Puerperal infection

　　目前认为孕期及产褥期阴道内的生态极复杂，有大量需氧菌、厌氧菌、真菌以及衣原体、支原体等寄生，但以厌氧菌占优势。另外，许多非致病菌在特定的环境下也要以致病。

　　1、需氧性链球菌：β-溶血性链球菌可分18族，B族链球菌（GBS）产生外毒素与溶组织酶，使其致病力、毒力、播散能力较强，与产褥感染关系密切，可引起严重感染，其临床特点为发热早（平均在产后11小时），体温超过38℃，有寒战、心率快、腹胀、子宫复旧不良、子宫旁或附件区触痛，甚至伴发菌血症。需氧性链球菌是外源性感染的主要致病菌。

　　2、大肠杆菌属：大肠杆菌与其相关的革兰阴性杆菌、变形杆菌，是外源性感染的主要菌种，也是菌血症和感染性休克最常见的病原菌。大肠杆菌寄生在阴道、会阴、尿道口周围，可于产褥期迅速增殖而发病。大肠杆菌在不同的环境对抗生素的敏感性有很大差异，需行药物敏感试验。

　　3、葡萄球菌：主要致病菌是金黄色葡萄球菌和表皮葡萄球菌。二者的致病有显著不同。金黄色葡萄菌多为外源性感染，很容易引起严重的伤口感染。表皮葡萄球菌存在于阴道菌丛内，引起的感染较轻。葡萄球菌因能产生青霉素酶而对青霉素出现耐药性。

　　4、厌氧性链球菌：以消化链球菌和消化球菌多见，存在于正常阴道中。当产道损伤时残留组织坏死，局部氧化还原电势低，该菌迅速繁殖，与大肠杆菌混合感染，放出异常恶臭气味。

　　5、厌氧类杆菌属：为一组绝对厌氧的革兰阴性杆菌，包括脆弱类杆菌、产色素类杆菌等。此类细菌有加速血液凝固的特点，可引起感染邻近部位的血栓性静脉炎。

　　此外，梭状芽孢杆菌、淋病双球菌均可导致产褥感染，但较少见。支原体和衣原体也可是产褥感染的病原体之一。

　　女性如果生产过程中被细菌入侵，很有可能会造成产褥感染，危及女性的生命。近期产褥感染的并发症有盆腔广泛脓肿，如脓肿破溃则向上播散至腹腔。如侵及整个盆腔，使整个盆腔增厚呈巨大包块状，不能辨别其内各器官，整个盆腔似乎被冻结，称为“冰冻骨盆”。病情加剧细菌进入血液循环引起脓毒血症、败血症，尤其是当感染血栓脱落时可致肺、脑、肾脓肿或栓塞死亡。

　　During delivery, infection may be caused by perineal injury or cesarean section injury, manifested as local burning, pain, and坠胀, purulent discharge刺激the urethral orifice, causing dysuria and frequent urination. Wound infection, the suture陷入swelling tissue, pus flows out of the needle hole. Vaginal and cervical infection is manifested as mucosal congestion, ulceration, and increased purulent discharge, leading to vaginal adhesion and even closure. If it spreads to the deep part, it can spread to the parametrial tissue around the uterus, causing pelvic adhesion peritonitis.

　　If the inflammation continues to develop, it spreads to the serous membrane of the uterus, forming pelvic peritonitis, and then develops into diffuse peritonitis, with systemic toxic symptoms such as high fever, nausea, abdominal distension. During examination, there is significant tenderness and rebound pain in the lower abdomen. Due to the relaxation of the maternal abdominal wall and the tension of the abdominal muscles is not obvious. Due to the inflammatory exudation on the peritoneal surface and the covering of fibrin, it can also form localized abscesses in the rectouterine凹陷, and the abscess can spread to the intestines and bladder, causing diarrhea, urgency, and difficulty in urination. Incomplete treatment in the acute stage can develop into chronic pelvic inflammatory disease leading to infertility.

　　Strengthen prenatal health education, maintain overall cleanliness, avoid pelvic bath and sexual intercourse in the late stage of pregnancy, enhance nutrition, and strengthen physical fitness. Treat complications such as acute vulvovaginitis and cervicitis, avoid premature rupture of membranes, dystocia, birth canal injury, and postpartum hemorrhage. Disinfect maternal items, strictly implement aseptic operation, and correctly master the indications for cesarean section. After delivery, observe closely, and apply antibiotics for prevention to those who may develop puerperal infection and puerperal morbidity.

　　Puerperal infection patients need to undergo a general and local physical examination, pay attention to exclude other diseases that may cause puerperal morbidity and wound infection, and perform blood and urine routine examinations. Detection of C-reactive protein in serum acute phase reaction substances is helpful for early diagnosis of infection.

　　1. Pathogen culture:After routine disinfection of the vagina and cervix, use a cotton swab to pass through the cervical canal, take uterine cavity secretions. Since it is often taken by the cervical bacterium, intestinal uterine凹陷 to take secretions or pus for aerobic and anaerobic dual culture;

　　2. Secretion smear examination:If the aerobic culture results are negative, but a large number of bacteria appear in the smear, it should be suspected of anaerobic bacterial infection;

　　3. Pathogen antigen and specific antibody tests:Many commercial drug kits have been launched, which can be tested quickly.

　　Determine the site of the lesion, through general examination, triple or double vaginal examination, sometimes it is possible to palpate thickened fallopian tubes or pelvic abscess masses. Auxiliary examinations such as B-ultrasound, color Doppler ultrasound, CT, and magnetic resonance imaging can make locative and qualitative diagnoses of inflammatory masses, abscesses, and venous thrombosis formed by puerperal infection.

　　Therapeutic food recipes suitable for puerperal infection patients include:

　　1. Silver and Forsythia Peach Kernel Cake

　　〔Ingredients〕Lonicera japonica and Forsythia suspensa each 50g, peach kernel 20g. White flour 250g.

　　〔制法〕Boil the first three herbs into a concentrated decoction, remove the dregs, and add flour to make dough. Make small cakes and fry or steam them.

　　〔功效〕Clear heat and detoxify, activate blood circulation, and eliminate inflammation. Suitable for auxiliary treatment for postpartum pelvic infection.

　　〔服法〕The above is a daily dose, eaten as staple food in portions. Eat for 1 week.

　　39. Shepherd's Purse and Radish Soup

　　〔原料〕Shepherd's Purse 100g, Lonicera japonica Thunb., Dandelion 20g, Green Radish 200g.

　　〔制法〕Boil the first four herbs together, remove the herbs after the radish is cooked.

　　〔功效〕Clear heat and detoxify. Promote diuresis and promote Qi. Suitable for puerperal infection, lower abdominal pain, and vaginal discharge like pus and blood.

　　〔服法〕Eat radish soup, 1 dose/day, for 5 consecutive days.

　　34. Coix Seed and Aconitum Decoction

　　〔原料〕Coix Seed 30g, Prepared Aconitum 10g, Patented Herbs 50g, Glutinous Rice 50g, Appropriate amount of sugar.

　　〔制法〕Boil the first three herbs into a decoction, remove the dregs, and add glutinous rice to cook into porridge. Add appropriate amount of sugar.

　　〔功效〕Detoxification, promoting blood circulation, and removing pus. Suitable for postpartum infection and auxiliary treatment for suppurative pelvic inflammatory disease.

　　〔服法〕2 times/day, taken warm, for 7 days as a course of treatment.

　　27. Specific treatment for puerperal infection is as follows:

　　26. 1. Supportive therapy, correct anemia and electrolyte disorders, and enhance immunity.

　　25. Clearing the residual products in the uterine cavity, incising the abscess for drainage, and taking a semi-recumbent position to remove the pathogenic tissue.

　　24. The application of antibiotics should pay attention to the problems of aerobic bacteria and anaerobic bacteria as well as drug-resistant strains. For severe infections, comprehensive treatment with broad-spectrum and highly effective antibiotics is preferred. If necessary, short-term administration of adrenal corticosteroids can be added to improve the body's stress response ability.

　　23. For patients with thrombophlebitis, in addition to the use of a large amount of antibiotics, heparin should be added for 48-72 hours, that is, 50mg of heparin added to 5% glucose solution for intravenous infusion, once every 6-8 hours. After the body temperature drops, it is changed to twice a day, maintained for 4-7 days, and oral administration of dicoumarol, dipyridamole, and other anticoagulants can also be used.活血化瘀中药及溶栓类药物治疗。If the purulent thrombus spreads continuously, consider ligating the ovarian vein, iliac internal vein, etc., or directly incising the diseased vein to remove the thrombus.

　　22. Severe cases can cause toxic shock and renal failure, which should be actively rescued. Treatment should be time-sensitive, otherwise it can be fatal.