脐带异常对围产产儿影响

目的探讨脐带异常对围产儿影响情况。方法采用回顾性分析的方法,分析我院住院分娩产妇临床资料,依据是否发生脐带异常分为脐带异常组和非脐带异常组。结果脐带缠绕在脐带异常发生率所占比例最高,孕周多在29～42周,脐带异常产妇胎儿头位异常率高于臀位异常率,胎儿均有不同程度的胎儿宫内生长迟缓,脐带异常产妇围产儿死亡率、胎儿宫内窘迫、新生儿窒息率均明显高于非脐带异常组,P〈0.05,差异均有统计学意义。结论对于脐带异常病例要密切观察,及时准确的诊断,同时作出相应的处理措施,对于降低围产儿的发病率和死亡率具有重要的临床意义。     

孕妇肝功能异常与妊娠并发症的关系及对围生儿生存质量的影响

目的:探讨孕妇肝功能异常与妊娠并发症的关系,并分析肝功能异常对围生儿生存质量的影响。方法:选取150例肝功异常孕妇为研究对象,将其归为观察组,再选取同期148例体检正常孕妇为对照组,对比两组孕妇妊娠并发症发生率、围产儿情况及围产儿生存质量。结果:观察组妊娠并发症中产后出血的发生率、妊娠高血压疾病(PIH)发生率显著高于对照组,差异有统计学意义(P<0.05),胎儿生长受限(FGR)、羊水粪染、胎儿窘迫的发生率显著高于对照组,差异有统计学意义(P<0.05),有妊娠并发症的患者FGR、羊水粪染、胎儿窘迫的发生率显著高于无妊娠并发症的孕妇,差异有统计学意义(P<0.05)。结论:孕妇肝损程度越严重,对母婴安全的威胁越大,且与妊娠并发症中高血压疾病、产后出血等有相关性,故孕期加强孕妇肝功检测,对预防并发症及提高围生儿生存质量均有积极作用。     

脐带异常对围产儿的影响

目的 :分析脐带异常对围产儿影响 ,采取措施 ,降低围产儿窒息率和死亡率。方法 :采用统计学分析 193例脐带异常组与 674例无脐带异常组对围产儿影响 ,分类分析脐带异常与围产儿预后。结果 :脐带异常组致胎儿窘迫 ,新生儿窒息 ,围产儿死亡 ,IUGR发生率明显高于无脐带异常组 ,(P<0 .0 1)。各类脐带异常中 ,对围产儿预后影响最大的是脐带脱垂和脐带扭转。结论 :脐带异常是影响围产儿生长和预后的重要因素。脐带脱垂、脐带扭转是造成围产儿死亡的主要原因。加强高危妊娠管理 ,综合监测是降低围产儿窒息率、死亡率的具体措施。     

脐带缠绕分娩方式及围产儿结局的临床观察

目的探析脐带缠绕的分娩方式及围产儿结局。方法选取我院2015年3月至2017年3月期间收治的80例脐带缠绕孕妇为观察组,选取同期无脐带缠绕的80例正常孕妇为对照组,对两组孕妇分娩方式及围产儿结局进行统计比较。结果观察组孕妇剖宫产率为26.3%,会阴侧切率为37.5%,高于对照组孕妇的11.3%、12.5%,对比具有统计学差异(P0.05)。观察组胎儿窘迫发生率为35.0%,新生儿窒息发生率为8.8%,高于对照组的12.5%、1.3%,比较具有统计学差异(P0.05)。脐带缠绕1周的剖宫产率为7.5%(6/80),脐带缠绕2周及以上的剖宫产率为18.8%(15/80),比较具有统计学差异(P0.05)。结论脐带缠绕易致使孕妇难产,使得剖宫产率上升,且缠绕周数越多,剖宫产率越高,同时也是胎儿窘迫、新生儿窒息的重要诱因,所以,必须加强产前、产中监护,改善围产儿结局。     

脐带附着异常610例临床分析

目的探讨脐带附着异常对围产结局的影响。方法回顾脐带附着异常的孕妇610例,包括帆状胎盘145例,球拍状胎盘465例,统计分析妊娠期并发症和围产结局。结果脐带附着异常的发生率为4.1%;其中帆状胎盘占23.8%,球拍状胎盘占76.2%;帆状胎盘孕妇胎儿生长受限、胎儿畸形发生率明显高于球拍状胎盘组（P〈0.05）,两组在妊娠期高血压疾病、胎儿窘迫、新生儿窒息及产后出血差异均无统计学意义（均P〉0.05）,两组剖宫产率差异无统计学意义（P〉0.05）。结论脐带帆状附着增加胎儿生长受限及畸形率,且新生儿入住新生儿重症监护室比率明显增加。脐带附着异常对母亲无明显影响,但剖宫产率增加,脐带附着异常并非剖宫产绝对指征,手术指征以产科指征为主,有胎心监护异常或前置血管等可能,建议剖宫产终止妊娠。     

妊娠晚期胎心监护的非应激性试验临床研究

目的探讨妊娠晚期胎心监护对临床的应用价值。方法选择280例胎心监护非应激性试验（NST）异常孕妇为观察组，抽取同期270例胎心监护（NST）正常孕妇作为对照组，分析两组孕妇妊娠合并症的发生率，胎心率监测结果及围产儿死亡率。结果观察组孕妇妊娠合并症明显高于对照组（P〈0．05）。观察组新生儿窒息和低体重儿的发生与对照组有显著性差异（P〈0．05），羊水污染和围产儿死亡率无显著差异（P〉0．05）。结论NST是妊娠晚期产前胎儿电子监护的有效方法可提前筛选预测胎儿宫内窘迫，为临床做出前瞻性诊断，改善围产儿预后。     

脐带绕颈对妊娠结局影响的探讨

目的探讨脐带绕颈最佳分娩方式的选择和对围产儿结局的影响。方法收集2008年1月-2013年1月五年间在焦作市人民医院住院终止妊娠的足月、头位、无产科并发症及并发症、单胎伴脐绕颈的病例资料,其中选取89例脐绕颈≥2周的病例作为观察组,选取162例脐绕颈1周的病例作为对照组,回归分析比较两组孕妇胎儿窘迫、新生儿窒息、死产率及剖宫产率。并比较脐带绕颈周数不同与分娩方式的关系。结果观察组的孕妇胎儿窘迫率、新生儿窒息率、死产率均高于对照组的孕妇,差异有统计学意义(P<0.05)。对照组的病例阴道分娩组与剖宫产组对围产儿的影响无统计学差异,观察组的孕妇自然分娩组胎儿窘迫率、新生儿窒息率、死产率均高于剖宫产组。结论脐带绕颈周数越多,围产儿并发症越高。脐带绕颈1周,可阴道试产,脐带绕颈≥2周的孕妇宜选择剖宫产终止妊娠。     

重度子痫前期子痫对母婴的临床影响分析

目的探讨重度子痫前期子痫对母婴的影响。方法 2009年3月-2012年5月我院收治50例重度子痫前期患者,给予解痉等为主的治疗,将其作为观察组,另随机选取同期50例健康孕妇作为对照组,比较两组孕妇围产儿的死亡率等结果。结果两组孕妇在并发症方面：观察组明显高于对照组,其差异具有统计学意义（P〈0.05）,两组围产儿预后情况比较发现,观察组预后明显较差,其差异具有统计学意义（P〈0.05）。结论降低重度子痫前期子痫的发生要做好妊娠期疾病的预测及治疗,同时选择适当时机终止妊娠可降低母婴并发症,保证母亲安全。     

妊娠晚期脐带过度扭转的临床观察与处理

目的通过分析脐带过度扭转对妊娠结局的影响,寻找正确处理的方法,降低其对围产儿的危害,提高围产儿存活率。方法选取2008年1月至2012年12月5年间妊娠晚期诊断脐带过度扭转175例已分娩产妇为观察组,随机选取同期脐带正常且无并发症200例已分娩产妇为对照组,采用回顾性分析的方法,比较两组妊娠结局。结果观察组胎儿生长受限、羊水过少、胎儿窘迫、死胎、死产发生率、剖宫产率明显高于正常对照组,差异有统计学意义。结论脐带过度扭转是导致胎儿窘迫及围产儿死亡的原因之一,应加强孕期监护,及早发现异常,适时终止妊娠,能提高围产儿质量。     

脐带异常与围产儿预后的临床研究

目的探讨脐带异常与围生儿的关系。方法选择191例脐带异常者为异常组进行回顾分析,并以同期186例脐带正常者作为对照组进行比较。结果 786例胎儿中,脐带绕颈所占比例最高为62.8%,异常组和对照组的剖宫产率分别为82.2%和50.7%,有显著性差异（P〈0.05）。异常组胎儿窘迫的发生率明显高于对照组,差异有统计学意义（P〈0.05）。结论脐带异常可致胎儿宫内窘迫、新生儿窒息、死胎,产前检查可以降低其对胎儿的不利影响。     

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.