上海市5365例阴道分娩产后出血计量研究

目的研究阴道分娩产后24h内出血总量.方法在上海6所医院,用血盘收集和纱布称重法分阶段精确测量会阴切开、第3产程、产后、产后2h、产后4h、产后24h内失血总量.结果5365例阴道分娩的产妇产后24h平均出血总量为(394.70±185.95)ml.六所医院产后24h平均出血量在(261.43±75.91)ml～(554.24±273.10)ml,产后出血量与第3产程长短、总产程长短、新生儿体重和产钳产有关,并可能与子宫收缩剂用量不同等因素有关.产后出血超过800ml者主要与子宫收缩乏力有关.结论产后24h平均出血总量约为400ml,建议将产后出血的界线改为≥600ml.     

624例剖宫产术后出血及相关因素分析

目的研究剖宫产术后24h阴道出血情况,提高剖宫产术后医疗护理质量。方法对624例剖宫产病例进行前瞻性研究,剖宫产手术结束后立即开始收集阴道血至产后24h,称重法测量出血量。手术前及手术后1-2d测血常规,出血多病例随时进行相关检查及处理。结果术中出血量平均（265.14±160.42）ml,手术结束后至24h出血量（152.51±160.42）ml,24h总出血量（416.98±208.76）ml。以剖宫产术中出血≥400ml为产后出血诊断标准,产后出血率为6.89%;以产后24h出血量≥500ml为标准,产后出血率达14.90%,差异有统计学意义（P〈0.05）。剖宫产术后至24h有76.76%患者出血量≥100ml。子宫乏力为产后出血的首要原因。结论加强剖宫产术后病人管理,及时发现并减少产后出血发生。     

米索前列醇联合催产素预防剖宫产术后出血临床效果观察

目的对米索前列醇配合催产素用于预防剖宫产术后出血的效果进行比较.方法 168例剖宫产患者随机分为3组,A组：胎儿娩出后宫体肌注催产素20U,并静滴林格氏液500 ml＋催产素20U.B组胎儿娩出后宫体肌注催产素20U,术毕清理阴道血后直肠置米索前列醇600 μg.C组胎儿娩出后宫体肌注催产素20U,并静滴林格氏液500 ml＋催产素20U,术毕清理阴道血后直肠置米索前列醇600 μg.观察各组术中和术后2 h、术后2～24 h出血量,手术前后血红蛋白及血压的变化.结果三组术中失血量A、C组明显少于B组,且术中失血量〉500 ml者均发生在B组.术后2 h及2～24 h失血量,使用米索前列醇的B、C组明显少于A组,差异有显著性.结论米索前列醇与催产素联合使用可明显加强子宫收缩,减少剖宫产术后出血量.     

PFNA治疗粗隆间骨折隐性失血量的回顾性研究

目的:对PFNA治疗股骨粗隆间骨折围手术期隐性失血进行量化研究。方法：回顾性研究我院自2013-1-1至2014-12-31符合纳入标准和排除标准的19例患者的病例资料,采用OSTHEO公式计算隐性失血量。结果：19例研究对象中,术中出血量平均110.53±84.42ml；出血总量平均896.78±309.99ml；隐性失血量平均769.41±284.80ml。结论：PFNA治疗股骨粗隆间骨折,患者围手术期隐性失血量达到769.41±284.80ml,占失血总量的85.80%,应引起高度重视并及时纠正贫血,减少并发症。     

改良新式剖宫产术82例临床分析

目的 :探讨改良新式剖宫产术的临床价值。方法 :改良新式剖宫产 82例 ,与下腹横切口子宫下段剖宫产 6 5例的手术开始至胎儿娩出时间、手术时间、术中出血、术后排气时间、切口愈合进行比较。结果 :两组在手术开始至胎儿娩出 (分别为6 .5± 1.5min和 11± 3min)、手术时间 (30± 10min和 6 0± 2 0min)、术中出血 (140± 6 0ml和 2 2 5± 75ml)、术后排气时间(2 5± 9h和 38± 10h)差异均有显著性 (P <0 .0 0 1) ;而切口愈合差异无显著性 (P =1.0 0 0 0 )。结论 :改良新式剖宫产术损伤小 ,出血少 ,术后恢复快 ,而且比新式剖宫产更简单 ,易于掌握。     

产后出血55例临床分析

胎儿娩出后24h内出血量超过500ml者称产后出血。产后出血是产科最常见而严重的并发症，是我国孕产妇死亡的主要原因。按流血量又可分为三类：（1）轻度产后出血：失血量占体内血液总量的15％～20％，失血500—600ml；（2）中度产后出血：失血量占体内血液总量的20％-30％，失血600—900ml；（3）重度产后出血：失血量超过总血量的30％。     

益母草注射液缩宫止血临床疗效观察

目的观察不同剂量益母草注射液对剖宫产缩宫止血效果的比较。方法245例行剖宫产分娩者按入院先后,根据不同治疗方案,分两组治疗,记录术中至术后72h各时点阴道出血量。结果至术后24h总出血量,1ml组为(397.71±159.10)ml,2ml组为(393.51±173.45)ml,两组失血量均低于全国及上海资料;手术24h后至72h各时段出血量,及术中因宫缩乏力追加益母草注射液者2ml组明显<1ml组,差异具有统计学意义(P<0.05)。结论两种剂量益母草注射液均可促进子宫收缩,明显减少产后出血,且2ml组对减少产后出血优于1ml组。     

新式剖宫产术与子宫下段及腹膜外剖宫产术临床对比观察

比较 1 2 5例新式剖宫产 (观察组 )与同期 50例子宫下段剖宫产 (对照 1组 )及30例腹膜外剖宫产 (对照 2组 )术中术后情况。结果 :观察组胎儿娩出的平均时间为 5.4± 1 .1 min,对照 1组 7.8± 2 .3min,对照 2组为 1 6.3± 5.2 min,P<0 .0 1 ;观察组术中出血量平均1 63± 72 ml,对照 1组 2 0 5± 83ml,对照 2组 1 99± 78ml,P<0 .0 5;观察组术后排气时间 2 1 .5± 6.2 h,对照 1组 36.9± 8.7h,P<0 .0 5;观察组术后留置导尿时间 2 0 .5± 5.1 h,对照 2组42 .5± 8.6h,P<0 .0 5;观察组术后无血尿发生 ,对照 2组有 5例。结论 :新式剖宫产手术时间及手术至胎儿娩出时间短 ,出血少 ,损伤小 ,恢复快     

米索前列醇直肠给药预防剖宫产术后出血的临床观察

目的:观察米索前列醇直肠给药用于预防剖宫产术后出血的效果。方法:选择50例有发生产后出血高危因素的剖宫产者,随机分为试验组(米索前列醇组)和对照组各25例。试验组手术结束后即给予米索前列醇400μg,对照组无特殊处理。观察两组术中、术后2、24 h出血量的差异。结果:术中出血量两组差异无统计学意义,而术后2 h平均出血量试验组(126±51.9)ml,对照组为(182±53.6)ml,差异有统计学意义(P<0.05)。术后24 h平均出血量试验组(382±60.2)ml,对照组为(432±62.8)ml,差异有统计学意义(P<0.05)。结论:米索前列醇直肠给药促进子宫收缩作用明显,能很好的预防剖宫产术后出血,且用药安全、有效。     

剖宫产术中处理子宫肌瘤53例分析

目的:分析剖宫产过程中肌瘤手术的可行性及意义。方法:对我院8年来剖宫产术中处理子宫肌瘤53例患者的资料进行回顾性分析。结果:手术失血量为(180±30)ml,手术时间为(49±7)min,术中、术后无严重并发症发生,无1例因出血过多而需行子宫切除者,术后近期复查子宫肌瘤未见明显复发。结论:病例合适﹑条件许可的情况下,剖宫产同时可行肌瘤剥除术,可减少近期再次手术。     

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.     

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.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…