米索前列醇防治高危产后出血临床研究

目的 :观察口服米索前列醇用于预防高危产后出血的效果。方法 :将足月妊娠分娩有发生产后出血高危因素的产妇 98例随机分为 :①实验组 :5 0例 ,在胎儿娩出后立即口服米索前列醇 4 0 0 μg ,②对照组 :4 8例 ,在胎儿娩出后立即宫体内注射催产素 2 0U。产后 2 4h内平均出血量 ,试验组 (390± 6 2 .9)mL ,对照组 (435± 6 9.3)mL ,两组比较 ,P <0 .0 5。用药前后血压变化差异无显著意义。结论 :米索前列醇具有比催产素更强的子宫收缩作用 ,能很好地预防高危因素的产后出血 ,且用药方便、安全。     

内镜下金属钛夹治疗活动性消化道出血的临床疗效观察

目的评价金属钛夹在活动性消化道出血治疗中的应用价值。方法回顾性分析2003年3月~2006年4月急诊内镜检查发现活动性出血灶和内镜下治疗后即时发生出血患者45例,应用奥林巴斯(Olympus)HX-5LR-1钛夹置放器及HX-600-135型金属钛夹,夹闭出血灶止血的临床疗效。结果45例患者共使用144枚钛夹,总有效率为100%。结论金属钛夹治疗活动性消化道出血安全有效,无明显并发症,值得临床推广应用。     

盆腔动脉化疗栓塞术治疗子宫颈癌合并大出血

目的:探讨髂内动脉化疗灌注术同时超选择性栓塞肿瘤供血动脉及出血动脉,治疗子宫颈癌合并大出血的临床价值。方法:对15例子宫颈癌合并大出血的患者进行选择性髂内动脉灌注化疗,同时超选择性栓塞肿瘤供血动脉及出血动脉。区域联合灌注化疗同时超选择肿瘤供血动脉给予化疗药-碘油乳化剂栓塞,供血动脉主干明胶海绵颗粒栓塞。结果:5例1~3月内再次出血并给予了二次栓塞治疗,10例确切止血未见复发。抗肿瘤疗效观察,完全缓解8例、部分缓解4例,总有效率80%。结论:对于子宫颈癌合并大出血患者,在选择性髂内动脉灌注化疗术同时选择性、超选择性栓塞肿瘤供血动脉及出血动脉,是一种安全有效地止血治疗措施,同时也是宫颈癌抗肿瘤治疗的一种有效方法。     

肝硬化合并上消化道出血98例病因分析

目的探讨肝硬化合并上消化道出血的病因.方法回顾性分析1998～2003年舞钢职工医院98例肝硬化合并上消化道出血患者的病因.结果 98例上消化道出血患者的病因中,食管胃底静脉曲张破裂出血占50.0% (49/98);门脉高压性胃病占26.53%(26/98),消化性溃疡占21.43%(21/98).结论肝硬化合并上消化道出血病因中,非曲张静脉出血(包括门脉高压性胃病、消化性溃疡)占有相当高的比例,应引起足够的重视.     

A conservative surgical approach for management of iatrogenic pulmonary artery perforation

Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.     

双气囊小肠镜诊断不明原因消化道出血的临床研究

背景:双气囊小肠镜(DBE)是诊断不明原因消化道出血(OGIB)的常用方法,不同地区OGIB病因有所差异。目的:评价DBE诊断OGIB的有效性和安全性,分析湖北地区OGIB患者的病因特点。方法:收集2006年12月～2012年1月武汉大学人民医院诊断为OGIB的216例患者,并接受DBE检查,对诊断结果、治疗、随访、并发症等进行回顾性分析。结果:DBE的诊断率为80.6%(174/216),并发症发生率为1.9%(4/216),DBE对76.8%(166/216)患者的治疗策略产生影响。湖北地区常见的OGIB病因依次为憩室/重复畸形(23.1%)、肿瘤(21.8%)、溃疡/糜烂(21.8%)、息肉(5.6%)等。结论:DBE是一种安全、有效的OGIB诊断方法。湖北地区OGIB病因以憩室/重复畸形、肿瘤、溃疡/糜烂较为常见。     

剖宫产合并子宫肌瘤切除术40例临床分析

目的探讨剖宫产时行子宫肌瘤切除术的安全性及可行性。方法 40例妊娠合并子宫肌瘤患者(治疗组)行剖宫产合并子宫肌瘤切除术;对42例妊娠无子宫肌瘤患者(对照组)行剖宫产术。比较2组手术时间及术中出血情况。结果治疗组手术时间为(59.12±6.29)min长于对照组的(31.24±5.21)min,差异有统计学意义(P<0.05);2组术中出血量比较差异无统计学意义(P>0.05)。结论对于经验丰富的医师,恰当把握适应证,对于妊娠合并子宫肌瘤患者在剖宫产术时行子宫肌瘤切除术是安全可行的。     

ACD - A solution as anticoagulant during continuous renal replacement therapy in high risk bleeding patients

Objective To assess the efficacy and safety of ACD-A solution as anticoagulant during continuous renal replacement therapy (CRRT) in high risk of bleeding patients. MethodsForty high risk bleeding patients on continuous veno - venous hemofiltration (CVVH) were randomly divided into two groups: ACD-A group (22 patients, 61 cases) and heparin-free group (18 patients, 47 cases). Serum creatinine, function of the coagulation system, electrolyte and acid-base were monitored pre - and post - CVVH. The vital signs of the patients during treatment, dialyser clotting and the incidence of bleeding episodes were recorded. Results(1) The serum level of creatinine decreased significantly after treatment in both groups, but the rate of decrease was obviously higher in ACD-A group than that in heparin - free group[(55.4±10.2)% vs (42.0±5.2)%, P＝0.031]. (2) The average duration of CVVH treatment was (17.3±3.8) h in ACD-A group and (9.7±4.5) h in heparin-free group. There was significant difference between them (P＝0.019). The frequency of dialyzer clotting was much higher in heparin-free group than that in ACD-A group (88% vs 4.9%, P＜0.001). (3) There was no significant difference in the function of the coagulation system between pre- and post-CVVH in either group (P＞0.05). (4) Electrolyte, acid-base and glucose tended to be stable during the treatment in ACD -A group. (5) The vital signs were kept stable and no bleeding episodes were found in all patients of two groups. ConclusionsAnticoagulation with ACD-A is safe, effective and convenient for CRRT in critically ill patients at high risk of bleeding. The occurrence of complications can be reduced by configurating appropriate replacement fluid and close laboratory monitoring.     

The effect of variable heart rate decelerations on intraventricular hemorrhage and other perinatal outcomes in preterm infants

Objective: We investigated the hypothesis that repetitive variable heart rate decelerations in labor are associated with an increased incidence of neonatal complications in premature infants. Methods: This was a retrospective case-control study. Singleton fetuses weighing between 750 and 2500 g at 25-35 weeks' gestation were considered for the study. Fetuses delivered by Cesarean section prior to labor were excluded. Heart rate traces were retrieved from an electronic archive and were assessed for the presence of variable decelerations. Cases had at least three variable decelerations in the hour prior to delivery and were matched 1 : 1 with controls for gestation, sex and birth weight. Results: A review of 6500 deliveries yielded 41 matched pairs. The groups were compared for the following outcomes. Measures of acute morbidity were cord pH at delivery, 5-min Apgar score and resuscitation; measures of chronic morbidity were intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis and death. There was no difference in measures of acute morbidity between the groups. The incidence of chronic morbid outcome measures in the cases was six (15%) vs. one (2.5%) in controls ( p = 0.01). Conclusions: This study suggests that variable decelerations in preterm infants are associated with chronic morbidity, particularly intraventricular hemorrhage through a mechanism independent of fetal acidemia. Further study is required to determine whether these infants would benefit from early Cesarean section.