经产妇分娩290例临床观察

目的研究经产妇的分娩特点，提高对经产妇的认识和管理。方法回顾分析2006年1月至12月收治的290例经产妇，与同期住院的674例非高龄初产妇。对比分析。结果经产妇的剖宫产率为36．90％，初产妇剖宫产率为16．02％，两组比较有统计学差异（P〈0．05），经产妇难产原因头盆不称为46．25％，胎儿窘迫为38．75％，初产妇难产原因为头盆不称52．96％，胎儿窘迫为27．78％；经产妇的产后出血及巨大儿的发生率明显高于初产妇，新生儿窒息率两组比较无统计差异（P〉0．05）；经产妇各产程时间均短于初产妇。结论加强经产妇分娩的产程观察，重视经产妇分娩的复杂和多变。     

超声诊断胎儿脐带缠绕的价值

目的探讨超声诊断胎儿脐带缠绕的临床价值及其影响超声诊断准确性的有关因素。方法对本组105例晚期妊娠孕妇进行产前超声检查，观察胎儿颈后部、躯干部、肢体部位皮肤和软组织有无脐带压迹，并与分娩证实的结果进行对比分析研究。结果经超声检查诊断胎儿脐带缠绕28例，占分娩总数26．6％；脐带绕颈25例，占23．8％；绕躯干2例，占1．9％；绕肢体1例，占0．95％。28例脐带缠绕者中，绕1周者25例，占缠绕总数的89．28％；绕2周者2例，占7．1％，绕3周以上者1例，占3．5％。临床分娩证实有脐带缠绕26例，超声诊断与分娩结果的符合率92．8％。结论超声诊断胎儿脐带缠绕具有非损伤性、可重复操作、方便快捷、准确性高的特点，但同时应考虑到影响超声诊断准确性的有关因素。     

超声诊断胎儿脐带缠绕的价值

目的探讨超声诊断胎儿脐带缠绕的临床价值及其影响超声诊断准确性的有关因素。方法对本组105例晚期妊娠孕妇进行产前超声检查，观察胎儿颈后部、躯干部、肢体部位皮肤和软组织有无脐带压迹，并与分娩证实的结果进行对比分析研究。结果经超声检查诊断胎儿脐带缠绕28例，占分娩总数26．6％；脐带绕颈25例，占23．8％；绕躯干2例，占1．9％；绕肢体1例，占0．95％。28例脐带缠绕者中，绕1周者25例，占缠绕总数的89．28％；绕2周者2例，占7．1％，绕3周以上者1例，占3．5％。临床分娩证实有脐带缠绕26例，超声诊断与分娩结果的符合率92．8％。结论超声诊断胎儿脐带缠绕具有非损伤性、可重复操作、方便快捷、准确性高的特点，但同时应考虑到影响超声诊断准确性的有关因素。     

751例脐带异常对围产儿的影响

脐带是胎儿向母体进行新陈代谢的唯一通道。各种脐带异常因素经常导致脐带血流障碍,从而引起胎儿宫内窘迫,新生儿窒息,甚至胎婴儿死亡。脐带异常是造成围产儿死亡的主要因素之一,为降低围产儿病死率,现将我院1996～1997年分娩中有各种脐带异常因素之股婴儿进行分析,以便寻求正确的诊断和处理方法。1临床资料自1996年～1997年在我院分娩的产妇总数为2346例。年龄最小20岁,最大41岁,25～30岁占82．61％（1938／2346）。初产妇2247例,经产妇99例。在分娩的2346名产妇中,产生脐带异常751例,发生率为3201％。其中,脐带缠绕685例,发…     

32例臀位脐带脱垂的临床助产体会

脐带脱垂是臀位产时严重的并发症，对胎儿威胁最大，如处理不当可导致胎儿迅速死亡。本文根据32例臀位脐带脱垂的临床分析，浅谈臀位脐带脱垂的助产体会。临床资料我院自1990年12月至1996年12月共收住臀位300例，发生脐带脱垂32例，发生率为10．67％。结果与分析1臀位脐带脱垂与各种因素的关系产次：32例中经产妇19例，占59．4％，初产妇13例，占40．6％。孕周：＞37周者占25例，＜37周者占7例。先露情况：32例中足先露ZI例，占65．6％，完全臀先露9例，占28．l％，单臀先露2例，占6．2％。胎心音情况：除4例院外破膜并发脐带脱垂已无胎心…     

结肠癌合并肠梗阻围手术期护理

目的探讨结肠癌患者的术前及术后护理。方法回顾性分析37例结肠癌合并肠梗阻患者资料，根据心理特点进行术中和术后护理，使之处于接受治疗的最佳状态。结果37例结肠癌合并肠梗阻患者中，行右半结肠I期切除吻合术14例（37．8％），左侧结肠癌23例（62．2％）。手术治疗随访的25例中，2例直肠癌有局部复发，占28．6％（2／7）；5例结肠癌有肝脏或肺部及其他脏器转移，占27．2％（5／18）；3和5年生存率分别是88％（22／25）和59％（11／19）。术前准备及术后护理，对患者康复有重要意义。结论充分术前准备及重视患者心理护理，加强术后病情观察是减少术后并发症发生和促进患者康复的关键，提高患者生存质量。     

彩色多普勒超声评价胎儿脐带缠绕程度及临床意义

目的：探讨彩色多普勒超声（CDFI）诊断妊娠晚期胎儿颈、胸部脐带缠绕程度不同时脐动脉S／D值及RI变化对预测胎儿宫内窘迫的价值。方法：将诊断为胎儿脐带缠绕107例患者分为脐带缠绕较紧组（11例）和脐带缠绕较松组（96例)。CDFI观察胎儿脐动脉S／D、RI，胎儿脐带缠绕处压迹的形态、胎儿心率及呼吸状况。并与20例正常妊娠晚期妇女对照观察。结果：11例胎儿颈部脐带缠绕较紧者，缠绕处压迹较深，S／D值＞3．0，较胎儿脐带缠绕松组及对照组明显增高，并伴有不同程度胎儿心率增快及呼吸急促，部分可见明显腹式呼吸；胎儿脐带缠绕较松组与对照组之间无明显差异。结论：CDFI检测对预测胎儿宫内窘迫，指导分娩方式的选择有重要参考意义，其中S／D值为较好的观察指标。     

前置胎盘65例临床分析

我院1993年1月至1995年12月间，住院分娩产妇总数为5266例，其中前反胎盘患者65例，前董胎盘发生率为1．23％，与国内各地报告基本相一致，规格临床资料分析如下。1临床资料1·1一般资料65例中，初产妇54例，经产妇11例，初产妇与经产妇之比约为5ti，年龄20～24岁11例（16．92％），25～29岁13例（66．15％），30～34岁7例（10．77％）．to35岁4例（6．15％）。65例均经过B超检查及临床验证确诊为前置胎盘．其中完全性前置胎盘29例（44，6％），部分性前置胎盘10例（15．38％），边缘性前置胎盘9例（13．85％）．低置胎盘17例（26．15％）…     

脐带绕颈202例临床分析

本文总结1992－01～1996－12间202例脐带绕颈的临床资料，并对其产前诊断问题加以讨论。1临术资料1．1发病率此期间分娩总数为1902例，其中脐带绕须者为202例，发生率为10．62％。其中绕颈1周者186例，占90．08％，绕颈2周者10例，占4．95％，绕颈3周者5例，占0．47％，绕颈5周者1例。202例中初产妇83例，经产妇119例。1．2脐带绕颈与脐带长度的关系2O2例脐带统须合并脐带过长者35例（脐带长度＞7Ocm），其中脐带绕颈5周的1例，脐带长度为108cm。1．3脐带绕须对胎儿的影响2O2例中发生宫内窘迫者54例，占2624％，其中脐带绕颈1周发生宫内窘…     

蓖麻油煎蛋食对妊娠晚期催产引产效果观察

对象与方法 对象：产妇经入院初步检查，估计可经阴道分娩者160例确定为食疗组。其中，初产妇147例（91．9％），经产妇13例（8．1％），年龄为20～37岁。已有产兆者101例，其中不规律宫缩伴血性分泌物65例，胎膜早破、宫颈未扩张36例为食疗催产；无产兆者46例，包括晚期妊娠21例，过期妊娠19例，死胎6例，为食疗引产。对照组随机抽取未用食疗法的产妇65例，年龄为20～38岁，初产妇59例（90．8％），经产妇6例（9．2％），均有临床征兆。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.