彩超检测正常胎儿大脑中动脉血流参数的临床研究

目的研究正常胎儿MCA血流参数的参考值范围及其随孕龄的变化规律。方法采集93例正常胎儿的MCA血流频谱图,利用自动描迹或手动描迹得到MCA-S、MCA-D、MCA-S/D、MCA-PI、MCA-RI,按照(18~23)孕周,(24~28)孕周,(29~33)孕周,(>34)孕周分组计算上述参数的均值,以x±s表示;通过SPSS13.0统计软件绘制上述各参数与孕龄的关系散点图。结果 MCA-S、MCA-D随孕龄的增长而增高,散点图显示其分布与孕龄呈线性正相关;MCA-S/D、MCA-PI、MCA-RI随孕龄的增长而降低,散点图显示其分布与孕龄呈线性负相关。结论 MCA做为供应大脑最重要的血管,掌握正常胎儿MCA血流变化规律为研究异常胎儿MCA变化奠定了基础。     

超声观察正常胎儿肾动脉的血流动力学参数及其临床价值

目的以彩色多普勒超声观察不同孕周胎儿肾动脉(RA)收缩期峰值血流速度(Vmax)、舒张期最低血流速度(Vmin)及搏动指数(PI)、阻力指数(RI),确定其正常参考值,分析其与孕龄的相关性。方法从接受常规产前超声检查的18～40周孕妇中选取符合条件的2627名进入样本库,测量胎儿肾动脉Vmax、Vmin和PI、RI,最后按孕龄分组,并进行统计学处理。结果胎儿左、右侧肾动脉血流Vmax(r=0.75,0.75)、Vmin(r=0.62,0.60)与孕龄呈正相关(P均<0.05),RI、PI随孕龄增长而呈缓慢下降趋势,仅在妊娠末期略有回升;胎儿左、右肾各血流参数测值间差异无统计学意义(P>0.05)。结论胎儿肾动脉血流速度与孕龄呈正相关,而肾动脉RI、PI随孕龄变化幅度很小。胎儿肾动脉血流监测可作为预测和评估胎儿有无宫内缺氧的方法之一。     

正常胎儿胸腹纵径比、总肺面积和肺纵径与肺发育的相关性研究

目的 应用二维超声观察不同孕周正常胎儿胸腹纵径比、总肺面积及肺纵径的参数值,探讨胎儿胸腹纵径比等参数对评估肺发育的应用价值.方法 对592例正常单胎妊娠18～40周胎儿进行肺二维超声扫查,采用标准四腔心观及胎儿躯干冠状切面,分别测定心脏面积、胸廓面积,肺尖至相应膈肌穹窿顶部的直线距离与膈肌穹窿顶部至胎儿膀胱底部的距离之比(胸腹纵径比),应用相关回归分析拟合总肺面积及肺纵径随孕周增长的回归方程.结果 正常妊娠胎儿总肺面积及肺纵径随着孕龄的增加而增大,总肺面积、肺纵径随着孕周增长的最适回归方程分别为:总肺:y =0.83X +13.894,R2 =0.914;肺纵径:y=0.669 X+3.124,R2=0.892.不同孕周胎儿胸腹纵径比在恒定范围内(0.44～0.59).结论 18～40周胎儿胸腹纵径比在恒定范围内,总肺面积与肺纵径值随孕周增长,上述参数可为产前评估胎肺发育提供有价值的参考指标.     

超声检测胎儿透明隔腔宽度及其临床意义

目的 探讨产前检测胎儿透明隔腔宽度的临床意义.方法 B超测量460名孕18～40周正常胎儿透明隔腔宽度,线性回归分析透明隔腔宽度与孕周的关系;比较167名孕18～40周透明隔腔正常胎儿(对照组)、7例透明隔腔缺失胎儿(观察组)中枢神经系统畸形发生率.结果 460名孕18～40周正常胎儿透明隔腔宽度(5.6±1.7)mm,线性回归分析结果显示,透明隔腔宽度与胎儿孕周无明显相关性(r=0.40,P＞0.05);观察组、对照组伴随中枢神经系统畸形发生率分别为100.00％,1.20％,二者比较差异有统计学意义(x2=132.18,P＜0.01).结论 超声检测胎儿透明隔腔宽度有助于产前诊断部分中枢神经系统畸形.     

三维超声测量胎儿肾脏及其血流容积与孕龄的相关性研究

目的探讨三维超声测量胎儿肾脏体积及肾脏血流容积与孕龄相关关系。方法应用三维超声重建技术测量89例(150枚肾脏)正常胎儿肾脏体积(Vr)及肾脏血流容积(Vf)并计算其比值(Vi)。结果①胎儿肾脏体积(Vr)与孕龄呈正相关(r=0.895,P<0.01);②胎儿肾脏血流容积(Vf)与孕龄呈正相关(r=0.752,P<0.01);③胎儿肾脏体积(Vr)及肾脏血流容积(Vf)的比值(Vi)与孕龄无明显相关性。结论三维超声可较准确测量胎儿肾脏及其血流容积,二者与孕龄呈线性正相关。     

超声探测正常孕20～40周胎儿卵圆孔的初步研究

目的 探讨超声测量胎儿卵圆孔的方法及标准测量切面,比较不同孕周段之间卵圆孔大小有无差别,并分析其大小与孕周之间的关系.方法 于孕20～40周超声测量胎儿卵圆孔大小,计量资料以x±s表示,不同孕周段间卵圆孔大小比较采用方差分析,卵圆孔大小与孕周的关系采用回归分析.结果 正常孕20～40周胎儿卵圆孔大小为(0.45±0.13)cm;不同孕周段间卵圆孔大小有统计学差异;卵圆孔大小与孕周的回归方程为Y=-0.13 0.02X.结论 超声下探测胎儿卵圆孔方法简单易掌握;卵圆孔大小随孕周增加而增大,其测值可做为超声评价胎儿心脏的一项指标.     

不同孕周正常胎儿心脏大小的超声检测与临床意义

目的 探讨产前超声检查胎儿心脏生长指标与孕周的相关性.方法 应用二维超声测量14～39周正常胎儿左心房(LA)、右心房(RA)、左心室(LV)、右心室(RV)、主动脉(AO)和肺动脉(PA)内径及卵圆孔大小(FO)、心脏面积(HA)、胸腔面积(TA)、心脏周长(HC)、胸廓周长(TC),分析孕周与测量值的关系. 结果 线性回归分析表明,胎儿时期心脏各腔室大小、AO、PA及室间隔(IVS)厚度随孕龄增加而增大,与孕周呈显著正相关;肺动脉与主动脉内径比值(PA/AO)、左心房与右心房内径比值(LA/RA)、左心室与右心室内径比值(LV/RV)、心脏周长与相应胸廓周长比值(HC/TC)、心脏面积与相应胸廓面积比值(HA/TA)与不同孕周比较各比值变化不明显. 结论胎儿心脏随孕龄增加而增大,其中心脏面积与孕周最具相关性.     

正常胎儿心脏发育与孕周增长关系的初步探讨

目的 初步探讨二维超声心动图在研究胎儿心脏发育与孕周增长关系中的应用价值.方法 回顾分析386例正常胎儿超声心动图测值,统计胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速,以及心率随孕周变化增长的关系,分析正常胎儿心脏发育趋势;比较胎儿左右房室大小.结果 ①胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速与孕周之间均呈线性相关关系,随孕周增长而增长,心脏横径与孕周间的线性相关性最大,动脉导管舒张期流速受孕周影响最小;胎心率与孕周无明显线性相关;②右心系统横径大于左心系统横径,右心房横径与左心房横径,右心室横径与左心室横径间比较差异有统计学意义;③心脏横径/孕周比值及心脏横径/胸廓横径比值均呈正态分布,前者均数为0.95,接近1.0;后者均数0.44,小于0.5.结论 二维超声心动图可作为评估胎儿心脏发育的检测方法.     

正常胎儿肾盂分离的超声检测

目的探讨正常胎儿肾盂分离现象的超声表现及其变化。方法对孕18至40周之间206例正常胎儿肾盂分离现象行超声检查及测量,并计算平均值和标准差。结果正常胎儿肾盂分离随孕周增长可逐渐增加,孕18至30周时胎儿肾盂前后径(APD)<4mm,孕30至40周时APD<7mm。结论了解正常胎儿肾盂分离的变化及其正常范围,尽早排除器质性病变,为临床提供诊断和参考。     

胎儿胆囊产前超声检测

目的 探讨胎儿胆囊的产前超声检测,分析不同孕周胎儿胆囊正常参考值范围.方法 孕15～40周单胎妊娠孕妇756例,应用Philips HDllXE彩色超声诊断仪行超声检查,测量胎儿胆囊长径、宽径及高度并进行分析.结果 超声显示胎儿胆囊位于上腹部脐静脉腹腔段右侧,孕15～32周胎儿胆囊长径、宽径及高度随孕周增加而增大.结论 通过超声测量不同孕周胎儿胆囊建立不同孕周胎儿胆囊大小的正常参考值范围,对指导临床有重要意义.     

切面超声心动图对心包积液的定量诊断

本文对１８例心包积液患者，采用切面超声心动图探查右心室前壁之前，左室后壁之后和心尖区三者心包脏层与壁层之间液性暗区宽度之和的均值，除８～１２小时累计的心包引流量，求得超声心动图每毫米宽度的液性暗区，相当于５２ｍｌ的心包积液量。心包积液时，以心尖区探得的液性暗区最宽，为２９．１４±１０．６６ｍｍ，故以剑突下穿刺心包易于成功和安全。     

The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

ObjectivesTo assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation.Design and settingThis is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited.Main outcome measuresSymptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life.ResultsSymptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function.ConclusionPatients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.     

Cross‐Sectional Evidence for a Stress‐Negative Affect Pathway to Substance Use among Sexual Minority Girls

Sexual minority girls (SMGs) are four times more likely to engage in substance use than are heterosexual girls. A better understanding of the explanatory mechanisms of this disparity is needed to inform prevention and intervention programs. The goal of this study was to conduct a preliminary test of a “stress‐negative affect” pathway by examining gay‐related victimization and depression as mediators of substance use among SMGs. Adolescent girls (N = 156, 41% SMGs) were recruited from two urban adolescent medicine clinics to participate in an NIH‐funded study of adolescent substance use. The average age was 17.0 years old and 57% were nonwhite. Mediation analyses were conducted in a multiple regression framework using SPSS and a mediation macro utilizing bias‐corrected bootstrapping. Four models were estimated to test mediated pathways from sexual orientation to gay‐related victimization (Mediator 1), to depression symptoms (Mediator 2), and then to each of four substance use variables: cigarettes, marijuana, alcohol, and heavy alcohol use. Significant mediated pathways (mediation tests with 95% CIs) were found for cigarette, alcohol and heavy alcohol use outcome variables. Results provide preliminary support for the minority stress hypothesis and the stress‐negative affect pathway, and may inform the development of future prevention and intervention programs.     

Burden of Neuropathic Pain in Indian Patients Attending Urban,Specialty Clinics: Results from a Cross Sectional Study

Background and Objective: Recent studies in Western populations have reported high patient burden of neuropathic pain. No data are currently available on the burden of neuropathic pain in Indian patients. Our study evaluated the burden of neuropathic pain in patients attending urban, private‐sector, specialty clinics. Methods: This cross‐sectional, observational study surveyed 467 patients with neuropathic pain to assess the burden of pain (pain severity, patient‐reported treatment effectiveness, impact of hypothetical pain relief on overall health rating), burden because of quality of life impairment (EuroQoL health state, pain interference with daily living, sleep and mood disturbances, medication‐related adverse events), and economic burden (treatment cost, impact on employment and productivity). Physicians filled out a clinical case report form to provide information on patient's neuropathic pain disorder and treatment provided. The data were analyzed to assess the overall burden of neuropathic pain. Results: Painful diabetic neuropathy was the most common cause of neuropathic pain (72%). Majority (64%) of patients reported moderate to severe pain, and about 50% reported moderate to severe pain‐related interference in activities of daily living. Substantial sleep impairment was reported as compared with general population. About 50% of patients reported co‐morbid mood disorders, while 67% reported medication‐related adverse event in the preceding week. Fifty‐seven per cent of patients reported an adverse impact on their employment status, including 13% who retired early or were unemployed. Among those currently working, 72% reported reduced productivity, including 22% who reported reduced productivity “most” or “all” of the time. Conclusions: In Indian patients with access to urban, private‐sector, specialty clinics neuropathic pain (particularly painful diabetic neuropathy) remains a significant medical condition with substantial negative impact on their quality of life. ?     

Age,Sex, Body Mass Index,and Laterality in the Foot Posture of Adolescents: A Cross Sectional Study

ObjectiveTo investigate the relationship between the right and left foot posture in terms of body mass index (BMI), sex, and age in adolescents aged 10 to 14.MethodsA total of 1400 adolescents were included. For assessment, the Foot Posture Index (FPI-6) was used. Each foot was assessed and ranked as supinated, normal, or pronated by the sum of the FPI-6 criteria. Each criterion was scored on a scale of –2 to +2, with negative for supinated and positive for pronated posture. A linear mixed model with repeated measures was used for statistical analysis.ResultsSex, BMI, and right and left foot are associated with FPI-6. The total score attributed for male sex (β = 0.29, P = .04) and the left foot (β = 0.73, P < .001) was higher (male right foot: mean ± standard deviation [SD], 3.09 ± 2.84, male left foot: 3.76 ± 2.80; female right foot: mean ± SD, 2.28 ± 2.61, female left foot: 3.45 ± 2.66; laterality for left foot: mean ± SD, 3.55 ± 2.71, laterality for right foot: mean ± SD, 2.82 ± 2.7). On the other hand, the correlation coefficient for the BMI was negative (β = -0.08, P = < .001), which means that the higher the BMI the lower the score attributed to the FPI-6.ConclusionsThe FPI-6 is positively related to the male sex and the left foot—that is, the predicted score is higher, so the feet tend to present with a tendency to pronation. Although BMI is associated with FPI-6, it was not possible to establish a relationship between high BMI and pronation of the feet.