{"countAll":0,"orderType":null,"readLevel":"0","lyTopicReq":{"id":"1878","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":null,"content":null,"barId":"1878","topicTypeId":null,"topicThemeId":"1015","readLevel":0,"files":null,"clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":null},"lyBarModerators":{"list":[],"list4Map":null,"pageBegin":0,"pageSize":8,"pageNumber":0,"totalPage":0,"totalRow":0},"metaSearch":{"description":"","keywords":"儿科","title":"儿科","channels":null},"data":{"list":[{"id":"5239","isDel":0,"createAt":1498396577646,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","title":"幼年特发性关节炎用药治疗方法","content":"

    幼年特发性性关节炎是一类儿童特发性关节滑膜炎，伴周围软组织肿胀和渗出，是儿童时期最常见的一种风湿性疾病。关节炎就是关节发生炎症，关节里面的液体会增加，使关节出现局部的发热、肿胀和疼痛等症状。

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 \"幼年特发性关节炎用药治疗方法\"

\n

什么是“晨僵”？

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    晨僵是幼年特发性性关节炎常见的症状，是指当关节在较长时间（如睡了一夜）不活动后出现疼痛、僵硬、活动受限，随着慢慢活动后，这些症状会有所好转。

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 \"幼年特发性关节炎用药治疗方法\"

\n

幼年特发性性关节炎主要是怎样治疗？

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    该病的治疗原则是缓解症状，保持关节活动和肌肉力量；防治或减少关节损害，最大程度地保持其功能状态。目前主要的药物分为两大类：一是对症抗炎止痛药（如双氯芬酸钠），该类药物只能缓解症状，不能阻止病情进展。其止痛作用起效很快。另外一类是慢作用改变病情药（氨甲喋呤、羟氯喹、来复米特等），该类药物可防止或减轻骨关节破坏性病变发生，生效时间较长，也有一定的副作用。随着对该病的不断研究发现一些生物制剂对该病也有一定的疗效。（马明圣供稿）

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转自协和医院官网

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","barId":"1708","topicTypeId":"1","topicThemeId":"1015","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":2037,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1498396577650,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1498396577650,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"b1a5ca4ddfad11e6a61c00163e04584d","isDel":0,"createAt":1484984778320,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"小海螺","password":"yiren2921","level":0,"nickName":"小海螺78","realName":null,"signName":"开心每一天","head":"http://01luntan.com/ly_img/1484985295689.jpg","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"2276635444@qq.com","address":null,"identityType":6,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110108","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"5238","isDel":0,"createAt":1498396192651,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","title":"儿童系统性红斑狼疮治疗方式与注意事项","content":"

  儿童系统性红斑狼疮（SLE）是一种侵犯多个系统、多个脏器的自身免疫性疾病。遗传素质、环境因素、性激素和免疫异常与本病的发生有关。该病非传染病，不需要隔离。

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如何治疗系统性红斑狼疮呢？

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肾上腺皮质激素为主要药物，开始时激素剂量会较大，治疗顺利会激素会慢慢减量，最后能维持病情稳定的最小剂量长期服用，总疗程需视病情而定。激素治疗期间常规补充钙及维生素D。如果病情较重可能会加用免疫抑制剂（如环磷酰胺等）。医生会根据患儿的病情制定治疗方案，并且会随着病情变化及时调整用药，提高患儿生活质量。

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系统性红斑狼疮患儿平时应注意什么？

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1. 尽量避免感染

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2. 不宜过度疲劳

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3. 不宜精神紧张或压力过大

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4. 不能长时间日光曝晒

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5. 避免服用诱发狼疮的药物，如磺胺类、对氨基水杨酸等

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6. 按医嘱服药，不能突然停用激素。（马明圣供稿）

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转自协和医院官网

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    儿童雾化吸入治疗是目前哮喘治疗中常用的给药方式，而吸入型激素是目前治疗气道炎症最有效的药物。随着激素雾化吸入疗法在儿童支气管哮喘、肺炎等疾病的应用和普及，患儿家属仍存在不少顾虑和疑问，现将常见问题概述如下：

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\"什么是雾化吸入治疗，儿童雾化吸入治疗的几个应知应会\"

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1、 雾化吸入激素有哪些作用？

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答：雾化吸入激素可以有效减轻气道炎症和气道高反应性、控制哮喘症状、减少哮喘发作、降低哮喘死亡率、改善肺功能以及生命质量。

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2、 吸入型激素的副作用类似于口服激素吗？安全性如何？

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答：目前吸入型激素吸入治疗药量仅为全身用药的几十分之一，经肝脏首被迅速灭活而不产生全身作用。因此雾化吸入局部给药治安全性好。

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3、激素雾化吸入治疗有哪些不良反应？

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答：布地奈德混悬液雾化吸入不良反应很少。个别患儿使用不当可出现口腔霉菌感染，可通过吸药后漱口或暂时停药1～2天和局部抗霉菌治疗即可缓解。其他还有声音嘶哑，停药后可自行缓解。

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4、 激素雾化吸入治疗有哪些注意事项？

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答：防止药物入眼，使用面罩吸药前不能涂抹油性面膏，吸药后及时清洗脸部，以减少经皮肤吸收的药量。雾化时采用坐位、半坐位或侧卧位，并适当拍背。呼吸节律对吸入药雾微粒量亦有影响，儿童吵闹时吸气短促，药雾以惯性运动存留于口咽部，疗效欠佳。定期消毒雾化器，避免污染。

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\"什么是雾化吸入治疗，儿童雾化吸入治疗的几个应知应会\"

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5、 需要根据孩子的体重来选择用药剂量吗？

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答：研究表明，给予儿童和成人吸入相同剂量的激素后，两者的药时曲线面积相似，即儿童患者一般无需按公斤体重计算用量。

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\"什么是雾化吸入治疗，儿童雾化吸入治疗的几个应知应会\"

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6、 雾化治疗时气流声音较吵，能关小流量吗？

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答：流量应控制在6～8L/min。原因为①药雾微粒直径以1～5 μm最适宜，如大于5 μm，绝大多数被截留在口咽部。如小于0.5 μm，虽能达到下呼吸道，但潮气呼吸时，90％的微粒又随呼气排出于体外。②药雾微粒大小与气流压力和流速有关，增加气流速度可使雾化输出量增加，减小药物微粒，缩短雾化时间，增强依从性。（翁若航）

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    许多家长并不知道小孩感冒怎么办，只要说明书上有治感冒这一项，就给孩子吃，于是吃抗生素就成了顺理成章的事情，殊不知，抗生素不可轻易使用，更不能滥用。

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\"小孩感冒怎么办？吃抗生素好吗？\"

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大多数上呼吸道感染不需要使用抗生素

\n

    急性上呼吸道感染（简称上感，俗称“感冒”）是儿科门诊最常见的疾病，也是让许多家长十分头疼的病，孩子常表现为发热、咳嗽、鼻塞、流涕等症状，有的孩子还会出现恶心、呕吐、腹泻等消化道症状，在儿科门诊常被诊断为“急性扁桃体炎”、“急性咽炎”、“急性鼻炎”等。其实这些病可以统称为上呼吸道感染，各种病毒和细菌均可以引起。其中，大多数上呼吸道感染是由病毒引起的，约占90%以上，而由细菌引起的仅占一小部分，也只有这一小部分的患儿需要使用抗生素。其实，在欧美发达国家，医生们对抗生素的使用是十分慎重的，如果孩子是病毒性感冒，根本不用药，只嘱咐家长让孩子多喝水、多休息，观察变化。

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\"小孩感冒怎么办？吃抗生素好吗？\"

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    有不少家长因为心疼孩子，一见孩子发烧、咳嗽或者有病情变化，就将抗生素作为首选药物给吃上了，觉得用了抗生素“保险”。其实，对于病毒性感冒的孩子，抗生素不但起不到任何正面的作用，有时甚至起到相反的作用。

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小孩感冒了怎么办

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\"小孩感冒怎么办？吃抗生素好吗？\"

\n

    孩子的上呼吸道感染是常见病，多数情况下都具有自限性，只要适当休息，合理饮食，可以口服一些针对发热和感冒症状的药物，几天就可以痊愈。如果孩子症状重、病程长，或者在任何家长觉得有必要的时候，应及时就医。作为家长，应破除“一感冒就用抗生素”的错误观念，在医生的指导下合理的使用抗生素。（李冀）

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转自协和医院官网

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   怀孕28周至37周的分娩，在医学上称为早产，七个月早产儿更需要专业的监护。北京协和医院儿科新生儿监护室组是国内最早建立的，其早产儿监护以系统管理为重点，首先是现场复苏，把好出生第一关。同时，通过呼吸疾病的防治结合、肠内肠外营养支持策略、控制院内感染、提高护理质量等，大大提高了极低出生体重儿的抢救成功率。在国内较早运用了多种先进治疗技术，并且开展高危儿的系统管理，进行早期干预和训练，发挥多科协作优势进行眼底和听力筛查与随访，通过早产儿联谊会，为早产儿父母提供相互交流的平台。

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  早产儿记录

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  北京协和医院儿科十余年来已经成功救治了数百例出生体重小于1500克的极低出生体重早产儿。目前救治成功的早产儿中胎龄最小的仅为25周、出生体重最轻的仅为520g。协和极低出生体重早产儿抢救成功率为98%，超低出生体重早产儿的抢救成功率79%，与国际先进水平相当。

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","barId":"1708","topicTypeId":"1","topicThemeId":"1015","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1842,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1498394012441,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1498394012441,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"b1a5ca4ddfad11e6a61c00163e04584d","isDel":0,"createAt":1484984778320,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"小海螺","password":"yiren2921","level":0,"nickName":"小海螺78","realName":null,"signName":"开心每一天","head":"http://01luntan.com/ly_img/1484985295689.jpg","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"2276635444@qq.com","address":null,"identityType":6,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110108","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"5232","isDel":0,"createAt":1498393701162,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","title":"早产儿的原因","content":"

    怀孕28周至37周的分娩，在医学上称为早产。早产儿的原因有多种，绒毛膜羊膜感染是重要原因。感染的来源是宫颈、阴道的微生物，部分来自宫内感染。感染也是导致胎膜早破的重要因素，早产常与胎膜早破合并存在。

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  助孕技术发展，使多胞胎出生率增加，而双胞或多胎妊娠可使宫腔内压力增高，致使提早临产。胎盘异常及子宫异常，也是早产常见原因。合并糖尿病、严重的哮喘、心脏病、高血压等，也会导致早产。心理压力、高龄等也可能是早产儿的原因。

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【妈妈偏爱9岁的弟弟 为了锻炼姐姐家务活都交给她做】海南临高县一名14岁的女生小玉6月1日一声不吭离开家，到现在也没回家。5日，她在qq空间上传了一段抽烟自拍视频，母亲李女士看到后感到震惊难过。小玉在当地中学读初二，老师曾听她说过妈妈偏爱9岁的弟弟，把家务活都交给她做，她“讨厌妈妈”。李女士表示，让女儿做家务本意是锻炼她一下，并没重男轻女，1日那天小玉还问她要钱买衣服，没想到之后就离家出走。李女士希望小玉尽快回家，承诺会改变教育方式。 

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\"妈妈偏爱9岁的弟弟

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关于此事，且看网友如何评论：

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疯子口木口木：嗯。。儿子就不用锻炼了吗

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Deer_槑菜：小的时候，我做饭，我弟弟是一定会在旁边帮忙烧火的，那些说男孩子不用做事的，脑子有坑吗？

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你有病啊_：我们这儿重男轻女也蛮明显的。自从有二胎政策，好多家庭男性都要求离婚。因为头胎是女儿，对象又老了生孩子风险太大。[费解][费解]刷新了我的三观。希望以后不要回来

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莫里瑞恩：他妈说的可能是真的，但是多半可能都是叫女孩子做事情，苛刻女孩子的时候都会说：你要让着你弟弟……比如说弟弟打了姐姐，姐姐还手了，母亲就责怪或者是殴打姐姐然后说：你要让着弟弟……

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小编观点：二胎家庭，老大内心感受需重视

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\"妈妈偏爱9岁的弟弟

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        父母在教育和照顾孩子时，需要坚持公平公正的原则。孩子因为年龄大或许要承担更多的责任，但这并不意味着，老大在所有事情上都要做出牺牲和让步。特别是不要让孩子因为弟弟妹妹的事情而无端被牵连。

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\"妈妈偏爱9岁的弟弟

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当然，很多时候绝对的公平是很难做到的，但父母就需要关注孩子会因此而出现的负面情绪。特别是在弟弟妹妹出生后，父母就需要更关注老大的心理变化和可能出现的失落和嫉妒感受。当孩子情绪低迷时，父母可以告诉孩子他的小时候受到过比弟弟妹妹更多的关爱，他和弟弟妹妹都是父母最爱的孩子，则孩子的内心会得到很大的安慰。 

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　鉴别是流感还是普通的感冒，还要到医院里诊断，需要去检查，检查出来是流感病毒引起的就是流感，其它病毒引起的就是普通感冒。

　　父母可以根据下面一些症状和表现来估计孩子是否感染的是流感：症状比较重，发烧比较高，有乏力、疲倦、周身酸痛，当然是比较大一点的孩子会说话，表达比较清楚，父母相对比较容易做出估计；但小孩子或不会说话，或表达不清楚，父母尤其要注意观察，如果发现孩子高烧不退，而且精神萎靡，父母要马上带孩子到医院就诊。

　　流感发病一般集中在冬春季节，而且传染性很强，所以，如果发现自己的孩子有发烧、咳嗽、头痛等症状，而周围也有孩子或成人同时有类似的症状，就可以怀疑孩子感染的是流感，就要加倍注意。但最终的诊断还是要在发病2－3日之内到医院检查，确定是否是由流感病毒感染引起。

流感与普通感冒的临床鉴别

症状普通感冒流感发热少见典型症状,常为高热(39～40℃),持续3～天头痛少见显著全身疼痛轻微常见,且严重痛乏,虚弱轻微早期出现,显著,可持续2～3周鼻塞,喷嚏,咽痛常见有时伴有胸部不适,咳嗽轻度至中度常见并发症少见支气管炎、肺炎,可威胁生命

　　如果父母发现周围的许多孩子在发烧、幼儿园、学校里有很多孩子出现咳嗽、发烧等症状，这是如果自己的孩子也发烧，就可以怀疑是流感。

　　流感治疗的基本原则

　　（1）隔离患者，流行期间对公共场所加强通风和空气消毒。

　　（2）及早应用抗流感病毒药物治疗：抗流感病毒药物只有早期（起病1～2天内）使用，才能取得最佳疗效。

　　（3）加强支持治疗和预防并发症：休息、多饮水、注意营养，饮食要易于消化，特别在儿童和老年患者更应重    视；密切观察和监测并发症，抗生素仅在明确或有充分证据提示继发细菌感染时方有应用指征。

　　（4）谨慎合理使用对症治疗药物：早期应用抗流感药物大多能有效改善症状，必要时可以联合应用缓解鼻黏膜充血药物、止咳祛痰药物。儿童忌用阿斯匹林（或含阿斯匹林成分药品）及其他水杨酸制剂，因为此类药物容易与流感的肝脏和神经系统产生并发症即ｒｅｙｅ综合征相关，偶可致死。

　　治疗方法：

　　流行性感冒以采用中药治疗为宜，多以消瘟解毒，发汗为主。如：银翘解毒丸，桑菊感冒片，板兰根冲剂等。普通感冒以温里解表为主，轻者可用生姜红糖汤，重者可用速效感冒胶囊，通宣理肺丸，防风通圣丸等。如有合并细菌感染者，可选用抗生素治疗。同时注意休息，多饮白开水。

 


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　 引起新生儿黄疸的原因主要有：生理原因有些胎儿在出生后第2～3日出现黄疸，第4～6日最重，随着肝脏功能的逐渐健全，黄疸通常在出生后的10～14日消退，个别有延误到20日以后者，属于生理现象。血型不合有的胎儿出生24小时以内出现黄疸，且持续不退。这种黄疸多是母子血型不合造成的。当胎儿的血液是rh因子阳性，而母亲的血液是rh因子阴性时，新生儿易发生溶血而出现黄疸。此种黄疸较严重，一般不会自然消退，而需换血、光照疗法或输白蛋白治疗。先天性胆道闭锁本病是一种少见的先天性畸形，黄疸乃因胚胎发育异常造成的胆道闭锁或狭窄，胆汁不能排泄或排泄不畅所致。黄疸的特点是出生不久即发生，呈进行性加重，全身皮肤深桔黄色，尿布被尿液染黄后用清水常冲洗不掉。此病预后恶劣，应早期手术。全身性巨细胞性包涵体病本病病源是细胞巨病毒，由无症状的带病毒孕妇通过胎盘感染胎儿。新生儿在出生一个月内出现黄疸、精神不振、咳嗽、肝脾肿大、消化不良和生长停滞等，应考虑是本病。败血症新生儿因免疫功能不健全抵抗力低下，易患脐带感染而发生败血症，败血症可并发中毒性肝炎或肝脓肿而出现黄疸。新生儿黄疸如超过一个月黄疸不消退，则应到医院儿科看病，以便正确判断和及时处理。

","barId":"1708","topicTypeId":"1","topicThemeId":"1015","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1834,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1486642999001,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1486642999000,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"b1a5ca4ddfad11e6a61c00163e04584d","isDel":0,"createAt":1484984778320,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"小海螺","password":"yiren2921","level":0,"nickName":"小海螺78","realName":null,"signName":"开心每一天","head":"http://01luntan.com/ly_img/1484985295689.jpg","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"2276635444@qq.com","address":null,"identityType":6,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110108","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"2752","isDel":0,"createAt":1486642969804,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","title":"新生儿颅内出血会影响智力","content":"

　　新生儿颅内出血是新生儿围生期死亡的主要原因之一，也是一个重要的致残因素。缺氧型出血是因缺氧造成毛细血管渗透性增加使血液渗出，此型可发生在出生前、出生时和出生后。而损伤型则都发生在出生时，当然在缺氧的基础上更易出现损伤。不可忽视的是剖宫产儿亦可发生颅内出血，且多为缺氧型。

　　新生儿颅内出血会影响智力

　　损伤型颅内出血见于臀位牵引，臀位助产和产钳，胎头负压吸引的颅内出血略少于产钳分娩。损伤型颅内出血都是体重偏大儿，且随体重的增加发生率增高，难产者发生损伤的机率明显大于自然分娩者。而体重越小发生缺氧型机率越多，而体重越大则损伤型越多。故防宫内生长迟缓及早产，防出生巨大儿，以及防胎位不正，头盆不称等，均是防新生儿颅内出血的关键，这就要求做好围生期保健。

　　轻型颅内出血儿几乎全都存活，后遗症较少，发生率0～10%；中型死亡率5～15%，后遗症发生率15～25%；重型则死亡率高达50～65%，几乎都有后遗症。颅内出血的常见后遗症有脑积水、脑穿通性囊变、留有智力落后、运动障碍、癫痫等，多为重残儿。故预防新生儿颅内出血应是防残工作的重点之一。

　　对胎儿宫内窒息，新生儿窒息及颅内出血等脑部损害性疾病，目前国内外除遵循既往的积极治疗外，还可采用高压氧舱治疗。我国已有优质婴儿舱投产和临床应用，疗效较为可靠，且越早得到进舱治疗，对脑缺氧缺血改善越早，疗效越好，后遗症越少，为防残提供了一个新的途径，应推广应用。


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　　准妈妈在走过十个月辛苦怀胎的日子后，最盼望的事，当然是迎接宝宝的哇哇坠地，但面对分娩除了兴奋的期待外，有些准妈妈却也存在一些隐忧，比方说，对生产过程痛楚的害怕，以及可能发生难产的恐惧。

　　尤其是，在经历漫长的产痛后，却被医师诊断为难产，需立即进行剖腹生产，此时又需面对另一种疼痛，对大多数孕妇来说，生一次痛两次实在是一大恶梦。

　　难产的原因知多少？

　　东元综合医院妇产部主治医师吴文艺指出，难产是泛指在分娩过程中出现某些情况，导致婴儿本身产生问题，或因母亲骨盘腔狭窄、子宫或阴道结构异常、子宫收缩无力或异常所导致。 实和联合诊所妇产科主治医师于西海也指出，难产依字面解释，即是「困难生产」的意思，临床上的表现是分娩过程缓慢，或甚至于停止。

　　而准妈妈分娩的过程主要可分为三个阶段：

　　一、是从阵痛开始至子宫颈全开，平均为十二小时以下，若初产妇超过二十小时、经产　妇超过十四小时都算是过长；

　　二、是由子宫颈全开至胎儿出生，平均为两小时；

　　三、是宝宝出生至胎盘娩出，一般为五至三十分钟。

　　在这三个阶段中，任何一个阶段不顺利导致生产时间过长，都可称为难产。

　　胎儿过大是最常见的难产问题

　　难产的原因和胎儿、产道和子宫收缩三者的互动息息相关。吴文艺医师说，胎儿本身造成的问题是难产的主要原因，最常见的情形是婴儿的头部太大，从超音波测量胎儿间顶距（bpd）可知头部大小。 若bpd超过10公分，生产是比较困难的；超过10.5公分，阴道生产就几乎不可能。

　　其它少数婴儿难产原因包括脑积水、胎儿长肿瘤、连体婴、巨婴及胎位不正如：臀部向下、前额向下、后枕位、横位等错误姿势，也会导致分娩困难。不过，由于科技医学的昌明，超音波的使用已普级化，胎位不正的问题都能在产前精确的掌握，而大幅降低了难产的发生率。

　　于西海医师也强调，胎儿的平均体重为3300～3400公克，太大的胎儿易造成产道的破裂及增加难产的机会。因此，准妈妈千万不要以「提供胎儿营养」为理由而对饮食毫无节制！怀孕期间，孕妇的体重增加宜控制在10～14公斤的合理范围内。正常的生产胎位应为头位，才能顺利生产。因此胎位不正如臀位、横位等都会造成难产。

　　适当规律运动降低难产风险

　　若不幸真的遭过难产的准妈妈，应该要有正确的认知，务必了解每一次难产都是个案，并不代表曾经难产即会再度难产。其次，定期产检有助于降低或消弭难产的情形，是最有效且最积极的作法。而家人如孕妇的丈夫、公婆或爸妈等，也应当负起协助的责任，与医师帮忙曾经有难产经验的妇女重建自信心。

　　此外，历经过难产痛苦的妇女，可多给自己一些时间平抚身心，再以一个健康及平和的心态来面对怀孕、生产这自然且宝贵的人生经验，如此一来，怀孕与生产将不再是一件害怕的事了。


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  接种疫苗后发生的异常反应要及时报告所在地段或乡卫生院保健科和区、县卫生防疫站，并及时、妥善处理，处理方法如下。

    1． 一般反应：一般的局部反应和全身反应不需任何处理，经适当休息就可恢复。局部反应较重时，可用清洁毛巾热敷，每天数次，每次10~15分钟。全身反应可对症治疗，发烧、头痛时服一些解热镇痛药，卧床休息、多喝开水、防止合并症及继发感染。

    2． 局部化脓：首先要区别是感染性化脓还是无菌性化脓。感染性化脓以抗感染为主，必要时切开引流；而无菌性化脓不应切开，切开后伤口可能长期不愈合。较轻的无菌性化脓经过热敷后可自行吸收，较重的可用无菌注射器抽脓，如脓肿破溃或有空腔，就需要切开排脓，必要时扩创，剔除坏死组织，用抗生素预防继发感染。

    3． 晕针：应立即平卧，头部放低些，注意保暖，喝些温开水或糖水，针刺人中、合谷、少商等穴位，一般短时即可恢复；严重的可皮下注射1：1000肾上腺素。

    4． 急性精神性反应如癔病性发作等可用针灸、暗示疗法，严重的给些镇静剂。

    5． 变态反应：如过敏性皮疹、血管神经性水肿可服抗过敏药物如扑尔敏等。血管神经性水肿除服抗过敏药物外，可用湿毛巾热敷。过敏性紫癜为出血性皮疹，除应用抗过敏药物外，适当用止血药物，必要时使用激素。对于过敏性休克要使病人平卧，立即注射1：1000肾上腺素，密切注意观察病情，血压下降应给升压药，呼吸困难应吸入氧气，总之要注意及时处理，及时治疗抢救。

    预防接种反应主要应由医务人员处理，但家长了解有关知识有利于在现场与医务人员配合。


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