427例前置胎盘高危因素分析

目的 探讨前置胎盘发病的高危因素.方法 回顾性分析本院2002年1月至2008年6月分娩的427例前置胎盘病例(病例组)和2135例随机抽取的单胎产妇作对照(对照组)的临床资料.结果 前置胎盘的发病率为1.16%(427/36 669).前置胎盘组产妇年龄大于对照组,年龄大于或等于30岁,尤其大于或等于35岁时前置胎盘的发病率明显增高(OR:2.3～2.6;95%CI:1.6～3.8),流产次数大于或等于3(OR:2.0～3.2;95%CI:1.3～6.8),产次大于或等于2(OR:1.4～3.2;95%CI:1.2～5.7),前次剖宫产(OR:1.6～2.8;95%CI:1.6～6.1)均是前置胎盘的高危因素.此外,早产(OR:4.6;95%CI:3.8～6.1)、先天性子宫畸形(OR:5.6;95%CI:3.3～7.5)及既往有前置胎盘史(OR:6.2;95%CI:3.6～8.2),也与前置胎盘密切相关.结论 孕妇年龄大于或等于35岁、流产次数大于或等于3次、产次大于或等于3、前次剖宫产、有早产史、先天性子宫畸形患者是前置胎盘发病的高危因素.     

前置胎盘患者新生儿出生体重的影响因素

目的探讨前置胎盘患者新生儿出生体重的影响因素。方法以2011~2014年间在我院分娩的单胎妊娠前置胎盘患者60例作为研究对象(研究组),同时随机选择同期无胎盘异常的单胎妊娠产妇60例作为对照组。回顾性分析入选病例产妇的一般临床资料以及新生儿出生体重及前置胎盘患者新生儿出生体重的影响因素。结果研究组的新生儿出生体重要低于对照组(P0.05);研究组早产的发生率明显高于对照组(P0.05)。多元线性回归分析显示,分娩时孕周是决定新生儿出生体重的预测因素(P0.01)。结论前置胎盘患者的新生儿出生体重较低,前置胎盘对新生儿出生体重的影响主要是由于其早产的发生率升高。对于前置胎盘患者,随分娩时孕周的增加,新生儿出生体重增加。     

药物流产与手术流产对再次妊娠影响的相关研究

目的 前瞻性比较药物流产与手术流产对再次妊娠孕期、围生期和新生儿并发症的影响.方法 选取单活胎、头位未产妇300例.按既往早期妊娠终止方式将入选孕妇分为药物流产组(n=100)和手术流产组(n=100),无流产史者设为对照组(n=100),观察3组孕期、国产期及新生儿并发症发生情况.结果 3组先兆流产发生率差异有显著性(X2=17.855,P＜0.05),其中手术流产组发生率(25.0%)显著高于药物流产组(11.0%)和对照组(5.0%)(X12=6.640,X22=15.686,P＜0.0125);3组胎盘粘连发生率差异有显著性(X 2=15.385,P＜0.05),其中手术流产组发生率(18.0%)显著高于药物流产组(6.0%)和时照组(3.0%)(X12=6.818,X22=17.971,P＜0.0125);3组胎盘残留发生率差异有显著性(X 2=8.143,P＜0.05),手术流产组发生率(12.0%)高于对照组(2.0%)(X2=7.680,P＜0.0125);手术流产组产时出血量(166.5±18.2)mt高于药物流产组(143.8±17.3)mL和对照组(139.1±16.9)mL,(t1=2.394,t2=4.188,P＜0.05).手术流产≥2次组先兆流产率、胎盘粘连率、胎盘残留率和产时出血量均显著高于手术流产1次组(X12=12.733,X22=-7.657,X22=7.924,t=3.585,P＜0.05),药物流产两亚组发生率差异无显著性(均P＞0.05);除药物流产≥2次亚组先兆流产发生率(16.7%)高于对照组(X2=5.204,P＜0.05)之外,药物流产组与对照组其他并发症发生率均无差异(均P＞0.05).3组新生儿并发症发生率无差异(均P＞0.05).结论 药物流产对再次妊娠的影响小于手术流产,两种流产次数越多,对再次妊娠的影响越大.     

143例凶险型前置胎盘发病的影响因素及围生期结局分析

目的 探讨凶险型前置胎盘发病的影响因素及围生期结局分析.方法 回顾分析2011年1月至2015年12月在百色市两所三甲医院住院分娩的143例凶险型前置胎盘孕产妇(研究组)和286例非凶险型前置胎盘孕产妇(对照组)的临床资料.结果 研究组孕产妇的平均年龄高于对照组(t=2.92,P=0.004);研究组孕产妇既往孕次、既往产次、既往流产次数、既往剖宫产次数、既往前置胎盘发生率均高于对照组(P＜0.01),研究组孕产妇的既往前置胎盘发生率高于对照组(x2=7.60,P=0.006);研究组孕产妇的产前孕周小于对照组(t=-12.33,P＜0.01).多因素分析显示,年龄、既往流产次数、既往剖宫产次是发生凶险型前置胎盘的影响因素,其中既往剖宫产次是3个影响因素中最主要的危险因素.研究组的产前出血发生率、产后出血发生率、子宫切除率、早产儿发生率均高于对照组(P＜0.01);研究组的术中出血量均高于对照组(P＜0.05);研究组的新生儿体质量和新生儿1 min Apgar评分等均低于对照组(P＜0.05).结论 年龄、既往流产次数、既往剖宫产次与凶险型前置胎盘的发生有关.     

胎膜早破危险因素及妊娠结局的临床回顾性分析

目的：旨在回顾性分析胎膜早破危险因素及妊娠结局情况。方法：选取该院产科于2013年1月至2015年12月收治160例胎膜早破产妇作为观察组和胎膜未早破产妇160例作为对照组,调查和记录产妇职业、流产史、胎儿胎位、产前感染;观察和记录胎膜早破对胎儿与产妇影响。结果：观察组产妇脑力劳动者比例显著高于对照组（P ＜0．001）;观察组有流产史患者比例为显著高于对照组（P ＜0．001）;对照组胎位正常率显著高于观察组（P ＜0．01）;对照组产妇产前感染率显著低于观察组（P ＜0．0001）;观察组胎儿窘迫及婴儿窒息率均显著高于对照组（P ＜0．01）;对照组产后体温升高和产褥感染率均显著低于观察组（P ＜0．001）。结论：围产期产妇体力劳动强度、流产史、胎位异常和产前感染均可影响胎膜早破发生率,而该并发症可直接威胁产妇及胎儿、新生儿健康和生命安全。     

前置胎盘植入的危险因素和并发症

目的：研究前置胎盘植入（PA）的危险因素和并发症。研究设计：回顾研究了20年来347例前置胎盘产妇，其中22例伴PA的产妇为研究组，325例无胎盘植入的产妇为对照组。结果：研究组的年龄、吸烟率和前次剖官产率均高于对照组。两组孕妇多产、反复流产、前壁或中央性胎盘及低社会经济地位者所占比例相似。PA的发生率随着剖宫产次数的增加而增加：以前未发生及1次、2次、3次、4次、5次剖宫产后相对应的PA发生率分别为1．9％、15．6％、23．5％、29．4％、33．3％、50．0％。逐步logistic回归分析筛选出PA的预测因子为高血压（OR13．9，95％CI2．1～91．2，P=0．006）、吸烟史（OR3．4，95％CI1．1～10．2，P=0．031）及剖宫产史（0R7．9，95％CI1．7～37．4，P=0．009）。PA组住院时间较长，估计失血量较多，需要输血的比例较高。仅病例组有孕妇实施了剖官产子宫切除及髂内动脉结扎。两组孕妇的分娩孕周和新生儿结局相似。结论：前置胎盘发生植入的危险因素为高血压、吸烟及剖宫产史，而新生儿结局与单纯前置胎盘类似。     

100例青春期妊娠产科结局临床分析

目的探讨青春期妊娠分娩产科结局的特点。方法对1990年至2002年在本院分娩的100例青春期妊娠与同期20078例成人产妇的临床资料进行回顾性对照分析。结果青春期妊娠所占分娩比例逐年上升；青春期组顺产率、早产发生率和急产发生率明显高于成人组(P值分别＜0．001、0．001、0．05),剖宫产率明显低于成人组(P＜0．01)；青春期组子癎和子癎前期重度发生率明显高于成人组(P＜0．001),两组胎膜早破、产后出血发生率的差异无显著性(P＞0．05)。两组新生儿结局的差异无显著性(P＞0．05)。结论青春期妊娠分娩比例逐年上升；与成人产妇比较,青春期产妇更易顺产、早产和急产,且更易发生子癎和子癎前期重度。     

前置胎盘患者围生产期的妊娠结局及相关影响因素分析

目的:探讨前置胎盘患者围生产期的妊娠结局及相关影响因素。方法:选取2014年1月～2021年11月在芜湖市第二人民医院诊断为前置胎盘的产妇105例,分为胎盘植入组和非胎盘植入组,Logistic回归分析前置胎盘患者围生产期妊娠结局的影响因素。结果:多因素Logistic回归结果显示,流产次数(≥2次)(OR₂=1.309;OR_≥3=1.824)、剖宫产次数(≥1次)(OR=1.854)、胎盘位置(前壁)(OR=1.252)、伴胎盘植入(是)(OR=6.012)是产后出血的危险因素。年龄(≥35岁)(OR=2.321)、伴胎盘植入(是)(OR=3.352)是子宫切除的危险因素。流产次数(≥3次)(OR=1.318)、伴胎盘植入(是)(OR=3.930)是末次住院总天数的危险因素,而入院孕周(≥32周)(OR₍32～38⁺⁶)=0.234;OR₍39～41⁺⁶)=0.156)是患者末次住院天数的保护因素。结论:前置胎盘患者围生产期的主要不良结局有产后出血、子宫...     

前置胎盘产前出血的相关危险因素及对妊娠结局的影响

目的：探讨前置胎盘患者产前出血的相关危险因素及对妊娠结局的影响。方法：以分娩前是否有过无痛性阴道流血将我院收治的75例前置胎盘分为出血组和未出血组,对两组资料进行回顾性分析。结果：出血组和未出血组年龄相当（P＞0．05）,但是孕产次数、流产以及宫腔操作次数差异显著（P＜0．05或0．01）。出血组中央型前置胎盘所占比例明显较高（P＜0．05）。出血组剖宫产率、早产率、产后出血率明显较未出血组高,终止妊娠时的孕周较短,住院总天数较长,和未出血组比较差异具有显著性（ P＜0．05或0．01）。结论：前置胎盘患者孕产次、流产以及宫腔操作次数与产前出血有一定的关系,而产前出血对前置胎盘患者的妊娠结局影响不良。     

前置胎盘发病对分娩结局的影响

目的:探讨前置胎盘发病对分娩结局的影响。方法:分析52例前置胎盘产妇及52例胎盘正常产妇的临床资料。结果:年龄越大、文化程度越低、流产次数越多、生育次数越多前置胎盘的发生率就越高;而具有盆腔炎史和剖宫产史的产妇,前置胎盘的发生率也明显高于无盆腔炎史和剖宫产史的产妇。观察组前置胎盘产妇出现胎盘植入、产后出血、早产、1 min Apgar评分及5 min Apgar评分≤7分的新生儿均明显高于对照组,经比较,差异具有统计学意义(P<0.05)。结论:前置胎盘的发病可以引发胎盘植入、产后出血、早产及新生儿窒息,必须加强预防和控制,以减少不良分娩结局的发生。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.