新生儿肺部超声在早产儿肺部感染评价中的价值

目的 探讨新生儿肺部超声在早产儿肺部感染评价中的价值。 方法 选取肺部感染早产儿80例为观察组，无肺部感染的早产儿80例为对照组，均给予新生儿肺部超声检查，比较2组肺部超声评分、氧合指数、呼吸指数，比较观察组不同病情、预后患儿肺部超声评分、氧合指数、呼吸指数,分析肺部超声评分和氧合指数、呼吸指数的相关性。 结果 观察组肺部超声评分、氧合指数低于对照组，呼吸指数高于对照组，差异有统计学意义（P＜0.05）。观察组极危重患儿肺部超声评分、氧合指数低于危重和非危重患儿，呼吸指数高于危重和非危重患儿，危重患儿肺部超声评分、氧合指数低于非危重患儿，呼吸指数高于非危重患儿，差异有统计学意义（P＜0.05）。肺部超声评分与呼吸指数呈负相关（r=-0.455，P＜0.05），与氧合指数呈正相关（r=0.470，P＜0.05）。观察组死亡患儿肺部超声评分、氧合指数低于存活患儿，呼吸指数高于存活患儿，差异有统计学意义（P＜0.05）。肺部超声评分预测患儿预后的ROC曲线下面积为0.874，高于呼吸指数和氧合指数（P＜0.05），其截断值为20分时，敏感度和特异度为88.50%和75.00%。 结论 新生儿肺部超声在早产儿肺部感染评价中有较好的效果，值得临床使用。     

PS联合CPAP治疗新生儿呼吸窘迫综合征临床研究

目的通过研究肺表面活性物质(PS)结合持续气道正压通气(CPAP)治疗新生儿呼吸窘迫综合征(NRDS)的治疗效果,进一步指导NRDS的临床治疗。方法选取于2017年4月-2018年10月间在本院收治的80例确诊为新生儿呼吸窘迫综合征的患儿作为研究对象,随机将患儿分为试验组和对照组,对照组给予持续气道正压通气治疗,试验组在对照组的基础上联合使用PS治疗。结果试验组对于呼吸窘迫缓解的有效率明显高于对照组,在气管插管内滴入PS治疗后试验组的血气情况明显优于对照组,且试验组患儿副作用发生率明显低于对照组,以上指标差异具有统计学意义,P <0.05。结论 PS结合CPAP在新生儿呼吸窘迫综合征的治疗中疗效很好。     

Intussusception in a premature neonate: A rare and often misdiagnosed clinical entity

Intussusception is a very rare cause of intestinal obstruction in neonates. It is of extremely rare occurrence among premature neonates. We present a case of 11-day-old premature neonate who presented with abdominal distension, intolerance to feeds, vomiting, significant bilious aspirate and bleeding per rectum. The initial diagnosis of necrotizing enterocolitis (NEC) led to a delay in the diagnosis. On exploratory laparotomy, it turned out to be a case of ileo-colic intussusception with Meckel''s diverticulum as a lead point. This site of intussusception (ileo-colic) and presence of a lead point among premature neonate is of exceedingly rare occurrence and very few such cases have been reported.In this article, the published work about clinical features and management on intussusceptions in premature neonates has been reviewed. The authors intend to highlight the difficulty in distinguishing the NEC and intussusception. Subtle clinical and radiological features which can help in differentiating the two conditions have been emphasized. This can avoid the delay in diagnosis and management which can prove critical. High index of suspicion with timely intervention is the key for optimizing outcome. A diagnosis of intussusception should always be considered in any preterm infant with suspected NEC.     

The need for a revival of psychoanalytic investigations into premature ejaculation

Although psychoanalysis was the first-choice treatment for premature ejaculation (PE) between 1920 and 1960, hardly any reports on its efficacy have been published. Moreover, a scientific debate about its findings has never been fully developed. The recent progress that has been made in the classification of three different PE syndromes creates a new opportunity for psychoanalytic investigations of men with complaints of PE, distinguished by the actual duration of their intravaginal ejaculation latency time (IELT). The term premature-like ejaculatory dysfunction has been introduced to distinguish men with self-perceived PE at normal and long IELT durations from those men with lifelong, acquired and normal variable PE. Psychoanalytic research may contribute to a better understanding of the consequences of objective early ejaculations on the unconscious mental life of men with the four forms of PE. By integrating neurobiological, clinical and epidemiological data of ejaculatory performance, a revival of psychoanalytic research of PE in the four distinct, classified PE groups, will probably contribute to a deeper insight in to the unconscious mental life of men affected by PE.     

57例胎膜早破的临床分析

目的探讨胎膜早破与剖宫产及母儿并发症的关系。方法对本院2004年~2005年分娩的898例产妇资料进行回顾性分析,其中胎膜早破组57例,对照组(胎膜未破)841例,对两组进行总体成数假设检验。结果胎膜早破组羊膜腔感染率、早产率、子宫内膜炎发生率均较对照组显著升高(P<0.01),但剖宫产率、新生儿成活率、产后出血率两组间无显著差异(P>0.01)。结论胎膜早破与羊膜腔感染综合征、早产、子宫内膜炎成因果关系,与剖宫产、新生儿成活、产后出血无必然的因果关系。故及时应用抗生素,适时促胎肺成熟,适时终止妊娠,合理选择分娩方式,可以使胎膜早破者不会提高剖宫产率、产后出血率、新生儿死亡率,但对于胎膜早破者需及时、有效、合理选择广谱抗生素,降低羊膜腔感染和子宫内膜炎发生率,降低早产率。     

TRH、EGF及地塞米松促进未成熟胎肺组织分化及表面活性物质合成的研究

目的 比较TRH、EGF与地塞米松对未成熟胎肺形态发育及表面活性物质水平的影响。方法 在兔妊娠第22－24d或第24－26d分别用TRH、EGF或地塞米松母体静脉注射治病，通过光镜、图像分析及电镜等技术观察胎肺的形态结构，并检测胎肺的磷脂水平。结果 光镜下，TRH、EGF与地塞米松治疗组第25d及27d胎肺肺泡腔、肺泡间隔发育均明显好于对照组；EGF、TRH与地塞米松治疗组第27d胎肺的肺泡腔与肺泡间隔的面积比无明显差异。但EGF和TRH治疗组第25d胎肺的肺泡腔与肺泡间隔之比明显小于地塞米松治疗组。电镜下，三个治疗组第27d胎肺内含有板层体的Ⅱ型上皮细胞数量明显多于对照组，但各治疗组及对照组第25d的胎肺Ⅱ型上皮细胞胞浆内几乎未见明显板层体，相反胞浆内糖原含量却非常丰富。此外，三个治疗组27d胎肺的磷脂水平均明显高于对照组。结论 EGF、TRH及地塞米松在兔妊娠第24－26d母体治疗均能促进胎肺的形态发育和表面活性物质的合成，三种治疗方法对胎肺的影响程序无明显不同；在妊娠第22－24d治疗，地塞米松对胎肺形态结构的促进作用较EGF和TRH更明显，但三者对Ⅱ型上皮细胞分化及表面活性物质的合成均无明显影响。     

623例慢性前列腺炎患者的性功能状况调查

目的:了解慢性前列腺炎对早泄(PE)和勃起功能障碍(ED)的影响,探讨它们之间的关系。方法:依据美国国立卫生研究院慢性前列腺炎症状指数评分表(NIH-CPSI)、中国早泄患者性功能评分表(C ISFPE)、国际勃起功能问卷评分表(IIEF-5);采用和患者面对面交谈、询问,并分别记录623例慢性前列腺炎患者的NIH-CPSI评分、C ISFPE评分、IIEF-5评分。结果:623例18~57岁的慢性前列腺炎患者中,PE发生率为39.0%,其中轻度占26.2%、中度占12.0%、重度占0.8%;ED发生率为16.9%,其中轻度占14.9%、中度占1.0%、重度占1.0%。慢性前列腺炎患者PE的发生率以年轻者为多,18~29岁组为42.9%(103/240)、30~39岁为37.0%(95/257)、40~57岁组为35.7%(45/126);ED发生率以年龄高者为多,18~29岁组为13.8%(33/240)、30~39岁为11.3%(29/257)、40~57岁组为34.1%(43/126)。统计学分析发现,NIH-CPSI评分与早泄评分以及与IIEF-5评分均无明显相关性。结论:慢性前列腺炎的症状轻重与PE和ED的轻重程度无明显的相关性。     

Atrial premature complexes and heart rate have prognostic significance in 1-month atrial fibrillation recurrence after electrical cardioversion.

AIMS: The aim of this study was to investigate the significance of simple 24-h Holter (24H) data after electrical cardioversion (CV) for atrial fibrillation (AF) recurrence. METHODS: We prospectively studied 47 consecutive patients subjected to CV, who successfully converted to sinus rhythm. All underwent echocardiography and 24H after CV. AF recurrence was studied at 14 days and 1 month by second 24H or by interim report of AF. RESULTS: About 53.2% remained in sinus rhythm (group I) and the rest recurred to AF (group II). Group I had fewer atrial premature complexes per hour (APC/h) (P = 0.002) and lower maximum (max HR), average, and minimum heart rates compared with group II (all Ps < 0.05). The optimal value of APC/h and max HR with best sensitivity and specificity was 32 APC/h and 90 bpm, respectively. These findings were the predictors of AF recurrence [hazard ratio (HR) = 4.5 with 95% CI = 1.7-11.7 and HR = 4.3 with 95% CI = 1.7-10.9, respectively]. Patients with the combination of both predictors had greater HR of AF recurrence compared with those with < 32 APC/h and max HR < 90 bpm (HR = 8.8 with 95% CI = 2.5-31.4). CONCLUSION: Patients with frequent APC/h and high max HR are at high risk for 1-month AF recurrence after electrical CV.     

胎膜早破并发胎盘早剥的临床分析

目的　探讨妊娠晚期胎膜早破并发胎盘早剥的发生率、早期诊断和处理要点。方法　回顾分析2 0 0 1年～2 0 0 4年郑州大学第三附属医院产科分娩的胎膜早破病例,其中并发胎盘早期剥离者8例,与非胎膜早破发生胎盘早剥者进行比较。分析早期诊断和母婴结局。结果　3年分娩总数为4 12 4例,胎膜早破并发胎盘早剥者占全部胎盘早剥的2 8 6 % ,胎膜早破是胎盘早剥的首位发病诱因。胎膜早破并发胎盘早剥的发生率为2 77% ,而非胎膜早破者为0 5 2 % ,两者相比差异有显著性(P <0 0 1)。间断腰痛、血性羊水、胎心异常为常见的临床表现。胎膜早破并发胎盘早剥时围产儿的死亡率为12 5‰,无孕产妇死亡。结论　胎膜早破是胎盘早剥的诱因之一,重视临床表现,并结合B超和胎心监护有助于早期诊断,以降低母儿并发症。