Baidu
map

Obstet Gynecol:关于围产期深静脉血栓,我们走到了哪里?

2015-11-24 candy 译 MedSci原创

    围产期静脉血栓预防已经困扰产妇及产科医生十几年了。在绝对的意义上,年轻、健康的围产期妇女相对其他有药物史和手术史的病人来说,临床静脉血栓的发生率普遍较小。另一方面,肺栓塞是引起潜在的、也是可预防的孕产妇死亡的一个主要原因。针对这类特殊群体的一些预防措施的有效性还缺乏足够的证据,再加上一些效益方面的考虑,使这些问题仍然悬而未决。  &nb

围产期静脉血栓预防已经困扰产妇及产科医生十几年了。在绝对的意义上,年轻、健康的围产期妇女相对其他有药物史和手术史的孕妇来说,临床静脉血栓的发生率普遍较小。另一方面,肺栓塞是引起潜在的、也是可预防的孕产妇死亡的一个主要原因。针对这类特殊群体的一些预防措施的有效性还缺乏足够的证据,再加上一些效益方面的考虑,使这些问题仍然悬而未决。

    
解决这一困境的第一步是分析2006年由Cassale和Grobman提供的关于对计划行剖宫产妇女的普遍性静脉血栓预防的效益报告。之后对2007年,在美国最大的可以提供剖腹产的医疗机构——美国医院,对100万个分娩产妇死亡案例进行回顾分析,制定了一项针对所有需要进行剖腹产手术妇女的普遍性围手术期预防措施(采用气压压缩的干预方式)。在2011年,这种方法被美国妇产科医师学会正式通过,在2014年的报告中显示这一政策的施行明显减少了剖宫产术后的肺栓塞死亡率。
    
在一项有228例需要使用这种加压装置的剖宫产和良性妇科手术的女性患者研究中,研究者发现依从率低于50%;依从性也与住院时间呈负相关。另外发现:一个有针对性的护理和病人教育计划可以提高依从性。研究者还发现,当存在一个不合理的护理和病患依从性较差时,病患的安危其实不会那么令人担忧。大多数深静脉血栓是在手术期间,由于病患长期不动而形成栓子;也就是说剖宫产术已知的静脉池与脊髓麻醉相关的这一说法是真实的。而且,剖宫产病人在术后12-24小时内都是完全卧床的。目前女性接受阴道或剖宫产手术的平均时间长度主要是基于非循证依据的legislative,而不是根据医疗的必要性,因此并不能准确反映术后的卧床静止时间。

作者通过这些70%的在第0天即开始预防措施的依从性良好的患者和对依从性差的患者进行观察分析后,发现术中频繁的使用气动压缩装置是影响因子。目前不存在有关于剖腹产术后预防措施的理想持续时间的数据。然而,尽管这个问题一直是被忽视的,但很高兴看到目前大多数接受剖腹产术的女性在围手术期会经历一个短暂的气压压缩装置的预防措施。另外,有一项研究证明,使用机械装置减少了术后肺栓塞死亡的发生率。该项目规定在术前使用激活设备,并在病人恢复行动后停止(大多数病人在术后24小时内即恢复行动。由于预防措施超出了权益动点的不确定价值,以及作者在论证提高长期使用装置的依从性上的困难,另外对于建议接受剖腹产女性使用该装置需要额外的花费,并且又还未证明这个术后预防措施的优点时,造成计划的施行异常困难。更加受益的方法也许涉及所有剖腹产女性在围产期时的一个更加合适的安置和压缩设备的激活,并且,要为挑选出的产前血栓患者和高危阴道分娩女性提供静脉栓塞的预防措施。在使用之前的普遍性剖腹产围手术期预防政策的情况下,这些女性是目前在妊娠期发生肺栓塞死亡的主要群体。这与目前由医疗和手术提供的数据一致,证明非手术患者发生院内死亡的百分比已经达到75%。
    
基于目前许多对无症状患者的血栓筛查研究,对于在院非产科病人的深静脉血栓风险的估计,建议采取同样的预防措施。这些研究对于定义住院分娩和围手术期女性患者中具有高风险深静脉血栓的这一群体是急需的,如此可以发展一个直接的、有据可依的预防建议。同时,应用风险评估和来自成熟风险评估模型的治疗方法以延长妊娠妇女预期住院时间方面是十分有益的。对于即将出院的高危女性,通过这样一个风险评估模型的预估结果(≥4分),与目前美国胸内科医师协会针对非住院患者的建议指南是一致的(作者建议,该评估模型中的危险因子“激素替换”应更改为“妊娠”)。对于高风险评估分数的需要采用硬膜外阻滞的女性患者应该使用机械预防。从实践的角度看,这些群体将包括活动性减少的患者,早期深静脉血栓患者,和已知的有血栓倾向的患者。
    
此外,也许是时候该加入其它外科专业,采纳和应用规范化手术护理方案以改进剖宫产孕妇静脉血栓栓塞的预防措施。这些建议要求对所有的成年手术患者在手术前后24小时内进行药物或机械预防,否则医生需要说明不采取预防的理由,正式应用这些预防措施,需要美国妇产科医师学会对剖腹产术中及围术期使用机械预防措施的重要性进行反复的强调,这同时将为致力于改善手术护理计划以提高依从性的大部分美国医院,带来基础设施方面的有力支持。通过反馈的95%-100%的高依从性,这些系统被证明的行之有效的。
    
曾经大家都不情愿对妊娠病人使用普遍性的安全预防措施,然而同时期望不要有任何特殊情况的出现,仅以生理机制为基础进行排除鉴别。成千上万例妊娠妇女因这一旧的围产期静脉血栓栓塞预防办法而死亡。所以目前迫切得需要发展基于人群筛选的妊娠期特异性风险数据的研究。同时,申请建立风险评估系统、住院分娩的预防措施,和高危病人的筛选机制,以及包含针对剖腹产病人的手术护理改进项目,需要基于全面的、理性的、全国性的围产期深静脉血栓预防计划。这个方法需要按以上所陈述的妊娠特殊数据类型更改,才是可行的。深静脉血栓的预防已经不容忽视,病人已经无法再等到一个重新创立的专门防血栓专业的出现。

原始出处:

Clark, S. L.Peripartum venous thromboembolism prophylaxis: where do we go from here? Obstet Gynecol,2015;125(1): 16-18.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
    2016-09-10 yhy100200
  3. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
    2016-09-13 fusion
  4. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
    2016-10-22 xue8602
  5. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
    2015-12-27 忠诚向上

    值得学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2043879, encodeId=e20c20438e92d, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Apr 02 17:12:00 CST 2016, time=2016-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2011215, encodeId=f30d201121559, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Sep 10 17:12:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697280, encodeId=8171169e2803e, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Sep 13 20:12:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955227, encodeId=dddb195522e55, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Oct 22 02:12:00 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49691, encodeId=5c1049691e8, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:07:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=44130, encodeId=9577441301f, content=剖宫产也有深静脉血栓。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 20:22:00 CST 2015, time=2015-11-29, status=1, ipAttribution=)]
    2015-11-29 三三五五

    剖宫产也有深静脉血栓。。。

    0

相关资讯

NEJM:低温对新生儿围产期缺氧有长期保护作用(TOBY研究)

《新英格兰医学杂志》上发表的一项最新研究显示,对面临脑损伤风险的新生儿进行低温治疗,能够获得长期的保护性效果。如果在围产期胎盘或脐带出现问题,就会使胎儿出现缺氧。在英国,每年大约有七十五万新生儿遇到这种情况,并可能因此患上严重的脑损伤。此前有研究显示,降低缺氧新生儿的体温,有助于避免这种脑损伤的出现。据悉,这种低温治疗的保护效果可以一直持续到患儿蹒跚学步的时期(大约18个月),不过当时还不清楚这些

J Watch评价:对围存活期分娩的指导建议

一场主题为产科和新生儿实践的研讨会上提出了存活期分娩孕妇给予何样干预措施的观点和建议。有高风险围存活期分娩(periviable gestational ,指胎儿20 0/7周到25 6/7周早产)的女性需要提供多方面的管理和咨询,其分娩需要在能提供母胎医学和新生儿重症监护服务的三级医疗中心进行。20周和25周围存活期早产的婴儿存活率分别为0%和>50%。最近由母胎医学和围产期儿科专

BMJ述评:中国防控乙肝重点在控制围产期病毒传播

乙型肝炎(乙肝)病毒感染在中国是最为严重传染病之一。尽管自1982年已有乙肝疫苗可以有效预防,但目前中国仍约有9300万乙肝病毒(HBV)携带者,每年用于治疗乙肝的费用约1000亿元人民币(约合106亿英镑,123亿欧元,160亿美元)。乙肝感染不仅增加了患肝癌和肝硬化的风险,而且乙肝患者还可能在求学、工作、人际关系及家庭中受到歧视。 中国政府于1992年提出新生儿接

Lancet:禁烟令有助于改善围产期和儿童健康

烟草对公众健康危害大。 一项大规模国际研究证实,在实施禁烟令的国家,出现早产儿及儿童患哮喘的比例都较禁烟前有所降低,儿童整体健康状况更好。 英国医学杂志《柳叶刀》(The Lancet)28 日在线刊登这一大规模研究的情况,参与研究者来自英国、荷兰、比利时和美国等多个国家。他们对北美洲及欧洲此前 11 项相关研究进行分析,并参考了所在国实施公共场所禁烟令的情况。这些研究涉及约 250 万份

Nature:心脏血管生成失衡导致围产期心肌病

在尼日利亚和海地等国家,围产期心肌症(Peripartum cardiomyopathy,PPCM)影响着0.33‰-0.33%的怀孕女性。该疾病在怀孕的最后一个月或坐月子的前五个月会出现心脏收缩的心力衰竭等症状。虽然近一半的患者在坐月子期间可能会恢复心脏功能,但也有很多的病人发展为慢性心力衰竭,最终只好心脏移植或走向死亡。 5月9月,Nature在线发表了由贝斯以色列女执事医疗中心等多家机构合

Baidu
map
Baidu
map
Baidu
map