孕期肥胖与妊娠并发症及分娩结局的关系

目的 探讨孕期肥胖与妊娠并发症及分娩结局的关系。方法测量586例足月单胎初产妇的身高、体重和孕期体重增长情况,如早孕期体重指数（BMI）≥24。分娩时BMI≥27则为肥胖。观察肥胖孕妇的妊娠并发症、分娩方式、产程以及产后出血、新生儿窒息、巨大儿发生情况。结果①孕期肥胖的妇女妊娠期糖尿病、妊娠高血压疾病以及产后出血产褥期感染的发生率与对照组比较差异有统计学意义;②孕期肥胖的孕妇总产程、产程异常发生率、剖宫产率、阴道助产率、巨大儿和新生儿死亡、窒息的发生率与时照组相比差异有统计学意义。结论孕期肥胖导致妊娠并发症增加,产程延长和手术产率增加。     

孕前肥胖及孕期体重增长过度与妊娠并发症及分娩结局的关系探讨

目的：探讨孕前肥胖，孕期体重增长过度、孕妇妊娠期并发症的发生以及其分娩结局的关系。方法：测量1118例足月单胎初产妇孕前的身高、体重和孕期体重增长情况，计算孕前体重指教。并分别观察肥胖孕妇的妊娠期并发症、分娩方式、产程以及产后出血、新生儿窒息、巨大儿发生情况。结果：①孕前肥胖及孕期体重增长过度的孕妇妊娠期糖尿病、妊娠期高血压疾病以及早产的发生率与对照组比较差异有显著性；②孕前肥胖及孕期体重增长过度孕妇总产程、产程异常发生率、剖宫产率、产钳助产率、巨大儿和新生儿窒息的发生率以及围生儿死亡率与对照组比较差异有显著性。结论：孕前肥胖及孕期体重过度对孕产妇和新生儿均产生不利影响，增加了妊娠期、分娩期并发症和增高了难产发生率。     

孕期肥胖对分娩过程及结局的影响

目的：探讨孕妇孕期肥胖对分娩方式及分娩过程所产生的影响,以尽量避免不良结果的发生。方法：选取2004年1月～2006年1月在我院门诊建卡产检至住院分娩的足月单胎初产妇1803例,其中符合孕前肥胖（体重指数BMI≥25kg/m2）及孕期肥胖（孕期体重增长≥15kg）的孕妇110例（6.10%）作为观察组,随机从其余孕妇中抽取280例作为对照组。观察两组肥胖孕妇的分娩方式、产程、宫口扩张速度及产后出血、新生儿窒息、巨大儿发生情况。结果：肥胖孕妇的产程异常率、宫口扩张速度、产后出血、巨大儿、新生儿窒息率与对照组比较,有显著性差异或非常显著性差异（P〈0.05或P〈0.01）。结论：孕期肥胖对产妇和新生儿均产生不利影响,增加了难产发生率、产程延长、产后出血及新生儿窒息的发生率。     

孕期体重管理对妊娠结局的影响研究

目的探讨孕期体重管理对妊娠结局的影响。方法收集2015年1月～2017年10月期间在我院进行孕期体检的初孕产妇350例,按照是否给予孕期体重管理分为两组,每组175例。对照组常规孕检,未实施体重管理;研究组在对照组的基础上实施体重管理,比较两组不同孕周BMI值;妊娠期高血压、妊娠期糖尿病、巨大儿、产后出血、胎儿宫内窘迫情况及分娩方式。结果研究组孕24周、32周、38周BMI值均低于对照组(P0.05)。研究组妊娠期高血压、妊娠期糖尿病、巨大儿、产后出血、胎儿宫内窘迫发生率均低于对照组,自然分娩率高于对照组(P0.05)。结论体重管理能够将孕妇BMI增长控制在正常范围内,有效降低妊娠期高血压、巨大儿等发生率,孕妇的分娩结局更好。     

孕期体重增幅与妊娠结局的相关性分析

目的 分析孕期体重增幅与妊娠结局之间的相关性.方法 选择2014年8月—2015年8月孕前18.5≤BMI≤23.9的150例孕妇,根据孕妇孕期体重增加情况分为增重过多组和对照组,观察2组孕妇妊娠期糖尿病、剖宫产、妊娠期高血压、巨大儿、新生儿窒息以及产后出血等的发生率.结果 增重过多组妊娠期糖尿病、妊娠期高血压、产后出血、新生儿窒息以及巨大儿等发生的概率均明显高于对照组,差异具有统计学意义(P<0.05).结论 孕期体重增幅与妊娠结局之间具有相关性,孕妇应合理控制孕期饮食,控制孕期体重增长幅度,防止孕期体重过度增长.     

助产士门诊对提高自然分娩率的影响

目的：探讨助产士门诊的开展对初产妇实施孕期干预支持的效果。方法：选择2016年1月至2016年10月妊娠期接受过助产士门诊孕期及产前健康指导分娩的单胎头位初产妇500例为观察组,同期妊娠期未接受过助产士门诊孕期及产前健康指导分娩的单胎头位初产妇500例为对照组。对照两组产妇的分娩方式、产后出血、妊娠期合并糖尿病及巨大儿发生情况进行比较。结果：观察组产妇的自然分娩情况高于对照组（P＜0．01）,产后出血、妊娠期合并糖尿病及巨大儿发生情况均低于对照组（P＜0．01）。结论：助产士门诊对促进自然分娩,降低剖宫产率,减少产后出血、妊娠期合并糖尿病及巨大儿发生有积极的作用。     

经产妇巨大儿相关因素及妊娠结局分析

目的探讨经产妇发生巨大儿的相关因素与妊娠结局的关系。方法回顾分析2009年1月-2011年7月在蚌医二附院分娩的65例无严重内外科合并症的非妊娠期糖尿病经产妇巨大儿的资料,并与随机选择的同期分娩无妊娠期糖尿病、无严重内外科合并症经产妇正常体重儿作对照分析,及同期分娩的健康初产妇巨大儿比较分析。结果经产妇巨大儿平均孕周、孕末期体重、孕末期宫高、腹围、剖宫产率、产后出血量、异常产程、新生儿窒息率均显著高于经产妇正常体重儿(P<0.05);与初产妇巨大儿比较,外来流动人口比例增加,正规产检比例明显降低,过期妊娠增多,择期剖宫产率低,新生儿窒息率、产后出血率增加。结论加强经产妇围产期管理,产前正确预测经产妇巨大儿,选择适当的分娩方式,对预防产后出血、降低母婴并发症至关重要。     

孕期妇女营养与体重增长问题探讨

目的探讨孕期妇女营养导致体重增长的情况所带来的问题和影响。方法 2010年1月至2011年7月期间来我院分娩的产妇中选取198例,根据孕期体重增长情况进行分组,比较孕期体重超增长带来的结果。结果孕期体重增长不同分组间妊娠期高血压疾病、妊娠期糖尿病、分娩方式、新生儿窒息、产后出血和巨大儿发生率的差别均有统计学意义（均P〈0.05）。结论孕期营养过剩导致体重增长过度对孕妇和新生儿都会产生不利的影响,妊娠期和分娩期并发症以及难产率都有所增加。     

孕期体重管理对新生儿出生体重及妊娠结局的影响

目的:探讨孕期体重管理对控制新生儿出生体重及改善妊娠结局的影响。方法:选择2018年3-12月于本院产检并计划在本院分娩的孕妇400例作为研究对象,按随机数字表法分为试验组和对照组,各200例。对照组进行常规产前检查,试验组在对照组基础上给予个体化体重管理。比较两组妊娠期高血压疾病、妊娠期糖尿病及孕期体重增长超过或小于合理范围发生率、新生儿体重、分娩孕周、新生儿结局及妊娠情况。结果:试验组妊娠期高血压疾病、妊娠期糖尿病及孕期体重增长超过合理范围发生率均明显低于对照组(P0.05);试验组新生儿体重正常及足月分娩比例均高于对照组(P0.05);试验组胎儿窘迫、巨大儿、产程阻滞、胎膜早破发生率及剖宫产率均明显低于对照组(P0.05)。结论:孕期体重管理可有效降低各种妊娠期疾病的发生率,减少新生儿出生体重异常,从而改善妊娠结局,值得临床推广使用。     

新生儿体重与孕妇年龄和体重指数的关系

目的：分析母亲年龄与新生儿出生体重的关系,以及孕期体重指数对新生儿出生体重的影响。方法：回顾性分析2005年1-12月在重庆医科大学附属第一医院产科出生的1301例新生儿体重;以及1999年1月至2003年7月在我院住院并进行阴道试产的初产妇576例,其中早孕期肥胖即体重指数（BMI）≥24有184例,分娩时肥胖（BMI）≥27有152例。观察出生体重与孕妇年龄和体重指数之间的关系。结果：在排出了妊娠合并糖尿病,非足月妊娠以及双胎、三胎妊娠,1301例新生儿平均出生体重为3396g．男婴平均出生体重为3453g,女婴为3397g,其中只有20-24岁组分娩的新生儿出生体重低于总体平均体重;早孕期肥胖孕妇巨大儿的发生率与对照组比较,差异有显著性,分娩时肥胖的产妇巨大儿的发生率与对照组比较,差异有显著性,早孕期体重增加≥15kg者巨大儿的发生率高于体重增加〈15kg者,差异有显著性。结论：母亲年龄过小影响胎儿生长发育,孕期母亲体重增长过多可导致巨大儿发生率增加。     

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.