悬浮红细胞联合手工分冰冻血浆输注对大量输血患者 凝血四项指标变化的影响

目的 探究悬浮红细胞联合手工分冰冻血浆输注对大量输血患者凝血四项指标变化的影响。方法 选取2013年9月～2017年4月我院58例大量输血患者,依据输血方式不同分组,各29例。对照组输入悬浮红细胞,于此基础上,实验组输入手工分冰冻血浆。对比两组大量输血前及输血后第1、3、5 天凝血四项指标水平。结果 输血前,两组凝血四项指标FIB、TT、APTT、PT水平相比,差异无统计学意义（P＞0.05）;输血后第1天,两组FIB水平较输血前下降,TT、APTT、PT水平较输血前上升,差异有统计学意义（P＜0.05）;输血后第3 、5天,两组FIB水平较输血后第1天上升,TT、APTT、PT水平较输血后1 d下降,差异有统计学意义（P＜0.05）;输血后第5天,实验组凝血四项指标FIB、TT、APTT、PT水平均基本恢复至输血前水平,差异有统计学意义（P＞0.05）;且输血后第1、3、5天 ,实验组FIB水平较对照组高,TT、APTT、PT水平均较对照组低,差异有统计学意义（P＜0.05）。结论 对大量输血患者联合输注悬浮红细胞、手工分冰冻血浆,有助于改善凝血功能,提高输血疗效,在临床治疗中具有重要意义。     

Repeated doses of GnRH antagonist at midcycle in artificial frozen embryo transfer cycles may not affect pregnancy outcomes

No significant differences in outcomes have been found between protocols of endometrial preparation for frozen embryo transfer (FET), though gonadotropin releasing hormone (GnRH) antagonists may have detrimental effects on the endometrium. We conducted a retrospective cohort noninferiority study at a single academic center of women receiving multiple doses of mid-cycle GnRH antagonist (GAnt) to those receiving GnRH agonist (GAg) to determine if there are detrimental effects of GnRH antagonists. 1047 FET cycles were identified, detailed data was available in 840 cycles: 610 GAg and 230 GAnt cycles. Patients undergoing GAnt cycles were older (40?±?6.6 versus 37?±?5.1 years, p?p?p?=?0.0009). Clinical pregnancy rates (CPRs) per transfer and implantation rates (IRs) were similar for GAnt and GAg cycles. There was a trend for higher pregnancy and IRs with GAg cycles in younger women (CPR 38.8% versus 26.7%, p?=?0.16; IR 36% versus 23.3%, p?=?0.07). Stratifying by diagnosis, CPR and IR were similar in GAnt and GAg cycles. A GAnt protocol of endometrial preparation for FET is not inferior to a GAg protocol regardless of patient age, use of donor oocyte, or infertility diagnosis.     

Fetal macrosomia as a risk factor for shoulder dystocia during vacuum extraction

Objective: Vacuum extraction of a macrosomic fetus is considered a risk factor for shoulder dystocia (SD). We evaluated maternal and fetal outcomes following vacuum extraction of macrosomic infants.

Methods: A retrospective cohort study conducted in two large teaching hospitals. All deliveries of macrosomic infants by vacuum extraction and vaginal delivery were compared. The primary outcome measure was SD. Secondary outcome measures were severe perineal lacerations and postpartum hemorrhage. For statistical analysis, we used McNemar’s test and χ² or Fisher’s exact tests. Odds ratios were analyzed via a logistic regression model.

Results: From 2003 to 2013, there were 6019 (5.45%) deliveries of macrosomic fetuses, and 230 (0.21%) were delivered by vacuum extraction. There were 23 (10%) and seven (3.04%) cases of SD in the study and control groups, respectively. The risk of SD was significantly higher in the study group (p?>?0.05). We found a significant association between SD and vacuum delivery [p?=?0.003; OR?=?3.54 (95% CI: 1.49–8.42)]. The composite adverse neonatal outcome rate was 6.5% (15/230) and 1.7% (4/230) in the study and control groups, respectively (p?=?0.009).

Conclusion: Vacuum extraction of a macrosomic infant is a risk factor for shoulder dystocia but not for postpartum hemorrhage or severe vaginal tears.     

Neonatal brachial plexus palsy: obstetric factors associated with litigation

Objective: Our objective was to compare characteristics between neonatal brachial plexus palsy (NBPP) cases that were litigated versus those that were not.

Study design: From May to December 2012, the University of Michigan Interdisciplinary Brachial Plexus Program surveyed 51 consecutive families whose children were treated for NBPP. Obstetric data was self-reported. Unless NBPP resolved, children were followed for at least two years. Student’s t-test and Chi-square test with odds ratio and 95% confidence intervals were calculated.

Results: Among 51 families surveyed, obstetric data were available for 98% (n?=?50). Litigation was pursued by 48% (n?=?24). Comparing families that litigated versus those that did not, there were no differences in demographics, peripartum characteristics, operative versus spontaneous vaginal birth, shoulder dystocia in current pregnancy (65% versus 54%; p?=?0.56) or birth weight above 9 lbs. The number of children having brachial nerve surgery was significantly higher among families that litigated (46%) versus those that did not (8%; p?=?0.002).

Conclusion: Though there were no differences in peripartum events, almost 1 out of 2 children managed by interdisciplinary team had concomitant litigation. The only factor associated with litigation was having brachial nerve surgery. Efforts are warranted to avert NBPP and mitigate litigations.     

Validity and reliability of elastic resistance bands for measuring shoulder muscle strength

Valid and reliable measurements of muscle strength are important in sport medicine. This study assesses concurrent validity and intrarater reliability (test–retest reliability) of elastic resistance bands for measuring shoulder muscle strength. Altogether, 50 healthy adults [mean age 36.0 (SD: 11.6), 29 women and 21 men] participated in testing and retesting 1–2 weeks later. The maximal elastic resistance (TheraBand) that each participant could hold for 3 s during standing bilateral shoulder abduction to 90° was converted into torque and validated against gold standard maximal voluntary isometric contraction (MVC) (Vishay force transducer) performed unilaterally while lying supine. The intrarater reliability of both tests were high; for the MVC and elastic band test, respectively, ICC(3,1) was 0.98 (95% CI: 0.97–0.99) and 0.99 (95% CI: 0.98–1.00), and measurement error was 4.8% (95% CI: 3.7–5.9) and 4.7% (95% CI: 3.1–6.2). For concurrent validity, ICC(3,1) was 0.96 (95% CI: 0.95–0.98) and measurement error was 8.1% (95% CI: 6.6–9.6), and the elastic band test explained 93% of the variance in the MVC test. However, the elastic band test produced systematically lower torque values than the MVC [56.5 (SD: 26.8) vs 66.5 (SD: 25.5) Nm, P < 0.01]. In conclusion, the test for shoulder muscle strength using elastic resistance bands has excellent validity and reliability, but produces systematically lower torque values than MVC. The reason for the lower torque values may be that the elastic band test has an initial concentric phase and is performed bilaterally and standing upright.     

紫河车联合寿胎丸加味治疗冷冻胚胎移植术后雌激素低下先兆流产患者临床研究

[目的]以冷冻胚胎移植(FET)术后雌二醇(E2)低的先兆流产患者为对象,采用紫河车联合寿胎丸加味治疗,观察临床疗效。[方法]选择FET术后14 d,100E2200 pg/m L的先兆流产患者160例,随机分配至治疗组和对照组。观察治疗前后中医症状评分,E_2、血清绒毛膜促性腺激素(β-HCG)上升情况及妊娠成功率。[结果]两组患者治疗后中医临床症状积分较治疗前显著下降(P0.01);血清E2、β-HCG水平均显著高于本组治疗前水平(P0.01)。与对照组相比,治疗组治疗后所有症状积分显著下降(P0.05);E2、β-HCG水平显著升高(P0.05)。治疗组和对照组妊娠成功率分别为77.5%、62.5%,差异有统计学意义(P0.05)。[结论]紫河车联合寿胎丸加味中药可有效改善FET术后雌激素低下先兆流产中医临床症状,显著提升雌激素及β-HCG水平,提高妊娠成功率,值得临床中推广使用。     

外固定支架能否成为治疗肱骨干骨折的理想选择？

背景：肱骨干骨折的治疗存在很多争议,桡神经损伤和骨折不愈合的发生率还很高,如何治疗复杂的肱骨干骨折是医生头痛的问题. 目的：综合分析外固定支架治疗肱骨干骨折的可靠性. 方法：利用外固定支架治疗肱骨干骨折患者10例.骨折均为外伤导致的闭合骨折,按AO分型：A型2例,B型骨折3例,C型骨折5例.采用麻醉下闭合复位或骨折端小切口复位,单纯外固定支架固定.治疗后1,4,8,12,20,24周和1年拍肱骨正侧位X射线片,观察骨折对位及骨折愈合情况,采用Constant评分及Mayo评分评估肩、肘关节功能. 结果与结论：随访12个月10例患者骨折均骨性愈合,愈合时间为外固定支架治疗后12-24周,平均16.1周愈合.1例出现桡神经损伤症状,于治疗后12周神经功能完全恢复.患者肩关节Constant评分平均为77.3分;肘关节功能恢复良好,Mayo评分平均为81.8分.结果证实,外固定支架治疗各型肱骨干骨折能取得较好的治疗效果.