妊娠合并心脏病67例临床观察

1.本文分析我院10年半妊娠合并心脏病的病案。妊娠合并心脏病之孕妇占同时期产科住院人数的0.85%;心脏病孕产妇病死率为1.5%。2.心脏病中以风湿性心脏病占绝大多数,为86.5%。3.经产妇及过去有心力衰竭史者,妊娠期中发生心力衰竭之机会较多。并发心房颤动及风湿热者,容易引起心力衰竭。心力衰竭发生的时间多在妊娠24——36周。4.心力衰竭之产妇,早产率较无心力衰竭者为高;婴儿病死率为4.2%。5.分娩方式以自产为主,辅以钳产。6.文中对妊娠各期之处理加以讨论。     

心力衰竭对晚期妊娠合并心脏病孕妇母婴妊娠结局的影响

目的:分析心力衰竭对晚期妊娠合并心脏病孕妇的分娩方式及母婴预后的影响。方法:对2012年1月～2016年1月在北京大学首钢医院产科住院分娩的166例晚期妊娠合并心脏病孕妇的临床资料进行回顾性分析,分析其分娩方式及妊娠结局,阐述心力衰竭对晚期妊娠合并心脏病孕妇母婴妊娠结局的影响。结果:166例研究对象中,晚期妊娠合并心脏病伴心力衰竭孕妇的分娩孕周明显小于无心力衰竭孕妇,先天性心脏病和妊娠期高血压性心脏病是晚期妊娠合并心脏病伴心力衰竭的常见心脏病类型。心力衰竭组孕产妇的剖宫产率、围产期出现妊娠期高血压、感染、低蛋白血症、胎儿生长受限(FGR)、早产、新生儿窒息、低出生体重、孕产妇及围产儿死亡的发生率均明显高于无心力衰竭组,差异有统计学意义(P<0.05)。结论:晚期妊娠合并心脏病伴心力衰竭孕妇的剖宫产率明显升高,其母儿预后不良。对于妊娠合并心脏病的孕妇应积极改善心功能状态,避免出现心力衰竭,有助于降低不良母婴妊娠结局的发生率,提高母婴的存活率。     

妊娠合并心脏病的护理

<正> 心脏病患者妊娠后,由于妊娠、分娩和产褥期的一系列变化,使心脏负担明显增加,易发生心力衰竭,我院自1991—1999年内,共收治了妊娠合并心脏病产妇168例,占我院同时期产科住院总数22562例的0.74％。因此,加强对心脏病孕产妇的护理,控制心衰的发生,对减少母婴的死亡率具有重要意义。     

妊娠合并心脏病79例临床预后分析

目的探讨妊娠合并心脏病对母婴预后影响的因素。方法对79例妊娠合并心脏病患者（包括双胎妊娠3例）的临床资料进行回顾性分析。结果妊娠合并心脏病患者中以心律失常、先天性心脏病和风湿性心瓣膜病为主,分娩方式与妊娠结局：剖宫产占78％;围生儿82例中低体质量儿23例,新生儿苍白窒息1例,围生儿死亡2例,孕产妇死亡1例。结论妊娠合并心脏病患者的母婴预后与心功能级别和抗心力衰竭处理密切相关。剖宫产为比较安全的分娩方式。     

全程护理干预在妊娠合并心脏病孕妇围生期中的临床应用

目的 探讨妊娠合并心脏病孕妇围生期实施全程护理干预措施的效果.方法 我院2010年1月—2016年3月收治23例妊娠合并心脏病患者,予一般护理、饮食指导、体位指导及心理护理等产前护理、产时护理、产后护理,及出院指导等全程护理干预措施.结果 23例妊娠合并心脏病孕妇中,阴道分娩11例,剖宫产12例.3例孕妇发生心力衰竭,经抢救后均好转,无孕产妇因心力衰竭或产科因素死亡.新生儿窒息2例,1例因重度窒息死亡.结论 加强妊娠合并心脏病孕妇的围生期监护,注意产前、产时及产后的观察及护理,可降低其心力衰竭发生率,改善母婴结局.     

41例妊娠合并心脏病的临床分析

妊娠合并心脏病仍是当前威胁孕产妇及四。产儿生命严重的产科问题，防治心脏病孕产妇心力衰竭是降低其死亡率的关键。本文分析了我院产科19SS—1993年6年间41例妊娠合并心脏病的孕产妇处理，强调加强产前保健、选择恰当的分娩方式及产时产后监护与防治心衰的重要性。1临床资料1．1发生率。1088～1993年，我院共收治孕产妇8210入，共中妊娠合并心脏病41人，占产妇总数0．425％，发生心衰者22人，占妊娠期心脏病53．65％，经治疗无一人死亡。1．2年龄、胎次与日产儿消况：年龄20～25岁10人，26～30岁20人，31～34岁6人，35岁以上5人。第1胎21…     

妊娠合并心脏病影响母儿预后因素的探讨

目的探讨妊娠合并器质性心脏病患者影响母儿预后的因素。方法对我院１０ａ间４６例妊娠合并器质性心脏病患者的有关临床资料进行回顾分析。结果心脏病孕产妇只有１例死亡，病死率２１．７４‰，围生儿病死率为６９．７６‰，较一般围生儿病死率１２．９‰高５．４倍。孕前未行外科手术者，发生心力衰竭者明显多于已行手术者，早产儿、胎儿生长发育迟缓（ＩＵＧＲ）及死胎发生率亦明显高于后者。本组剖宫产率为３０．２％，其中心功能Ⅲ、Ⅳ级者４例，占９．３％。２５例阴道分娩者发生心衰死亡１例，而剖宫产的１８例病人无１例死亡。结论心脏病孕妇，尤其是发生过心力衰竭的孕妇，其胎儿的预后较正常孕妇的胎儿差。器质性心脏病患者在妊娠前经治疗心功能Ⅰ～Ⅱ级者能胜任妊娠。改善母婴预后的关键在于积极防治各种并发症，根据产时产科情况及心脏功能，适时终止妊娠可获良好的妊娠结局。     

妊娠合并心力衰竭16例诊治体会

妊娠合并心力衰竭１６例诊治体会海门县人民医院妇产科倪贤才妊娠合并心脏病是产科严重合并症之一，而心力衰竭是妊娠合并心脏病最常见的死亡原因。因此及时诊断、妥善处理各种妊娠心脏病，防治心脏病孕产妇心力衰竭成为提高产科安全度，降低孕产妇死亡率的重要内容。本文...     

49例妊娠合并心脏病的临床分析

目的：探讨妊娠舍并心脏病的临床治疗。方法：本文对我院49例妊娠合并心脏病临床资料进行回顾性分析。结果：49例妊娠合并心脏病患者阴道分娩14例,占28．57％,剖宫产35例,占71．43％。其中心功能Ⅲ-Ⅳ级者18例,行剖宫产16例．剖宫产率高迭88．89％,明显高于心功能Ⅰ～Ⅱ级者（P〈O．01）。孕产妇死亡1例,死亡率2．04％,围产儿死亡5例,死亡率10．20％。结论：妊娠合并心脏病孕妇分娩方式主要取决于心功能等级及产科情况。早期预防,及时诊断,正确治疗,适时行剖宫产可以降低孕产妇及围产儿死亡率。     

妊娠合并心脏病患者分娩期间的观察及护理

妊娠合并心脏病是产科的严重并发症，由于妊娠和分娩加重了心脏的负担，使心脏功能进一步减退而导致心力衰竭，严重影响母婴安全。我院自2002年4月～2004年6月共收治此类患者10例，安全分娩9例，出现心衰死亡1例。现报道如下。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.