妊娠梅毒患者的驱梅治疗及对围产结局的影响

目的:探讨妊娠期驱梅治疗的方法及对围产结局的影响。方法:选取89例妊娠期合并梅毒孕妇,依据确诊梅毒及首次注射首剂青霉素治疗时间分为3组,其中在妊娠早期(孕周≤12周)24例为早孕组,妊娠中期(12周<孕周<29周)31例为中孕组,妊娠晚期(孕周≥29周)34例为晚孕组,给予规范苄星青霉素或红霉素治疗,观察围产儿预后。结果:早孕组及中孕组产妇不良妊娠结局发生率分别为8.33%、19.35%,明显低于晚孕组(52.94%),差异具有统计学意义(P<0.05);89例孕妇根据初次检测RPR滴度不同分组,其中滴度≤1∶4者53例,滴度≥1∶8者36例,滴度≤1∶4者新生儿不良预后发生率为7.55%,明显低于滴度≥1∶8孕妇分娩的新生儿不良预后发生率(27.18%),差异具有统计学意义(P<0.05),先天性梅毒患病率分别为3.22%、22.77%,差异具有统计学意义(P<0.05);早孕组孕妇分娩新生儿RPR阳性率为20.83%,先天性梅毒患病率为0,中孕组分别为19.35%、3.23%,晚孕组分别为70.59%、26.47%,早孕组及中孕组RPR阳性率、先天性梅毒患病率明显低于晚孕组,差异具有统计学意义(P<0.05)。结论:妊娠合并梅毒孕妇采取驱梅治疗时机与围产儿的预后及先天性梅毒患病率密切相关,早期正规进行驱梅治疗能明显改善围产儿预后,降低先天性梅毒发生率。     

新生儿先天性梅毒39例预后与孕母诊治情况的关系

目的:研究新生儿先天性梅毒发病及预后与其母妊娠期间治疗情况的关系。方法:分析先天性梅毒39例新生儿临床资料,根据孕妇正规治疗者与未治疗或治疗不彻底者病情观察组与对照组,常规给予青霉素治疗疗程2周,神经梅毒疗程3周。孕母青霉素过敏者给予红霉素治疗。结果:对照组因多器官功能衰竭死亡1例,余38例出院时情况良好。随访患儿RPR抗体1年内转阴35例,治疗1年后尚未转阴2例。观察组出院RPR转阴5例,治疗后4个月转阴6例,对照组出院RPR转阴11例,治疗后9个月RPR转阴13例。观察组与对照组患儿胎龄、体质量、重要脏器损害比较差异均有统计学意义(P<0.05)。结论:积极开展婚前及孕期梅毒筛查,早期诊断、早期正规治疗是减少梅毒对患儿损害的关键。     

梅毒孕妇所产新生儿血清学检测及转归情况分析

目的:分析梅毒孕妇所产新生儿血清学检测及转归情况。方法:选择2016年2月-2017年2月来本院治疗的单胎妊娠合并梅毒的孕妇160例及活产新生儿160例为研究对象。于新生儿出生前进行快速血清反应素试验(RPR)和梅毒螺旋体颗粒凝集(TPPA)试验,新生儿出生后3 d定期进行梅毒血清学检测。对妊娠合并梅毒的孕妇和新生儿梅毒血清学进行分析,比较不同时间段血清学转阴情况。结果:160例孕妇中,TPPA单阳性46例,RPR、TPPA双阳性114例,新生儿TPPA单阳性49例,111例为RPR和TPPA双阳性。孕妇单TPPA阳性与孕妇双阳性的新生儿梅毒血清测试结果比较,差异有统计学意义(P0.05)。根据持续检测后,新生儿双阳性中,出生6个月后,RPR阳性已全部转阴;出生18个月后,TPPA阳性已全部转阴。新生儿单TPPA阳性中,出生18个月后,TPPA阳性已全部转阴。TPPA单阳性新生儿阴峰出现在出生后第5～6个月。孕妇RPR的滴度越高,新生儿RPR的阴性时间越长(P0.05)。新生儿出生时RPR滴度在1︰1～1︰4时,新生儿的血清RPR阴性时间逐渐增加,但滴度为1︰8时的血清RPR阴性时间明显缩短;新生儿出生时RPR滴度阴性～1︰2,新生儿的血清TPPA阴性时间明显增加,RPR滴度1︰4～1︰8时,新生儿的血清TPPA阴性时间逐渐缩短。结论:经过治疗的妊娠合并梅毒孕妇所产新生儿梅毒血清学检查结果中RPR和TPPA双阳性占比仍然很高,孕妇产前RPR滴度高的新生儿阳性持续时间可能较长,但出生后一段时间内可转成阴性。建议对梅毒阳性新生儿进行长期随访,对先天性梅毒的诊断应慎重。     

新生儿梅毒螺旋体乳胶凝集试验阳性60例临床分析

目的探讨梅毒螺旋体乳胶凝集试验（TPPA）阳性新生儿母亲治疗情况对新生儿发病的影响及新生儿梅毒的主要表现。方法对我院2002年至2007年查出的60例TPPA阳性新生儿进行临床分型、x线检查、免疫测定和定期随访。结果新生儿期共确诊先天性梅毒35例，疑诊10例，正常15例。确诊35例中，母亲均未治疗。新生儿快速梅毒血清试验（RPR）滴剂≥母4倍28例，先天性梅毒以早产、肝脾肿大、皮疹为主；6例并发神经梅毒，脑脊液RPR阳性。确诊组治疗后RPR滴度不同程度下降；疑诊组RPR滴度均在6个月内转阴，正常组持续阴性。结论母亲产前定期产检，常规筛查，有效治疗可降低先天性梅毒的发病率；早期诊断、早期治疗、定期随访可明显降低先天性梅毒的病死率。     

妊娠合并梅毒的产前治疗对妊娠结局及母婴预后的影响

目的 研究妊娠合并梅毒患者在产前进行治疗对妊娠结局以及母婴预后效果的影响.方法 回顾相关资料选取妊娠梅毒患者60例,由于在产前的不同时间进行治疗,分为孕早期组(<20周)34例和孕中晚期组(≥20周)26例,两组均对已经确诊的梅毒患者进行治疗,观察并对比两组患者的不同时间治疗后的妊娠结局、新生儿的Apgar评分及母婴RPR滴度.结果 进行不同时间的干预治疗后,效果不同,其中孕早期组患者的正常分娩率高于孕中晚期组,且妊娠不良结局的发生率低于孕中晚期组,且新生儿的预后Apgar评分及母婴RPR滴度均优于孕中晚期组,各小组患者间的数据结果进行比较后,发现差异较显著,差异具有统计学意义(P<0.05).结论 针对梅毒妊娠患者进行产前不同时间的治疗后,发现妊娠前期的治疗效果较好,增加了正常分娩的的发生率,减少了妊娠不良结局情况的发生,提高了母婴的生存质量,值得患者信赖和在临床中推广应用.     

30例先天性梅毒的临床分析

目的:探讨新生儿先天性梅毒的临床表现,诊断及治疗。方法:对30例先天性梅毒患者进行回顾性总结分析。结果:患者先天性梅毒临床表现复杂、多样化,缺乏典型症状,主要表现为皮肤损害、早产、鼻塞、病理性黄疸、发热、消化道症状、肝脏肿大、贫血、骨损害、神经梅毒等,梅毒快速血浆反应素试验(RPR)及甲苯胺红不加热血清试验(TRUST)均为阳性可以诊断。应用青霉素治疗疗效好,剂量10万U/(kg·d),分2次静脉滴注,q12h,疗程2周。确诊神经梅毒的新生儿疗程3周。结论:先天性梅毒临床表现多样,有多脏器损害,易误诊、漏诊,如果早发现、早诊断、早治疗,可以减少先天性梅毒对新生儿身心的损害、取得良好的预后。     

孕妇梅毒筛查的临床意义

目的探讨梅毒筛查的临床意义。方法2009年所有产科门诊孕妇孕中期常规行梅毒快速血浆反应素环状卡片试验（RPR）筛查,对RPR阳性者再行梅毒螺旋体明胶颗粒凝集试验（TPPA）确诊,并行甲苯胺红不加热血清试验（TRUST）滴度检测,对确诊梅毒者实行长效青霉素标准治疗3周,并追踪梅毒孕妇产后新生儿TPPA及TRUST滴度检测情况,记录结果并分析。结果3660例孕妇RPR阳性7例,发生率0．19％,检测TPPA阳性4例,占RPR阳性者57．14％（4n）,梅毒检出率0．11％（4/3660）,1例梅毒孕妇TRUST滴度1：64,胎儿宫内死亡引产,余3例梅毒孕妇TRUST滴度1：1～1：4,产前滴度均为1：2,3名梅毒孕妇分娩的新生儿TPPA检测均阳性,TRUST滴度均0,未提示发生胎传梅毒。结论孕妇梅毒筛查检出率低,但梅毒孕妇早检查、早确诊、早治疗对改善胎儿预后、预防胎传梅毒有重要意义。     

新生儿先天性梅毒诊治体会

目的:探讨新生儿先天性梅毒的诊疗方法.方法:对7例确诊为先天性梅毒病例的诊疗过程采用回顾性分析.结果:7例快速血浆反应素试验(RPR)、梅毒螺旋体血凝试验(TPHA)均为阳性,母亲血TPHA均为阳性,经青霉素1个疗程驱梅治疗,治愈好转出院.结论:先天性梅毒早期诊断,经青霉素充分治疗者,预后良好.     

妊娠合并梅毒170例临床分析

目的探讨妊娠梅毒患者临床特点、治疗方法和妊娠结局,以降低先天性梅毒发生率。方法170例经血清学检查确诊为梅毒的孕妇,根据妊娠期是否行全疗程抗梅毒治疗,分为治疗组(92例)和未治疗组(78例),选择同期正常孕妇为对照组(100例)。比较三组孕妇的妊娠结局,治疗组和未治疗组围产儿预后及新生儿先天梅毒的发生情况。结果①妊娠结局:治疗组足月分娩率为93.47%(86/92),未治疗组仅为30.76%(24/78),对照组为96.00%(96/100)。未治疗组与治疗组、对照组比较,差异有显著性(P<0.05)。治疗组早产及死胎发生率分别为6.52%(6/92)和2.17%(2/92),接近对照组的6.00%(6/100)、0,明显低于未治疗组的30.77%(24/78)、28.21%(22/78),差异有显著性(P<0.05)。治疗组窒息儿、低体重儿、先天梅毒患儿发生率及新生儿死亡率明显低于未治疗组,两组比较,差异有显著性(P<0.05)。治疗组分娩正常新生儿者占60.86%(56/92),未治疗组仅占25.64%(20/78)。②治疗孕周越早,先天梅毒患儿发生率越低(P<0.05)。先天梅毒患儿的发生率,应用苄星青霉素孕妇为23.07%(18/78),应用红霉素孕妇为100%(14/14)。③新生儿血清RPR阳性率治疗组为79.50%,未治疗组为100%,差异无显著意义。结论妊娠梅毒患者临床分期以潜伏期梅毒为主,体征及症状不典型,容易误诊。因此,妊娠早期常规梅毒筛查特别重要。治疗开始时的孕周及用药,是影响妊娠梅毒结局的重要因素。     

早期先天性梅毒32例临床分析

目的探讨早期先天性梅毒的诊断、治疗及预防措施。方法回顾分析32例经临床、梅毒血清学检查确诊的早期先天性梅毒患儿的临床资料。结果早期先天性梅毒临床表现多种多样,以皮疹为主,易产生合并症,患儿及其母亲快速血浆反应素试验(RPR)及梅毒螺旋体血凝试验(TPHA)均为阳性,且患儿RPR滴度均高于其母亲RPR滴度的4倍以上。确诊后给予青霉素10~15万u/(kg.d)治疗,疗程2周,25例(78.1%)临床痊愈,5例(15.6%)临床好转。结论对于无严重合并症的早期先天性梅毒患儿临床治愈率高。预防先天性梅毒的关键是围生期早期诊断及治疗。     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.