产前诊断对预防围生儿出生缺陷的效果分析

目的分析产前诊断对预防围生儿出生缺陷的效果,为加强出生缺陷干预,降低出生缺陷发生率提供参考依据。方法采用回顾性队列研究,将2003年6月开展产前诊断活动前的432例作为对照组,活动后的568例作为观察组。比较分析两组研究对象围生儿出生缺陷情况。结果本研究共出现16例围生儿出生缺陷,最常见的三种出生缺陷类型为多指(趾)(0.50%)、神经管畸形(0.40%)以及先天性心脏病(0.20%);观察组出生缺陷发生率明显小于对照组。结论对围产期孕妇进行产前诊断能够确保及时发现存在缺陷障碍的胎儿,从而采取治疗性终止妊娠等措施,进而有效降低围生儿的出生缺陷发生率,提高分娩质量,对提高我国人口质量有十分重要的意义。     

妊娠晚期不同状况羊膜腔内细菌学临床研究

目的 研究妊娠晚期和分娩期不同状况下羊膜腔内细菌状况,从而为母婴感染的防治提供对策.方法 随机对不同原因进行剖宫产的患者,用无菌方法于术中取羊水10 ml,行细菌培养,对细菌进行鉴定并作药物敏感试验.所有病例术前、术中未使用抗生素,术后常规使用抗生素.根据患者剖宫产术前孕产状况分为3组:胎膜早破组34例,试产组(无胎膜早破)34例,待产组(无胎膜早破)27例.对3组的细菌阳性率,细菌种类及分布,以及细菌敏感性进行统计学分析.结果 不同状况下羊膜腔内细菌培养阳性率:胎膜早破组61.8%(21/34),试产组52.9%(18/34),待产组11.1%(3/27),3组阳性率比较差异有统计学意义(χ2=17.29,P=0.000),提示破膜和试产是细菌感染的重要诱因;胎膜早破组与胎膜完整试产组阳性率比较,差异无统计学意义(χ2=0.541,P=0.462).不同状况下羊膜腔内细菌种属和分布情况:最多见为表皮葡萄球菌,其次为金黄色葡萄球菌、链球菌,大肠埃希菌、假单胞菌.胎膜早破组与胎膜完整试产组细菌种类分布比较,差异无统计学意义(χ2=11.9,P=0.535).胎膜早破组与试产组细菌感染率差异无统计学意义,且细菌种类和分布差异无统计学意义,提示经阴道上行至羊膜腔感染为主要感染途径.各种细菌敏感试验结果:头孢类抗生素、青霉素衍生物、克林霉素、奎奴普丁、万古霉素、呋喃妥因、夫西地酸、替考拉宁、阿米卡星、美罗培南等对多种细菌敏感;青霉素、红霉素、链霉素、庆大霉素对多种细菌耐药.结论 经阴道上行至羊膜腔感染为主要感染途径.对胎膜早破患者、对试产后手术患者应使用敏感抗生素,严格无菌操作、术中冲洗宫腔和切口、术后使用有效抗生素是预防术后感染的必要措施.

Abstract：

Objective To study bacterial conditions in amniotic cavity of the third trimester and the delivery. Methods Patients underwent cesarean section due to various reasons were randomly enrolled in the study. Ten ml aqua amnii taken from using aspesis were cultured and the bacteria were identified and tested for drug sensitivity. All patients were not treated with antibiotics before and during operation,conventional antibiotics treatnent was used after operation. The patients were divided into 3 groups based on their status: 34 cases of premature rupture of membrane ( PROM ), thirty-four cases of labor without PROM, and 27 cases of pregnancy without PROM. The positive rate, species , distribution and drug sensitivity of bacteria in the 3 groups were analyzed. Results The positive rate was 61.8% (21/34) in PROM ,52. 9% ( 18/34 ) in labor without PROM,11.1% (3/27)in pregnancy without PROM. The positive rates were significantly different among the 3 groups (x2 = 17.29 ,P =0.000). However, there was no significant difference between the labor without PROM group and the pregnancy without PROM group ( x2 = 0.541 , P = 0.462 ). Staphylococcus epidermidis was the most common isolated bacteria, following by staphylococcus aureas, streptococcus, colon bacillus, and pseudomonas. There were no significant differences of bacterial species between labor without PROM and pregnancy without PROM( x2 = 11.9,P =0.535 ). The relative higher positive rate in the labor without PROM and PROM indicated that they were important inducement of bacteria infection. There were no significant difference on positive rate and bacteria species distribution between the PROM and labor without PROM group,which suggested that up-bound along vagina to amniotic cavity was the most common route of infection. Sensitive antibiotics should be given to the patients of PROM and labor without PROM targeted at staphylococcus,streptococcus, colon bacillus and monad. Antibiotics such as Cephems, Penicillins and Clindamycin were sensitive to various bacteria and safe to both mother and baby, thus were recommended. Quinupristin, Vancomycin,Furantoin, Fusidic ,Teicoplanin, Amikacin and Meropenem were also sensitive to various bacteria, but due to their side effects and the principle of ladder antibiotics using, they were recommended as second line antibiotics. Conclutions Up-bound along vagina to amniotic cavity is the most common route of infection. For rupture of membrane and labor without PROM patients, antibiotics should be given, and strict aseptic technique,washing cavity and incision, using antibiotics after operation are necessary to prevent infection.     

急性髓性白血病完全缓解患者残留白血病细胞检测研究

本研究的目的是观察急性髓性白血病患者完全缓解后血液和骨髓中微小残留病变变化情况 ,并探讨微小残留病变在监测急性髓性白血病复发中的应用价值。用流式细胞术检测 3 3例化疗达完全缓解的急性髓性白血病患者血液和骨髓中残留白血病细胞 (residualleukemiccells,RLC)。结果显示 :急性髓性白血病完全缓解组和正常对照组外周血RLC分别为 ( 4 .75 18± 4 .15 3 7) %和 ( 0 .4 83 5± 0 .2 0 0 5 ) % ,二者比较有统计学差异 (P <0 .0 0 1) ;完全缓解组骨髓和正常对照组骨髓RLC分别为 ( 17.90 82± 2 0 .4 819) %和 ( 0 .72 85± 0 .2 2 0 9) % ,二者比较有统计学差异 ( P <0 .0 0 1) ;持续缓解组与复发组外周血RLC分别为 ( 2 .2 3 3± 1.5 92 3 ) %和 ( 10 .2 3 69± 9.4 714 ) % ;持续缓解组与复发组骨髓RLC分别为 ( 4 .779± 3 .0 3 3 6) %和 ( 3 8.0 685± 19.4 2 95 ) %。二组比较有统计学差异 (P <0 0 0 1)。结论 :应用流式细胞术检测残留白血病细胞对及时预测复发有重要意义 ,有利于在复发早期进行治疗。     

手术室的科学管理体会

随着医学科学的发展,医院实行分级管理,在医院的分级管理工作中,手术室管理已经提高到重要的位置,如何科学的管理手术室成为非常重要的课题。以人为本进行手术室管理,科学合理安排人员、时间完成手术,加强医疗设备的管理,严格执行消毒隔离制度,建立健全各项工作制度,加强医患沟通提供人性化服务,发挥手术室护士长核心作用,这些都是提高手术室管理水平的重要因素。     

2%碘酊治疗急慢性根尖炎123例体会

慢性根尖炎多由急性根尖炎或根尖脓肿转变而来,彻底根治根尖炎是临床保留患牙的有效方法.自1998年以来我科应用2%碘酊治疗急慢性根尖炎123例,临床效果满意,总结如下.     

IIVP方案治疗复发难治高危弥漫大B细胞淋巴瘤1O例

目的探讨IIVP方案【去甲氧柔红霉素（IDA）、异环磷酰胺（IFO）、依托泊苷（VP16）]治疗复发难治、高危弥漫大B细胞淋巴瘤的治疗效果。方法IFO1g／m^2，静脉滴注，第1天至第5天，配合巯乙磺酸钠400mg／次．0、3、6、9h静脉推注4次，IDA10mg／m^2，静脉推注，第1天至第2天，VP16 150mg／m^2，静脉滴注，第1天至第3天，每4周重复，每疗程后进行疗效评价。结果复发难治、高危弥漫大B细胞淋巴瘤10例，完全缓解（CR）2例，不确定的完全缓解（CRu）2例，部分缓解（PR）3例，有效率（CR＋CRu＋PR）70％。结论IIVP方案治疗复发难治、高危弥漫大B细胞淋巴瘤可取得较高的缓解率，并为白体干细胞移植创造条件，进一步提高此类患者的治疗效果。     

广东省顺德地区6 503例孕中期羊水染色体核型结果分析

目的 探讨羊水细胞异常核型发生的频率、类型与不同产前诊断指征之间的关系,评估羊水穿刺术诊断染色体疾病的临床价值。方法 选取2009年7月～2018年7月在广东医科大学顺德妇女儿童医院产前诊断中心具有产前诊断指征的孕妇6 503例,进行羊水穿刺,胎儿羊水细胞染色体核型分析。结果①6 503例羊水细胞中,检出染色体异常核型358例,异常率5.51%。染色体数目异常264例,其中21三体128例,18三体51例,13三体20例,性染色体数目异常65例; 染色体的结构异常66例; 嵌合体28例。各产前诊断指征中,染色体异常检出率分别为3.34%,3.15%,61.95%,17.22%,37.14%,5.60%和0.62%,经χ²检验发现,高龄组与血清学筛查高风险组,高龄组与不良孕产史组,血清学筛查高风险组与不良孕产史组,差异均无统计学意义(χ2=0.147～2.279,均P>0.05); 其余各组之间两两比较,差异均有统计学意义(χ2=7.411～997.801,均P<0.01)。②2 456例高龄孕妇中,年龄35～39岁组与年龄≥40岁组胎儿染色体异常检出率分别为2.70%和5.63%,两者比较,差异有统计学意义(χ2=11.059,P<0.01)。③无创产前基因筛查(NIPT)对21三体、18三体和13三体的检测准确度分别为80.28%,75.86%和44.00%,对性染色体异常的检测准确度为55.17%,对其他染色体异常的检测准确度为22.73%。结论 ①对具有明确产前诊断指征的孕妇行羊膜腔穿刺术,进行羊水细胞染色体核型分析非常重要,可有效地检出染色体异常胎儿,避免其出生,提高人口素质。②高龄孕妇,尤其是≥40岁的高龄孕妇,进行产前诊断非常必要。③NIPT对筛查胎儿染色体疾病准确率较高,但只是筛查手段,不能完全代替羊水细胞核型分析。     

全反式维A酸?三氧化二砷?HA方案联合诱导12例成人急性早幼粒细胞白血病

南京医科大学附属南京第一医院血液科2003年9月～2007年9月,使用全反式维A酸(ATRA)、三氧化二砷(As2O3)、高三尖杉酯碱(HHT)、阿糖胞苷(Ara-c)方案联合诱导成人急性早幼粒细胞白血病(APL)12例,取得了较好疗效,现将治疗情况报告如下.