运动手环对2型糖尿病合并非酒精性脂肪性肝病患者糖脂代谢、胰岛素抵抗和BMI的影响

目的探讨运动手环对2型糖尿病(T2DM)患者并发非酒精性脂肪性肝病(NAFLD)患者脂糖代谢、胰岛素抵抗和体质量指数(BMI)的影响。方法选取该院68例诊断为T2DM并发NAFLD的患者为研究对象,随机分为对照组与观察组,每组34例。患者入院后均予以降血糖、护肝等药物治疗及健康宣教,包括饮食指导、运动指导、药物指导等综合治疗,观察组在对照组治疗基础上联合使用运动手环。两组于干预后3个月比较糖脂代谢及肝功能情况,并检测脂肪因子瘦素、脂联素,评估胰岛素抵抗、BMI改善情况。结果干预后两组空腹血糖(FPG)、低密度脂蛋白-胆固醇、高密度脂蛋白-胆固醇水平比较差异均无统计学意义(P0.05),但对照组餐后2小时血糖、糖化血红蛋白及总胆固醇、三酰甘油水平均明显高于观察组(P0.05);干预后两组脂联素水平比较差异无统计学意义(P0.05),但对照组天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、瘦素均显著高于观察组(P0.05);干预后对照组稳态模型评估-胰岛素抵抗指数、BMI依次是(5.6±1.1)、(26.3±4.6)kg/m2,均显著高于观察组的(4.2±0.8)、(24.2±3.5)kg/m2(P0.05)。结论运动手环可以为T2DM并发NAFLD患者提供科学、有效的康复指导,显著改善机体糖脂代谢,缓解胰岛素抵抗情况,延缓疾病发展。     

空腹C肽联合胰岛素抵抗指数评估2型糖尿病患者非酒精性脂肪肝肝纤维化的价值

目的 利用空腹C肽联合胰岛素抵抗指数（HOMA-IR）评估2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）患者肝纤维化程度。方法 前瞻性选取T2DM合并NAFLD患者246例,根据Fibro Scan检测出的患者肝脏组织硬度值（LSM）,将患者分为进展性肝纤维化组（n=35）与非进展性肝纤维化组（n=211）。记录患者的年龄、性别、体重指数（BMI）、T2DM病程、血管收缩压、舒张压、空腹血糖（FPG）、空腹C肽、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、尿酸（UA）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、天冬氨酸转移酶（AST）、丙氨酸转移酶（ALT）、γ-谷氨酰转肽酶（GGT）、HOMA-IR等相关指标,并采用单因素及多因素logistic回归分析影响患者肝纤维化进展的影响因素,并采用受试者工作特性曲线（ROC）评估空腹C肽联合HOMA-IR对T2DM合并NAFLD患者肝纤维化的预测价值。结果 单因素分析结果显示,进展性肝纤维组患者的年龄、BMI、空腹C肽、FINS、AST、HOMA-IR均明显高于非进展性肝纤维化组患...     

幽门螺杆菌感染与非酒精性脂肪肝对2型糖尿病患者糖脂代谢的影响

目的探讨幽门螺杆菌(Hp)感染与非酒精性脂肪肝(NAFLD)对2型糖尿病(T2DM)患者糖脂代谢的影响。方法选取2016年5月至2018年1月在河北港口集团有限公司港口医院内分泌科住院的179例T2DM患者作为研究对象,根据是否合并NAFLD及是否有Hp感染分为4组,Ⅰ组:T2DM合并NAFLD及Hp感染,65例;Ⅱ组:T2DM合并NAFLD,41例;Ⅲ组:T2DM合并Hp感染,43例;Ⅳ组:T2DM未合并NAFLD及无Hp感染,30例。记录并比较4组患者一般资料及生化指标。结果 T2DM患者NAFLD发生率为59.2%(106/179),Hp感染率为60.3%(108/179),同时患NAFLD与Hp感染者比例为36.3%(65/179)。与Ⅳ组比较,Ⅰ组体质量指数(BMI)、腰围(男性与女性)、舒张压、空腹C肽、天门冬氨酸氨基转移酶(AST)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均升高,糖尿病病程较短,Ⅱ组BMI、腰围(女性)、丙氨酸氨基转移酶、AST、TG、空腹C肽水平均升高,糖尿病病程较短,高密度脂蛋白胆固醇(HDL-C)(女性)水平降低,Ⅲ组糖尿病病程较短,差异均有统计学意义(P<0.05)。与Ⅰ组比较,Ⅲ组患者BMI、腰围(男性)、舒张压、TG、空腹胰岛素、空腹C肽、尿酸水平均降低,HDL-C(女性)水平升高,差异均有统计学意义(P<0.05);而其他指标4组间比较,差异均无统计学意义(P>0.05)。二元Logistic回归分析发现,BMI、TC、TG、LDL-C是T2DM患者合并NAFLD的独立危险因素(OR=1.267、0.342、2.501、5.862,P<0.05);TC是T2DM患者合并Hp感染的独立危险因素(OR=1.47,P<0.05)。结论 NAFLD与Hp感染会加剧T2DM患者糖脂代谢紊乱,积极控制NAFLD危险因素、开展Hp普查工作,可为临床早期监测、预防和治疗T2DM及其相关疾病提供有效措施。     

新诊断2型糖尿病合并非酒精性脂肪肝临床分析

目的 探讨2型糖尿病(T2DM)合并非酒精性脂肪肝与胰岛素抵抗之间的关系.方法 对32例新诊断2型糖尿病合并非酒精性脂肪肝患者和28例新诊断2型糖尿病不合并非酒精性脂肪肝患者的血糖、体重指数(BMI)、空腹及餐后2 h胰岛素、C肽、脂代谢指标、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)等进行比较分析.结果 合并脂肪肝组的体重指数、腰围、甘油三酯、胰岛素抵抗指数均明显高于非脂肪肝组(P＜0.05).结论 T2DM合并脂肪肝患者存在明显的胰岛素抵抗、高胰岛素血症、脂代谢紊乱和超重,应加强综合管理.     

2型糖尿病合并非酒精性脂肪肝的临床特征分析

[目的]探讨2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）与胰岛素抵抗、血脂紊乱、尿酸的关系及其发病因素.[方法]对本院2011年1~8月的133例T2DM住院患者的临床资料进行回顾性分析,根据腹部B超结果分为合并NAFLD组（A组,70例）和不合并NAFLD组（B组,63例）,分析比较两组体重指数（BMI）、腰围（WL）、空腹胰岛素、餐后2 h胰岛素、脂代谢指标、尿酸的水平.[结果]与B组比较,A组的T2DM患者的BMI、WL、空腹胰岛素、血甘油三酯（TG）,低密度脂蛋白胆固醇（LDL-C）、胆固醇、尿酸显著增高（P均＜0.05）;同时高密度脂蛋白（HDL-C）显著降低（P＜0.05）;Logistic回归分析显示：BMI、WL、TG、HDL-C对T2DM合并NAFLD的发生有显著影响（P均＜0.05）.[结论]2型糖尿病患者合并NAFLD,与肥胖（主要是腹型肥胖）、血脂紊乱、尿酸增高相关;而与糖尿病病程、血糖控制程度、糖化血红蛋白不相关,导致糖尿病合并NAFLD的最主要原因为胰岛素抵抗及其所包含的脂代谢紊乱.     

2型糖尿病患者非酒精性脂肪肝与尿白蛋白排泄率的关系

目的 探讨合并非酒精性脂肪肝(NAFLD)的2型糖尿病(T2DM)患者尿白蛋白排泄率(UAER)的变化特点及其相关性.方法 T2DM患者228例,根据是否合并NAFLD分为糖尿病合并NAFLD组(135例)和糖尿病无NAFLD组(93例),另选年龄、性别匹配的40例健康受试者为对照组,比较两组患者体重指数(BMI)、空腹血糖(FPG)、血脂、空腹胰岛素(FINS)、空腹C肽、胰岛素抵抗指数(HOMA-IR)、24h UAER的差异,用卡方检验分析两组间正常、微量和大量UAER的分布差异,进一步以T2DM合并NAFLD为应变量,以各临床生化指标为自变量,用单因素和多因素Logistic回归分析方法分析T2DM合并NAFLD的危险因素.结果 糖尿病合并NAFLD组BMI、甘油三酯(TG)、FINS和空腹C肽、HOMI-IR、UAER高于非NAFLD组,差异有统计学意义(P均<0.05).卡方检验显示,糖尿病合并NAFLD患者微量白蛋白尿和大量白蛋白尿发生率高于无NAFLD组,差异有统计学意义(χ2=23.905,P=0.001).Logistic回归分析显示,BMI(OR=4.66,P=0.001)、TG(OR=8.46,P=0.000)及UAER(OR=3.73,P=0.003)升高是T2DM合并NAFLD的危险因素.结论 T2DM患者中NAFLD与BMI、TG及UAER的升高密切相关,T2DM合并NAFLD患者糖尿病肾病的发病率显著高于无合并NAFLD患者.     

2型糖尿病患者PRMT1的表达水平与胰岛素抵抗的相关性研究

目的 探讨2型糖尿病(T2DM)患者蛋白质精氨酸甲基转移酶1(PRMT1)的表达水平与胰岛素抵抗(IR)的相关性。方法 回顾性选取2021年4月至2022年7月在上海市奉贤区中心医院就诊的T2DM患者89例为T2DM组,另选取同期在上海市奉贤区中心医院进行体检的健康者60名作为对照组,收集整理所有患者的临床基本资料。采用实时荧光定量PCR法检测两组血清PRMT1 mRNA相对表达量并进行比较;检测T2DM组和对照组空腹胰岛素(FINS)、空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平,计算胰岛素抵抗指数(HOMA-IR),并进行比较分析;检测两组脂代谢指标[甘油三酯、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]进行比较分析;采用Pearson相关性分析T2DM患者HOMA-IR与PRMT1相对表达量、脂代谢指标的相关性;采用Logistic回归分析T2DM患者IR发生的影响因素。结果 T2DM组患者PRMT1、FINS、空腹血糖和HOMA-IR水平分别为1.56±0.40、(12.94±3.88) mU/L、(9.56±2.24...     

2型糖尿病合并非酒精性脂肪肝病患者凝血状态的探讨

目的 探讨2型糖尿病（T2DM）合并非酒精性脂肪肝病（NAFLD）患者凝血指标的变化,及其在临床上的意义.方法 对426例T2DM患者根据是否合并NAFLD分为合并NAFLD组70例及不合并NAFLD组356例,分别检测两组患者的空腹血糖（FPG）、空腹胰岛素（FINS）、血浆凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血尿酸（UA）、血清转氨酶等指标,并计算体重指数（BMI）及胰岛素抵抗指数（HOMA-IR）.结果 发现T2DM患者中NAFLD的患病率为16.43%,男性为11.21%,女性为22.68%,两者差异有统计学意义（P〈0.05）.T2DM合并NAFLD组与不合并NAFLD组相比,BMI、LDL-C及HOMA-IR均升高,差异有统计学意义（P〈0.05,P〈0.01）;APTT下降,差异有统计学意义（P＜0.05）.通过非条件Logistic 回归分析显示NAFLD与BMI、LDL-C及HOMA-IR密切相关.结论 T2DM合并NAFLD患者存在明显的超重、胰岛素抵抗、脂代谢紊乱及高凝状态,故临床上在强化血糖治疗的同时应重视减肥、改善胰岛素抵抗、降脂、抗凝,从而有利于阻止或延缓病情的发生与发展.     

2型糖尿病患者血清视黄醇结合蛋白4水平的临床意义

目的 检测2型糖尿病(T2DM)患者正常体重组和肥胖组的血清视黄醇结合蛋白4(RBP4)水平,探讨与血脂和胰岛素敏感性等的相关性.方法 以体重指数(BMI)将63例糖尿病患者分成两组:T2DM超重/肥胖组和T2DM正常体重组,均采用HOMA-IR评价各组胰岛素敏感性,测定受试者的BMI、腰臀比(WHR),检测空腹状态下血清RBP4、血糖、糖化血红蛋白(HbAlc)、血浆葡萄糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)和胰岛素水平,并以55例健康体检者作对照.结果 T2DM超重/肥胖组血清RBP4浓度明显高于对照组和T2DM正常体重组,差异均有统计学意义(t分别=3.04、2.77,P均＜0.05);RBP4与HOMA-IR、BMI、WHR、TG明显正相关(r分别=0.33、O.28、0.24、0.32,P均＜0.05);多元线性逐步回归分析发现:HOMA-IR、BMI、TG、性别和年龄是血清RBP4的独立相关因素(r分别=0.33、0.56、0.55、-0.41、0.37,P均＜0.05).结论 血清RBP4与胰岛素抵抗呈正相关,可能与T2DM发病有一定关系.     

2型糖尿病患者胰岛素抵抗与血清游离脂肪酸浓度的关系

目的探讨2型糖尿病(T2DM)患者空腹与餐后2 h游离脂肪酸(FFA)浓度和胰岛素抵抗的关系。方法测定100例T2DM患者(根据亚洲糖尿病论坛的推荐分为控制良好和控制不良2组)及50名正常对照者的糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、空腹FFA及餐后2 hFFA。以稳态模式评估胰岛素抵抗指数(HOMA-IR)。结果与对照组比较,T2DM组的FPG、2 h PG、FFA、2 h FFA、HbA1c、HOMA-IR均明显增高(P<0.01)。T2DM控制不良组各项指标均高于控制良好组(P<0.05),FFA、2 h FFA与HOMA-IR、HbA1c、FPG、2 h PG均呈明显的正相关(r分别为0.910、0.876,0.851、0.759,0.908、0.746,0.769、0.674,P<0.01)。结论 T2DM患者体内FFA浓度的增高与胰岛素抵抗存在明显相关性,与T2DM的发病机制有密切关系。     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.