1016例脐带绕颈的临床分析

目的探讨脐带绕颈对围产儿预后的影响.方法对2003年1月-12月间分娩的1016例有脐带绕颈者进行了胎儿宫内窘迫发生率、新生儿窒息情况及分娩方式的统计分析;并以同期分娩的3969例无脐带绕颈者作为对照组进行对比统计分析.结果有脐带绕颈组的胎窘发生率及剖宫产率明显高于对照组(P＜0.05),二组新生儿窒息无明显差异(P＞0.05).结论虽然脐带绕颈可使胎儿宫内窘迫发生率及剖宫产率明显增高,但基于脐带绕颈正确诊断的误差及剖宫产手术并发症对孕妇的危险,所以孕期提示有脐带绕颈可能的孕妇,剖宫产不是首选的分娩方式,而是应加强胎儿的宫内监测,尤其是进入分娩期后,更需密切观察产程进展,注意胎头下降及胎心变化,一旦发现异常情况,宜根据产程的进展情况,及时采取有效的助产方法,尽量及早去除造成胎儿宫内窘迫的因素,这对减少新生儿窒息和降低围产儿死亡率都是十分重要的.     

结合NST评估脐动脉血流S/D≥4围产儿预后

本文回顾性地分析1994年10月至1998年10月在本院产前病区住院孕妇单胎妊娠中测得31例脐动脉血流S/D≥4围产儿结局IUGR的发生率为67.7%;新生儿窒息率为45.1%;围产儿死亡率为32.2%;胎儿畸形率为19.4%.本文还发现与脐带因素密切相关,脐带异常占64.5%.结合无负荷试验(NST)结果显示31例S/D≥4中NST评分＜7分组较NST评分≥7分组围产儿死亡、羊水Ⅱ-Ⅲ°粪染明显增高(P组均＜0.025),表明围产儿预后更差.NST≥7组较NST评分＜7组脐带异常的发生率明显增高(P值＜0.025).提示结合胎心监护可更准确评估胎儿宫内情况.动态观察脐动脉血流S/D值,结合胎心监护,可作为估价胎儿安全的一种最佳方法[1].本文结合胎心监护回顾性地分析脐动脉血流S/D≥4围产儿结局.     

羊水过少对围产儿的影响及分娩方式选择浅析

目的研究羊水过少对围产儿的影响及分娩方式的选择.方法收治羊水过少102例,与随机抽取同期分娩102例羊水量正常病例,就妊娠并发症、围产儿情况、分娩方式进行比较.结果羊水过少组合并妊高征、过期妊娠、IUGR明显增高,合并羊水Ⅲ*浊、胎儿宫内窘迫明显高于羊水量正常组,剖宫产机会也明显增高[1].结论应用B超诊断,羊水过少合并妊高征、过期妊娠、IUGR以计划剖宫产为宜,对降低围产儿死亡率有重要意义.     

重度妊娠高血压疾病终止妊娠时机及分娩方式探讨

目的 探讨重度妊娠高血压疾病(重度妊高征)患者终止妊娠的时机与方式.方法 对218例重度妊高征患者的临床资料进行回顾性分析,观察孕产妇并发症及新生儿窒息率和围产儿病死率.结果 ＜34周分娩的新生儿窒息率、围产儿病死率均明显高于34～36周与＞36周者(P＜0.01),各孕周间孕产妇并发症发生率差异无统计学意义(P＞0.05);与剖宫产组比较,阴道分娩组新生儿窒息率、围产儿病死率及孕产妇并发症均显著升高,差异有统计学意义(P＜0.05).结论 重度妊高征终止妊娠的最佳时机为36周后,剖宫产是终止妊娠的最佳方式.     

围产儿死亡及死因分析

本文对我院１９８４－１９９５年间１７７例围产儿死亡及其死因进行了回顾性分析。本组围产儿死亡率为１４．６８‰。死亡围产儿中早产儿占４２．９４％，畸形儿占１８．６４％。新生儿首位死因为窒息，胎死宫内首位原因为脐带、胎盘因素所致的宫内缺氧。资料表明降低围产儿死亡率的主要环节是防治早产，加强对畸形儿的筛查，做好围产期保健，防治胎儿宫内缺氧，提高产科质量，搞好新生儿窒息抢救工作。     

高邮地区2005年-2007年围产儿死亡调查分析

目的探讨围产儿死亡原因,以提高围产期保健工作质量及降低围产儿死亡率。方法对高邮地区2005年-2007年的98例围产儿死亡资料进行调查分析。结果高邮地区2005年-2007年围产儿死亡98例,死亡率分别为8.09‰、7.52‰、4.18‰,呈逐年下降趋势,其中死胎53.06%,死产4.08%,新生儿死亡42.86%。围产儿死亡原因主要为不明原因、胎儿畸形、早产、新生儿窒息、脐带因素、胎盘因素等。结论加强围产期监护,预防为主,提高孕期监测质量和宫内诊断技术,加强高危孕产妇的管理和严格遵守高危妊娠转诊制度,不断提高产科质量,是降低围产儿死亡率的重要手段。     

妊高征82例临床分析

目的探讨妊高征的临床特点。方法回顾分析82例妊高征发生的一般情况,以及66例单胎中重度妊高征并发症,新生儿新生儿窒息、围产儿死亡与孕周、新生儿体重、分娩方式的关系。结果重高征发生以9至1月份发生率最高,常见的并发症有产后出血、胎儿生长受限、新生儿窒息。中重度妊高征以孕36~37 6w组、新生儿体重≥2500g的新生儿窒息率、围产儿死亡率最低,几组比较均有显著性差异(P<0.01)。剖宫产比阴道分娩新生儿窒息率、围产儿死亡率均低,2组比较无显著性差异(P>0.05)。结论适龄、适时妊娠可以减少妊高征的发生,中重度妊高征应选择在孕36~37 6w,估计胎儿体重≥2500g时终止妊娠较合适。     

脐动脉血流速度监测的临床意义-附118例异常分析

目的利用脐动脉血流速度监测孕晚期及分娩期胎儿的脐动脉阻力,通过对脐动脉血流速度波形分析,结合胎心监护,间接判断胎盘血流,脐带血流速度有无异常,决定正确的分娩方式,有效降低胎儿宫内窘迫及新生儿窒息的发生率,具有重要的临床意义.方法检测842例孕妇,其中S/D、PI、RI增高者118例(异常组),随机选择正常者100例(正常组),配合NST监护,将两组进行比较.结果合并IUGR及妊高症时S/D,RI值变化最大,分别为S/D6.47 ± 0.45、4.14±0.18,RI0.97±0.33、1.01 ± 0.65,监护阳性行剖宫产者25例,与正常组比较,P＜0.005,但两组新生儿Apgar平分比较P＞0.01.结论说明通过胎儿脐动脉血流监测能及时发现并处理胎儿宫内异常,新生儿预后良好.     

围产儿宫内感染的防治

本文收集１９９２年本院分娩中发生宫内感染１４１例围产儿作观察组；随机抽样同期分娩１５０例无宫内感染围产儿作对照组，进行分析对比结果提示：母亲产前感染、胎膜早破为围产儿宫内感染的主要原因。感染组中早产发生率、产程异常胎儿宫内窘迫发生率、围产儿出生时Ａｐｇａｒ评分＜７分者、羊水受污染程度、新生儿窒息、新生儿合并症发生率、围产儿死亡率均高于对照组。ｘ２检验Ｐ＜０．０１。而妊娠合并在高征、妊娠合并肝损、ＡＢＯ血型不合、头盆不称发生率虽高于对照组，但Ｐ＞０．０５，差别无显著意义。本文１４１例宫内感染围产儿经治疗痊愈１１７例，治愈率８２．９８％。对防治的主要性进行了讨论。     

佛山市妇幼保健院2013年双胎妊娠围产儿结局分析研究

目的：探讨我院双胎妊娠围产儿的分娩结局以及其与分娩方式的关系。方法抽取我院2013年1~12月的孕产妇共2673例以及双胎妊娠围产儿5346例进行研究,对婴儿的分娩结果、婴儿转归以及呼吸状况等指标进行统计分析,并观察不同分娩方式与分娩结局的关系。结果所有胎儿均为活产,无死亡病例。胎儿1呼吸正常率高达98.13%,窒息率仅为1.87%,而胎儿2呼吸正常率则为96.03%,窒息率为3.97%。其中,剖宫产手术产胎儿的窒息率为6.80%,显著高于顺产分娩的4.43%,数据分析发现其差异具有显著性(<0.01)。结论我院2013年双胎妊娠围产儿的分娩结局良好,同时合理选择双胎妊娠的分娩方式对降低新生儿窒息率具有非常重要的临床意义。     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

VACTERL with hydrocephalus: Family with X-linked VACTERL-H

We describe in a five generation family four affected males with hydrocephalus (4 offspring/4 examined) due to aqueductal stenosis (3/3), symmetrical radial ray abnormalities (4/4), renal anomalies (2/3), anal atresia (3/4), hypoplastic penis/abnormal testes (2/3), and cardiac abnormalities (1/3). X-linked inheritance seems certain in this family. These abnormalities are characteristic of the rare X-linked VACTERL-H syndrome. In addition, one maternal female cousin had a severe tracheo-esophageal fistula. This may represent partial manifestation in a female carrier. Chromosomes were apparently normal (46XY) with no spontaneous or excess induced breakages in one of the affected offspring and his mother. In the absence of a genetic marker, diagnostic ultrasonography is the investigation of choice for early in utero detection of this syndrome. A confident ultrasonographic diagnosis was possible by 20 weeks in the 2 cases examined. Am. J. Med. Genet. 76:74–78, 1998. © 1998 Wiley-Liss, Inc.     

拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒慢性感染的临床研究

目的 观察拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒(HBV)慢性感染的临床疗效。方法 慢性乙型肝炎患者90例。设联合治疗组28例，单用拉米夫定组30例，单用泛昔洛韦组32例。联合治疗组给予口服拉米夫定0．1g／d(PO)，泛昔洛韦1．5g／d(PO)，24周。拉米夫定、泛昔洛韦单用组剂量及疗程分别同联合治疗组。结果 3组均无明显副反应，丙氨酸转氨酶(ALT)复常率无差异。3组HBV DNA阴转率分别为89．3％、66．7％、40．6％，差异有显著性。乙型肝炎表面抗原(HBeAg)阴转率分别为28．6％、23．3％、21．9％，差异无显著性。结论 拉米夫定与泛昔洛韦联合用药安全、耐受性好，临床显示联合治疗对HBV DNA的抑制作用显著优于单用药。     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.