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Jingdong book

妇科内分泌诊治指南解读·病案分析

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Jingdong book

妇科内分泌诊治指南解读·病案分析

Name: 妇科内分泌诊治指南解读·病案分析
Brand: Jingdong book
SKU: 3117006481
Price: 19.46 USD
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《妇科内分泌诊治指南解读·病案分析》在实施过程中，各级妇产科医师对指南中各种原则和指导建议如何应用于某一特定的患者个体，以及在治疗过程发生各种所谓非预期表象的原因及其应对方法常感困惑，迫切需要对于上述指南和共识进行解读，以便在临床实践中进行参考。

Catalogue

第一章《绝经过渡期和绝经后激素补充治疗临床应用指南（2009）》解读·病案分析
引言
绝经相关的激素补充治疗及其指南修订的历史回顾
解读细则
总结与展望
病案分析
附录一绝经过渡期和绝经后激素补充治疗临床应用指南（2009年）

第二章《多囊卵巢综合征的诊断和治疗专家共识》解读·病案分析
引言
解读细则
总结与展望
病案分析
附录二青春期多囊卵巢综合征的特点和治疗
附录三多囊卵巢综合征的诊断和治疗专家共识

第三章《高催乳素血症诊疗共识》解读·病案分析
引言
解读细则
总结与展望
病案分析
附录四高催乳素血症诊疗共识
附录五 2011版高催乳素血症诊治指南与共识（美国内分泌学会临床应用指南）

第四章《功能失调性子宫出血临床诊疗指南》
解读·病案分析
引言
解读细则
评价与展望
病案分析
附录六功能失调性子宫出血临床诊疗指南

Book Abstract

2.非肠道途径非肠道途径又分为经皮吸收雌激素和阴道局部应用雌激素，两者的差别比较大，故分而述之。
（1）经皮吸收雌激素：经皮吸收雌激素首先进入体循环，进入肝脏的比例极小，避免了肝脏首过效应：因经皮肤吸收直接进入体循环，基本不被破坏，生物利用度高，因而使患者总摄入药量降低：明显降低甘油三酯，不影响血浆总胆固醇、低密度脂蛋白和高密度脂蛋白，可提高胰岛素敏感性而不改变血浆生长激素浓度，不改变肝脏对肾素.血管紧张素-醛固酮系统的作用，对于以甘油三酯增高为主的血脂异常、有糖尿病和高血压、且需要应用雌激素的患者更安全。雌二醇与雌酮的比例在育龄期妇女中为2：1，而在绝经后妇女中为1：2，绝经后妇女雌二醇与雌酮的异常比值和雄激素分泌之间的关联性可能是增加冠心病风险的联合因素。口服雌二醇后体内雌二醇与雌酮的比例为1：5，而经皮雌激素进入体内后雌二醇与雌酮的比例为1：1，更接近育龄期女性的比例。经皮吸收雌激素与口服雌激素相比，深静脉血栓或肺栓塞的发生风险基本可以忽略不计。因此，经皮吸收雌激素对于需长期应用雌激素治疗、有肝胆功能障碍或血栓形成高危因素的患者具有独到的优点。
目前临床使用的经皮吸收雌激素有贴剂和凝胶，应用较广泛的是第三代含丙烯酸的基质型贴剂（商品名：松奇），其有效成分是半水合雌二醇，进入人体后分解为雌二醇和水，其中，雌二醇与人体分泌的雌激素分子结构相同。松奇为热敏性基质型贴剂，实现7日稳定释放，对皮肤刺激性少。松奇剂量为每贴含半水合雌二醇1.5mg，每日恒定释放50μg，可持续7天。贴用后3小时血浆药物浓度达到治疗水平，贴用24小时达到血浆药物浓度峰值，且持续1周保持在有效浓度。除去片剂后，雌二醇可以在24小时内恢复基础水平。
……

Introduction

妇科内分泌疾病指的是一类由于生殖内分泌轴功能失调导致生殖内分泌激素分泌异常（过高或过低）而造成的疾病，主要包括月经相关疾病、绝经相关疾病、不育症和性发育异常。不难看出，除了炎症之外，妇科内分泌疾病实际上是妇科门诊的主要病种。中华医学会妇产科学分会主任委员，著名妇产科专家郎景和教授说过“内科学是各种医学专科的基础，而妇科内分泌则是妇产科的基础”。很多妇产科疾病或由妇科内分泌失调引起，或对妇科内分泌造成影响，或两者兼而有之，从而产生多种复杂的症状和体征。在临床上虽然妇科内分泌疾病是常见疾病，但由于妇产科归类于手术科室，妇产科医生也大多痴迷于手术的操作，因而对于妇科内分泌疾病的重视程度有限，造成在碰到需要采用内分泌手段进行处理的疾病时往往感到困惑。但妇科内分泌疾病是客观存在的，也是需要我们妇产科大夫进行处理的。而且随着时代的发展，各种妇科内分泌疾病的诊治需求也在不断提高，难度也在不断加深。
在绝经方面，由于随着生活条件的改善，医疗和保健状况的进步，人类的寿命在不断延长，随之而来的老年化是人类目前面临的一项重大问题。老年化实际上就是人体各种器官功能退化直至衰竭的过程，绝经是女性达到一定年龄时由卵巢功能衰竭，雌激素分泌下降所导致，是器官退化的典型代表，卵巢是最早出现并达到完全退化的器官。绝经前后女性的生活质量和健康状况截然不同，绝经期综合征、骨质疏松和泌尿生殖道萎缩给绝大部分绝经期女性带来无尽的困扰。作为妇产科医生，有义务为绝经后妇女提供最好的整体临床医疗以缓解绝经症状和预防较远期的绝经后退化性疾病。

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