臀位改良倒转术矫正妊娠晚期臀先露

目的分析应用臀位改良倒转术矫正妊娠晚期臀先露的效果。方法选择88例无手术禁忌症的臀先露孕妇，通过口服沙丁胺醇2．4～7．2mg，0．5～2h后，在B超监测下进行外胎位术。结果成功79例，成功率89．8％。结论臀位改良倒转术是一种安全、经济、有效，便于推广的矫正臀先露的有效措施。     

B超监视下臀位倒转术126例分析

目的 降低单胎臀位的发生率,提高头位分娩率。方法 对妊娠３０～４０周单臀位、具有外倒转术适应证的孕妇１２６例,术前０．３～１ｈ口服硫酸舒喘灵４．８ｍｇ,在Ｂ超监视下实行外倒转术矫正臀位。术后采用综合措施防治臀位复变。结果 成功率９１．２７％,单胎臀位发生率、臀位剖宫产率等均显著降低,未发生并发症。结论 Ｂ超监视下臀位倒转术是降低臀位发生率的有效方法。     

B超监测下臀位外倒转术临床应用的前瞻性研究

目的 观察和探讨对臀位孕妇施行B超监测下臀位外倒转术的安全性及临床疗效,分析外倒转术的成功率及成功后的分娩方式。 方法 以2017年1月～2018年6月门诊就诊的,≥37周单胎臀位孕妇为研究对象,共计23例,分别行B超监测下的臀位外倒转术,观察外倒转术的临床疗效,随访记录孕妇的妊娠结局及胎儿窘迫、胎盘早剥、胎儿损伤及胎膜早破等并发症的发生率,分析外倒转术操作成功的影响因素。 结果 行B超监测下的外倒转术后,共成功纠正胎位19例,占82.6%;失败4例,占17.4%,其中术后胎方位恢复臀位者3例,术中胎心率出现变化者1例。全程无胎儿窘迫、胎盘早剥、胎儿损伤及胎膜早破等操作并发症的发生。随访操作成功的19例患者,均顺利分娩,分娩过程未出现其他严重母婴并发症。 结论 对于足月单胎臀位孕妇施行B超监测下的臀位外倒转术,能够有效纠正胎位、减少分娩并发症及降低剖宫产率,值得在临床进一步推广应用。     

应用B超选择单胎臀位剖宫产术的临床分析

臀位是常见异常胎位 ,目前剖宫产率已上升到 70 %～82 % [1 ] 。近年一些学者认为无限制地提高剖宫产并不能无限度地降低臀产儿死亡率和损伤率。因此 ,如何正确处理臀位产是提高产科质量的重要课题。现将我院 1993～ 1996年应用 B超选择单胎臀位剖宫产 76例进行临床分析 ,报告如下。1　临床资料1.1　一般资料　我院同期住院分娩 1771例 ,年龄 2 2～ 34岁 ,其中单胎臀位 147例 ,发生率 8.3% ;同期剖宫产 2 12例 ,剖宫产率 11.97% ,其中单胎臀位 76例 ,占臀位产 5 1.7%。1.2　方法　采用东芝 SAL - 32 B超声显像仪 ,探头 5 MHz。受检者取平…     

两种臀位矫正方法临床比较观察

臀位占分娩总数的4%～6%,目前大多提倡剖宫产.为了降低剖宫产率,临床多采用几种方法行臀位矫正.笔者对1995年11月至2000年12月产前诊断为臀位者220例,孕28周,用臀位自行纠正法(也称骨盆位自己回转法[1])与改进的胸膝卧位法矫正臀位比较,现将结果报告如下.     

臀位在B超监视下行外倒转术228例分析

228例经B超检查发现为单胎臂位,并证明无合并症的单臀、足位,完全臀初产妇(在孕周31～37周时),并术前30分钟口服硫酸舒喘灵7.2毫克,然后在B超荧光屏监视下,行外倒转术,将臀位转为头位,成功220例,占92.1％;未成功8例,占7.9％。争取倒转成功,以通过阴道正常分娩,可降低围产儿死亡率。同时就外倒转术成功与失败原因进行讨论。     

单胎臀位分娩方式397例临床分析

<正> 臀位是常见的异常胎位,围产儿死亡率及并发症明显高于头位。如何选择臀位的分娩方式及降低围产儿病亡率值得产科工作者重视。本文对我院5年来臀位分娩397例进行分析,讨论如下: 临床资料 一、一般资料: 1.1988年1月至1992年12月,我院分娩总数6725例,其中臀位产397例,发生率为5.9％。臀位分娩中剖宫产136例,占34.25％,经阴道分娩261例,占65.75％(其中臀位助产164例,臀牵引97例)。两种产式对比剖宫产率逐年下降,1988年为38.04％(35/92),1989年为36.14％(30/83),1990年为33.34％(24/72),1991年为32.50％(26/80),1992年为     

抬臀侧卧纠正臀位120例分析

臀位是常见的异常胎位，妊娠和分娩期存在较多的高危因素。近几年，医院为了保证母婴健康，采用放宽常规剖宫产方法处理臀位，形成剖宫产率增高，而围产儿死亡率并未降低，且母体并发症增高。因此努力降低臀位的发生率是改进处理好臀位的关键，近１年余我们采取抬臀侧卧纠正臀位取得较好效果。现报道如下。１临床资料临床资料：２０００年１月～２００１年１０月在我院就诊的妊娠２８～３６周的臀位且具备臀位矫正适应证的２２８例孕妇，随机分为两组。A组：膝胸卧位组１１６例；B组：抬臀侧卧组１１２例。两组孕妇年龄、孕产次、孕周均无…     

我院10年单胎臀位分娩方式变化分析

①目的探讨臂位分娩方式变化对围生儿的影响,确定适宜的臀位分娩方式.②方法对我院1990年11月～1999年12月10年间单胎臀位350例分娩方式变化进行回顾性分析.③结果臀位剖宫产率呈上升趋势,近2年为93.33%.臀位剖宫产指征中社会因素上升极显著(P＜0 01).臀位剖宫产儿窒息率、死亡率较臀位阴道分娩儿之间差异有显著性(P＜0.01);臀位剖宫产率上升至50%～79%时,新生儿重度窒息率、围生儿死亡率有显著下降(P＜0.05);臀位剖宫产率进一步上升至80%以后,不能进一步改善臀产儿预后.④结论臀位剖宫产率在50%～79%之间较合适,应适当降低臀位剖宫产率.     

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臀位是临床上常见的异常胎位，约占分娩总数的3．2％～5．8％，如何正确处理臀位，选择合适的分娩方式，改善臀位产儿的预后，仍为产科工作者深入讨论的课题之一。从我国目前的情况看，剖宫产率一路走高，已经达到一个不正常的程度，而臀位剖宫产更是上升明显。臀位经阴道分娩逐年下降，据报道从1990年～1999年10月间臀位剖宫产率从2017％逐年上升到93．33％，我院臀位剖宫产由2000年的58％上升至2005年的87％，有的医院臀位几乎是常规剖宫产，张丹报道1999年～2002年无1倒胎儿正常的足月臀位是自主选择阴道分娩。     

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.     

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.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.