妊娠期肝内胆汁淤积症对孕妇肝功能及妊娠结局的影响

目的 探讨妊娠期肝内胆汁淤积症(ICP)对孕妇肝功能及妊娠结局的影响.方法 选择78例ICP孕妇为ICP组,78例正常孕妇为对照组.对比两组血清ALT、AST水平及妊娠结局的差异.结果 ICP组孕妇血清ALT、AST水平及剖宫产、宫内窘迫、新生儿窒息、羊水粪染、早产等发生率高于对照组,新生儿出生体重低于对照组(均P<0.05).结论 ICP可引起孕妇肝功能异常,增加剖宫产、宫内窘迫、新生儿窒息、羊水粪染、早产等的发生率,并可减少新生儿出生体重.     

妊娠期糖尿病的筛查和治疗对妊娠结局的影响

目的：探讨妊娠期糖尿病（GDM）筛查和治疗对妊娠结局的影响。方法：选择GDM孕妇208例（GDM组）和健康孕妇192例（对照组）,对两组孕妇一般情况、妊娠结局及围产儿结局进行比较。结果：GDM组孕妇平均年龄明显高于对照组,孕周低于对照组,差异有统计学意义（P均〈0.05）。而两组孕妇在体重、孕次、产次等方面的差异无统计学意义（P〉0.05）。两组妊娠结局比较,GDM组早产、剖宫产、妊娠期高血压发生率均明显高于对照组（P均〈0.05）,胎膜早破、羊水过多、产后出血的发生率差异无统计学意义（P均〉0.05）。两组巨大儿、低体重儿、高胆红素血症、新生儿体血糖、新生儿窒息发生率差异无统计学意义（P〉0.05）。结论：加强GDM筛查,及早诊断,通过饮食、运动及胰岛素等系统化治疗及规范化管理,可以有效控制血糖,减少妊娠合并症及改善围生儿预后。     

孕期科学管理亚临床甲减与妊娠结局的关系

目的:观察科学管理亚临床甲状腺功能减退(甲减)孕妇对妊娠结局的影响。方法:将122例孕12~30周的亚临床甲减单胎妊娠孕妇随机分为观察组60例和对照组62例,对两组孕妇行常规孕检及甲状腺激素水平检测、糖耐量试验,并对观察组行孕期科学管理干预,观察比较两组妊娠不良结局发生率和新生儿不良事件发生率。结果:对照组发生糖耐量异常、流产、早产、新生儿低体重等并发症的发生率均高于观察组,差异均有统计学意义(P0.05)。两组的剖宫产、巨产儿、死胎、宫内窘迫、产后出血、贫血、胎盘早剥、前置胎盘、妊娠期高血压的发生率及Apgar评分比较,差异均无统计学意义(P0.05)。结论:对已经诊断为妊娠期亚临床甲减孕妇实施全孕程、科学管理干预,可显著降低孕妇孕期并发症及新生儿不良结局发生率。     

数字健康个性化营养管理对妊娠期糖尿病孕妇妊娠结局的影响

目的:探讨通过数字健康管理平台进行的个性化饮食指导和营养管理对妊娠期糖尿病孕妇妊娠结局的影响.方法:将120例妊娠期糖尿病孕妇分为干预组和对照组,每组各60例.对照组采取常规护理管理措施,观察组在对照组的基础上加用数字健康个性化营养管理.比较两组孕妇孕期增重、产前血糖和血脂变化情况、母婴结局.结果:干预组孕妇孕期增重、产前空腹血糖(FBG)、产前餐后2h血糖(2 h PBG)、孕期胰岛素使用率均低于对照组(P＜0.05);干预组孕妇剖宫产、早产发生率均低于对照组(P＜0.05);干预组分娩孕周大于对照组(P＜0.05),但胎盘重量、新生儿体重、巨大儿发生率、新生儿低血糖发生率均低于对照组(P＜0.05).结论:数字健康个性化营养管理有利于妊娠期糖尿病孕妇体重的合理增长,可有效控制血糖水平,降低母婴结局不良的发生率,改善预后.     

妊娠期甲状腺功能减退对妊娠结局的影响

目的研究妊娠期甲状腺功能减退孕妇的患病率、妊娠结局及治疗。方法收集6 051例产妇,其中396例首次诊断为妊娠期甲状腺功能减退患者,并分为治疗组(A组)与未治疗组(B组),随机抽取同期住院的100例无甲状腺相关疾病的正常孕妇(C组)为对照组,根据临床资料进行对比与分析。结果 A组和B组贫血、妊娠期高血压与早产发生率差异均有统计学意义(均<0.05),但两组妊娠期糖代谢异常、妊娠期肝内胆汁淤积症(ICP)、胎儿宫内窘迫及产后出血发生率差异均无统计学意义(均>0.05)。B组与C组贫血、妊娠期高血压与早产发生率差异均有统计学意义(均<0.05),但两组妊娠期糖代谢异常、ICP、胎儿宫内窘迫及产后出血发生差异均无统计学意义(均>0.05))。A组和C组产妇贫血、妊娠期高血压、早产、妊娠期糖代谢异常、ICP及胎儿宫内窘迫发生率差异均无统计学意义(均>0.05)。结论妊娠期有必要进行甲状腺功能筛查,确诊为妊娠期甲状腺功能减退应积极治疗。     

妊娠期高血压疾病合并乙肝孕妇肝功能指标变化及妊娠结局情况分析

目的:探讨妊娠期高血压疾病合并乙型肝炎病毒(HBV)感染孕妇肝功能指标及妊娠结局情况。方法:选取2016年1-12月本院产科住院进行分娩的200例孕妇。根据孕妇情况分为正常妊娠组(n=53)、妊娠期高血压疾病组(n=55)、妊娠合并HBV感染组(n=48)及妊娠期高血压疾病合并HBV感染组(n=44)。比较四组妊娠晚期肝功能指标水平(ALT、AST、TBIL、TBA)以及不良妊娠结局情况。结果:正常妊娠组ALT、AST、TBIL、TBA水平均低于妊娠期高血压疾病组,妊娠期高血压疾病组ALT、AST、TBIL、TBA水平均低于妊娠合并HBV感染组,妊娠合并HBV感染组ALT、AST、TBIL、TBA水平均低于妊娠期高血压疾病合并HBV感染组,各组间比较差异均有统计学意义(P0.05);妊娠期高血压疾病合并HBV感染组早产、胎盘早剥、产后出血、产褥感染发生率均高于正常妊娠组,且早产发生率均高于妊娠期高血压疾病组、妊娠合并HBV感染组,胎盘早剥发生率高于妊娠合并HBV感染组,比较差异均有统计学意义(P0.05)。结论:妊娠期高血压疾病合并HBV感染患者可加重肝功能损伤,增加妊娠不良结局发生率,对患者肝功能和正常妊娠造成严重影响。     

乙肝病毒感染合并肝内胆汁淤积对妊娠的影响

目的:探讨乙肝病毒感染合并肝内胆汁淤积对妊娠的影响。方法:妊娠期肝内胆汁淤积症(ICP)合并乙肝病毒感染(HBV)孕妇83例为HBV+ICP组,无HBV感染的单纯ICP 253例为ICP组,比较两组妊娠结局及其合并症。结果:HBV+ICP组的肝功能异常、胆汁酸高,胎儿窘迫、早产和新生儿窒息等妊娠合并症高于ICP组,差异有统计学意义(P<0.05);两组间的死胎、产后出血及新生儿体重等差异无统计学意义(P>0.05)。结论:HBV感染合并ICP可增加妊娠风险。     

妊娠期糖尿病的规范化治疗对妊娠结局的影响

目的探讨妊娠期糖尿病(GDM)规范化治疗对妊娠结局的影响。方法选择我院101例GDM孕妇,根据血糖控制情况分为血糖控制满意组(满意组78例)和血糖控制不满意组(不满意组,23例),与同期住院分娩的无内科合并症的糖代谢正常孕妇(正常对照组,80例)进行对比,分析在孕妇和围生儿并发症发生率方面有无差异。结果满意组孕妇妊娠期高血压疾病、羊水过多、早产、胎膜早破及产后出血发生率和围生儿巨大儿、胎儿窘迫、新生儿窒息及高胆红素血症发生率与正常对照组比较,差异均无统计学意义(P>0.05);不满意组的妊娠期高血压疾病、羊水过多、早产、胎膜早破、产后出血、巨大儿、胎儿窘迫、新生儿窒息及高胆红素血症发生率均高于满意组(P<0.05)。结论 GDM如能得到满意控制,孕妇和围生儿并发症发生率均可降低到糖代谢正常孕妇的水平,加强孕期管理,规范化治疗GDM,能有效控制血糖,降低母婴并发症的发生率。     

葡萄糖耐量试验不同时间点血糖水平预测妊娠期糖尿病的妊娠结局

目的 分析口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)不同时间点血糖水平预测妊娠期糖尿病(gestational diabets, GDM)的妊娠结局。方法 筛选2016年6月—2017年12月在上海交通大学医学院附属同仁医院产检诊断为GDM的668例孕妇,检测空腹血糖（fasting blood glucose, FBG）及75g OGTT试验。根据血糖水平分为3组： FBG异常为GDM Ⅰ组（n=328）;FBG正常,OGTT 1h或OGTT 2h其中一项血糖异常为GDM Ⅱ组(n=224);FBG、OGTT 1h、OGTT 2h 3个时间点血糖均异常为GDM Ⅲ组（n=116）。分析3组孕妇的不同时间点血糖水平、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IRI）以及母婴不良结局的发生情况。结果 GDM Ⅲ组孕妇的FBG、OGTT 1h、OGTT 2h血糖水平,及FINS水平、HOMA-IRI均明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05);而GDM Ⅱ组的以上指标水平均明显高于GDM Ⅰ组(P＜0.05)。GDM Ⅲ组孕妇的妊娠不良结局的发生率明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05),GDM Ⅱ组的以上新生儿不良结局明显高于GDM Ⅰ组(P＜0.05)。GDM Ⅲ组孕妇的新生儿不良结局的发生率明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05);而GDM Ⅱ组与GDM Ⅰ组的新生儿不良结局,差异无统计学意义(P＞0.05)。结论 GDM孕妇的OGTT试验时间点异常越多、血糖与胰岛素水平越高提示GDM程度越重,表现为妊娠不良结局、新生儿出现巨大儿发生率可能越高。     

孕妇身体质量指数和孕期体重增加与妊娠结局的相关性研究

目的:研究孕妇身体质量指数和其孕期增重对妊娠结局的影响。方法:选取分娩的孕妇1 044例,根据不同的孕妇身体质量指数分为三组,根据孕期体重增加的不同幅度分为三组,比较各组的剖宫产率、巨大儿发生率、新生儿窒息率、产后出血率、早产率、妊娠期高血压疾病的发病率和妊娠期糖尿病的发病率。结果:超重组的剖宫产率、巨大儿发生率、新生儿窒息率和妊娠期糖尿病的发病率高于正常体重组,差异均有统计学意义(P<0.05),低体重组早产率、新生儿窒息率高于正常体重组,差异有统计学意义(P<0.05);孕期增重不足组的早产率、新生儿窒息率高于增重合适组,差异均有统计学意义(P<0.05),增重过多组的剖宫产率、巨大儿发生率、产后出血率、妊娠期糖尿病的发病率高于增重合适组,差异均有统计学意义(P<0.05)。结论:孕妇体重指数、孕期体重增长的增幅对分娩结局有影响,孕前保持正常体重、孕期合理营养控制适宜的体重增长有利于取得理想的分娩结局。     

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.     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.