脓毒症大鼠血小板生成素水平与脓毒症严重程度的关系

目的 观察二次打击致脓毒症大鼠血清血小板生成素(TPO)水平的改变,并初步探讨脓毒症时血清TPO水平与脓毒症严重程度的关系.方法 将SD大鼠分成健康对照组(A,n=10)、手术对照组(B,n=8)、脓毒症组(C,n=15)、严重脓毒症组(D,n=12)和脓毒性休克组(E,n=8).通过低血容量休克打击后注射不同剂量(1 mg/kg、2 mg/kg、3 mg/kg)大肠杆菌内毒素(LPS)复制脓毒症、严重脓毒症及脓毒性休克模型.24 h后测定大鼠血小板计数和血清TPO、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平.结果 脓毒症组血小板较健康对照组无明显变化,严重脓毒症组和脓毒性休克组血小板计数下降显著(P＜0.01).TPO水平在脓毒症组开始升高,在严重脓毒症组和脓毒性休克组显著升高水平(P＜0.01).IL-6、TNF-α在脓毒症组、严重脓毒症组和脓毒性休克组逐渐升高.多元线性回归分析显示:TPO与IL-6密切相关(r=0.832,P＜0.00).结论 脓毒症大鼠血清TPO水平升高,脓毒症严重程度是TPO水平主要决定因素,TPO水平可作为脓毒症严重程度的生物学标志.     

脂多糖刺激后腹腔巨噬细胞表面Toll样受体表达的变化

目的探讨LPS刺激后小鼠腹腔巨噬细胞表面TLR2、TLR4表达的动态变化.方法常规方法从BALB/C小鼠腹腔中分离出巨噬细胞,调整细胞数为2×106/孔,分为6组,每组设3个复孔,加入LP S使其终浓度为1μg/ml,在终浓度为1μg/ml LPS刺激下,5%CO2,37℃孵育0、1.5、3、6、16、24h.用异硫氢酸荧光素(FITC)标记的大鼠抗小鼠TLR2抗体和藻红蛋白(PE)标记的大鼠抗小鼠TLR4抗体对小鼠腹腔巨噬细胞进行免疫荧光染色,流式细胞仪(FCM)测定FITC、PE阳性细胞数及其平均荧光强度(MFI).结果1.随着LPS刺激时间的延长,TLR2阳性率逐步上升,6h达到高峰后出现缓慢下降趋势,各刺激组阳性率与对照组组相比,P＜0.01.TLR2 MFI则随着LPS刺激时间的延长而缓慢下降,各刺激组与对照组相比,P＜0.05.2.随着LPS刺激时间的延长,TLR4阳性率逐步上升,刺激达24h时,阳性率为14.02%+1.23%,与对照组(8.98%±1.06%)相比,P＜0.01.TLR4 MFI也随着刺激时间的延长而上升,各刺激组与对照组相比,P＜0.05.结论LPS能够引起巨噬细胞TLR2/4表达和分布发生变化,说明TLR2与TLR4均参与针对LPS的反应.     

诺和锐30每日3次注射对初诊2型糖尿病的疗效

目的 比较不同胰岛素强化治疗对初诊2型糖尿病的疗效.方法 将120例初诊2型糖尿病患者按随机数字表法分为2组:诺和锐30组(n=60)每日3次诺和锐30皮下注射;诺和灵组(n=60)每日4次重组人胰岛素治疗(三餐前30 min皮下注射诺和灵R,睡前皮下注射诺和灵N).结果 2组相比,诺和锐30组血糖达标时间更短(P＜0.01),胰岛素用量更少(P＜0.01),低血糖发生率更低(P＜0.01).结论 诺和锐30每日3次注射可作为初诊2型糖尿病的有效治疗手段之一.     

脓毒症大鼠心肌细胞Toll样受体4和炎症因子基因表达的变化及作用机制

目的 观察脓毒症大鼠心肌细胞凋亡的变化及与Toll样受体4(TLR4)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)基因表达的关系;同时探讨谷氨酰胺(Gln)在脓毒症心肌损伤治疗中的保护作用.方法 采用内毒素脂多糖(LPS)腹腔注射法制备脓毒症大鼠模型.将大鼠随机分为对照组、LPS组及Gln组,再分为术后0、6、12、24 h亚组,每组6只.于相应时间点取心肌组织,采用逆转录-聚合酶链反应(RT-PCR)检测TLR4、TNF-α及IL-6的mRNA表达,并观察心肌组织病理学改变.结果 LPS组大鼠心肌细胞凋亡程度增高.LPS组、Gln组各时间点心肌细胞TLR4、TNF-α及IL-6的mRNA表达均较对照组明显增加(P均<0.05).而Gln组心肌细胞凋亡程度较LPS组轻,各时间点TLR4 mRNA表达均较LPS组升高幅度明显降低,且于12 h、24 h差异有统计学意义;TNF-α mRNA表达亦降低,于6 h、24 h差异有统计学意义;IL-6 mRNA表达较LPS组升高幅度降低,且于12 h差异有统计学意义(P均<0.05).结论 TLR4信号转导基因及其调控细胞因子TNF-α、IL-6基因表达在脓毒症心肌细胞损伤的发生发展中起重要作用.Gln通过影响相关基因表达干预脓毒症心肌细胞的凋亡.     

胰岛素对心肺复苏大鼠神经元凋亡及Bcl-2,Bax mRNA表达的影响

目的 探讨脑室内注射胰岛素对心肺复苏(cardiopulmonary resuscitation,CPR)后大鼠海马CA1区神经元凋亡和对抑凋亡因子Bcl-2,促凋亡因子Bax mRNA表达的影响.方法 实验地点在首都医科大学宣武医院试验动物中心.30只雄性SD大鼠随机(随机数字法)分为假手术组(对照组,n=6)、心肺复苏组(复苏组,n=12)及CPR后胰岛素干预组(胰岛素组,n=12).经食道超速起搏诱发6min室颤制备大鼠CPR模型;以CPR后大鼠恢复室上性心率、收缩压超过60 mmHg(1 mmHg=0.133 kPa)并持续10 min以上,作为自主循环恢复(ROCS)标准;ROCS 10 min后,胰岛素组大鼠经立体定位仪定位,脑室内注射12.5 μL(1 U)胰岛素,其余2组大鼠注射等量生理盐水.维持生命体征,CPR后24,72 h,应用实时荧光PCR (Realtime-PCR)测定海马CA1区神经元Bcl-2,Bax mRNA的表达量;CPR后7d,应用TUNEL染色检测海马CA1区神经元凋亡;CPR前后监测大鼠静脉血糖变化.计量资料采用均数±标准差(-x±s),组间比较采用单因素方差分析(ANOVA);相关性统计应用Pearson相关分析,以P＜0.05为差异具有统计学意义.结果 ①CPR后24,72 h,胰岛素组大鼠Bcl-2 mRNA表达量均高于复苏组(1.45±0.05) vs.(0.79±0.01);(0.95±0.06) vs.(0.35±0.03),差异具有统计学意义(P＜0.01).组内比较发现,胰岛素组、复苏组72 h表达均低于24 h(P＜0.01).而胰岛素组与复苏组Bax mRNA表达差异无统计学意义(P＞0.05),胰岛素组、复苏组72 h与24h比较差异无统计学意义(P＞0.05).②CPR后7d,胰岛素组大鼠海马CA1区神经元凋亡计数,复苏组(124.75±17.35)个/mm2明显高于对照组(5.12±3.26)个/mm2和胰岛素组(92.79±7.49)个/mm2,差异具有统计学意义(P＜0.01).③各组大鼠各时间点外周静脉血糖比较无统计学意义(P＞0.05).结论 脑室内注射1U胰岛素,能够促进CPR后大鼠神经元促凋亡因子Bcl-2 mRNA的表达,抑制神经元凋亡,具有神经保护作用.脑室注射1U胰岛素不降低外周血糖.     

高血糖对2型糖尿病胰岛β细胞功能及胰岛素抵抗的影响

目的观察葡萄糖毒性对胰岛β细胞功能及胰岛素抵抗的影响.方法采用前瞻性研究,对38例初次诊断的2型糖尿病患者予强化降糖治疗并观察血糖控制前后胰岛β细胞功能及计算胰岛素抵抗指数.结果血糖控制后反映胰岛β细胞功能的指数显著升高(P＜0.01)Homa-Is(3.19±1.16比5.23±1.97,t=20.416);FNNS/FPG(0.019±0.08比1.02±0.07,t=44.218),胰岛素抵抗指数显著下降(P＜0.01)Homa-IR(2.03±0.82比1.12±0.41,t=10.223)及IAI(-5.84±1.29比-4.62±0.86,t=2.823).结论纠正葡萄糖毒性,可改善早期2型糖尿病患者胰岛β细胞功能,减轻胰岛素抵抗.     

血必净注射液对脓毒症大鼠营养代谢的影响

目的:观察血必净注射液对脓毒症大鼠血糖、血脂、血浆蛋白等营养物质含量的影响.方法:健康雄性wistar大鼠60只随机分为对照组(n=20)、脓毒症组(n=20)和血必净治疗组(n=20).脓毒症组、血必净治疗组于注射内毒素(LPS)后0.5 h分别尾静脉注射4 mL/kg生理盐水(NS)和血必净注射液,正常对照组予以注射4mL/kg NS.在注射NS/LPS后2、6、12、24 h,经颈动脉取血用于检测血浆血糖、血脂、血浆总蛋白和白蛋白值.结果:脓毒症组大鼠在LPS尾静脉注射后2 h,血糖浓度开始升高,6 h后达到高峰,并且血糖浓度一直处于较高水平,而血必净和对照组比较,血糖变化无统计学意义.血必净组2 h后甘油三酯、极低密度脂蛋白升高明显,12、24 h后各血脂指标和对照组比较无统计学意义.脓毒症组大鼠24 h后总蛋白、白蛋白明显下降,而血必净和对照组比较不明显.结论:脓毒症早期应用血必净注射液可以控制血糖,减少脂蛋白的参与炎症复合物的形成,减少血浆蛋白分解.     

多器官功能障碍综合征大鼠胰岛β细胞超微结构和功能的改变

目的 探讨多器官功能障碍综合征(MODS)时胰岛β细胞超微结构和功能的变化,为临床治疗MODS高血糖提供理论依据.方法实验地点为福建省立医院动物房、福建省立陕院心血管研究所重点实验窜、福建省立医院病理科与福建医科大学电镜室.清洁级健康雄性SD大鼠16只,体质量180～220 g,随机分成2组,即:MODS组和埘照组,每组8只.MODS组大鼠腹腔内注射大肠杆菌菌液,同时钳断大鼠左下肢,造成感染复合创伤二次打击MODS大鼠模型.对照组给予等量生理盐水腹腔内注射.48 h后榆测有2个以上器官或系统功能障碍即为MODS组造模成功.成功造模后,两组大鼠心脏穿刺抽血,测定空腹血糖、血清胰岛素水平(抽血前禁食12 h).之后两组大鼠迅速腹腔内注射20%葡萄糖液(2 g葡萄糖/ks体质量),30 min后,再次心脏抽血测定糖负荷血糖及血清胰岛素水平.两组大鼠血糖的比较用成组t检验,血清胰岛素水平经自然对数转换正态化后进入成组t检验.抽血后取标本电镜下观察两组大鼠胰岛β细胞超微结构,免疫组化分析胰岛β细胞Bax蛋白表达.结果 和正常埘照组比较,MODS组大鼠空腹血糖、糖负荷30 min后血糖及Bax蛋白表达明显高于正常对照组(P<0.01).糖负倚30 min后,对照组大鼠血清胰岛素明显升高,而MODS组升高不明显,两组比较差异具有统计学意义(P<0.01).电镜下MODS大鼠胰岛β细胞出现空泡变性,少数细胞坏死,及出现线粒体肿胀,粗面内质网扩张等一系列趟微结构病理改变.结论 MODS大鼠胰岛β细胞超微结构出现明显病理改,变,其Bax蛋白表达明显增高.MODS大鼠血糖升高可能与胰岛β细胞出现的这些改变从而导致其胰岛素分泌不足有关.     

谷氨酰胺对脓毒症大鼠心肌细胞Bcl-2/Bax表达的影响

目的 研究脓毒症大鼠心肌细胞凋亡与Bcl-2/Bax基因及蛋白表达的关系,探讨谷氨酰胺(Gin)对脓毒症心肌细胞凋亡的保护作用.方法采用内毒素(LPS 4 ms/ks)腹腔注射法制作脓毒症大鼠模型,实验地点在中山大学北校区动物实验中心.健康Sprague-Dawley(sD)大鼠72只随机分为对照组、LPS组及LPS+Gln(0.3g/kg)组,再分为0 h,6 h,12 h,24 h亚组(腹腔注射后每组成功存活至观察时间点的大鼠累积达到6只,n=6),检测各时点心肌细胞凋亡率和Bcl-2及Bax蛋白的含量,同时检测心肌Bcl-2及Bax mRNA表达.对结果进行方差分析和相关性统计分析.结果 LPS组大鼠心肌细胞凋亡率6 h、12 h及24 h均明显高于埘照组(F=186.786,P<0.01);心肌细胞Bax蛋白表达术后6 h降低(F=9.027,P<0.01),之后高于对照组;而Bcl-2蛋白表达6 h,12 h及24 h均低于对照组(F=301.142,P<0.01);Bax/Bcl-2蛋白表达比明显高于对照组(F=527.373,P<0.01);BaxmRNA和Bcl-2 6 h,12 h及24 h较对照组均明显上调(F=126.157,80.745,P<0.01).LPS+Gln组与LPS组比较,6 h,12 h及24 h心肌细胞凋亡率明显低于LPS组(F=75.187,P<0.01);Bax蛋白表达下降(F=20.981,P<0.01),而Bcl-2蛋白却升高(F 164.969,P<0.000);Bax/Bcl-2蛋白表达比降低(F=141.426,P<0.01);Bax mRNA和Bcl-2 6 h,12 h及24 h组较LPS组均明显下调(F=103.463,89.373,P<0.01).结论 Bcl-2抗凋亡基因及Bax促凋亡基因及其蛋白的表达参与脓毒症心肌细胞凋亡;应用Gln能影响凋亡相关基因及蛋白表达,减轻脓毒症心肌细胞的凋亡,改善脓毒症预后.     

谷氨酰胺对脓毒症大鼠心肌细胞Bcl-2/Bax表达的影响

目的 研究脓毒症大鼠心肌细胞凋亡与Bcl-2/Bax基因及蛋白表达的关系,探讨谷氨酰胺(Gin)对脓毒症心肌细胞凋亡的保护作用.方法采用内毒素(LPS 4 ms/ks)腹腔注射法制作脓毒症大鼠模型,实验地点在中山大学北校区动物实验中心.健康Sprague-Dawley(sD)大鼠72只随机分为对照组、LPS组及LPS+Gln(0.3g/kg)组,再分为0 h,6 h,12 h,24 h亚组(腹腔注射后每组成功存活至观察时间点的大鼠累积达到6只,n=6),检测各时点心肌细胞凋亡率和Bcl-2及Bax蛋白的含量,同时检测心肌Bcl-2及Bax mRNA表达.对结果进行方差分析和相关性统计分析.结果 LPS组大鼠心肌细胞凋亡率6 h、12 h及24 h均明显高于埘照组(F=186.786,P<0.01);心肌细胞Bax蛋白表达术后6 h降低(F=9.027,P<0.01),之后高于对照组;而Bcl-2蛋白表达6 h,12 h及24 h均低于对照组(F=301.142,P<0.01);Bax/Bcl-2蛋白表达比明显高于对照组(F=527.373,P<0.01);BaxmRNA和Bcl-2 6 h,12 h及24 h较对照组均明显上调(F=126.157,80.745,P<0.01).LPS+Gln组与LPS组比较,6 h,12 h及24 h心肌细胞凋亡率明显低于LPS组(F=75.187,P<0.01);Bax蛋白表达下降(F=20.981,P<0.01),而Bcl-2蛋白却升高(F 164.969,P<0.000);Bax/Bcl-2蛋白表达比降低(F=141.426,P<0.01);Bax mRNA和Bcl-2 6 h,12 h及24 h组较LPS组均明显下调(F=103.463,89.373,P<0.01).结论 Bcl-2抗凋亡基因及Bax促凋亡基因及其蛋白的表达参与脓毒症心肌细胞凋亡;应用Gln能影响凋亡相关基因及蛋白表达,减轻脓毒症心肌细胞的凋亡,改善脓毒症预后.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.