产时胎儿电子监护图形与新生儿脐动脉血酸碱度的相关性研究

目的 探讨胎儿电子监护图形评估胎儿酸碱失衡的临床价值. 方法 产程中胎儿电子监护图形异常的产妇82例,其中早期减速图形18例,晚期减速图形16例,轻度变异减速18例,重度变异减速15例,心动过缓15 例. 全产程胎儿监护图形均正常的40例产妇为对照组. 各组胎儿娩出后立即检测脐动脉血酸碱度( pH)、剩余碱( BE)、标准碳酸氢盐( SB)、二氧化碳分压( PCO2 )、氧分压( PO2 ). 结果 与对照组比较,重度变异减速组、晚期减速组及胎儿心动过缓组pH、BE、SB、PO2均明显下降, PCO2 明显升高(P<0.05). 早期减速组各指标值与对照组比较,差异均无统计学意义(P>0.05),与早期减速组比较,重度变异减速组、晚期减速组pH、BE、SB、PO2 均明显下降, PCO2 明显升高(P<0.05). 重度变异减速组、晚期减速组及胎儿心动过缓组的血气各指标值比较,差异均无统计学意义(P>0.05). 结论 早期减速图形与酸中毒无关;轻度变异减速图形示胎儿处于缺氧代偿期,但尚无酸中毒;晚期减速、重度变异减速及心动过缓示胎儿酸中毒,一旦出现应该做好进一步评估,必时及时终止妊娠.     

第二产程不可靠胎心监护图形与围产儿结局的关系

目的：探讨第二产程胎心监护图形不可靠者和分娩方式及围产儿结局的关系。方法：回顾性分析阴道分娩且具备完整胎心监护资料的孕妇400例,观察第二产程不可靠胎心监护图形与围产儿结局的关系。结果：胎心监护图形不可靠者为观察组（210例）,可靠者为对照组（190例）。胎心监护图形异常的发生率为52．5％（210／400）。其中中度可变减速137例,重度可变减速50例,中度晚期减速2例,重度晚期减速2例,中度可变减速伴延长减速15例,中度可变减速伴中度晚期减速2例,重度可变减速伴重度晚期减速2例。其中伴有心动过速27例,基线变异平直2例,基线变异减弱2例。对照组阴道助产率为10％,观察组为24．8％,差异有显著性（P〈0．01）。观察组轻度窒息7人,重度窒息1人,窒息发生率3．8％,对照组轻度窒息2人,无重度窒息者,窒息发生率1．1％。x^2检验,两组窒息率无差异。结论：不可靠的曲线大多数既无胎儿窘迫又无新生儿窒息表现,因此其并不是一个很好的预后指标,应根据异常图形出现的频率及持续时间,结合其他监测全面判断,达到既降低了围产病率及死亡率,又避免了过度的产科干预的目的。     

胎心监护在诊断胎儿窘迫中的应用

目的:探讨胎心监护与胎儿窘迫及剖宫产之间的关系。方法:回顾1 575例住院分娩孕妇的胎心监护,发现图形异常者136例,其中74例考虑胎儿窘迫进行剖宫产术,术中发现有异常因素者55例,未发现异常19例。结果:胎心基线变异明显减弱或消失,重度变异减速及晚期减速者发生羊水粪染、脐带绕颈及新生儿窒息比例明显高于其他胎心监护图形异常者。结论:胎心监护能早期发现胎儿窘迫,但单凭胎心监护图形异常,作为胎儿窘迫诊断会出现假阳性判断,造成对产程不必要干预及剖宫产率上升。     

胎心监护与羊水粪染的关系

目的 探讨电子胎心监护与羊水粪染胎儿窘迫之问的关系.方法 回顾性分析2008年1月至2010年1月在我院住院分娩的136例孕产妇电子胎心监护图形.结果 发现胎心监护图形异常中,发生Ⅲ度羊水粪染的胎心监护异常图形主要为NST无反应型、重度变异减速及晚期减速;而Ⅲ度羊水粪染的新生儿窒息率较Ⅰ、Ⅱ度羊水粪染差异有显著性 (P<0.05),由此而说明发生新生儿窒息的胎心监护异常图形主要为NST无反应型、重度变异减速及晚期减速.结论 电子胎心监护能早期发现胎儿窘迫,但是,单凭胎心监护图形异常作为胎儿窘迫诊断会出现假阳性判断,当出现异常图型时,应严密监护,根据胎心监护异常的图形和程度及胎儿能够娩出的时间选择恰当的分娩方式,可降低新生儿窒息率及围生儿死亡率.     

胎心监护异常图形与新生儿结局的关系

目的探讨第一产程胎心监护异常图形与新生儿结局的关系,减少新生儿窒息、降低剖宫产率。方法回顾分析2007年3月～2008年3月在我院足月单胎头位分娩产妇,随机抽取480例,第一产程中胎心监护异常图形204例（观察组）和胎心监护正常图形276例（对照组）的临床资料。结果第一产程胎心监护异常图形的发生率为42．5％,常见类型为轻度变异减速（50．4％）、其次为早期减速,占21．1％,其他异常为晚期减速、心动过速、心动过缓、基线变异减弱、延长减速、重度变异减速,发生比例均在10％以下。观察组中剖宫产例数、羊水污染例数、羊水过少例数、脐带缠绕例数多于对照组,有统计学差异（P〈0．05）。两组新生儿体重、发生新生儿童息的例数无显著性差异（P〉0．05）。结论第一产程异常FHR图形的发生率较高,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关,其他图形可在严密监护下继续试产。     

产时胎心监护不同减速类型减速区面积与新生儿酸中毒的关系

目的〖KG*2〗探究产时胎心监护不同减速类型减速区面积与新生儿酸中毒的关系。 〖HTH〗方法〖KG*2〗分析足月分娩的120例产妇产前胎心监护图形的不同减速类型减速区面积,按照pH＜7.20和（或）碱剩余＜-12.00 mmoL/L的标准将120例观察对象分为A组（酸中毒组,n=53）和B组（非酸中毒组,n=67）,分析产前胎心监护图形,将图形按照早期减速、晚期减速和变异减速进行区分,并将不同类型减速的面积差异分别与新生儿酸中毒情况进行对比。 〖HTH〗结果〖KG*2〗2组胎心监护图形早期减速区域面积差异无统计学意义（P＞0.05）,A组新生儿血气pH值和碱剩余值小于B组,差异有统计学意义（P＜0.05）;A组胎心监护图形晚期减速和变异减速区域面积明显大于B组,新生儿血气分析pH值和碱剩余值也明显小于B组(P＜0.05)。轻度酸中毒组减速区面积小于重度酸中毒组（P＜0.05）。 〖HTH〗结论〖KG*2〗胎心监护图形出现早期减速与新生儿出现酸中毒概率关系不明显,新生儿酸中毒程度随减速区面积增加而加深。能够较为准确的判断新生儿状况并对针对危险信号的产生给予相应的补救措施,减少新生儿酸中毒状况,对提高新生儿健康率和生存率有明显的作用。     

产程中胎心监护异常图形相关因素分析

目的:探讨产程中异常胎心监护图形与围产儿结局的关系。方法:对我院足月单胎头位分娩产妇产程胎心监护(FHR)图形300例进行观察、记录和分析。结果:产程中CST评分及图形异常124例,正常176例,图形异常胎儿宫内窘迫、新生儿窒息的发生率明显高于对照组(P<0.05),阴道手术产、剖宫产率明显高于对照组(P<0.05)。常见类型依次为重度早发减速(ED)、中重度变化减速(VD)、晚期减速(LD)、基线变异减弱以及胎心率基线异常。结论:产程中重度变异减速、晚期减速、基线变异减弱与胎儿宫内窘迫及新生儿窒息的发生相关,应引起高度重视。     

胎儿窘迫患者372例的临床分析

目的 探讨胎儿窘迫的临床诊断. 方法 回顾性分析我院2008-01～2009-12因胎儿窘迫剖宫产病例372例的临床资料,重点分析胎儿窘迫的诊断依据,对依据电子胎心率监护图形而诊断的病例,对图形进行重新评估. 结果 以羊水污染及以胎心监护图形诊断胎儿窘迫的病例中,366例新生儿预后良好,6例评分≤7;羊水Ⅲ度污染及胎心监护图形出现轻度心动过缓、自发性的胎心率减速、轻度心动过速、轻度变异减速、基线变异减小的患者,20%的病例于剖宫产术中未发现任何可能导致胎儿窘迫因素,新生儿评分良好. 结论对胎儿窘迫的诊断应考虑多方面因素,使用尽可能多的检测手段,使其更具客观性,减少不必要的干预.     

第二产程胎心监护图形分析

目的 探讨第二产程胎心监护图形特点及第二产程的不良CTG图形。方法 对237例足月、单胎、头位，无阴道分娩禁忌症者，在第二产程行胎心内监护，用多因素LogisLic回归分析，分析与新生儿不良结局相关的胎心率图形。结果 16种第二产程胎心率图形中，轻度可变减速的发生率最高，为53．24％。以是否新生儿结局不良为应变量，引入Logistic回归方程的变量有晚期减速、延长减速、重度可变减速、基线变异减弱或消失、重度心动过缓及融合减速，OR值分别为2．88、2．84、4.49、6．76、7．00及3．46。结论 第二产程最常见的胎心率图形是轻度可变减速。晚期减速、延长减速、重度可变减速、基线变异消失、重度心动过缓及融合减速是第二产程的不良图形。终末减速是第二产程所特有的图形，多发生在胎儿娩出后期，如能很快娩出胎儿，则对胎儿无不良影响。     

胎心监护在诊断胎儿窘迫中的临床意义

目的:分析临产时胎心监护的图形,及时诊断胎儿窘迫,减少新生儿窒息发生率.方法:回顾120例住院分娩孕妇的胎心监护,产后结合羊水情况及新生儿Apgar评分综合考虑诊断胎儿窘迫.其中100例诊断胎儿窘迫行剖宫产术,术中发现有异常因素者68例,未发现异常32例.结果:胎心基线变异明显减弱或消失,胎心基线持续高于160次/分或低于110次/分(持续时间大于10分钟),重度变异减速及晚期减速者发生羊水粪染、新生儿窒息比例明显升高.结论:胎心监护可作为胎儿窘迫的重要诊断手段,但有一定的误诊率,一定程度上使剖宫产率升高.     

Fatal promise of immortality

The Census of 2001 brings the heartening news that the secular decline in the sex ratio of file population has come to a halt: The sex ratio in the population has increased from 927 females per thousand males to 933 females per thousand males in 2001. However it also brings disturbing figures of the continuing decline in the sex ratio in the 0-6 years age group. Partly due to higher female mortality in this age group, demographers had agreed that it is also due to female foeticide, the sex-selective abortion of female foetuses. The figure for the number of females per 1000 males has come down from 945 in 1991 to 927 in 2001. Some states in the country, Himachal Pradesh, with a decline of 54, Punjab of 82, Haryana of 59, and Delhi and Gujarat of 50 each, have shown more precipitous declines. Indeed the sex ratio at birth, based on the SRS, points to an increasing masculinisation from 109.5 males per 100 females in 1990 to 111.0 males per 100 females in 1998. As a consequence there has been a great deal of official concern, the Indian Medical Association initiated a campaign to sensitise the public, the Supreme Court has instructed states to implement the Prenatal Diagnostic Techniques (PNDA) Act, and so-called religious leaders have too entered the fray. The situation is complex: Prenatal sex diagnostic tests are increasingly available, prospective parents apparently want it. A section of the medical profession, which supplies these services, argues that they reflect the values of society and are merely meeting the demands of women. It is in this context that Amin Malouf's excellent novel 'The Century after Beatrice' should perhaps be made essential reading for medical students, indeed all medical professionals.     

Fatal xylenol self-poisoning

A case of fatal xylenol ingestion by a long-stay mental hospital patient is described. The clinical course was similar to that observed in other phenolic poisonings with active bowel sounds, nausea and vomiting, severe metabolic acidosis, hypotension and cardiac and renal failure. The formulation of xylenol ingested contains alcohol which would facilitate absorption; due to the dangers of such poisonings care must be exercised as to access and exposure to xylenol sterilising agents.     

Fatal intestinal amoebiasis

The clinical presentation of amoebic colitis are diverse. Amoebiasis is comparatively rare in the U.K. and, unless the clinician is aware of the condition, wrong diagnosis often leads to delay in appropriate treatment resulting in high mortality. Diagnosis rests on clinical suspicion, stool examination, sigmoidoscopy with rectal biopsy and serological tests. Amoebiasis is readily treatable and death from it should be very rare.     

Fatal thermal injury

Two fatal cases of thermal injury are described, one of which was the result of heat stroke and the other was the result of the uncommon condition, neuroleptic malignant syndrome. The clinical profiles, management and post-mortem findings of these two separate conditions are compared to highlight their important differences.