乳杆菌活菌胶囊在配合治疗产后滴虫性阴道炎中的价值

目的探讨应用乳杆菌活菌胶囊在配合治疗产后滴虫性阴道炎中的作用。方法将90例患滴虫性阴道炎的产后妇女随机分为2组,研究组应用甲硝唑400 mg,每日2次,连服7 d,同时每日晚塞1粒乳杆菌活菌胶囊入阴道,连用10 d;对照组应用甲硝唑400 mg,每日2次,连服7 d。2组患者14 d后复查并检查白带常规,对其临床治愈率、白带清洁度、pH进行比较。30 d后随访检查滴虫性阴道炎复发情况。结果用药后研究组治愈率高于对照组,2组差异有统计学意义(P<0.05);研究组、对照组pH均有降低,但研究组pH低于对照组,2组差异有统计学意义(P<0.05);用药后研究组阴道清洁度I、II度比率高于对照组,研究组复发率低于对照组,差异均有统计学意义(P<0.05)。结论产妇应用乳杆菌活菌胶囊配合治疗滴虫性阴道炎可提高治愈率,改善阴道微环境并降低复发率。     

经会阴实时三维盆底超声评估不同分娩方式对产后女性前腔室结构和盆膈裂孔的影响

摘要 目的：探讨经会阴实时三维盆底超声评估不同分娩方式对产后女性前腔室结构和盆膈裂孔的影响。方法：回顾性分析2015年1月至2019年10月在我院接受检查的100例产妇的诊治资料。根据分娩方式的不同,将患者分为经阴道分娩组（n=55）和剖宫产分娩组（n=45）。比较两组产妇在静息状态和Valsalva状态下的前腔室和盆膈裂孔超声参数。结果：在静息状态下,两组的膀胱颈位置、逼尿肌厚度、膀胱后角和尿道倾斜角相比无差异（P>0.05）。经阴道分娩组在Valsalva状态下的膀胱颈移动度和尿道旋转角均大于剖宫产分娩组,尿道内口漏斗形成率和膀胱膨出率均高于剖宫产分娩组（P<0.05）。在Valsalva状态下,经阴道分娩组的盆膈裂孔前后径、左右径、面积和周长均大于剖宫产分娩组（P<0.05）;在静息状态下,两组的上述指标相比,差异均无统计学意义（P>0.05）。结论：应用经会阴实时三维盆底超声技术观察产妇前腔室结构和盆膈裂孔的参数变化,可评估产妇盆底功能受损的程度,经阴道分娩对其影响较大。     

Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果观察

目的:探讨Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果。方法:选取2015年6月～2018年6月在我院经剖宫产术分娩并发生产后出血的产妇81例进行回顾性分析。根据术中止血方法的不同分为两组,对照组40例采用Cook双球囊进行止血,观察组41例在对照组的基础上应用改良B-Lynch缝合术进行止血。对两组患者的手术相关指标、止血成功率、子宫切除率、术后恢复情况和并发症发生情况进行比较。结果:观察组的术中出血量、术后24 h出血量和输血量显著低于对照组(P0.05),止血时间显著短于对照组(P0.05);观察组患者的止血成功率显著高于对照组(P0.05),子宫切除率和切口恢复时间显著低于对照组(P0.05),两组患者的住院时间和并发症发生率比较无统计学差异(P0.05)。结论:Cook双球囊联合改良B-Lynch缝合术对剖宫产产后出血患者的临床效果显著优于单用Cook双球囊,且安全性较高。     

Serum concentrations of androstenediol and androstenediol sulfate, and their relation to cytokine production during and after normal pregnancy

Since it is known that androstenediol (ADIOL) has potent immunoregulatory effects, changes in ADIOL levels during and after pregnancy might affect the maternal immune system. We examined serum concentrations of ADIOL and androstenediol 3-sulfate (ADIOLS) together with IFN-gamma and IL-4 production levels during pregnancy and after delivery up to 10-11 months postpartum. The subjects were 73 normal pregnant, 76 normal postpartum, and 28 normal non-pregnant women. ADIOL and ADIOLS were measured using EIA and GC/MS, respectively. The cytokine levels in the supernatant of whole-blood cultures stimulated with phorbol 12-myristate 13-acetate and ionomycin were measured using ELISA. ADIOL levels significantly decreased compared to non-pregnant levels in the first trimester (P < 0.05) and were reversed in the third trimester (P < 0.05). After pregnancy, ADIOL levels gradually declined, and a significant decrease was observed at 10-11 months postpartum (P < 0.05). ADIOLS levels were significantly lower in the third trimester (P < 0.05) and significantly higher at the first month postpartum (P < 0.001) compared to non-pregnant women. IFN-gamma and IL-4 levels decreased during pregnancy and subsequently increased postpartum. On the other hand, we found significant negative correlations between ADIOL concentrations and production levels of IFN-gamma (P < 0.05) or IL-4 (P < 0.05). These findings suggest that ADIOL may be involved in modifying the maternal immune response during and after pregnancy.     

电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁患者盆底肌力、尿流动力学和生活质量的影响

摘要 目的：探讨电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁（SUI）患者盆底肌力、尿流动力学和生活质量的影响。方法：选取2019年6月~2021年11月期间于我院就诊的产后SUI患者109例,按照入院就诊奇偶顺序分为两组,其中对照组54例,接受Kegel盆底康复训练,研究组55例,接受电针阴部神经刺激疗法联合Kegel盆底康复训练。对比两组疗效、漏尿量、尿失禁程度、盆底肌力、尿流动力学和生活质量。结果：研究组的临床总有效率高于对照组（P<0.05）。两组治疗后盆底肌肌力各指标（手测肌力和Ⅰ类肌纤维最大值、Ⅱ类肌纤维平均值）均升高,且研究组高于对照组（P<0.05）。两组治疗后漏尿量、尿失禁程度评分均下降,且研究组低于对照组（P<0.05）。两组治疗后尿流动力学相关指标[腹压漏尿点压（AL-PP）、最大尿流率（Qmax）和最大尿道闭合压力（MUCP）]均升高,且研究组高于对照组（P<0.05）。两组治疗后尿失禁生活质量量表（I-QOL）各维度（限制性行为、心理影响、社交活动受限）评分及总分均升高,且研究组高于对照组（P<0.05）。结论：电针阴部神经刺激疗法联合Kegel盆底康复训练可有效改善产后SUI患者的盆底肌肌力和尿失禁情况,减少漏尿量,同时可促进尿流动力学恢复,进而提高患者的生活质量。     

Depressive and anxiety symptoms in the early puerperium are related to increased degradation of tryptophan into kynurenine,a phenomenon which is related to immune activation

There is now some evidence that i) the availability of plasma tryptophan, the precursor of serotonin, is significantly lower in pregnant women at the end of term and the first few days after delivery than in nonpregnant women; and ii) both pregnancy and the early puerperium are accompanied by activation of the inflammatory response system. The aims of the present study were to examine the effects of pregnancy and delivery on plasma kynurenine, a major tryptophan catabolite synthesized after induction of indoleamine-2, 3 dioxygenase (IDO) by pro-inflammatory cytokines. We measured plasma kynurenine and tryptophan and immune markers, such as serum interleukin-6 (IL-6), IL-8 and the leukemia inhibitory factor-receptor (LIF-R) in healthy, nonpregnant and pregnant women at the end of term and one and three days after delivery. Plasma kynurenine was significantly lower in pregnant women at the end of term than in nonpregnant women, findings which may be attributed to lower plasma tryptophan at the end of term. The kynurenine/tryptophan (K/T) quotient was significantly higher in the pregnant women at the end of term and in the early puerperium than in nonpregnant women. In the early puerperium there was a significant increase in plasma kynurenine and the K/T quotient. The increases in plasma kynurenine and the K/T quotient were significantly more pronounced in women whose anxiety and depression scores significantly increased in the puerperium. The changes from the end of term to the early puerperium in plasma kynurenine and the K/T quotient were significantly related to those in the immune markers. It is concluded that 1) lower plasma kynurenine at the end of term is the consequence of lower plasma tryptophan; 2) the increased K/T quotient at the end of term and in the early puerperium indicates inflammation-induced degradation of tryptophan along the kynurenine pathway; and 3) that depressive and anxiety symptoms in the early puerperium are (causally) related to an increased catabolism of tryptophan into kynurenine, a phenomenon which probably results from immune activation.     

加味甘麦大枣汤对气血两虚型产后抑郁症患者肠道菌群和血清5-HT的影响

观察加味甘麦大枣汤对气血两虚型产后抑郁症（PPD）患者肠道菌群和血清5-羟色胺（5-HT）水平的影响。

选取2022年10月至2023年8月就诊于甘州区妇幼保健院且符合纳入标准的气血亏虚型产后抑郁症患者60例作为研究对象,按其就诊顺序随机分为观察组、对照组,每组各30例。对照组给予西医常规治疗,观察组在西医常规治疗基础上联合加味甘麦大枣汤治疗,疗程4周。分别于治疗前和治疗后采用中医证候积分和汉密尔顿抑郁量表（HAMD）评价治疗疗效。通过高通量测序法检测两组患者治疗前后粪便中的菌群多样性和各分类学水平分布。采用酶联免疫吸附测定（ELISA）检测两组患者血清5-HT水平。

与本组治疗前比较,治疗后两组患者中医证候积分和HAMD评分均明显下降,差异具有统计学意义（P＜0.05）。治疗后,与对照组比较,观察组的中医证候积分和HAMD评分显著下降（P＜0.05）。观察组临床有效率为96.7%,高于对照组的76.7%（χ²=8.967,P=0.030）。观察组肠道菌群在治疗后的Simpson指数和Shannon指数较治疗前升高（P＜0.05）,拟杆菌门（Bacteroidetes）、瘤胃菌科（Ruminococcaceae）、拟杆菌属（Bacteroides）和双歧杆菌属（Bifidobacterium）相对丰度显著高于对照组（P＜0.05）,变形菌门（Proteobacteria）、肠杆菌科（Enterobacteriaceae）、粪球菌属（Coprococcus）和志贺菌属（Shigella）相对丰度显著低于对照组（P＜0.05）。两组患者血清5-HT水平治疗后均明显升高（P＜0.05）,观察组5-HT水平升高的更明显（P=0.010）。

加味甘麦大枣汤可辅助临床治疗改善PPD患者的临床症状,调节患者肠道菌群,提高血清5-HT水平。

     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。     

孕产妇情绪评估及个性化干预对降低产后抑郁症的作用研究

目的:研究孕产妇情绪评估及个性化干预对降低产后抑郁症的作用。方法:选取我院收诊的孕期检查产妇,经抑郁自评量表(SDS)筛查,选取其中SDS评分在42-52分的产妇186例作为研究对象,采取数字随机法分为观察组和对照组,对照组采取常规护理,观察组在此基础上,采取个性化干预,比较两组对产后抑郁症的降低情况。结果:观察组患者产后1个月的SDS评分低于对照组,差异有统计学意义(P0.05)。观察组患者产前7天、产后1个月的SDS评分均低于入院时,差异均有统计学意义(P0.05)。观察组患者产后1、3、12个月的产后抑郁症发生率均低于对照组,差异均有统计学意义(P0.05)。两组患者产后3、12个月的产后抑郁症发生率均低于产后1个月,差异均有统计学意义(P0.05)。两组患者产后12个月的产后抑郁症发生率均低于产后3个月,差异均有统计学意义(P0.05)。结论:孕产妇产前、产后普遍存在抑郁情绪,个性化干预对降低产后抑郁症的作用明显,是一种优秀的护理方法。     

Duration of daily bull exposure on resumption of ovulatory activity in postpartum,primiparous, suckled,beef cows

The objective of this experiment was to determine if duration of daily bull exposure influences length of postpartum anestrus in primiparous, anovular, suckled, beef cows. The null hypotheses were that intervals from calving or the start of bull exposure (D 0) to resumption of ovulatory activity (OA), and proportions of cows that resumed OA during the experiment does not differ among cows exposed to bulls for 0 h, 6 h, or 12 h daily, and that there is no relationship between the duration of bull exposure and interval to resumption of OA in cows exposed to bulls for 0 h, 6 h, or 12 h daily. At 51.5 ± 2.3 d (±SE) after calving, cows were assigned randomly to be exposed for 12 h (BE12; n = 15) or 6 h daily (BE6; n = 14) to bulls, or not exposed to bulls (NE; n = 10) for 45 d. Interval from calving or from D 0 to resumption of OA was shorter (P < 0.05) and the proportion of cows that resumed OA during the experiment was greater (P < 0.05) for BE12 than for NE cows. Interval from D 0 to resumption of OA did not differ (P > 0.10) between BE6 cows and either BE12 or NE cows. However, interval from calving to resumption of OA was shorter (P < 0.05) for BE6 than NE cows. The proportion of cows that resumed OA did not differ (P > 0.10) between BE6 cows and BE12 cows; however, the proportion of cows that resumed OA during the experiment tended (P = 0.08) to be greater for BE6 cows than for NE cows. There was a linear relationship between intervals from calving (b₁ = −7.64 d/h; P < 0.05) and D 0 (b₁ = −3.3 d/h; P < 0.05) to resumption of OA and duration of daily bull exposure. Thus, the duration of bull-pheromone stimuli that cows perceive each day is related to when primiparous, postpartum, anestrous, suckled cows respond to this stimulus and undergo the physiological changes necessary to resume ovulatory activity.