痰热清联合沙美特罗替卡松治疗COPD的疗效及对血气指标的影响

目的探讨痰热清联合沙美特罗替卡松治疗慢性阻塞性肺疾病(COPD)的临床疗效及对血清指标的影响。方法选择已确诊的COPD患者102例,随机分为治疗组与对照组各51例。2组均给予常规西医综合疗法;对照组在西医综合治疗基础上采用沙美特罗替卡松治疗,治疗组在对照组治疗基础上联合使用痰热清治疗。2周为1个疗程。应用全自动血气分析仪检测动脉血气指标[p(CO2)、p(O2)];监测2组第1秒用力呼气容积(FEV1)及其占预计值的百分比(FEV1%),观察2组症状改善情况及疗效。结果治疗组主要症状(包括哮鸣音、呼吸不畅、咳嗽咳痰)及治疗总有效率均明显高于对照组(P均<0.05);2组治疗后p(CO2)均较治疗前有所降低(P均<0.05),且治疗组降低程度明显低于对照组(P<0.05);2组治疗后p(O2)、FEV1、FEV1%均较治疗前有所升高(P均<0.05),且治疗组升高程度明显高于对照组(P均<0.05)。2组均无严重不良反应。结论痰热清联合沙美特罗替卡松治疗COPD可明显改善症状、肺功能及肺通气,疗效显著且安全可靠,可作为临床首选治疗方法加以推广应用。     

葡萄糖筛查试验阳性孕妇血清瘦素水平与糖代谢的关系

目的探讨葡萄糖筛查试验(GCT)阳性孕妇血清瘦素(LP)水平与糖代谢的关系及其妊娠结局。方法采用放射免疫法分别测定23例GCT阳性但口服葡萄糖耐量试验(OGTT)阴性孕妇、20例糖耐量低下(IGT)孕妇、20例妊娠期糖尿病(GDM)孕妇(以上为观察组)和30例正常孕妇(对照组)的血清LP、空腹胰岛素(FINS)和空腹血糖(FBG)水平,对各组血清LP水平、FINS水平、FBG水平、胰岛素抵抗指数(HOMA-IR)及胰岛素分泌指数(HOMA-IS)进行分析比较,并比较妊娠结局。结果①观察组血清LP水平、FINS水平、FBG水平、HOMA-IR及HOMA-IS与对照组相比,差异有统计学意义(P<0.01);糖代谢异常孕妇血清LP水平与FINS水平、FBG水平、HOMA-IR及HOMA-IS呈正相关(P<0.01)。②各观察组的血清LP水平、FINS水平、FBG水平、HOMA-IR及HOMA-IS相比较,差异无统计学意义(P>0.05)。③分娩孕周、因胎儿大和胎儿宫内窘迫而进行的剖宫产率及新生儿体质量,观察组与对照组相比,差异有统计学意义(P<0.05),而各观察组之间的差异无统计学意义(P>0.05)。结论妊娠期糖代谢异常孕妇存在胰岛素抵抗和高胰岛素分泌,与血清LP水平升高密切相关;GCT阳性但OGTT阴性孕妇已存在糖代谢异常,并与妊娠结局相关。     

腹腔镜下腹股沟韧带悬吊术治疗中重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜下腹股沟韧带悬吊术(LILS)治疗中重度盆腔器官脱垂(POP)的临床疗效。方法:自2014年5月至2016年4月,收集上海市第一妇婴保健院收治的78例中重度子宫脱垂/阴道穹隆脱垂行LILS的患者。记录其围手术期指标如:手术时间、出血量、术中并发症,比较术前及术后12个月POP定量(POP-Q)分度法各指示点,并评价其解剖治愈率及复发率等。通过盆底功能障碍性疾病症状问卷简表(PFDI-20)及POP-尿失禁性生活问卷(PSIQ-12)评价主观治愈率以及术后性功能相关症状改善情况。结果:78例术前POP-Q分度为子宫脱垂/阴道穹隆脱垂Ⅲ～Ⅳ度患者中,行全子宫切除术+LILS 57例,行LILS患者21例。平均手术时间130.5分钟(82～190分钟),术中平均出血量51.3 ml(5～200 ml),平均住院时间6.2天(4～8天)。术中无严重的并发症发生。所有的患者获得至少12个月的随访,其客观治愈率93.6%(73/78),总复发率6.4%(5/78)。术后PFDI-20评分较术前明显提高,差异均有统计学意义(P0.05)。PSIQ-12评分及有性生活患者的数量较术前明显提高,差异均有统计学意义(P0.05)。结论:LILS用于治疗中重度POP的患者,其主客观治愈率高、手术并发症少、近期效果及性生活质量明显提高,远期疗效有待进一步研究。     

上海市浦东新区妇女绝经年龄及行经年限调查与影响因素分析

Objective To investigate natural spontaneous menopausal age , menstruation span and their relationship with menarche age and parity in Pudong district of Shanghai. Methods From Jan 2007 to Jul 2008, 15 083 spontaneous menopause women undergoing cervical cancer screening were enrolled in this study. The questionnaire included menarche age, parity, spontaneous menopausal age and menstruation span. Those women were divided into four groups based on age, which were group of 56 -60, 61 -65, 66 -70 and more than 70. Analysis of variance (ANOVA) was used for comparing difference between menopausal age and menstruation span. Multiple factor regressions was used to analyze the relationship between menarche age, parity and menopausal age and menstruation span. Results (1) Spontaneous menopausal age: the minimum was 29 years old, the maximum was 61 years old, and the mean age was (50.6 ±3.7)years old. The mean spontaneous menopause age were (50.9 ± 3.4), ( 50.7 ± 3.7 ), (50.0 ± 4.1 ), (49.6 ±4.0) years in groups of 56 -60, 61 -65, 66 -70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menopausal age were observed, which the difference of 1.36 year was shown between groups of 56 - 60 and more than 70 years. (2) Menstruation span: the mean of menstruation span was (34.3 ± 4.1 ) years, which the minimal age of 12 years and maximal age of 48 years were recorded. (34.6 ± 3.8), (34.3 ± 4.1 ), (33.9 ± 4.6), (33.2 ± 4. 5) were observed in groups of 56 - 60,61 -65, 66 -70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menstruation span were observed, which the difference of 1.41 year was shown between groups of 56 –60 and more than 70 years. (3)The impact of menarche age on menopausal age and menstruation span: there was no correlation between menarche age and menopausal age ( r = 0.02); however, menstruation span was found to be negatively correlated with the menarche age ( r = - 0.43 ). (4) The impact of parity on menopausal age and menstruation span: the mean menopausal age of women who had 1 -2 deliveries was significantly higher than those had no delivery or more than 3 deliveries ( P < 0.05 ). However, there was no difference in menopausal age between women with 1 and 2 deliveries or between women without delivery and more than 3 deliveries (P > 0.05). Menstruation span of women with 1 delivery was significantly longer that those with more than 1 delivery( P < 0.05 ), similarly, women with 2 deliveries had longer menstruation span than women without delivery or more than 3 deliveries(P < 0.05 ). There were no difference in menstruation span between women with more than 3 deliveries and without delivery ( P >0.05 ). (5) Multifactor regression analysis for menstruation span: menarche age was correlated with menstruation span negatively ( r = - 0.97,P <0.001 ). There was significantly different menstruation span between group of 61 -65, 66 -70 or more than 70 years and group of 56-60 (r= -0. 18, P=0.020; r= -0.78,P <0.001 and r= - 1.23,P<0.001). Menstruation span in women with 1 -2 deliveries was significantly longer than that of women without delivery or more than 3 deliveries. (6)Multifactor logistic analysis of menopausal age: there was no association between menarche age and menopausal age, however, significant differences were found in mean menopausal age between different groups, which show that menopausal age of group 56 - 60 years was significant higher than the other groups, including age-group 61 -65 years ,66 -70 years and over 70 years ( r = - 0.18, P = 0.020; r = - 0.78,P < 0.001; r = - 1.23, P < 0.001 ). Menopausal age in women with 1 - 2 deliveries was significantly higher than those of women without delivery or with more than 3 deliveries,however, no difference between women with 1 and 2 deliveries or between women without deliveries and more than 3 deliveries was observed. Conclusion (1) Menopausal age and menstruation span exhibited increasing trends in Pudong district of Shanghai. (2) Menarche age and parity were the important factors influencing menopausal age and menstruation span. (3) With younger age of menarche, the menstruation span become longer. (4) Deliveries of 1 -2 times can significantly delay the menopause and prolong menstruation span, however, the multiple deliveries ( ≥ 3 times) had no significant impact on menopausal age and menstruation span.     

腹腔镜不同术式子宫全切手术对女性盆底功能的影响

目的比较腹腔镜筋膜内子宫切除术（classic intrafascial supracervical hysterectomy，CISH）与腹腔镜辅助下阴式子宫切除术（1aparoscopic assisted vaginal hysterectomy，LAVH）对盆底功能的影响。方法2003年3月-2005年12月，行CISH35例，LAVH44例，术后随访22～38个月：解剖学结局根据临床检查进行盆腔器官脱垂评定，功能性结果采用女性盆底功能障碍症状调查问卷评价。结果CISH膀胱膨出发生率低于LAVH[11．4％（4／35）VS34．1％（15／44），X^2=5．481，P=0．019]，直肠膨出发生率2组无显著差异[17．1％（6／35）VS13．6％（6／44），X^2=0．186，P=0．666]。C1SH后无一例残留宫颈脱垂，LAVH后7例残端脱垂，发生率15．9％（P=0．016）。CISH术后性生活满意度下降率低于LAVH[14．3％（5／35）VS38．1％（16／42），X^2=5．456，P=0．019]。结论CISH术在保持女性盆底结构和功能方面优于LAVH术。     

子宫锥辅助下腹腔镜阴道骶骨固定术治疗重度盆腔器官脱垂疗效分析

目的 评价在自主研发子宫锥辅助下行腹腔镜阴道骶骨固定术治疗重度盆腔器官脱垂的疗效。方法 2014年6月—2018年8月在同济大学附属第一妇婴保健院对52例重度子宫脱垂伴有不同程度阴道前后壁膨出的患者,用自主研发子宫锥辅助行腹腔镜下自制“Y”型聚丙烯网片阴道骶骨固定术。记录手术时间、出血量,采用盆腔器官脱垂定量分度法（POP-Q）评估各点位置,通过盆底功能障碍性疾病症状问卷简表(PFDI-20)、盆底疾病生活质量影响问卷（I-QOL）及术后尿失禁相关症状改善情况盆腔脏器脱垂/尿失禁性功能问卷（PISQ-12）,评价客观治愈率及主观治愈率。结果 52例患者手术顺利,术中无盆腔器官损伤及大出血等并发症,手术时间为（148.3±32.0）min,出血量为（61.3±46.2）mL。52例获得15～40个月的随访,中位随访时间22.5个月,术后POP-Q各指示点(Aa, Ba, C, Ap, Bp)可达解剖复位(P＜0.001),无手术失败,术后复发2例。主观治愈率为94.2%,客观治愈率96.2%,3例患者术后出现新发尿失禁,2例患者(3.8%)发生阴道顶端网片暴露,术前、术后PFDI-20及PISQ-12两者比较,差异有统计学意义(P＜0.05)。结论 腹腔镜阴道骶骨固定术主、客观治愈率高,子宫锥辅助能够使手术视野暴露更清晰、缩短手术时间、降低术中术后并发症、使解剖学复位更好。     

腹腔镜腹股沟韧带悬吊技术治疗老年女性子宫脱垂的应用体会

目的:探讨腹腔镜腹股沟韧带悬吊术治疗老年女性重度子宫脱垂的应用价值。方法:回顾分析2015年6月至2017年6月收治的21例合并普通妇科疾病需同时切除子宫的重度子宫脱垂患者的临床资料,腹腔镜子宫切除术后行腹股沟韧带阴道残端悬吊。观察手术时间、网片植入时间、术中出血量、悬吊出血量、住院时间、术中术后并发症,采用盆底器官脱垂定量分期法比较术前及术后12个月各指示点,评价其解剖治愈率。采用盆底功能障碍性疾病症状问卷简表20(PFDI-20)及盆底器官脱垂-尿失禁性生活问卷12(PSIQ-12)评价主观治愈率及术后性功能相关症状改善情况。结果:21例患者均成功完成手术,无一例中转开腹,手术时间平均(120.95±20.10) min,其中网片植入时间平均(55.57±16.44) min,失血量平均(53.33±21.06) mL,其中悬吊出血(13.81±11.39) mL,平均住院(5.86±1.42) d。术中、术后无严重并发症发生。术后12个月,盆腔器官脱垂定量分期法各指示点可达解剖复位,其解剖治愈率为100%。术后PFDI-20总分、分量表评分、PISQ-12评分均较术前改善,差异有统计学意义(P0.01)。结论:腹腔镜下腹股沟韧带悬吊技术治疗老年女性重度子宫脱垂安全,近期疗效肯定。     

中枢神经系统曲霉菌感染1例

<正>1 临床资料患者，女，53岁，急性起病，因“左手反复抽搐1 d”于2022年9月2日入住我院神经外科。患者入院1 d前无明显诱因出现发作性左手抽搐，不伴意识丧失、双眼凝视、牙关紧闭、二便失禁。每次发作持续1～2 min后自行终止，共发作3次，发作后伴左侧肢体无力，左上肢持物不稳，左下肢尚可拖步行走。伴头痛、呕吐，不伴发热、精神行为异常。休息后无好转，当地医院头颅MRI提示：右额顶叶交界区皮层下结节样异常信号伴大片水肿区，     

子宫-腹股沟韧带及筋膜固定术治疗子宫脱垂的手术体会

目的:探讨腹腔镜或开腹通过腹股沟韧带及筋膜固定治疗子宫脱垂或伴有阴道前、后壁膨出手术的可行性、安全性和治疗效果。方法:回顾分析2010年6月至2014年5月通过用聚丙烯网片吊带将脱垂子宫(或同时伴有阴道前、后壁膨出)悬吊固定在腹股沟韧带及筋膜上(腹股沟管入口即腹股沟管深环处的腹股沟韧带及筋膜)的5例患者的临床资料。观察手术时间、术中出血量,随访术后疗效。结果:5例患者完成经腹或腹腔镜腹股沟韧带及筋膜固定治疗子宫脱垂手术,手术时间40~100min,出血量10~150ml。4例患者术后1个月、6个月随访,阴道长度均大于7cm,无腹痛,性生活正常,伴随症状消失;1例腹腔镜患者术后1月随访阴道长度约9cm,无慢性盆腔疼痛。结论:腹股沟韧带及筋膜固定术治疗子宫脱垂或同时伴有阴道前、后壁膨出手术是一种安全、可行、相对简单的治疗方法。