22.2% and mortality was 8.7%.The authors consider that to perfect the emergency treatment system,enrich the knowlege and skill of the basic personnel so that the injured can be properly treated is cruical to improve the cure rate and reduce the mortality.
Objective To analyze early and midterm outcomes and summarize clinical experience of mitral valve repair with artificial chordae for degenerative mitral regurgitation （MR）. Methods Clinical data of 78 patients with degenerative MR who underwent mitral valve repair with Gore-Tex artificial chordae from October 2008 to December 2011 in General Hospita1 of Shenyang Military Command were retrospectively analyzed. There were 47 male patients and 31female patients with their age of 52.7±9.6 years，who all had degenerative MR. Operation techniques included simple GoreTex artificial chordae replacement in 15 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet in 58 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet and Sliding technique in 5 patients. One to three （2.15±1.05） Gore-Tex artificial chordae were used for each patient，and annuloplasty ring was used for all the patients. Thirty-nine patients underwent concomitant tricuspid valvuloplasty. Intraoperative transesophagealechocardiography showed none obvious MR in 62 patients，trivial MR in 13 patients and mild MR in 3 patients. All thepatients were followed up after discharge. Echocardiography was used to evaluate heart function and MR degree duringfollow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus bradycardiain 5 patients，supraventricular tachycardia in 8 patients，late cardiac tamponade in 1 patient，and permanent pacemakerimplantation in 1 patient. Seventy patients were followed up for 1-2 years with the follow-up rate of 89.74% （70/78）. Duringfollow-up，1 patient died of cerebral embolism 13 months after discharge，and all the other patients remained alive. There were 60 patients with NYHA classⅠand 9 patients with NYHA classⅡ. Echocardiography at 1 year after dischargeshowed that left atrial diameter，left ventricular end-diastolic diameter，left ventricular end-systolic diameter，and pulmonary artery systolic pressure were significantly smaller or lower than preoperative values （P＜0.05），left ventricular ejection fraction （68.00%±7.00% vs. 55.00%±6.00%） and cardiac output were significantly higher than preoperative values（P＜0.05），and MR degree （ratio of regurgitation beam area and left atrial area） was significantly reduced compared with preoperative MR degree （3.45%±5.56% vs. 39.55%±9.86%，P＜0.05）. No artificial chordae rupture was found. There were47 patients without MR and 22 patients with trivial MR during follow-up. Conclusion Gore-Tex artificial chordae replacement is a safe and effective surgical technique for the treatment of degenerative MR.
Abstract： Objective To summarize our experience and clinical outcomes of preservation of posterior leaflet and subvalvular structures in mitral valve replacement（MVR）. Methods We retrospectively analyzed the clinical data of 1 035 patients who underwent MVR in Beijing An Zhen Hospital from January 2006 to March 2011. There were 562 male patients and 473 female patients with their age of 37-78（53.84±13.13）years old. There were 712 patients with rheumatic valvular heart disease and 323 patients with degenerative valve disease, 389 patients with mitral stenosis and 646 patients with mitral regurgitation. No patient had coronary artery disease in this group. For 457 patients in non-preservation group, bothleaflets and corresponding chordal excision was performed, while for 578 patients in preservation group, posterior leafletand subvalvular structures were preserved. There was no statistical difference in demographic and preoperative clinical characteristics between the two groups. Postoperative mortality and morbidity, and left ventricular size and function were compared between the two groups. Results There was no statistical difference in postoperative mortality（2.63% vs. 1.21%, P =0.091）and morbidity （8.53% vs. 7.44%, P=0.519）between the non-preservation group and preservation group, except that the rate of left ventricular rupture of non-preservation group was significantly higher than that of preservation group（1.09% vs. 0.00%, P=0.012）. The average left ventricular end-diastolic dimension （LVEDD）measured by echocardiography 6 months after surgery decreased in both groups, but there was no statistical difference between the two groups. The average left ventricular ejection fraction (LVEF) 6 months after surgery was significantly improved compared with preoperative average LVEF in both groups. The average LVEF 6 months after surgery in patients with mitral regurgitation in the preservation group was significantly higher than that in non-preservation group （56.00%±3.47% vs. 53.00%±3.13%，P =0.000）, and there was no statistical difference in the average LVEF 6 months after surgery in patients with mitral stenosis between the two groups（57.00%±5.58% vs. 56.00%±4.79%，P =0.066）. Conclusion Preservation of posterior leaflet and subvalvular structures in MVR is a safe and effective surgical technique to reduce the risk of left ventricle rupture and improve postoperative left ventricular function．
Abstract： Objective To investigate the cause, treatment， and prevention strategy of early left ventricular rupture after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 7 patients who had early left ventricular rupture after MVR， among a total of 2 638 MVR patients， between May 1981 and November 2010 in General Hospital of Shenyang Military District. There were 2 male patients and 5 female patients with their age ranging from 28 to 71 years old. One patient was New York Heart Association （NYHA） functional classⅡand 6 patients were NYHA functional classⅢ. Preoperative echocardiography showed that their left ventricular ejection fraction （LVEF） was 49%-60% and their left ventricular end diastolic volume （LVEDV） was 29-42 ml. All the patients underwent prothetic valve replacement under moderate hypothermia， general anesthesia and extracorporeal circulation. Results All the 7patients underwent surgical repair for their early left ventricular rupture. There were 2 patients with TypeⅠ， 4 patients with TypeⅡ， and 1 patient with TypeⅢleft ventricular rupture. Four patients died of hemorrhagic shock or low cardiac output syndrome. Three patients were successfully healed and discharged from hospital 7-15 days after the operation. The 3 surviving patients were followed up for 4.5-18.0 years, and they all had good general condition and satisfactory quality of life. No late pseudo-aneurysm was found during follow-up. Conclusions Early left ventricular rupture is difficult to repair with a high mortality. Effective prevention strategy should be applied to avoid it as much as possible. Once left ventricular rupture occurs during the surgery， extracorporeal circulation should be quickly established， and it’s possible to save patients’ life by reliable intracardiac and epicardial repair according to patients’ individual condition.
Objective?To investigate clinical characteristics， diagnosis， and treatment for patients with spontaneous esophageal rupture， and improve clinical diagnostic and treatment level.?Methods?We retrospectively analyzed the clinical data of 34 patients with spontaneous esophageal rupture who were treated in Subei People’s Hospital from January 1996 to June 2010. There were 28 male patients and 6 female patients with their age ranging from 32 to 80 years old (mean 57.6 years old). Main clinical manifestations included severe chest and abdominal pain after vomiting， fever， dyspnea and shock. The duration between disease onset and establishing diagnosis ranged from 4 hours to 7 days. Thirteen patients received conservative treatment including chest drainage， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy. Twenty one patients received surgical treatment including layered anastomosis of the ruptured esophagus， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.?Results?All the patients were cured without in-hospital death. The mean hospital stay of the 13 patients who received conservative treatment was 46 days， while that of the 21 patients who received surgical treatment was 17 days. All the ruptured esophagus were one-stage healed. All the 34 patients were followed up from l to 8 years， including 11 patients in the conservative treatment group and 19 patients in the surgical treatment group， but 4 patients was lost during follow-up. All the patients had a normal diet without symptoms of esophageal stricture， reflux esophagitis or chronic thoracic empyema.?Conclusion Spontaneous esophageal rupture is a thoracic emergency with a high misdiagnosis rate and mortality．Early diagnosis， early surgical repair of ruptured esophagus and satisfactory chest drainage play a vital role in the treatment for patients with spontaneous rupture of esophagus.