新生儿窒息与羊水粪染的临床研究

将 8 2例孕龄在 37～ 42周新生儿窒息及其羊水情况、电脑胎儿胎心监护进行分析 ,研究新生儿窒息与羊水粪染的关系。结果 :新生儿窒息与羊水粪染有关。新生儿轻度窒息组羊水粪染为Ⅰ～Ⅱ度的比例高 ,而新生儿重度窒息组羊水粪染为Ⅲ度的比例高 (P <0 .0 5 ) ;Ⅲ度羊水粪染者胎心监护的异常发生率明显高于羊水清亮或Ⅰ度羊水粪染者 (P <0 .0 1) ;电脑胎心监护对新生儿窒息的预测准确率为 46 .34 %。结论 :新生儿窒息的发生与羊水粪染的程度有关。一旦出现羊水粪染Ⅲ度应立即结束分娩 ,出现羊水粪染Ⅰ～Ⅱ度时 ,要在胎心监护下密切观察产程的进展 ,一旦出现异常尽快结束分娩 ,以便降低新生儿窒息的发生率 ,减少围产儿死亡率     

妊高征患者瘦素水平测定及与胎儿发育的关系

目的研究妊高征患者及其新生儿脐血瘦素水平,以探讨瘦素在妊高征发病中的意义及其与胎儿宫内发育的关系.方法正常孕妇,轻、中、重度妊高征患者各10例,分别于入院后抽取肘前静脉血,分娩时抽取脐静脉血测定瘦素水平.结果正常妊娠组,轻、中、重度妊高征组母血瘦素分别为21.07±5.79ng/ml,19.84±6.19 ng/ml,25.31±6.34ng/ml,30.16±6.78ng/ml;脐血瘦素分别为4.20±2.04ng/ml,3.54±1.95ng/ml,6.32±1.60ng/ml,8.51±2.31 ng/ml;胎儿体重分别为3160±368.03g,3140±441.46g,2920±548.33g,2670±539.65g.正常妊娠组与轻度妊高征组母血及脐血瘦素水平比较均无显著性差异(P＞0.05);重度妊高征组较中度妊高征组母血及脐血瘦素水平均增高,差异有显著性(P＜0.01,P＜0.05);中度妊高征组较对照组(轻度妊高征组及正常妊娠组合并)母血及脐血瘦素水平也均增高,差异也有显著性(P＜0.05,P＜0.01).重度妊高征组母血瘦素与脐血瘦素水平呈显著性正相关(r=0.9,P＜0.01),其余各组均无此相关性.重度妊高征组新生儿体重低于正常妊娠组,差异有显著性(t=2.37,P＜0.05),其余各组间比较均无显著性差异.各组脐血瘦素水平均与新生儿体重呈正相关.结论妊高征患者母血、脐血瘦素均有随病情逐渐增高的趋势,瘦素参与妊高征的发病;重度妊高征时胎盘瘦素可能是脐血瘦素的来源之一并有促进胎儿宫内发育的作用.     

脐血流S/D比值检测联合胎心监护预测胎儿宫内缺氧的价值

目的 探讨超声检测脐动脉血流速度收缩期末以及舒张期末峰值（S/D）合并胎心监护技术预测胎儿宫内缺氧的价值。方法 回顾性分析2017年2月~2019年1月我院接受产检的68例产妇的临床资料,均接受脐血流检测S/D比值合并胎心监护方式,根据参考检测数据将所有产妇分成四组:A组（反应型与S/D＜3）23例,B组（反应型与S/D≥3）17例,C组（无反应型与S/D＜3）14例,D组（无反应型与S/D≥3）14例,分析胎心监护与脐血流S/D比值检测结果,比较四组胎儿宫内缺氧及Apgar评分、羊水粪染程度。结果 四组胎儿宫内缺氧及Apgar评分比较,差异有统计学意义（P＜0.05）;D组胎儿宫内缺氧率及新生儿窒息率高于其他三组,差异有统计学意义（P＜0.05）。A组、B组、C组羊水清亮率及羊水粪染程度比较,差异无统计学意义（P＞0.05）;D组羊水清亮率低于其他三组,羊水粪染程度高于其他三组,差异有统计学意义（P＜0.05）。结论 脐血流S/D比值检测联合胎心监护方式可提高胎儿宫内缺氧判定精准性,进而改善妊娠结局。     

羊膜腔输液时羊水中电解质浓度变化的实验研究

目的探讨因胎儿窘迫进行羊膜腔输液时羊水中电解质浓度变化,为其临床应用提供客观依据.方法随机选择30例正常产妇作正常组,70例胎儿窘迫者作为胎儿窘迫组,其中40名行羊膜腔输液作治疗组,30名接受传统的宫内复苏治疗为对照组.取各组羊水进行渗透浓度测定分析;每例新生儿出生时行Apgar 1min及5min评分.结果胎儿窘迫组的羊水中Na 浓度和Mg2 浓度(分别为106.30±11.40mmol/L和0.36±0.11mmol/L)较正常组(128.41±11.00mmol/L和0.51±0.14mmol/L)显著降低(P＜0.005,P＜0.005);K 浓度Ca2 (分别为4.80±0.19mmol/L和1.68±0.13mmol/L)较正常组(4.14±0.29mmol/L和1.09±0.28mmol/L)显著升高(P＜0.005,P＜0.005).治疗组行羊膜腔输液后的羊水Na 浓度显著升高;而K 和Ca2 浓度则显著降低,与正常组无显著性差异(P＞0.05).Mg2 浓度无明显变化.治疗组的新生儿窒息率、因胎儿窘迫而行剖宫产率(分别为5%、2.5%)较对照组(分别为16.7%、13.3%)显著降低(P＜0.05,P＜0.05),而与正常组(分别为3.33%、6.67%)相比无显著性差异(P＞0.05,P＞0.05).结论羊膜腔输液不仅可补充适量羊水来缓解因羊水过少使胎儿受压而导致缺氧,还可通过羊水中电介质浓度的变化来改善胎儿宫内状况,是一种治疗胎儿窘迫的适宜技术.     

巨大儿孕母血清、羊水、脐血瘦素水平测定及意义

目的探讨瘦素(1eptin)与巨大儿发病的关系.方法应用酶联免疫法(ELISA)检测20例巨大儿(巨大儿组)及20例正常体重儿(对照组)孕母血清.羊水及脐血瘦素水平.结果(1)巨大儿组孕母血清瘦素平均(25.6±8.2ng/rml),羊水瘦素平均(5.9±1.7ng/m1)与对照组(18.8±7.8ng/ml)及(3.9±1.7ng/ml)比较相差显著.分别为(P＜0.05)(P＜0.01).(2)巨大儿组脐血瘦素水平平均(16.8±7.0ng/m1)明显高于对照组(7.7±4.6rg/ml)(P＜0.001).(3)两组孕母血清瘦素与胎儿出生重量无相关性,而脐血瘦素水平与胎儿出生重量呈正相关.(r=0.65,P＜0.01)结论脐血瘦素来源于胎盘及胎儿组织.巨大儿的发病与脐血瘦素水平相关.     

宫内生长迟缓新生儿脐血瘦素及甘油三酯变化的研究

目的观察宫内生长迟缓(IUGR)新生儿脐血中的瘦素(leptin)、甘油三酯(TG)水平,分析这些指标变化程度与胎儿生长的关系,探讨IUGR新生儿血脂代谢的特点.方法 77例新生儿脐血标本分为3组:(1)小于胎龄儿组( SGA):17例;(2)适于胎龄儿( AGA)组:41例;(3)大于胎龄儿( LGA)组:19例.采用高敏酶免疫分析法测定新生儿脐血中瘦素水平,全自动生化分析仪测定TG水平.各组间均数比较选用单因素方差分析,各指标与出生体重及胎龄的关系采用等级相关分析.结果 (1)脐血瘦素水平AGA、SGA、LGA 3组差异有统计学意义(F=17.75,P<0.01);SGA组(0.7147±0.5761)ng/ml显著低于AGA组(2.710±0.4329)ng/ml(P<0.01),而AGA组低于LGA组(5.687±0.3916)ng/ml(P<0.05).脐血瘦素水平随胎龄及出生体重增加而增加(r分别=0.332和0.654,P均<0.01).(2)脐血TG水平AGA、SGA、LGA 3组差异有统计学意义(F=8.85,P＜0.05);SGA组(0.7141±0.1576)mmol/l显著高于AGA组(0.5027±0.1330)mmol/l(P<0.01), 而AGA组与LGA组(0.4907±0.1397)mmol/L之间差异无统计学意义(P>0.05).TG与出生体重呈负相关(r=-0.320,P=0.050),与胎龄无相关性(r=0.129,P>0.05). (3)脐血瘦素与TG呈负相关关系(r=-0.280,P<0.05).结论 IUGR新生儿脐血瘦素明显降低,瘦素与胎龄及出生体重呈正相关.IUGR新生儿脐血TG偏高,TG与出生体重负相关,与胎龄无相关性.脐血瘦素与TG呈负相关.     

产妇与新生儿瘦素水平和新生儿体重的观察及其临床意义

探讨胎盘、羊水、新生儿脐血和产妇血清中的瘦素水平与胎儿体重和妊高征的关系.采用放射免疫分析法,分别检测59名产妇胎盘、羊水、新生儿脐血和产妇血清中的瘦素水平,并对其结果进行t检验.结果是:(1)正常产妇胎盘、羊水、新生儿脐血和产妇血清中的瘦素水平分别为27.4±9.2μg/g、9.2±4.8μg/L、13.6±9.8μg/L、19.5±8.9μg/L;(2)妊高征产妇胎盘、羊水、新生儿脐血和产妇血清中的瘦素水平分别为36.5±8.5μg/g、15.3±3.9μg/L、19.8±5.6μg/L、29.3±11.7μg/L.妊高征组与正常产妇组的胎盘、羊水、新生儿脐血和产妇血清中的瘦素水平有显著性差异(P＜0.01),检测孕妇血清和羊水中的瘦素水平,对于评估胎儿的发育和体重、妊高征的治疗和预后具有重要意义.     

硬膜外分娩镇痛的临床研究

目的:探讨硬膜外分娩镇痛效果及其对产程、母婴状况的影响.方法:将0.1%布比卡因及芬太尼5 μg/ml混合液硬膜外分娩镇痛的300例产妇作为镇痛组,将未用任何镇痛药的300例产妇作为对照组,比较两组的产痛程度、产程时间、分娩方式、产后出血量、羊水粪染率、新生儿窒息及缩宫素应用等.结果:镇痛组300例产妇中显效90.33%(271/300),有效9.67%(29/300),总镇痛有效率100%;镇痛组的活跃期和第二产程时间短于对照组,差异有显著性意义(P＜0.01);镇痛组自然分娩率明显高于对照组(P＜0.05),剖宫产率则以对照组为高(P＜0.05);两组羊水粪染率、新生儿窒息、Apgar评分、产后出血量及缩宫素应用的比较无显著性差异(P＜0.05).结论:硬膜外分娩镇痛是一种理想的、安全有效的分娩镇痛方法.     

妊娠期肝内胆汁淤积症的瘦素水平

目的探讨血清中瘦素与肝内胆汁淤积症(ICP)关系、发病原因.方法采用放射免疫法检测76例(观察组)ICP孕妇血清中瘦素水平与正常孕妇(对照组)血清瘦素水平;ICP孕妇的血清中瘦素水平与不同孕周、羊水污染程度的相关性.结果1.观察组76例ICP孕妇瘦素水平为(31±8.1)ng/ml,对照组正常孕妇血清瘦素水平(24.±6.3)ng/ml,两组比较有极显著性差异(P＜0.01).2.观察组按孕妇的孕周分为30.1～35w、＞35w两组,分别为48例与28例,其瘦素水平为(32.4±4)ng/ml、(32.5±7.6)ng/ml,两组比较无显著差异(P＞0.05).3.观察组共76例,ICP合并羊水Ⅲ度污染30例与无羊水Ⅲ度污染46例比较瘦素水平,分别为(35.4±6.1)ng/ml、(29.8±7.5)ng/ml,即瘦素水平ICP合并羊水Ⅲ度污染明显高于ICP无合并羊水Ⅲ度污染的孕妇,有显著差异(P＜0.05).ICP孕妇血清中瘦素水平与各不同孕周相关指数(0.22;P＞0.05)无相关性;而ICP孕妇血清中瘦素水平与羊水污染程度相关指数(0.67;P＜0.01)有明显的相关性.结论ICP与瘦素有着密切的关系,即瘦素与ICP疾病在免疫功能失常、雌激素发病学说有相关联系,以及在胎盘缺氧时反映出来的瘦素水平升高,有助于我们对ICP合并胎儿窘迫进行监察,可作为临床观察指标.     

浅析羊水Ⅲ度污染的产科处理方法

目的 探讨羊水胎粪污染的产科处理的时机与方法.方法 对2006年10月～2008年10月在我院分娩1636例产妇中,羊水有胎粪污染的足月妊娠的产妇431例,进行回顾性分析,其中破膜时羊水粪染(A组)319例,产程中羊水由清亮变为胎粪污染(B组)112例,随机选择对同期产程中羊水清亮的430例足月妊娠的产妇作为对照组.结果 羊水胎粪污染的发生率26.34%,粪染组在母体合并症,胎监异常,脐血流异常,新生儿窒息及剖宫产率均高于对照组.A组脐血流异常明显高于B组,B组胎心监护异常及新生儿窒息明显高于A组,A、B两组间母体并发症,剖宫产无明显差异.羊水胎粪污染组中剖宫产与阴道分娩的新生儿窒息率有显著差异.结论 重视羊水胎粪污染的临床处理.在伴发母体并发症,脐血流异常,胎心监护异常情况下,及产程中羊水由清亮变为粪染时处理需积极,应该及早剖宫产为宜.如果是经产妇可在严密监护下阴道分娩.     

MRI图像均匀度评价方法的研究

本计ＭＲＩ图像均匀度的评价方法作了改进，即利用信噪比均匀度作辅助评价与信号强度均匀度相结合对图像均匀工作更加合理的评价。利用此方法检测了高场、中场和低场的ＭＩＲ成像设备，对此方法作了验证，说明了引方法的有效性。     

男性不育治疗技术的研究进展

卵细胞浆内单精子显微受精(intracytoplasmic sperm injection,ICSI)[1]技术的成功应用,给男性不育的治疗带来了革命性的突破,近几年ICSI技术不断改进和完善,出现了外科手术法从睾丸和附睾取精(testicular sperm extraction,TESE)[2,3]与ICSI相结合技术(TESE-ICSI)[4],睾丸和附睾抽吸精子(testicular sperm aspiration,TESA)与ICSI相结合技术(TESA-ICSI)[5,6]以及TESE-ICSI与冷冻精子相结合技术[7].尽管男性不育治疗技术在不断完善和成熟,但是仍然有许多问题还未解决.     

不同鞋条件对后跟着地跑者跟腱负荷特征的影响

目的 探究不同鞋条件（极简鞋和传统跑鞋）对跑步时跟腱负荷特征的影响。方法 招募16名健康男性后跟着地跑步爱好者,要求其以3.16~3.50 m/s速度在两种鞋条件下完成跑步实验。采用超声影像仪获取跟腱横截面积成像。采用运动捕捉系统和三维测力台获取踝关节矢状面运动学和地面反作用力数据,并计算踝关节和跟腱的力学参数。采用配对样本t检验比较两种鞋条件对各因变参数（踝关节角度、触地角度、跟腱力、应力、应变等）的影响。结果 与传统跑鞋相比,穿着极简鞋时的足触地角度显著降低39.9%。同时,踝关节力矩、跟腱力峰值、跟腱负载率峰值和平均负载率均显著增加,而达到跟腱力峰值的时间显著减小。穿着极简鞋时的跟腱应力峰值、跟腱应变峰值及其应力率和应变率峰值也显著增加。结论 习惯穿着传统跑鞋并采用后跟着地的跑者在穿着极简鞋后显著增加了跟腱的负荷特征,建议该类跑者循序渐进地过渡至极简鞋,以适应性地提高跟腱承受负荷的能力。     

大学生罗杰斯自我意象心理测评结果

目的：了解和评价大学生人格中自我意象的心理健康水平和影响其心理水平的相关因素。方法：对１８３名工大学生做随机抽样,采用香港中文大学林孟平编制的”罗杰斯自我意象问卷（ＲＳＩＱ）”做心理测验,全部数据用ＳＰＳＳ做统计分析。结果：５３．０１％的学生为高自我意象,４６．９９％为低自我意象。     

房室瓣骑跨的形态分析

对１０例先天性畸形心脏的房室瓣骑跨进行形态分析，其中７例为三尖瓣骑跨，２例为二尖瓣骑跨和１例为两侧室瓣骑跨，９例属完全性骑跨和１例属不完全性骑跨。除去瓣骑跨外，房室瓣还伴有瓣，降落伞形，囊状副瓣，异位乳头肌和异位腱索等畸形。     

Die Wand der primären Hydrozele des Kindes

Zusammenfassung Die primäre Hydrozele des Kindes ist charakterisiert durch ein ausgeprägtes Wandödem, als dessen Ursachen fehlende Lymphgefäße und venöse Stauung angesehen werden müssen. Die morphologischen und klinischen Unterschiede zwischen Säuglingsund Klemkindhydrozelen sprechen für die Annahme, daß das pathologisch gesteigerte Filtrat der verquollenen Lamina parietalis der Tunica vaginalis testis bei vorzeitigem Verschluß des Processus vaginalis peritonei nicht in die Bauchhöhle drainiert werden kann und somit zur Hydrozele führt.

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The wall of primary hydrocele in childhoodLight and electron microscopic findings

Summary Hydroceles of infants and children are characterized by edematous wall-thickening, caused by lacking lymph vessels and venous congestion. The morphologic and clinical differences between hydroceles of infants and children favor the following hypothesis: Pathologically increased filtration of fluid from the parietal tunica vaginalis can't be drained into the peritoneal cavity because the processus vaginalis closes too early and gives raise to hydrocele.

Fräulein B. Höltken und Frau B. Moraw danken wir für ihre Mitarbeit. Der Deutschen Forschungsgemeinschaft danken wir für Sachbeihilfe.     

Vascular tumors of bone: A study of 17 cases other than ordinary hemangioma,with an evaluation of the relationship of hemangioendothelioma of bone to epithelioid hemangioma,epithelioid hemangioendothelioma,and high-grade angiosarcoma

Cases filed as vascular tumor of bone other than ordinary hemangioma were reviewed. They were included in the study if there was adequate histologic material and clinical information, clear evidence of bone origin, and at least 5 years follow-up. The study group comprised 17 cases, of which 13 were categorized as hemangioendothelioma of bone, 1 as epithelioid hemangioendothelioma, and 3 as high-grade angiosarcoma. Hemangioendothelioma of bone had growth patterns varying from vasoformative to solid, but well-formed vessels were present in at least some area in all cases. The cells generally had a rounded, epithelioid character, regular nuclei, and relatively few mitotic figures; occasional features included spindle cells and scattered enlarged, hyperchromatic or pleomorphic nuclei. Lymphoplasmacytic and eosinophilic inflammatory infiltrate ranged from prominent to slight or absent, and myxoid or hyaline stroma was never more than focal. Epithelioid hemangioma could not be separated from hemangioendothelioma of bone. The single epithelioid hemangioendothelioma for the most part had cords of relatively uniform epithelioid cells in a prominent myxoid stroma but focally demonstrated an angiosarcoma-like appearance, with irregular vascular spaces and marked nuclear pleomorphism. The high-grade angiosarcomas exhibited predominantly irregular vasoformation combined with solid areas, diffuse nuclear hyperchromatism and pleomorphism, and, in 2 cases, numerous mitotic figures (the third case had only a small biopsy and a postradiation amputation specimen). Of the hemangioendotheliomas of bone, 7 were unicentric and 6 were regionally multicentric either concurrently or sequentially. Three patients had intraosseous local recurrence, 2 had discontinuous regional skin or soft tissue involvement (including the popliteal artery in 1), and 1 had a solitary lung metastasis, but none died of tumor. The patient with epithelioid hemangioendothelioma had multicentric tumors in widely separated bones and died with liver and lung metastases. Two of the high-grade angiosarcomas were unicentric, and the third was regionally multicentric, with a popliteal artery-soft tissue component as well. All 3 of these patients died with metastases in various sites.     

Age of puberty: data from the United States of America

In an attempt to determine whether the secular trend toward an earlier onset of puberty has continued over recent decades in the United States of America, published reports concerning the age of attainment of pubertal events have been reviewed. Such reports are very limited and vary in both design and inclusive ages of study subjects. Among females, two recent large cross-sectional studies indicate that fifty percent of females in the United States attain Tanner breast stage 2 at 9.5 to 9.7 years of age. This is younger than previously thought, although adequate earlier studies of girls in the United States are not available for comparison. These two studies also indicate that about 14% of girls attain Tanner stage 2 while 8 years of age; one study extends earlier reporting that about 6% exhibit onset of breast development while 7 years of age. There is no evidence that the age of menarche or the attainment of adult (Tanner 5) breast development has decreased over the past 30 years. The data also suggest an earlier onset of Tanner stage 2 pubic hair but no change in attainment of stage 5. Among males, pubic hair may be appearing at younger ages, but data are inadequate or too inconsistent to allow firm interpretation. The lack of standardization of genital criteria of pubertal onset in the male makes any conclusions regarding secular trends impossible. In summary, earlier secular trends over recent decades related to better health, improved nutrition or socio-economic status, or any putative influence by endocrine disrupters cannot be verified.