TNF-α和IL-6对绒毛膜11β-羟基类固醇脱氢酶I型和前列腺素合成酶II型的调节

目的 :研究肿瘤坏死因子 (TNF α)、白细胞介素 6(IL 6)对胎膜糖皮质激素代谢酶 11β 羟基类固醇脱氢酶I型 (11β HSD1)和前列腺素合成酶II型 (PGHS 2 )的影响 ,以探讨细胞因子导致分娩启动的机制。方法 :利用薄层层析法 (TLC)和Westernblot杂交法分别从酶活性、蛋白表达水平 ,研究IL 6、TNF α对原代培养的人类绒毛膜细胞 11β HSD1及PGHS 2水平的影响。结果 :TNF α和IL 6对绒毛膜滋养层细胞 11β HSD1还原酶活性有促进作用 ,对绒毛膜细胞 11β HSD1和PGHS 2的蛋白表达均有上调作用。 结论 :IL 6、TNF α对胎膜 11β HSD1及PGHS 2的诱导作用可能是其导致分娩启动的机制之一     

Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol.

OBJECTIVES: To compare the effectiveness of 25 microg vs. 50 microg of intravaginal misoprostol for cervical ripening and labor induction beyond 41 weeks' gestation. METHODS: The study population consisted of 120 women not in active labor with a gestational age >41 weeks, singleton pregnancy with vertex presentation, reactive fetal heart rate tracing, amniotic fluid index >/=5, and Bishop score <5. Women were randomized to receive either 25 microg (n=60) or 50 microg (n=60) of intravaginal misoprostol. The dose was repeated every 4 h (maximum number of doses limited to six) until the patient exhibited three contractions in 10 min. The main outcome measure was the induction-vaginal delivery interval. RESULTS: There was no significant difference between the two groups with regard to the induction-vaginal delivery interval (685+/-201 min in the 25 microg group vs. 627+/-177 min in the 50 microg group, P=0.09). The proportion of women delivering vaginally with one dose of vaginal misoprostol was significantly greater in the 50 microg group (0/49 vs. 41/47, P<0.001). There were no differences in the rates of cesarean and operative vaginal delivery rates, or in the incidences of tachysystole and hyperstimulation syndrome in the two treatment groups. Neonatal outcomes were also similar. CONCLUSIONS: Intravaginal administration of 25 microg of misoprostol appears to be as effective as 50 microg for cervical ripening and labor induction beyond 41 weeks' gestation.     

Pethidine versus tramadol for pain relief during labor.

OBJECTIVE: To evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine in labor. METHOD: Fifty-nine full term parturients were randomly assigned to one of two groups in active labor. Group 1 received 100 mg pethidine; group 2, 100 mg tramadol, intramuscularly. Analgesic efficacy, maternal side effects, changes in the blood pressure, heart rate, and duration of labor were assessed. RESULT: At 30 and 60 min after drug administration, pain relief was greater in the pethidine group than in tramadol group. The incidence of nausea and fatigue was higher in the tramadol group. Following drug administration the decrease in systolic and diastolic blood pressure and the increase in heart rate were statistically significant in both groups. No significant difference was found between the groups when compared for duration of labor and Apgar scores. None of the neonates developed respiratory depression. CONCLUSION: Pethidine seems to be a better alternative than tramadol in obstetric analgesia because of its superiority in analgesic efficacy and low incidence of maternal side effects.     

PNS单体Rb_l对豚鼠心脏乳头肌动作电位和收缩力的影响

目的 :了解PNS单体Rbl对豚鼠心脏乳头肌动作电位和收缩力的影响。方法 :运用带有动作电位和收缩力分析软件控制的细胞内微电极技术 ,研究了三七皂苷 (PNS)单体Rbl对豚鼠正常心脏乳头肌动作电位 (AP)各特征参数及收缩力 (FC)的影响。结果 :Rb1 1 0～ 30 μmol·L- 1 分别使APD 2 0 ,APD 90明显缩短 ,FC显著下降 (P<0 .0 1 ,n =5) ,并可降低高钾诱发的豚鼠乳头肌慢反应动作电位的动作电位幅值 (APA)及零相最大上升速率(Vmax) (P <0 .0 5 ,n =5)。但对静息电位 (RP) ,APA ,Vmax及AP的超射值 (OS)无明显影响 (P >0 .0 5 ,n =5)。另外 ,Rbl可浓度依赖性地抑制乳头肌收缩力 (FC) ,RP ,APA不随Rbl剂量增加而产生明显变化 ,呈典型的兴奋 收缩脱藕联。结论 :其效应可能通过阻滞钙通道而产生     

苦参碱对豚鼠心肌电生理及机械特性的影响

目的　观察苦参碱对离体豚鼠右心室乳头状肌动作电位及收缩力 (Fc)的影响 ,以探讨其抗心律失常的作用机制。方法　采用标准玻璃微电极技术记录心肌细胞动作电位 ,肌力换能器同步记录心肌收缩力。结果　苦参碱 10、2 5、5 0 μmol·L-1可浓度依赖性地延长快反应动作电位(FAP)的复极 5 0 %时程 (APD50 )、复极 90 %时程 (APD90 )和有效不应期 (ERP) ,延长高钾除极组织胺及氯化钡诱发的慢反应动作电位 (SAP)的APD50 、APD90 ;但对FAP、SAP的动作电位振幅 (APA)、0期最大除极速率 (Vmax)及Fc无明显影响。结论　结果提示苦参碱对心肌细胞钠、钙离子通道无明显影响 ,其延长APD的作用可能是阻断心肌钾通道的结果。     

米非司酮用于足月妊娠引产时脐动脉血流的测定

目的：评价米非司酮用于足月妊娠引产时对胎盘血液供应的影响。方法：将９７例妊娠３８～４２周具有引产指征的孕妇随机分为两组：治疗组（４９例）给予口服米非司酮，每次５０ｍｇ１２小时１次连续２天后，阴道置米索前列醇２５μｇ，１２小时１次；对照组（４８例）予静脉推注蒂洛安２００ｍｇ，每日１次连续３天后，静脉点滴催产素引产。两组孕妇均在用药前及用药后３６～４８小时行脐动脉血流速度测定，以收缩期血流速度峰值（Ｓ）与舒张末期血流速度峰值（Ｄ）的比值（Ｓ／Ｄ）为测定参数，观察用药前及用药后３６～４８小时的脐血流Ｓ／Ｄ值的改变。结果：两组用药前及用药后３６～４８小时的脐血流Ｓ／Ｄ值比较，差异无显著性（Ｐ＞０．０５）。结论：米非司酮５０ｍｇ１２小时１次连续２天口服用于足月妊娠引产不仅效果良好，且对胎盘血流动力学无显著影响。     

Transcutaneous electrical nerve stimulation (TENS) for adjuvant pain-relief during labor and delivery

Objective: We examined the efficacy of transcutaneous electrical nerve stimulation (TENS) in general and the new Freemom TENS device (LifeCare, Israel) in particular, for pain relief during labor and delivery. Methods: The study group consisted of 104 women. Forty-six nulliparas (44.2%) and 58 multiparas (55.8%), all of whom used the TENS device for pain relief during labor. All participants completed a questionnaire on the degree of pain relief afforded them by TENS during the delivery and related questions. The objective evaluation was based on the documented labor and delivery parameters including medical interventions during delivery. Results: The majority of subjects (72% of the nulliparas and 69% of the multiparas) considered TENS effective for the relief of pain during labor. Most of them (67% of the nulliparas and 60% of the multiparas) responded positively to the use of TENS in future deliveries. Sixty-five percent of the multiparas considered TENS at least as effective as the other pain relief methods they had used before. TENS significantly reduced the duration of the first stage of labor P<0.001 for nulliparas, P<0.005 for multiparas and it significantly decreased the amount of analgesics administered to individual patients. No significant difference was found in fetal heart rate tracings, Apgar scores and cord blood pH between the study group and an equal number of matched controls who used other forms of pain management. Conclusions: TENS is an effective non-pharmacological, non-invasive adjuvant pain relief modality for use in labor and delivery. TENS application reduced the duration of the first stage of labor and the amount of analgesic drug administered. There were no adverse effects on mothers or newborns.     

硬膜外阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床分析

目的:观察硬膜外腔阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床效果及对产科质量的影响。方法:将低浓度罗哌卡因和小剂量含芬太尼的混合液注入硬膜外腔。配合Doula式分娩及连续胎心监护,用于76例没有产科并发症及麻醉禁忌症进入活跃期的初产妇作为观察组,将单纯采用Doula式分娩的89例相同条件的初产妇作为对照组,比较两组的镇痛效果及其对产科质量的影响。结果:两组镇痛效果有极显著性差异(P<0.01),催产素使用有显著性差异(P<0.05),产程时间、分娩方式、产后出血量、胎儿窘迫、胎心监护异常发生率及新生儿窒息发生率无显著性差异(P>0.05)。结论:硬膜外腔阻滞麻醉用于分娩镇痛,效果可靠,对母婴无不良影响,配合Doula式分娩及连续胎心监护,安全有效。     

Misoprostol vs. oxytocin for induction of labor at term.

Efficacy of misoprostol was studied for induction of labor at term. Seventy patients were randomized to Group A (n = 36, oral misoprostol 50 microg four hourly to maximum of 5 doses) and B (n = 34, continuous oxytocin infusion). Induction-delivery interval was shorter with misoprostol (7.7 +/- 2.8 h against 14.3 +/- 4.8 h with oxytocin) but the rates of vaginal delivery, cesarean, neonatal outcome variables were similar. Hence, misoprostol is an effective agent for induction of labor at term.     

Drotaverine hydrochloride for augmentation of labor.

OBJECTIVES: To study the use of drotaverine hydrochloride for acceleration of labor and relief of labor pains. METHODS: In this double-blind placebo-controlled randomized study, 100 primigravidas in uncomplicated spontaneous labor at term were given drotaverine hydrochloride or placebo (distilled water) intramuscularly. Labor events, including pain (assessed by a visual analog scale and a verbal rating scale), neonatal outcome, and side effects of the drug were recorded. Student's t-test was used for analysis. RESULTS: Forty-four patients in the drug group and 40 in the placebo group had complete data for analysis after decoding. In drotaverine group, there was a mean 15% reduction in the duration of the first stage of labor and a mean 19% reduction in the second stage. The maximum shortening of the first stage (28%) was observed when drotaverine was administered when cervical dilatation was 4 cm (P=0.044). There were no adverse fetal effects, but atonic postpartum hemorrhage was more common in the drotaverine group. There was no relief of pain with the drug except in the fourth stage of labor. CONCLUSIONS: Drotaverine hydrochloride is safe and effective in accelerating labor, but not effective in lessening labor pain.