医院产科抢救流程

医院产科抢救流程 厦门东南医院产科抢救流程 目录 新生儿心肺复苏抢救规范.............................................................................. 1 新 生 儿 窒 息 抢 救 流 程...................................................................... 2 子痫抢救处理流程.......................................................................................... 3 子痫的紧急处理.............................................................................................. 4 子痫抢救规程.................................................................................................. 4 产后失血性休克抢救规程.............................................................................. 5 DIC抢救规程.................................................................................................. 5 羊水栓塞抢救规程.......................................................................................... 5 脐带脱垂抢救规程.......................................................................................... 6 甲状腺危象抢救规程...................................................................................... 6 前置胎盘的处理原则...................................................................................... 7 胎盘早剥处理原则.......................................................................................... 7 心衰的治疗规范.............................................................................................. 8 重症肝炎合并妊娠的处理原则...................................................................... 8 围产期心衰抢救规程.................................................................................... 10 围产期心肺脑复苏抢救规程........................................................................ 10 糖尿病酮症酸中毒的抢救规程.................................................................... 10 子宫破裂抢救规程........................................................................................ 11 新生儿心肺复苏抢救规范 1、初步复苏处理: 置复温床、擦干羊水、摆好体位、暂缓断脐，清理呼吸道(口、鼻、咽部羊水、 粘液)进行触觉刺激。 2、评价呼吸: ?无自主呼吸:正压纯氧15-30秒;无药物抑制，评价心率;有 药物抑制，给予纳洛酮后评价心率。 ?有自主呼吸，评价心率，心率大于100次/分，评价肤色;心率小于100次/分， 同无自主呼吸处理。 3、评价心率: ?心率小于60次/分，行气管插管加压给氧、心外按摩30秒。 ?心率60-100次/分，面罩加压给氧。 以上处理后，再次评价心率。心率小于80次/分，开始用药，大于100次/分，继 续给氧，评价肤色。 ?心率大于100次/分，观察自主呼吸。 4、评价肤色: ?红润或周围性青紫，继续观察。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ?紫绀，继续给氧。 5、药物治疗: 心率小于80次/分，开始用药，肾上腺素(1:10000)0.1-0.3ml/kg静脉滴注或气管内给药，必要时每5分钟重复给药;再次评价心率，大于100次/分，停止给药;小于100次/分，根据情况给予碳酸氢钠、扩容剂。 新 生 儿 窒 息 抢 救 流 程 保温 擦干全身，摆好体位， 肩胛部垫高3厘米，吸净口鼻 20秒 腔粘液，触觉刺激，轻弹足底 内完成 心，轻擦后背 观察呼吸 无自主呼吸 有自主呼吸 100%氧气气囊正压 心率,100次/分 评价心率 通气15~30秒 呼吸暂停为药物抑制？ 无 给纳络酮 评价心率 心率>100次/分 心率<60次/分 心率于60~80次/分 心率>100次/分 继续正压通气 自主呼吸建立 评价皮肤颜色 评价心率 后停正压通气 心率<80次/分 四肢青紫 或红润 紫绀 胸外按压30秒无效 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 气管插管药物复苏 观察 给氧 子痫抢救处理流程 了解病情及用药情况，测量 左侧卧位，吸氧、 神志、血压、脉搏、呼吸、体温 吸痰，防声光刺激、防 瞳孔大小、对光反射、腱反射， 使用硫酸镁 坠床，上开口器防唇舌 病理反射，查宫高、胎心、宫缩 咬伤。 情况，胎儿情况。查血尿常规、 肝肾功能、电解质。记出入量。 如院外未用药: 院外已用硫酸镁静推 1)25%硫酸镁16ml(4g)+5%GS20 ml静脉推注 或肌注: 2)25%硫酸镁20 ml(5g)+2%普鲁卡因2 ml深部 25%硫酸镁30 ml(7.5g)+5% 肌注(20分钟后仍抽搐时可加用) 葡萄糖500 ml静点1.5~2.0 3)25%硫酸镁30 ml(7.5g)+5%GS500 ml静点 g/小时。 2/小时 4)监测腱反射、呼吸、尿量，备好10% 糖酸钙拮抗镁中毒。 其他药物治疗 防感染 平均动脉压?128mmHg 降颅压20%甘露醇250 ml， 或舒张压?100mmHg 如心肾功能不好，则速尿 予降压药 20~40mg，可6小时后重复 安定10mg静点 冬眠一号1/3量入壶 (速度,5分钟) 地塞米松10mg入壶 病情稳定转上级医院或抽搐 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 停止后2小时终止妊娠 子痫的紧急处理 1.要点:尽快控制抽搐、加强护理，防治并发症，及时终止妊娠。 控制抽搐: 2. ?安定 10mg+25%葡萄糖液30ml静脉推注(2分钟以上)。?25%硫酸镁 10ml+25%葡萄糖液30ml静脉推注(10分钟以上)，继之用25%硫酸镁40ml+50ml葡萄糖液500-1000ml静脉滴注。?如抽搐未能及时控制时，可用冬眠一号1/3量加于25%葡萄糖液20ml中静脉推注(?5分钟推完)，下余2/3量加于5%葡萄糖50ml中静滴。 3.护理: ?安置病人于安静避光房间，专人护理。?卷有纱布的压舌板随时备用。 ?维持呼吸道通畅、吸氧。?记出入量，留置导尿管。?禁饮食、头侧卧，防治呕吐物吸入。?记录血压、脉搏、呼吸每15分钟一次。?胎儿未娩出前安置胎儿监护仪或10分钟听胎心率一次。?各种操作均应轻柔，以减少刺激。?注意颅内水肿、梗塞、出血、心衰、酸中毒、电解质紊乱、DIC、尿毒症等并发症。 4.及时终止妊娠: ?剖宫产:不能在短时间内分娩，可在控制抽搐后行剖宫产。 ?经阴分娩:抬头低、宫口近开权，可考虑经阴分娩。 子痫抢救规程 1.一般处理:平卧，侧头，置开口器，避免声、光刺激，清理呼吸道，给氧。了解病史，记录生命体征，导尿并记尿量。 2.开放静脉通路: ?控制抽搐:冬眠一号半量、安定、鲁米那钠静脉点滴或入壶;?解痉:硫酸镁5g冲击，20g维持;?扩容:白蛋白、血、低右;?降压:肼苯哒嗪12.5—25mg、酚妥拉明20—40mg静脉点滴 3.预防感染:首选青霉素或头孢类 4.监测血生化，纠正酸中毒及血电解质紊乱 5.产科处理: ?临产:缩短第二产程，若血压控制不良，剖宫产 ?未临产:控制抽搐2小时后，行剖宫产术 6.处理并发症: 肾衰:应用利尿剂; 心衰:应用强心剂; 脑水肿、脑疝:应用甘露醇、速尿快速脱水并保持脑部低温; 颅内出血:应用止血剂，必要时开颅 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 产后失血性休克抢救规程 1.根据不同病因采用相应措施:如子宫收缩不良应用宫缩剂、按摩子宫等。 2.开放两条以上的静脉通路。 3.组成抢救小组，人员包括产科大夫、产科护士、麻醉科大夫。持续导尿、记尿量;持续心电监护;持续低流量吸氧;急查血常规、血凝四项、血生化;合血备血等。 4.迅速补液，20分钟内补液1000ml，后40分钟补液1000ml，好转后6小时内再补1000ml，按先晶体后胶体补液原则进行。 5.血HCT维持在30%左右，孕产妇死亡率最低，故输血应维持血HCT在30%左右为宜，最好输新鲜全血。 6.血管活性药物应用:多巴胺 20mg + 5%葡萄糖250ml静脉点滴，根据血压情况调整滴速;酚妥拉明 20mg + 5%葡萄糖 250ml静脉点滴，根据血压情况调整滴速。 7.其他药物应用:如阿托品、654-2、东莨菪碱。如有电解质紊乱表现，给予纠正。 8.应用足量有效抗生素预防感染。 9.护肾:在补足液体的情况下若每小时尿量小于17ml，予速尿20mg入壶;必要时加倍给予。 10.护心:若有心衰表现，给予西地兰 0.4mg 静注(慢)。 11.必要时果断行子宫切除术。 DIC抢救规程 1.高凝阶段:凝血时间缩短，凝血酶原时间缩短，纤维蛋白原增多。应用肝素、潘生丁、阿司匹林、右旋糖酐、抑肽酶 2.消耗性低凝期:血小板小于100×109/L，凝血时间延长，纤维蛋白原降低，凝血酶原时间延长。补充凝血因子、输新鲜血、输纤维蛋白原及凝血酶原复合物，补充Vitk1 3.继发性纤溶期:3P试验阴性，凝血酶原时间延长，FDP定量大于20ug/ml，优球蛋白溶解时间缩短，凝血酶原时间延长，D-2聚体阳性。给予6-氨基己酸、止血环酸、止血芳酸、新凝灵、立止血等治疗。 4.改善器官功能:给氧、抗休克、利尿、纠正酸中毒 5.去除病因，处理原发病 羊水栓塞抢救规程 1.抗过敏:地塞米松20-40mg静脉滴注或氢化考地松300-400mg静脉滴注 2.解除肺动脉高压:罂粟碱30-90mg静脉入壶;阿托品1-2mg静脉入壶;氨茶碱250-500mg静脉滴注 3.加压给氧 4.纠正休克:补充血容量、输血、输液，多巴胺20-80mg、阿拉明20-80mg、酚妥拉明20-40mg静脉滴注 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 5.抗心衰营养心肌:西地兰0.4mg静脉滴注，ATP、辅酶A、细胞色素C 6.纠正DIC: ?高凝阶段:肝素50mg、潘生丁200-400mg、阿司匹林0.75mg、右旋糖酐、抑肽酶2-4万U静脉滴注 ?消耗性低凝期:补充凝血因子、输新鲜血、输纤维蛋白原、Vitk 20-40mg静脉滴注 ?纤溶阶段:6-氨基己酸4-6g、止血芳酸100-300mg、立止血1KU、新凝灵600mg。 7.纠正肾衰:速尿40mg静推;利尿酸50—100mg静推;甘露醇250ml静脉滴注 8.选用广谱抗生素:首选头孢类 9.产科处理: 第一产程:抑制宫缩，迅速剖宫产终止妊娠 第二产程:助产，缩短第二产程，禁用宫缩剂 产后:检查修补产道损伤，剥离胎盘，必要时子宫切除 脐带脱垂抢救规程 1、缓解脐带压迫 ?脐先露采取臀高头低位，脐带对侧的侧俯卧位。 ?脐带脱垂可采取脐带还纳术。 ?充盈膀胱或者经阴道上推先露，以缓解对脐带的压迫，直至剖宫产将胎儿娩出。 2、提高胎儿对缺氧的耐受性 ?给氧。 ?静脉点滴葡萄糖及维生素C。 、分娩方式的选择: 3 ?宫口开全，先露已降至盆底:立即阴道助产; ?宫口未开全，先露未达盆底，不具备助产条件者，立即就地行剖宫产手术。 4、术后常规给予抗生素预防感染。 甲状腺危象抢救规程 1.请内科医生会诊，共同用药或转内科病房治疗。 2.药物治疗:?丙硫氧嘧啶:一次口服或经胃管给药600-1200mg，以后每日维持量300-600mg，分三次口服。 ?碘溶液:每6时一次，每日20-30滴。 ?普萘洛尔:口服20-30mg，每6时一次，紧急情况下可采用静脉注射1-5mg(单次应用)，降低周围组织对甲状腺素儿茶酚胺的反应。 ?地塞米松10-30mg，静脉滴注。 3.对证治疗:包括吸氧、物理降温、口服阿司匹林及静脉补液、纠正水电解质紊乱、强心剂等。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 前置胎盘的处理原则 1、一旦诊断明确或者高度可疑，应立即住院，在确保母亲安全的前提下，期待胎儿生存，降低婴儿死亡率。 2、给予补血、止血，及时做好输血及手术准备。(根据出血量多少、有无休克、孕龄、胎位、胎儿是否存活及宫口开大的程度，选择处理方法) 3、期待疗法:多用于部分性或边缘性前置胎盘，阴道出血不多，胎儿存活者。 ?住院观察，绝对卧床休息。 ?每日氧气吸入3次，每次20-30分钟。 ?给予补血药物纠正贫血。 ?应用宫缩抑制剂:硫酸镁、沙丁胺醇等防止早产。 ?宫颈内口环扎术:根据颈管长度选用，防止子宫颈口扩大，有助延长孕龄。缝合时，加用宫缩抑制剂，采用硬膜外麻醉。 ?期待至妊娠36周，主动终止妊娠。终止妊娠前，应用地塞米松促胎肺成熟。 4、终止妊娠:?终止妊娠指征:?孕妇反复多量出血致贫血甚至休克者，无论胎儿是否成熟，均应立即终止妊娠。?胎龄达36周以后，胎儿成熟度检查提示胎儿肺成熟者。 ?终止妊娠方式: 剖宫产术:?为前置胎盘的主要分娩方式，子宫切口的选择以避开胎盘为原则。?胎儿娩出后，子宫体部注射催产素或麦角新碱，切口边缘以卵圆钳钳夹止血。?胎盘未及时娩出者，迅速徒手剥离胎盘。若胎盘剥离面出血，可用明胶海绵上放凝血酶或巴曲酶，快速置出血部位，再加沙垫压迫10分钟。? 若剥离困难，胎盘粘连或植入并出血多者，应选择切除子宫。?若局部渗血，用可吸收线局部“8”字缝合，或宫腔及下段填纱24小时后阴道抽出。?以上方法无效，可行子宫动脉、髂内动脉结扎术，或行子宫全切术或次全子宫切除术。 阴道分娩:?仅适用于边缘性前置胎盘、枕先露、流血不多，估计在短时间内能结束分娩者。?决定阴道分娩后，先行人工破膜，破膜后胎头下降压迫胎盘止血，并可促进子宫收缩加速分娩。?若破膜后胎先露下降不理想，仍有出血，应立即改行剖宫产术。 胎盘早剥处理原则 1. 一般处理:输液、备血、给氧、抢救休克等应急措施。严密观察病情变化，测血压、记尿量、完善各项辅助检查，根据病情补充血容量、输血等。 2.及时终止妊娠 ?经阴道分娩:?产妇，轻型病例，一般情况较好，估计短时间内能结束分娩者，可经阴道分娩。?先行破膜，使羊水缓慢流出，用腹带包裹腹部，起到压迫胎盘，使之不再继续剥离的作用。?必要时静脉滴注催产素，缩短产程。?产程中严密观察血压、脉搏、宫底高度、宫缩情况及胎心。有条件可行全程胎心监护。 ?剖宫产:?重型胎盘早剥，特别是初产妇，不能在短时间内结束分娩者。?轻型胎盘早剥，出现胎儿窘迫征象，需抢救胎儿者。?重型胎盘早剥，产妇病情恶化，虽胎儿已死亡，但不能立即经阴道分娩者。?破膜后产程无进展者。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 3.并发症及处理: ?产后出血:胎儿、胎盘娩出后，及时宫体注射催产素并按摩子宫。 ?剖宫产术中发现子宫胎盘卒中，配以热盐水纱垫湿热敷子宫，若不奏效，可行子宫动脉上行支结扎或用可吸收线大“8”字缝合卒中部位浆肌层。 ?若不能控制出血或发生DIC，应行子宫切除术。 ?DIC及凝血功能障碍:重型早剥及胎死宫内者，出现皮下注射部位出血、尿血、咯血及呕血等，提示DIC发生，应立即采取应对措施。 ?急性肾功能衰竭:易发生在有重度妊高征，出现失血性休克并发DIC的患者。记尿量、补充血容量，每小时尿量小于17ml时，应给20%甘露醇250ml快速滴注，或速尿40mg静推。严密监测肾功能，必要时行透析疗法。 心衰的治疗规范 1.半卧位或坐位，高流量吸氧(6-8L/分)或者加压供氧。 2.镇静剂:吗啡10mg肌肉注射，或杜冷丁50mg肌肉注射。 3.洋地黄药物的应用:对充血性心衰效果好，如心瓣膜病、先心、高血压心脏病;对阵发性室上速和快速性心房颤动或扑动并发心衰时有明显疗效，对肺心病、心肌炎等心衰疗效较差。 -对低排高阻型心衰，给予强心利尿;多采用快速洋地黄类药物，如西地兰4. 0.2-0.4mg加入25%葡萄糖20ml,缓慢静脉注射，4-6小时后重复给药，总量不超过0.8-1.0mg。然后改用口服维持，与此同时可给予速尿20-40mg，静脉注射，对合并肺水肿者，效果更好。 5.发生急性肺水肿时，可给地塞米松10-20mg静脉注射，解除支气管的痉挛，缓解肺水肿。 6.及时终止妊娠。 7.产后72小时内，应密切观察产妇的心率、呼吸、脉搏、血压、体温，每4小时一次;心功能?-?级每2小时一次，严防心衰及感染的发生。 8.产后4小时内要绝对卧床休息，其后继续保证充分休息，根据心功能情况，产后至少2周后方可出院。 9.应用广谱抗生素预防感染，自临产至产后1周，无感染方可停药，尤其是预防亚急性感染性心内膜炎的发生。主要用要为青霉素等。 10.心功能级?-?者可以哺乳，但应避免劳累，心功能?-?者，不宜哺乳，及时退奶。 11.不宜再妊娠者，产后心功能良好且稳定者，可于产后1周行绝育手术，如有心衰，带心衰控制后再手术。 12.产后如果心率超过100次/分，仍需继续应用强心药。 重症肝炎合并妊娠的处理原则 1.应请肝病科医生协同处理。 2.预防与治疗肝性脑病: for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ?饮食与热量:低蛋白、低脂肪、高碳水化合物饮食，限制蛋白入量(小于20g/日)。增加碳水化合物，保障热量供给，维持在1800kcal/日以上。补充大量维生素。必要时补充新鲜血浆和白蛋白。 ?抑制肠道内产生和吸收毒性物质:口服新霉素、甲硝唑、乳果糖。 ?脱氨药的应用:精氨酸或谷氨酸钠静脉点滴。 ?支链氨基酸的应用:6-合氨基酸250ml每日1-2次静点。 ?维得健100mg静脉滴注，每日2次。 ?其他:10%葡萄糖250ml+胰高血糖素1-2mg+胰岛素8U+50%葡萄糖250ml+10%氯化钾10ml+辅酶A 50U+ATP 20mg静脉点滴。 ?预防肝细胞坏死、促进肝细胞再生:促肝细胞生成素静脉点滴。 3.调节免疫功能:如胸腺肽。 4.维持水电解质、酸碱平衡。 5.预防和治疗DIC: ?动态观察血小板、PT、APTT、纤维蛋白原的变化。 ?肝素应用的问题:重症肝炎在应用肝素时，必须补充新鲜血液、血浆、抗凝血酶?;宜小计量应用;在临产或分娩结束12小时内不宜应用，以免发生创面大出血。 ?在DIC治疗中复方丹参的作用较肝素缓和、安全。 6.积极治疗并发症(如感染、出血、肾衰等)。 产科处理: 7. ?早孕发病者首先治疗肝炎，病情好转后应尽早行人工流产术。 ?中孕发病时，因手术危险性大，一般不宜终止妊娠;但个别重症患者，经保守治疗无效，病情继续发展，亦可考虑终止妊娠。 ?晚期妊娠发病者，宜积极保肝治疗24小时后尽早终止妊娠。分娩方式选择剖宫产术，应做好输血准备，备好新鲜血、新鲜冰冻血浆、浓缩红细胞、凝血酶原复合物、纤维蛋白原等。 ?产后注意观察阴道出血量、子宫收缩情况。 ?抗生素预防感染，选用肝损小的抗生素，如青霉素、头孢类。 ?回奶时避免应用雌激素。 妊娠期急性脂肪肝治疗原则 1.此病凶险，处理难度大，应请肝病科医生协同处理。 2.一般治疗: ?卧床休息。 ?给予高碳水化合物、低脂肪、低蛋白饮食。 ?纠正低血糖、水电解质紊乱及酸中毒。 3.使用保肝药物和维生素C、K、ATP、辅酶A等。 4.成分输血纠正凝血因子的消耗，大量冷冻新鲜血浆可补充凝血因子，输人体血清白蛋白纠正低蛋白血症，降低脑水肿发生率。也可根据情况给予浓缩红细胞悬液、血小板及新鲜血液。 5.肾上腺皮质激素的应用，短时间使用可保护肾小管上皮，宜用氢化可的松每日200-300mg静滴。 6.换血及血浆置换。 7.其他(纠正及治疗并发症)。 8.使用H2受体阻滞剂，维持胃液PH>5避免发生应激性溃疡。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 9.肾功能衰竭，利尿剂无效时可行透析疗法、人工肾等治疗。 10.纠正休克，改善微循环障碍。 11.产科处理: ?一旦确诊或高度怀疑时，无论病情轻重、病程早晚、均应尽快终止妊娠。 ?剖宫产适用于短期内无分娩可能者。术中宜采用局部或硬膜外麻醉，不应全麻以免加重肝脏损害。 ?若胎死宫内，宫颈条件差，短期内不能经阴分娩者也应行剖宫产术。 ?若剖宫产时发生凝血障碍，出血不止，经缩宫剂等保守治疗无效宜行子宫全切术。术后禁用镇静、止痛剂。 ?若宫颈条件好，胎儿较小，估计短期内分娩者亦可考虑经阴道分娩(或引产)。 ?产后应注意休息，不宜哺乳。 围产期心衰抢救规程 1.半卧位给氧，持续心电监护，持续导尿，计出入量。 2.应用血管活性药物:硝酸甘油、消心痛、多巴胺、酚妥拉明等治疗 3.强心、利尿:西地兰0.4mg，速尿20-40mg 4.应用镇静剂:度冷丁50-100mg肌注、吗啡5-10mg肌注 产科处理:短时间内可经阴道分娩则缩短第二产程，行阴道助产;无产兆或短5. 时间内无法经阴道分娩者，宜采用剖宫产术终止妊娠，采用硬膜外麻醉，产后腹部加压沙袋。 6.选择广谱足量有效抗生素控制感染，纠正心律失常，纠正酸中毒，监测血气、生化，控制输液量及速度，限盐。 围产期心肺脑复苏抢救规程 1.开放气道、清除喉头血液、分泌物、呕吐物 2.人工呼吸:面罩、加压给氧、气管插管、呼吸机 3.重建循环:心前区捶击、胸外心脏按压 4.开放静脉通路，行药物治疗:肾上腺素能药、碱性药 5.经上述处理5分钟无效，急诊剖宫取胎 6.保持脑灌注:应用血管活性药物，补液 7.心电监护，请内科会诊，协助抢救。 糖尿病酮症酸中毒的抢救规程 1、补液，纠正低血容量，常用生理盐水或5%葡萄糖溶液。 2、小剂量胰岛素持续静滴: 血糖,13.9mmol/L,RI加入生理盐水，每小时5μ。 血糖?13.9mmol/L,RI加入5%葡萄糖溶液，酮体转阴后，改皮下注射。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 3、纠正水电解质紊乱及酸中毒。 4、持续胎心监护。 急性胎儿宫内窘迫抢救规程 1、积极寻找母儿双方原因:如心衰、呼吸困难、贫血、脐带脱垂等。 2、及早纠正酸中毒，静脉补液加5%碳酸氢钠250ml。 3、尽快终止妊娠:若宫内窘迫达严重阶段必须尽快结束分娩。 ?宫颈尚未完全扩张，宫缩过强致胎儿窘迫情况不严重者，应立即停止滴注催产素或用抑制宫缩的药物，嘱产妇左侧卧位，吸氧(5升/分，面罩供氧)观察10分钟，若胎心率变为正常，可继续吸氧观察;若无显效，应行剖宫产手术。 ?宫口开全，胎先露部已达坐骨棘平面以下3cm者，吸氧同时应尽快助产，经阴道娩出胎儿。 子宫破裂抢救规程 1.先兆子宫破裂:立即给以抑制子宫收缩药物(肌注哌替啶100mg，或静脉全身麻醉)，立即行剖宫产术。 2.子宫破裂:在输血、输液、给氧、抢救休克的同时，尽快手术治疗。 ?若破口整齐、距破裂时间短、无明显感染者或患者全身情况差不能耐受大手术者，可行修补术，并行输卵管结扎术。 ?破口大、不整齐，有明显感染者应行子宫次全切除术。 ?若破口大、撕伤超过宫颈者，应行子宫全切术。 术后给予足量有效抗生素。 3. 严重休克者应尽可能就地抢救，若必须转送，应输血、输液、包扎腹部后方可转送。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet