呼吸功能训练联合球囊扩张术在鼻咽癌放疗后环咽肌失弛缓的康复治疗中的应用

目的 探讨呼吸功能训练联合球囊扩张术对鼻咽癌放疗后环咽肌失弛缓患者吞咽功能恢复的影响。 方法 采用随机数字表法将120例鼻咽癌放疗后环咽肌失弛缓患者分为观察组和对照组,每组60例,对照组给予常规吞咽功能康复训练及球囊扩张术治疗,观察组在此基础上辅以呼吸功能训练,每周训练5 d,持续训练8周。分别于治疗前、治疗4周和治疗8周后,采用通过吞咽造影检查评分(VFSS)、功能性经口摄食量表评分（FOIS）、环咽肌功能状态及安德森吞咽困难量表(MDADI)对2组患者的吞咽功能进行疗效评定。 结果 治疗4周后,2组患者的VFSS、FOIS及MDADI各项评分均较组内治疗前明显升高（P＜0.05）,且随着治疗时间的延长,上述评分均升高更加显著(P<0.05)。治疗8周后,观察组患者的VFSS评分［（8.02±0.89）分］、FOIS评分［（5.36±0.79）分］及MDADI评分［总体（4.27±0.64）、生理（34.70±3.38）、功能（22.14±1.78）、情感（27.09±2.70）分］与组内治疗前［（2.13±0.35）、（1.50±0.40）、(2.65±0.42)、(19.37±0.45)、( 13.14±0.49)和( 17.43±1.20)分］相比均有明显改善(P<0.05),且观察组较同时间点对照组［(4.65±0.72)、(3.14±0.70)、(3.77±0.54)、(26.82±2.38)、(20.64±1.95)和(25.64±2.62)分］改善更为显著,组间差异有统计学意义（P＜0.05）。 结论 呼吸功能训练协同球囊扩张术可对鼻咽癌放疗后环咽肌失弛缓患者的吞咽功能改善有促进作用,可明显减轻或延缓鼻咽癌放疗后出现的吞咽障碍。     

吞咽训练结合吞咽电刺激治疗帕金森重度吞咽障碍患者的疗效观察

目的 观察常规吞咽训练联合吞咽电刺激治疗帕金森重度吞咽障碍患者的疗效。 方法 采用随机分组软件将36例帕金森重度吞咽障碍患者分为观察组及对照组。对照组给予常规吞咽训练，观察组给予吞咽电刺激及常规吞咽训练。于治疗前、治疗15 d后分别采用改良曼恩吞咽功能评估量表（MMASA）、标准吞咽功能评定量表（SSA）对2组患者吞咽功能进行评定。 结果 治疗后对照组MMASA评分［（62.0±8.2）分］较治疗前无明显改变（P>0.05），SSA评分［ (28.2±4.0)分］较治疗前明显下降（P<0.05）；观察组MMASA评分［ (77.9±12.6)分］、SSA评分［ (32.9±3.6)分］均较治疗前及对照组明显改善（P<0.05）；治疗后观察组患者拔管率（47.1%）明显优于对照组（15.8%），组间差异具有统计学意义（P<0.05）。 结论 吞咽电刺激联合常规吞咽训练对帕金森重度吞咽障碍患者具有显著疗效，该联合疗法值得临床进一步研究、推广。     

重复性外周磁刺激联合吞咽功能训练治疗脑卒中后咽期吞咽障碍的疗效观察

目的 观察重复性外周磁刺激联合吞咽功能训练治疗脑卒中后咽期吞咽障碍的临床疗效。 方法 采用随机数字表法将60例脑卒中偏瘫伴咽期吞咽障碍患者分为外周磁刺激组（观察组）和对照组,每组30例。2组患者均给予常规吞咽功能训练,观察组患者在此基础上辅以重复性外周磁刺激治疗。于治疗前、治疗4周后分别采用洼田饮水试验、功能性经口摄食量表（FOIS）和渗透-误吸量表（PAS）评定2组患者吞咽功能改善情况。 结果 治疗4周后观察组和对照组患者FOIS评分［分别(4.47±1.11)分和（3.38±1.05）分］、洼田饮水试验评分［分别(1.97±0.76)分和（2.40±0.81）分］及PAS评分［分别(2.07±1.01)分和（2.73±1.14）分］均较组内治疗前明显改善（P<0.05）;通过组间比较发现,治疗后观察组患者洼田饮水试验评分、FOIS评分及PSA评分亦显著优于对照组水平,组间差异均具有统计学意义（P<0.05）。 结论 重复性外周磁刺激联合吞咽功能训练能明显改善脑卒中患者咽期吞咽障碍,其疗效优于单纯吞咽功能训练,该联合疗法值得在脑卒中吞咽障碍患者中推广、应用。     

球囊扩张治疗对脑卒中后吞咽障碍患者抑郁和焦虑的影响

目的 观察球囊扩张术对脑卒中后吞咽障碍患者吞咽功能及抑郁、焦虑病情的改善作用。 方法 采用随机数字表法将38例伴有抑郁、焦虑症状的脑卒中后吞咽障碍患者分为观察组（19例）及对照组（19例）。2组患者均给予常规药物治疗及吞咽功能训练,观察组患者在此基础上辅以导尿管球囊扩张治疗。2组患者治疗时间均不超过5周,如治疗过程中患者恢复正常经口进食则终止治疗。于治疗前、治疗后分别采用视频吞咽造影检查（VFSS）、洼田饮水试验、汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）对2组患者进行疗效评定。 结果 治疗结束时发现观察组及对照组患者VFSS吞咽障碍程度评分［分别为（7.92±0.45）分和（5.92±0.39）分］、洼田饮水试验评分［分别为（1.42±0.47）分和（2.71±0.55）分］、HAMD评分［分别为（7.5±1.8）分和（8.8±2.1）分］及HAMA评分［分别为（8.3±1.9）分和（9.8±2.4）分］均较治疗前明显改善（P<0.05）;并且观察组患者上述疗效指标改善幅度均显著优于对照组水平,组间差异均具有统计学意义(P<0.05)。 结论 在常规吞咽功能训练基础上辅以球囊扩张治疗,能进一步改善脑卒中患者吞咽功能,对缓解患者抑郁及焦虑情绪均有明显促进作用。     

吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响

目的 观察吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响。 方法 采用随机数字表法将56例喉癌术后放疗后患者分为实验组和对照组,每组28例。2组患者均接受常规健康咨询和吞咽训练,实验组在此基础上给予营养干预。在干预前、干预后3个月,采用安德森吞咽困难量表(MDADI)、患者主观整体营养状况评分量表（PG-SGA)、生活质量调查表30(QLQ-C30)评价2组患者的吞咽功能、营养状态、生活质量。 结果 干预前,2组患者MDADI评分、PG-SGA评分、QLQ-C30评分比较,差异无统计学意义（P>0.05）。实验组干预后3个月MDADI评分［（63.96±11.37）分］、PG-SGA评分［（3.07±1.75）分］、QLQ-C30评分［（55.93±7.07）分］较组内治疗前显著改善（P<0.05）,对照组干预后3个月仅MDADI评分［（58.72±10.57）分］较组内治疗前改善（P<0.05）。与对照组干预后3个月比较,实验组MDADI评分、PG-SGA评分、QLQ-C30评分显著改善（P<0.05）。实验组与对照组干预前、后3个月MDADI评分、PG-SGA评分、QLQ-C30评分差值［（13.43±10.23）分、（1.81±1.63）分、（7.47±6.32）分］比较,差异有统计学意义（P<0.05）。 结论 吞咽训练结合营养干预可以更有效改善喉癌患者术后放疗后的吞咽功能和营养状态,提高患者的生活质量。     

爱荷华口肌训练仪配合吞咽功能训练治疗脑卒中后吞咽功能障碍的临床观察

目的观察美国产的爱荷华口肌训练仪（IOPI）配合吞咽功能训练治疗脑卒中后吞咽功能障碍的临床疗效。 方法选取脑卒中后吞咽功能障碍患者60例,按随机数字表法分为对照组和治疗组,每组30例。对照组给予常规药物治疗和康复训练,治疗组在此基础上配合IOPI进行治疗。观察2组患者治疗1个月和2个月后的疗效,并采用视频透视吞咽检查（VFSS）评分进行评估。 结果治疗前,2组患者VFSS评分比较,差异无统计学意义（P>0.05）;治疗1个月后,2组患者VFSS评分较组内治疗前明显提高,差异有统计学意义（P<0.05）,且治疗组VFSS评分［（4.20±0.92）分］优于对照组［（3.30±0.67）分］;治疗2个月后,2组患者VFSS评分均较组内治疗1个月时明显提高（P<0.05）,且治疗组VFSS评分（6.50±1.28）优于同时间点对照组（5.24±1.13）,组间差异有统计学意义（P<0.05）。 结论IOPI配合吞咽功能训练治疗脑卒中后吞咽功能障碍疗效显著,值得临床推广应用。     

呼吸训练治疗脑卒中后吞咽功能障碍患者的疗效观察

目的 观察呼吸功能训练对脑卒中患者吞咽功能障碍的改善作用。 方法 采用随机数字表法将42例脑卒中后吞咽障碍患者分为观察组及对照组,每组21例。对照组患者给予常规吞咽功能训练,观察组患者在此基础上辅以呼吸功能训练,每天训练1次。于治疗前、治疗4周后分别采用洼田饮水试验、吞咽造影检查（VFSS）评估患者吞咽功能,同时对2组患者治疗前、后用力肺活量（FVC）、1秒用力呼气量（FEV1）及呼气峰流速（PEF）进行检测。 结果 治疗4周后,观察组患者治疗显效率（85.71%）明显高于对照组（61.90%）,组间差异具有统计学意义（P<0.05）;2组患者治疗后VFSS评分均较治疗前明显提高（P<0.05）,并且观察组患者VFSS评分［（8.92±0.95）分］亦显著高于对照组水平［（7.36±1.62）分］,组间差异具有统计学意义（P<0.05）;观察组治疗后FVC［（3.57±0.48）L］、FEV1［(2.83±0.49)L/s］及PEF［(5.36±1.04)L/s］均较治疗前及对照组明显改善,差异均具有统计学意义（P<0.05）。 结论 在常规吞咽功能训练基础上辅以呼吸训练,能进一步改善脑卒中患者吞咽功能及肺功能,其疗效优于单纯吞咽功能训练,该联合疗法值得临床推广、应用。     

吞咽造影数字化分析评价脑干卒中后吞咽障碍患者咽部功能治疗前后的变化

目的使用吞咽造影数字化分析方法观察改良球囊扩张术治疗对脑干卒中后吞咽障碍患者咽部收缩功能的影响，定量评价脑干卒中后吞咽功能变化。 方法选取30例脑干卒中后经吞咽造影诊断为咽期吞咽障碍的患者，按患者治疗方法的不同，将接受球囊扩张术治疗的15例患者设为球囊扩张组，接受常规吞咽治疗的15例患者设为常规治疗组。球囊扩张组给予球囊扩张术治疗和常规吞咽康复治疗，各1次/日，每次30min；常规治疗组仅给予常规吞咽康复训练，2次/日，每次30min；2组治疗均为5次/周，共3周。分别于治疗前和治疗后，进行吞咽造影评估和数字化测量分析，测量指标包括咽收缩率和咽收缩持续时间。 结果治疗后球囊扩张组在吞咽稀流质、浓流质及糊状食物时，患者的咽收缩率分别为（0.20±0.03）、（0.14±0.05）和（0.15±0.04），治疗前后差异均有统计学意义（P<0.05）；治疗后球囊扩张组患者吞咽稀流质、浓流质及糊状食物时咽收缩持续时间分别为（990.34±96.14）、（1010.47±133.64）和（1180.10±121.27）ms，治疗前、后差异有统计学意义（P<0.05）。常规治疗组患者治疗后吞咽稀流质、浓流质及糊状食物时的咽收缩率及咽收缩持续时间治疗前后差异亦有统计学意义（P<0.05）。 结论吞咽造影数字化分析能够有效地量化吞咽功能，咽收缩率及咽收缩持续时间可用于分析咽部功能治疗前后的变化。     

外周磁刺激与神经肌肉电刺激治疗脑卒中后咽期吞咽障碍的疗效对比

目的 观察对比外周磁刺激（PMS）与神经肌肉电刺激（NMES）治疗脑卒中后咽期吞咽障碍的疗效。 方法 采用随机数字表法将60例符合筛选标准的脑卒中咽期吞咽障碍患者分成对照组、电刺激组及磁刺激组,每组20例。3组患者均给予常规吞咽功能训练,电刺激组在此基础上辅以神经肌肉电刺激,磁刺激组则辅以外周磁刺激,上述干预均每天治疗2次,每周治疗6d。于治疗前、治疗4周后分别采用标准吞咽量表（SSA）、功能性经口摄食量表（FOIS）及包括渗透-误吸量表评分（PAS)和视频吞咽障碍分级（VDS)在内的视频透视吞咽检查（VFSS）对3组患者治疗效果进行评价。 结果 治疗4周后发现3组患者SSA评分、渗透-误吸量表（PAS)评分、视频吞咽障碍分级（VDS)评分及FOIS评分均较治疗前明显改善（P<0.05）;进一步分析发现,电刺激组、磁刺激组SSA评分［分别为(30.6±3.2)分、(24.1±2.8)分］、VDS评分［分别为(24.4±5.6)分、(18.2±8.2)分］、PAS评分［分别为(3.25±1.12)分、(2.56±0.66)分］及FOIS评分［分别为(4.31±0.97)分、(4.94±0.81)分］改善幅度均显著优于对照组（P<0.05）,并且磁刺激组上述指标的改善幅度亦显著优于电刺激组,组间差异具有统计学意义（P<0.05）。 结论 外周磁刺激可明显改善脑卒中后咽期吞咽障碍,其治疗效果明显优于神经肌肉电刺激。     

食物质地改良联合下颏抗阻力训练治疗头颈部肿瘤放疗后吞咽困难的疗效观察

目的 观察食物质地改良联合下颏抗阻力（CTAR）训练对头颈部肿瘤放疗后吞咽困难患者吞咽功能及误吸的影响。 方法 采用随机数字表法将96例头颈部肿瘤放疗后吞咽困难患者分为对照组、食物改良组、CTAR组及联合组,每组24例。4组患者均给予常规吞咽功能训练,食物改良组在此基础上针对食物质地进行改良,CTAR组则辅以CTAR训练,联合组则在食物质地改良基础上辅以CTAR训练。于训练前、训练4周后采用视频吞咽造影检查（VFSS）对患者吞咽功能进行评分,采用渗透-误吸量表（PAS）对患者误吸程度进行评估。 结果 经4周干预后发现4组患者VFSS评分、PAS评级均较治疗前明显改善（P＜0.05）;并且联合组治疗后VFSS评分［（7.42±0.41）分］、PAS评级均显著优于对照组、食物改良组及CTAR组水平（P＜0.05）,食物改良组及CTAR组VFSS评分［分别为（5.96±0.82）分和（6.03±0.76）分］、PAS评级亦显著优于对照组水平（P＜0.05）。 结论 在食物质地改良基础上辅以CTAR训练能进一步改善头颈部肿瘤放疗后吞咽困难患者的吞咽功能,减少误吸发生,该联合疗法值得临床推广、应用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.