不同胎龄脐带静脉顺应性的变化及其临床意义

目的：为脐带静脉的临床应用从生物力学性质上提供理论依据。方法：采用胎龄以24－42周流产及自然分娩正常胎儿脐带静脉50例，测定其压力－容积关系。结果：脐带静脉的p-V曲线可用抛物线拟合。脐带静脉顺应性随胎龄增加而增大，但39周以后又降低。结论：人脐带静脉是动脉移植物的良好替代材料，在移植时除了考虑脐带静脉与宿主动脉相匹配外，还应注意其顺应性与胎龄的关系，建议选用胎龄在37－40周之间的脐带静脉作为临床应用的移植材料。     

胎儿脐带静脉的生物力学特性研究

探讨胎儿脐带静脉随胎龄变化的生物力学特性的改变,为临床挑选适当的血管代用品提供理论依据。方法：33例新鲜脐带静脉,用生物软组织力学试验机测定血管的压力、容积、外径等力学参数,计算出弹性模量、顺应性。结果：37－40周时脐静脉的P－V曲线比较高,弹性模量与血压的关系曲线较低,此时段顺应性最好。结论：建议选用胎龄在37－40 周之间的脐静脉作为移植材料。     

胎儿静脉壁组织结构增龄性变化的定量分析

目的：探讨胎儿脐带静脉随胎龄变化的形态学改变，为临床挑选适当的血管代用品提供科学的理论依据。方法：33例新鲜脐带，常规石蜡包埋、切片、HE染组织结构，Weigert,Aniline Blue及桔黄G分染弹性纤维，胶原纤维和平滑肌，光镜观察及计算机图像分析。结果：随胎龄随长，脐静脉管径、中膜厚度、中膜弹性纤维含量逐渐增多；平滑肌含量及细胞核的数密度和面密度在37－40周最大（P＜0．05），胶原纤维则最小，因而此时段顺应性最好。结论：脐静脉管壁中各成分的含量随胎龄变化呈不等比增长，37－40周时血管顺应性最好。建议选用此时段胎龄的脐静脉作为移植材料。     

胎儿脐静脉壁组织结构增龄性变化的定量分析

目的 :探讨胎儿脐带静脉随胎龄变化的形态学改变 ,为临床挑选适当的血管代用品提供科学的理论依据。方法 :3 3例新鲜脐带 ,常规石蜡包埋、切片、HE染组织结构 ,Weigert,AnilineBlue及桔黄G分染弹性纤维 ,胶原纤维和平滑肌 ,光镜观察及计算机图像分析。结果 :随胎龄随长 ,脐静脉管径、中膜厚度、中膜弹性纤维含量逐渐增多 ;平滑肌含量及细胞核的数密度和面密度在 3 7～ 40周最大 (P <0 .0 5 ) ,胶原纤维则最小 ,因而此时段顺应性最好。结论 :脐静脉管壁中各成分的含量随胎龄变化呈不等比增长 ,3 7～ 40周时血管顺应性最好。建议选用此时段胎龄的脐静脉作为移植材料。     

自体静脉移植血管顺应性的研究

自体静脉是四肢动脉重建的首选材料,顺应性差异是影响移植血管远期通畅率的原因之一。本文综述了自体静脉移植血管的顺应性及顺应性差异机理的研究。自体静脉移植血管力学性质的变化主要是由于动脉血流应力,其顺应性在末后相当一般时间内保持稳定。离体试验显示,自体静脉移植血管具有与静脉相同的压力——容积关系,管壁组织结构的变化并未影响其血管腔的弹性。     

人脐静脉组织构筑及其临床应用价值

本研究旨在为脐带静脉作为小口径移植材料的临床应用提供理论依据。采用胎龄在 2 4～ 4 2周脐带静脉 5 0例 ,常规石蜡包埋、切片。用HE法、Weigert法、苯胺蓝法及桔黄G法分别染组织结构、弹性纤维 胶原纤维和平滑肌。光镜观察后 ,用计算机图像分析系统测量其中膜显微结构成分的相对含量。随胎龄增加 ,脐带静脉中膜弹性纤维含量逐渐增多 ,胶原纤维含量及C/E值逐渐减少 (P <0 0 1)。近段胶原纤维含量比远段少 (P <0 0 1) ,由近段到远段C/E值逐渐增大。脐带静脉具有与普通中等动脉相似的结构 ,作为小口径动脉移植的替代材料是可行的 ,建议选用胎龄在 37～ 4 0周之间的脐带静脉作为临床应用的移植材料。同时应注意选择不同段脐带静脉 ,使移植材料与宿主血管间的组织构筑尽可能相近 ,以提高移植血管的远期通畅率。     

自体静脉移植血管的压力—容积关系

本实验测试了狗自体静脉移植血管压力—容积(P-V)关系,并用指数函数V=a-be~(-k·p)拟合P-V的实测数据,计算出血管弹性参数k和血管顺应性明显变小的转折点处相应的压力值P_t.比较正常动脉、正常静脉和移植血管间k值和P_t值,结果显示,正常静脉和移植血管无显著差异(P>0.05),但二者与正常动脉有非常显著差异(P<0.01).自体静脉移植血管与正常静脉具有相同的顺应性特点,明显不同于正常动脉的顺应性特点.     

冻干辐照处理脐动脉血管物理性能的实验研究

为寻找理想的同种异体小口径血管移植材料，１９９３年７月至１９９４年５月，采用冻干辐照方法处理人脐动脉血管，并与新鲜脐血管、单纯冻干脐血管进行物理性能的比较，结果表明，经冻干辐照处理之后，脐动脉血管的物理性能改善，弹性和顺应性都明显提高，能够满足移植血管物理性能方面的要求。     

不同段脐带静脉的生物力学特性及其临床应用价值

目的 :为脐带静脉作为小口径移植材料的临床应用提供理论依据。方法 :采用胎龄在 3 7～ 40周自然分娩正常胎儿脐带静脉 2 0例 ,在生物软组织力学试验机上测定不同段脐带静脉的压力 -直径关系 ,计算出弹性模量。横断取材 ,冰冻切片 ,HE法染色 ,用计算机图像分析系统测量其几何形态学指标。结果 :近、中、远段脐带静脉的Einc、Ep和Ev均随压力的上升而增大 ,近段 3种弹性模量均低于远段 (P <0 .0 1) ,由近段到远段呈增大趋势。中膜厚度及外径值从近段到远段逐渐减小。结论 :脐带静脉作为小口径动脉移植的替代材料是可行的 ,在血管移植时 ,应注意选择不同段脐带静脉 ,使作为移植材料的脐带静脉与宿主血管材料间的生物力学特性尽量相近 ,以提高移植血管的远期通畅率     

胎儿脐静脉与大脑中动脉拉伸力学特性的对比分析

对比分析胎儿脐静脉与大脑中动脉的力学特性,为大脑中动脉损伤以胎儿脐静脉移植修复提供生物力学特性基础。取正常人新鲜尸体大脑中动脉与新鲜胎儿脐静脉各15个试样进行拉伸实验。分别将大脑中动脉和胎儿脐静脉试样装夹在电子万能试验机的夹头内,以0.3 mm/min的实验速度对试样进行实验。结果表明,胎儿脐静脉的弹性限度应变值、最大应变值大于大脑中动脉组,差异显著(P0.05),胎儿脐静脉组最大应力、弹性模量值小于大脑中动脉组,差异显著(P0.05)。胎儿脐静脉的应力-应变曲线和大脑中动脉的应力-应变曲线变化规律相似。胎儿脐静脉的拉伸力学特性有利于移植大脑中动脉损伤的修复。     

胎儿心脏畸形孕早期筛查中脐静脉导管血流频谱参数与染色体异常的关系分析

目的探讨胎儿心脏畸形孕早期筛查中脐静脉导管血流频谱参数与染色体异常的关系。方法本研究回顾性分析了2013年1月至2018年5月期间1326例孕11~14w胎儿的临床资料。采用GE E8型彩色多普勒超声诊断仪检查胎儿脐静脉导管血流频谱参数,其中包括心室收缩期波峰(S波)、心室舒张早期波峰(D波)、心房收缩期波峰(a波)、阻力指数(RI)、搏动指数(PI)和S/a比值。结果1326例孕11~14w胎儿中共有1267例为正常胎儿,59例为异常胎儿。随着孕周的升高,胎儿的RI、PI和S/a比值均逐渐降低。43例脐静脉导管异常胎儿中38例为a波反向,5例为a波消失。脐静脉导管异常组的胎儿异常率(18.60%)显著高于正常组(3.98%),差异有统计学意义(P<0.001)。脐静脉导管正常组和异常组的染色体异常具有显著差异(P<0.05)。脐静脉导管血流频谱参数诊断染色体异常的特异度为0.74%,阴性预测值为96.08%。结论在孕11~14w胎儿的早期筛查中,脐静脉导管血流频谱参数异常主要表现为a波反向和消失。脐静脉导管血流频谱参数诊断胎儿染色体异常的特异度和阴性预测值较高,可作为胎儿染色体异常早期筛查的诊断指标。     

The histology and histomorphometry of umbilical cord cross section in preeclampsia and normal pregnancies: a comparative study

ABSTRACT

The umbilical cord is the connecting link between the mother and the fetus and its morphology is an indicator of fetal well-being. Preeclampsia is a disorder of pregnancy associated with new-onset hypertension, which occurs most often after 20 weeks of gestation. There are structural differences in the umbilical cord of normotensive and hypertensive pregnant women. This research aimed to study the histology and histomorphometry of umbilical cord areas in preeclampsia and compare the parameters with normal uncomplicated pregnancies of gestational age 37–40 weeks. A total of 70 umbilical cords were studied from preeclampsia (n = 35) and normal (n = 35) pregnancies. The parameters studied included cross-sectional areas (CSA) of umbilical cord, umbilical vein lumen, umbilical vein wall, umbilical artery lumen, umbilical artery wall, and Wharton’s jelly, including the presence of edema in the vessel walls and Wharton’s jelly and basement membrane thickening. The mean umbilical cord CSA was significantly higher in preeclampsia (p = 0.014). The mean umbilical artery lumen CSA was significantly lower than the normal pregnancy cords (p = 0.006). The mean Wharton’s jelly CSA in preeclampsia was significantly higher than the normal pregnancy cords (p = 0.004). The parameters for umbilical vein lumen CSA, umbilical vein wall CSA, and umbilical artery wall CSA did not show any significant difference. Histological findings were edema (p < 0.001) and thickened basement membranes (p < 0.0001) were considered significant.     

胎儿脐带静脉的蠕变特性

为脐带静脉作为小口径移植材料的临床应用提供蠕变特性指标。对产妇年龄在22～28岁,胎龄37～40周自然分娩正常胎儿脐带静脉近胎盘段和远胎盘段各10个试样在日本岛津电子万能试验机上进行蠕变实验,模拟人体温在36.5±0.5℃的温度场下以0.01 Mpa/s的应力增加速度对试样施加应力,设定时间为7 200 s。采集100个数据,采用归一化分析的方法计算两组试样的归一化蠕变方程。两组试样蠕变曲线是以指数关系变化的,胎儿脐带静脉近胎盘段和远胎盘段7 200 s蠕变量差异显著(P<0.05)。胎儿脐带静脉近胎盘段和远胎盘段具有不同的蠕变特性。     

The fetal gallbladder: morphology and morphometry by microdissection

Most studies of the fetal gallbladder have been performed using ultrasonography. The identification of the fetal gallbladder and the presence of gallstones have been determined this way. The purpose of this study was to investigate the morphology and morphometry of the actual fetal gallbladder by microdissection and to examine its internal features and content. Eighty-nine formalin-embalmed fetuses of CR age 35 mm to 342 mm, i.e. 10 weeks to 36 weeks gestational age (GA), were studied by hepatic evisceration. The fetal gallbladder was examined in-situ in its bed, in relation to the umbilical vein, the anterior hepatic margin and its protrusion below the inferior hepatic surface of the liver. After excision, the form, length and diameters of the gallbladder were determined and its internal surface, lumen and content also examined. The mean length of the fetal gallbladder for the gestational ages studied ranged from 2.21 mm (10 weeks GA) to 281.6 mm (32 weeks GA); the mean fundal diameter ranged from 0.4 mm (one specimen only) to 9.42.4 mm for the same period, while the infundibular width ranged from 0.41 mm (one specimen only) to 9.01.6 mm, and the antero-posterior diameter at the fundus ranged from 0.90.3 mm to 9.03.3 mm for the same period. The parameters of the gallbladder for the period examined showed a curvilinear increase in size and were consistent with the ultrasonographic studies. The distance of the fetal gallbladder from the umbilical vein was variable and, as the gallbladder lengthened, the fundus encroached the anterior hepatic margin towards 34 weeks. A descent of the gallbladder from an "intra-hepatic" position early in fetal life to a sub-hepatic position later was clearly evident. The gallbladder wall was thick in early fetal life (10-13 weeks GA) and contained crumbly debris. Bile staining occurred at 14 weeks gestational age and the mucosa took on the normal appearance with the bile having an adult colour and consistency at 20 weeks GA.     

妊娠期糖尿病患者脐血促红细胞生成素含量及其与胎儿缺氧的相关性研究

目的通过测定妊娠期糖尿病(GDM)患者与正常妊娠孕妇脐血促红细胞生成素(EPO)的浓度和脐血血气分析,探讨GDM患者的脐血EPO水平与其胎儿慢性缺氧的相关性,以期为临床找到一种反映GDM所致的胎儿慢性缺氧及预测后遗症的理想指标。方法应用酶联免疫吸附试验测定法(ELISA)对30例GDM患者(实验组)及30例正常妊娠孕妇(对照组)的剖宫产儿的脐静脉血清EPO进行定量检测,同时进行脐静脉血气分析。应用独立样本t检验,所有的实测值均采用x±s表示。由于脐血EPO与血气分析之间可能存在一定关系,故行单因素相关分析,并行相关系数的显著性检验,所有分析均在SPSS 11.5软件包上完成。结果①实验组的脐静脉血EPO浓度,比对照组相应的EPO浓度明显升高,P<0.01;②脐血EPO值与脐血PCO2呈正相关,P<0.01;与BE值呈负相关,P<0.01;与pH值、PO2无相关性,P>0.05。结论 GDM患者脐血EPO水平明显升高,与胎儿宫内慢性缺氧程度有密切关系。预测胎儿慢性缺氧,检测脐血或羊水中EPO的价值可能优于脐血血气分析。     

The fetal gallbladder morphology and morphometry by microdissection

Most studies of the fetal gallbladder have been performed using ultrasonography. The identification of the fetal gallbladder and the presence of gallstones have been determined this way. The purpose of this study was to investigate the morphology and morphometry of the actual fetal gallbladder by microdissection and to examine its internal features and content. Eighty-nine formalin-embalmed fetuses of CR age 35mm to 342mm, i.e. 10 weeks to 36 weeks gestational age (GA), were studied by hepatic evisceration. The fetal gallbladder was examined in-situ in its bed, in relation to the umbilical vein, the anterior hepatic margin and its protrusion below the inferior hepatic surface of the liver. After excision, the form, length and diameters of the gallbladder were determined and its internal surface, lumen and content also examined. The mean length of the fetal gallbladder for the gestational ages studied ranged from 2.21mm (10 weeks GA) to 281.6mm (32 weeks GA) the mean fundal diameter ranged from 0.4mm (one specimen only) to 9.42.4mm for the same period, while the infundibular width ranged from 0.41mm (one specimen only) to 9.01.6mm, and the antero-posterior diameter at the fundus ranged from 0.90.3mm to 9.03.3mm for the same period. The parameters of the gallbladder for the period examined showed a curvilinear increase in size and were consistent with the ultrasonographic studies. The distance of the fetal gallbladder from the umbilical vein was variable and, as the gallbladder lengthened, the fundus encroached the anterior hepatic margin towards 34 weeks. A descent of the gallbladder from an “intra-hepatic” position early in fetal life to a sub-hepatic position later was clearly evident. The gallbladder wall was thick in early fetal life (10–13 weeks GA) and contained crumbly debris. Bile staining occurred at 14 weeks gestational age and the mucosa took on the normal appearance with the bile having an adult colour and consistency at 20 weeks GA.     

妊高征孕妇胎盘微循环功能与脐动脉血流的相关性研究

胎盘微循环功能的监测是产科医生进行临床决策的重要参考内容,它与胎儿胎盘循环直接相关,关系到产科质量的优劣和围产儿的预后。过去常通过查尿雌三醇、尿雌激素／肌酐比值（ｅｓｔｒｉｏｌ／ｃｒｅａｔｉｎｉｎｅ,Ｅ／Ｃ值）等间接监测胎盘微循环功能。目前应用超声多普勒测定脐动脉血流阻力已成为产科监护较理想的手段之一［１,２］,故我们选用超声多普勒测定妊高征孕妇脐动脉血流速度波型收缩期峰值／舒张末期峰值（ｓｙｓｔｏｌｉｃｐｅｒｉｏｄｃｒｅｓｔｖａｌｕｅ／ｄｉｓｔｏｌｉｃｅｎｄｐｅｒｉｏｄｃｒｅｓｔｖａｌｕｅ,…     

Comparison of alterations in fetal regional arterial vascular resistance in appropriate-for-gestational-age singleton, twin and triplet pregnancies.

The objective of this longitudinal study was to evaluate alterations in fetal vascular resistance of fetal peripheral arteries with advancing gestation in singleton appropriate-for-gestational-age (S-AGA), twin appropriate-for-gestational-age (Tw-AGA) and triplet appropriate-for-gestational-age (Tri-AGA) infants. Colour Doppler flow imaging and pulsed Doppler ultrasonographic examinations were performed on 35 S-AGA, 52 Tw-AGA and 12 Tri-AGA fetuses. The pulsatility index for middle cerebral artery (MCAPI), umbilical artery (UAPI), descending aorta (DAPI), splenic artery (SAPI), renal artery (RAPI) and femoral artery (FAPI) was measured as vascular resistance every 2 weeks after 15 weeks of menstrual age until delivery. Optimal models and normal ranges for pulsatility index for each artery in each group were generated. The alterations in various fetal regional arterial pulsatility indices with advancing gestational age showed no significant differences in S-AGA, Tw-AGA and Tri-AGA infants, respectively. These results suggest that there is no significant difference for regional arterial vascular resistance in AGA fetuses among singleton, twin, and triplet pregnancies, whereas there was a slight difference in fetal growth pattern among singleton, twin, and triplet pregnancies described in our previous investigation.