产后出血南京鼓楼医院妇产科课件

南 京 大 学 医 学 院 附 属 南 京 鼓 楼 医 院 戴毅敏 2007年1月13日 for mothers -产褥保健知识讲座 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏1 什么是产褥期? 从胎盘娩出至产妇全身各器官(除乳腺 外)恢复至妊娠前状态,包括形态和功 能,这一阶段成为产褥期 一般规定为6周 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏2 产后妈妈面临的问题 产后出血 产后伤口恢复: 剖宫产 阴道分娩 大小问题 正常子宫恢复 月经恢复 营养(饮食)问题 母乳喂养 产后休假 产后避孕 产后锻炼 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏3 一、产后出血 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏4 产后2小时 在产房渡过 -80%的产后出血发生在产后2小时. 目标: 降低孕产妇死亡率 减少子宫切除率 尽可能减少母亲的失血量 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏5 产后出血常见原因 子宫收缩乏力 胎盘粘连,滞留,植入 产道裂伤 凝血功能障碍 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏6 产后出血的计量 自己监护 标准:少于月经量 护士的监护 接血盆 称重-卫生纸/看护垫 血常规 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏7 助产士的工作-产后2 小时 护士的工作: 观察产后出血、产妇的临床症状 压肚子-帮助宫腔积血排出 测量血压 教授哺乳方法 进行产后哺乳知识的初步教育 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏8 产妇可以做的事情 最重要的：小憩 可以进食 建议：稀饭，多饮水 认真实践哺乳知识 接受护士的“压肚子” Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏9 二、产后的大小问题 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏10 顺产产后的排尿问题 第1次排尿可能有点小问题常见 注意: 多引水 精神放松 不要怕痛 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏11 排尿障碍怎么办? 排尿障碍的原因:尿潴留 尿不尽 解决办法:环境刺激-持续放水 局部热敷 按压下腹 药物熏灸 最后一招-持续导尿 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏12 剖宫产产后的排尿问题 持续留置尿管24-48小时 拔管后,多引水 精神放松 不要怕痛 拔管后出现排尿障碍者少见 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏13 产后的大便问题 便秘的原因: 灌肠 产后不吃有渣食物 害怕伤口疼痛 应对办法 正常规律饮食! 包括:蔬菜,水果,米饭 药物缓解 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏14 三、产后伤口的恢复 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏15 顺产后的伤口 2种伤口类型： 侧切伤口 正中伤口 缝合方法： 皮内-不拆线 外缝伤口-需要拆线 愈合时间：3-5天 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏16 会阴伤口的护理 伤口的感觉： 第1天-疼痛 第2天-不动不疼 第3天-动也不痛 护理要点： 护士：每天进行冲洗2次 产妇：大小便后清水洗 少用一次性内裤 正常伤口：无须用药 产后3天可以拆线 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏17 会阴伤口需要消毒液洗吗? 女性生殖道有正常菌群,保护我们的健康 常见女性外用药: PP粉,碘剂, 肤阴洁,洁尔阴etc 伤口无异常,我们不建议大家使用. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏18 剖宫产的皮肤伤口 产后7-10天愈合 较会阴伤口明显疼痛 镇痛方法：度冷丁 镇痛泵 不需要每天换药 产后子宫伤口线头脱落 致产后出血 完全愈合时间漫长 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏19 小问题1-宫缩痛 产后1-2天出现 初产妇不明显 经产妇明显,有时需要度冷丁 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏20 小问题2-褥汗 产后一周内出现 应对方法: 勤换内衣-棉质 (准备内衣) 避免感冒 建议洗澡-避免皮肤疾病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏21 四、产后在医院的日常生活 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏22 顺产后的饮食 正常规律的饮食： 和孕前一样 适当增加汤类食物 有蔬菜、水果 应该盐 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏23 剖宫产后的饮食 产后6小时后可以饮水，汤 -产后第一天最多准备稀饭汤 排气后可以正常进食 和顺产一样的饮食 注意： 不建议吃萝卜汤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏24 在医院获得健康知识的途径 自学床头手册-鼓楼特色 指导您在院期间,每天的注意事项 向护士咨询 建议: 尽量在医院学习知识 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏25 医院食堂的饮食资源 常规的产饭： 三餐二汤 早餐品种多 汤类：鱼汤 骨头汤 酒酿鸡蛋汤 特殊病人饮食-食堂安排： 糖尿病，低脂，流质等 “月子汤”-食堂直接定餐 特殊要求-食堂定餐 提醒：是食堂不是饭店 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏26 医院为宝宝提供的服务 出生体检-儿科医生完成 新生儿疾病筛查 新生儿听力筛查 疫苗接种 每天洗澡 教授抚触技巧 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏27 产后多下床！ 顺产者，小憩后即可下床 剖宫产产后6小时可以下床 注意事项： (1) 缓慢下床,预防晕倒: 晕倒原因:体重突降 出血后身体不适应 饮水不足 (2) 维持日常生活的活动量 即可 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏28 多下床的好处 促进恶露排出,促进子宫恢复 避免静脉血栓形成 促进肌肉恢复张力 增强自信 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏29 卫生常识问题 每天刷牙-避免刷牙水 需要洗澡-淋浴 阴道分娩者,稍休息后 剖宫产者,产后7天后 房间要通风 不需要戴帽子 母婴同室，注意安全 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏30 产后探视注意 减少探视的人数!Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏31 产后恶露持续时间 一般持续:4-6周 总量达:500ml 性状:血性-产后3天内 浆液性-4-14天 白色-14天以后 有腥味,不臭 突然变成血性的需要引起重视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏32 住院费用 阴道顺娩：2500元 剖宫产：4000元 不同的病种差异极大 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏33 “VIP”服务 鼓楼医院自1892年建院以来, 一直以”服务大众”为己任 是一所”平民医院” 没有万元以上的”分娩套餐” 对特殊需求者也有相应的服务 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏34 五、母乳喂养 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏35 Breastfeeding - Best For Baby. Best For Mom. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏36 母乳喂养的好处1 对母亲: 促进子宫复旧-减少出血 促进体型恢复 经济-省钱 卫生-宝宝不生病 方便-省事 增进母子感情-安心 产后避孕 推迟来月经-减少癌症的发病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏37 母乳喂养的好处2 对婴儿: 营养素齐全 营养素比例恰当 肠道菌群恰当-不便秘 抗感染 温度适宜 丰富的抗体-抗过敏 宝宝不生病 减少哮喘发病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏38 母乳喂养的要求 产后半小时内开奶 24小时母婴同室 按需哺乳 纯母乳喂养4-6个月 母婴分开的情况下, 学会保持泌乳的方法 4小时挤一次 不用安慰奶嘴 一侧吃完再吃另一侧 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏39 母乳喂养中的问题-开奶晚 择期剖宫产者比较晚 阴道试产后剖宫产开奶不晚 解决办法: 早吸吮 勤吸吮 增加汤类饮食-”月子汤” 中药-通草,乳泉颗粒 短期人工喂养 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏40 母乳喂养中的问题-乳头皲裂 疼痛 感染 解决办法: 乳汁外敷 雌激素 不用肥皂,酒精洗 正确含接 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏41 母乳喂养中其他常见的问题 乳汁不足-多,勤吸吮是最好的解决办法 乳腺管不畅-硬结,发热,疼痛 乳腺炎-停止哺乳,输液, 甚至手术 副乳问题 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏42 母乳喂养中应该持有的态度 充分的信心,有迎接困难的心理准备 您和宝宝之间要有一个相互适应的过程: 宝宝要学习 新妈妈也要学习 尽可能推迟加奶粉的时间 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏43 六、营养小常识 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏44 产后访视制度 社区医疗保健人员进行家访 时间:产后3天,14天,28天 访视内容: 产妇起居,睡眠 母乳喂养 伤口恢复情况 婴儿生长情况 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏45 七、产后避孕问题 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏46 产后避孕 指产后6个月或整个哺乳期 产后42天即可排卵 产后避孕失败的风险: 哺乳,产后,子宫软-穿孔 产后短期人流-元气大伤 住院手术-无法承担抚育后代的重任 乳汁会明显减少-不能母乳喂养 子宫复旧不良-胚胎植入,宫外孕 剖宫产者- 瘢痕妊娠-子宫切除 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏47 产后避孕 哺乳本身不是正式的计划生育措施 产后6个月内、纯母乳喂养、无月经时，怀孕几率小于2% LAM 推荐方法： 1、宫内置环：阴道分娩后3个月；剖宫产后6个月 2、避孕套 3、避孕药尽量不用，但纯孕激素避孕药可用 4、紧急避孕：5天内上环、72小时内米非司酮 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏48 IUD因症取出的原因 首要原因 出血，占 65%以上 次要原因 腰酸、腹痛，占 26%左右 停止续用率三年中依次为 6.48% 5.08% 3.35% 第6年以后为 0.56%0.02% Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 戴毅敏49 IUD与妊娠 年龄：年轻妇女带器妊娠率高 30岁带器妊娠危险为25岁的60% 35岁为25岁的35% Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client