特发性血小板减少性紫癜抗核抗体阳性的临床意义

目的 探讨抗核抗体(ANA)在特发性血小板减少性紫癜(ITP)中的临床价值.方法 回顾性分析1998年1月至2009年1月间进行的ANA检测的71例ITP患者临床资料.71例ITP患者中,ANA阳性20例(28.2%).42例ITP患者接受了初治方案为泼尼松1 mg/(kg·d)的治疗,其中12例ANA阳性(ANA阳性组).结果 治疗第7天,ANA阳性组平均血小板计数增加(16.5±14.0)×10~9/L,ANA阴性组增加(42.7±15.2)×10~9/L,2组比较差异有统计学意义(P＜0.05);治疗第15天,ANA阳性组平均血小板计数增加(43.1±8.1)×10~9/L,ANA阴性组增加(64.2±14.8)×10~9/L,2组比较差异有统计学意义(P＜0.05).对年龄、性别、骨髓巨核细胞数和红细胞沉降率进行调整后,ANA阳性组与ANA阴性组之间血小板计数增加值仍具有统计学意义(P＜0.05).结论 ANA阳性的ITP患者可能对泼尼松治疗反应差.     

唾液胃蛋白酶与合并胃食管反流的慢性阻塞性肺疾病加重关系的研究

目的探讨唾液胃蛋白酶对评估合并胃食管反流病的慢性阻塞性肺疾病(COPD)患者加重风险的意义。方法前瞻性选取2015年1~12月年龄50岁的COPD稳定期患者76例,根据唾液胃蛋白酶检测结果分为两组:唾液胃蛋白酶阳性组和唾液胃蛋白酶阴性组,每组各38例。两组患者每半年随访一次,共随访1年。每次随访记录两组慢性阻塞性肺疾病急性加重(AECOPD)的次数、慢性阻塞性肺病评估测试(CAT)问卷、肺功能、胃食管反流病问卷(Gerd Q)。随访1年后,两组患者均给予奥美拉唑治疗半年,继续随访至2年,观察两组患者AECOPD次数及Gerd Q评分的变化。结果在1年随访期时,两组患者均有2例病例失访,唾液胃蛋白酶阳性组患者AECOPD次数及CAT问卷评分明显高于唾液胃蛋白酶阴性组[(3.08±1.01)次/年vs.(1.79±0.70)次/年;(33.84±3.49)分vs.(27.76±4.43)分],差异具有统计学意义(P0.01)。在随访1年时,唾液胃蛋白酶阳性组患者第1秒用力呼气容积(FEV1)较唾液胃蛋白酶阴性组明显下降[(0.83±0.11)L vs.(0.99±0.12)L],差异具有统计学意义(P0.05);两组患者Gerd Q量表评分[(14.45±3.10)分vs.(14.34±2.68)分]比较,差异无统计学意义(P0.05)。1年后两组均予口服奥美拉唑治疗半年,继续随访至2年,两组患者Gerd Q评分较治疗前均下降[(14.45±3.10)分vs.(3.05±2.7)分;(14.34±2.68)分vs.(7.82±2.25)分],差异具有统计学意义(P0.05);唾液胃蛋白酶阳性组患者下降幅度较唾液胃蛋白酶阴性组大[(11.45±4.06)分vs.(6.57±3.28)分],差异具有统计学意义(P0.01)。在2年随访期内,唾液胃蛋白酶阳性组患者AECOPD次数较1年前发作次数减少[(3.08±1.01)次/年vs.(2.50±0.50)次/年],差异具有统计学意义(P0.05),而唾液胃蛋白酶阴性组AECOPD次数较治疗前有轻度增加[(1.79±0.70)次/年vs.(2.20±0.60)次/年],差异无统计学意义(P0.05)。结论唾液胃蛋白酶阳性与合并胃食管反流的COPD稳定期患者的急性加重有关,对慢性阻塞性肺疾病合并胃食管反流病的患者给予质子泵抑制剂(PPI)治疗前应考虑行唾液胃蛋白酶检测。     

COPD患者气道炎性标记物与咳嗽、咳痰的相关性

目的探讨慢性阻塞性肺疾病(COPD)患者痰液及气道中炎性标记物(中性粒细胞比例、嗜酸性粒细胞比例及趋化因子Eotaxin、RANTES)水平与咳嗽、咳痰的相关性。方法选取安岳县人民医院2016年9月至2017年10月确诊的COPD患者为研究对象,将有咳嗽、咳痰症状的患者作为观察组,将仅有咳嗽,但无咳痰症状患者作为阳性对照组,将无咳嗽、咳痰患者作为阴性对照组,收集合格痰液标本,分别检测痰液上清液Eotaxin、RANTES水平及计数痰涂片各细胞成分比例。结果 86例取得合格痰标本患者中,观察组痰上清液Eotaxin水平[(7.45±1.47)pg/mL]明显高于阳性对照组[(4.17±1.03)pg/mL]及阴性对照组[(2.03±0.55)pg/mL],差异均有统计学意义(P0.05);阳性对照组也明显高于阴性对照组,差异有统计学意义(P0.05);观察组RANTES水平[(7.11±2.13)pg/mL]明显高于阳性对照组[(4.23±1.32)pg/mL]及阴性对照组[(2.55±0.47)pg/mL)],差异有统计学意义(P0.05);阳性对照组高于阴性对照组,差异有统计学意义(P0.05);在痰涂片中,观察组中性粒细胞[(4.62±1.07)×106cells/mL]高于阳性对照组[(3.03±0.82)×10~6cells/mL]及阴性对照组[(2.37±0.71)×10~6cells/mL],差异有统计学意义(P0.05);观察组嗜酸性粒细胞[(0.23±0.06)×10~6cells/mL]与阳性对照组[(0.19±0.04)×10~6cells/mL]差异无统计学意义(P0.05);观察组与阴性对照组[(0.18±0.05)×10~6cells/mL]比较,差异有统计学意义(P0.05);阳性对照组与阴性对照组比较,差异无统计学意义(P0.05)。结论中性粒细胞、嗜酸性粒细胞及其趋化因子Eotaxin、RANTES等气道炎性标记物参与了COPD患者咳嗽、咳痰反应过程,痰中嗜酸性粒细胞趋化因子Eotaxin、RANTES水平与气道炎症程度有关。     

艾滋病/隐球菌性脑膜炎与艾滋病/结核性脑膜炎临床特征的差异性研究

目的分析艾滋病合并隐球菌性脑膜炎(AIDS/CM)与艾滋病合并结核性脑膜炎(AIDS/TBM)临床特征,为临床鉴别诊断提供依据。方法收集AIDS/CM与AIDS/TBM患者临床资料,比较其人口学信息、临床表现、实验室检查、影像学检查及转归的异同。结果共纳入AIDS/CM 122例,AIDS/TBM 52例;两组病例在人口学方面差异无统计学意义;临床表现比较:AIDS/TBM患者发热和意识障碍发生率显著高于AIDS/CM患者(P0.05);实验室检查结果比较:AIDS/CM患者CD4~+T淋巴细胞计数水平较AIDS/TBM患者低;AIDS/TBM患者脑脊液蛋白水平显著高于AIDS/CM患者,而脑脊液压力及脑脊液氯化物定量水平显著低于AIDS/CM患者(P 0.05);影像学比较:AIDS/CM患者肺部病灶发生率显著低于AIDS/TBM患者,但基底节病变发生率显著高于AIDS/TBM患者(P0.05)。结论 AIDS/CM与AIDS/TBM在临床表现、实验室检查结果及影像学表现上存在差异,经综合分析容易找到鉴别诊断线索。     

抗着丝点抗体阳性的原发性胆汁性肝硬化患者临床分析

目的:探讨原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)患者抗着丝点抗体(anticentromere antibody,ACA)与临床表现间的关系.方法:156例PBC患者,分为ACA阳性组46例,ACA阴性组110例,比较2组临床表现,肝功能及免疫学指标.结果:ACA阳性组患者乏力、黄疸发生率低于ACA阴性组(P＜0.05).2组肝功能各指标比较差异无统计学意义(P＞0.05).ACA阳性组IgM水平和CD4+水平较ACA阴性组高(P＜0.05).结论:ACA阳性PBC患者临床表现隐匿,易漏诊.     

痰液细菌培养联合NLR和血清IL-6检测在AECOPD诊断中的应用价值分析

目的探讨痰细菌培养联合中性粒细胞和淋巴细胞比值(NLR)和血清白细胞介素-6(IL-6)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床应用价值。方法回顾性分析2018年3月～2020年2月亳州市人民医院收治的诊断明确AECOPD 患者160例(痰细菌培养阴性125例,阳性35例),按照AECOPD进程中是否合并肺源性心脏病、呼吸衰竭及肺动脉高压等凶险并发症,把125例痰培养阴性患者分为单纯组(67例)和合并症组(58例)。另选35例COPD 稳定期患者为对照组。比较其血常规指标和血清IL-6、超敏C反应蛋白(hs-CRP)等炎性标志物水平。结果 (1)痰细菌培养阴性组、痰细菌培养阳性组与对照组三组间比较,AECOPD患者血清NLR和IL-6水平在三组的差异具有统计学意义(P0.05);而WBC、hs-CRP、PCT的差异没有统计学意义(P0.05)。(2)NLR水平在三组间的两两比较显示,阳性组和阴性组间的差异无统计学意义 (P0.05),但阳性组与对照组、阴性组与对照组间的差异均有统计学意义(P0.05)。(3)IL-6表达水平在三组间的两两比较显示,阳性组与阴性组、阳性组与对照组的差异均无统计学意义 (P0.05),但阴性组与对照组间的差异均有统计学意义(P0.05)。(4)AECOPD痰培养阴性患者中合并凶险症状组与单纯组组间比较,显示WBC、PCT、NLR、IL-6和hs-CRP表达水平差异均无统计学意义(P0.05)。(5)各炎性指标因子在AECOPD患者痰培养阴性组的ROC曲线显示,NLR和IL-6在痰培养阴性患者的曲线下面积分别为0.720、0.689。结论痰细菌培养结果联合NLR和IL-6的表达水平可协助诊疗AECOPD 患者的病情,尤其是对缺乏特异性指标的痰细菌培养阴性的AECOPD患者。     

抗结核药物对肺结核合并乙型肝炎患者肝功能及HBV-DNA水平的影响

目的探究抗结核药物对肺结核合并乙型肝炎(简称乙肝)患者肝功能及HBV-DNA水平的影响。方法回顾性分析2013年6月至2018年5月神木市医院及西安市胸科医院收治的83例肺结核合并乙肝患者的临床资料,按血清HBe Ag检测结果不同将患者分为HBe Ag阳性组(n=45)和HBe Ag阴性组(n=38),按血清HBV-DNA水平不同将患者分为高水平组(HBV-DNA≥103copies/ml,n=43)和低水平组(HBV-DNA 103copies/ml,n=40),分析肝损害发生率与HBV-DNA定量水平的相关性、肝损害程度与HBV-DNA定量水平的相关性,并记录肝损害出现时间及恢复时间。结果 HBV-DNA高水平组患者中的HBe Ag阳性及阴性的肝损害发生率分别为46. 5%、48. 9%,均分别高于低水平组中的12. 5%、11. 1%,差异具有统计学意义(P 0. 05);相同HBV-DNA水平患者的血清HBe Ag阳性和阴性的肝损害率比较,差异无统计学意义(P 0. 05)。HBe Ag阴性组患者中,血清HBV-DNA高水平组的丙氨酸氨基转移酶(ALT)和总胆红素(TBL)分别为(108. 41±8. 32) U/L、(34. 51±5. 79)μmol/L,均分别高于其低水平组的(78. 36±7. 25) U/L、(22. 85±4. 25)μmol/L,差异具有统计学意义(P 0. 05)。HBV-DNA高水平组患者的HBe Ag阳性和阴性的肝损害时间分别为(15. 43±3. 96) d、(16. 38±4. 12) d,分别短于低水平组的(28. 35±4. 02) d、(32. 59±4. 36) d,差异具有统计学意义(P 0. 05); HBV-DNA高水平组的肝功能恢复时间分别为(83. 24±6. 38) d、(84. 25±7. 63) d,分别长于低水平组(61. 06±5. 92) d、(60. 39±6. 38) d,差异具有统计学意义(P 0. 05)。结论对肺结核合并乙肝患者实施抗结核治疗会引起肝损害,且与HBV-DNA病毒载量密切相关,同时,HBe Ag阴性患者的血清HBV-DNA水平与肝功能指标呈正相关,此外,高水平病毒载量的肺结核患者肝损害发生时间早,且恢复时间长。     

DWI阴性的急性缺血性脑卒中患者rt-PA静脉溶栓的 临床研究

目的:观察发病24 h内头部弥散加权成像(DWI)阴性的急性缺血性脑卒中患者rt-PA静脉溶栓的临床疗效及安全性。方法:回顾性分析行rt-PA静脉溶栓的急性缺血性脑卒中患者78例临床资料,根据患者入院后头部DWI检查结果,将患者分为DWI阳性组69例和DWI阴性组9例,分析比较2组患者的基本资料、入院至溶栓时间(DNT)、症状性颅内出血、3个月预后良好(MRS2分)比例、死亡率、发病至DWI扫描时间、后循环梗死比例等指标。结果:2组患者基本资料差异无统计学意义(P0.05);2组低密度脂蛋白(LDL)、DNT、发病至扫描时间、后循环脑梗死比例差异有统计学意义(P0.05);2组症状性颅内出血发生率低和死亡率差异无统计学意义(P0.05);DWI阴性组90 d MRS2分的比例较高(P0.05)。结论:与DWI阳性患者相比,DWI阴性的急性缺血性脑卒中患者rt-PA静脉溶栓后临床疗效更好,安全性相当。     

D-二聚体阴性肺血栓栓塞症临床分析

目的对D-二聚体阴性肺血栓栓塞症(PTE)病例与D-二聚体升高者进行对比分析。方法螺旋CT肺动脉造影(CTPA)确诊的42例PTE患者进行回顾性分析,包括性别、年龄、危险因素、临床表现、心电图、血气分析、下肢静脉及心脏超声、D-二聚体值测定、发病至就诊时间等。结果 D-二聚体值:D-二聚体阴性组(313.91±132.96)ng/L,D-二聚体升高组为(1 711±2 182.76)ng/L。发病至就诊时间:D-二聚体阴性组(9.73±3.80)d,D-二聚体升高组(5.10±2.90)d,两组相比差异有统计学意义(P<0.05)。临床各种表现对比两组无明显差异,均以呼吸困难为最常见表现,达80%以上。危险因素对比:D-二聚体阴性组高龄增多。辅助检查结果对比:D-二聚体阴性组超声心动图阳性发现率高。结论 D-二聚体测定应该与临床表现等相结合,如高度怀疑肺栓塞,特别是超声心动图发现基础病难以解释的右心负荷加重,则应进一步做CTPA等相关检查,以减少漏诊和误诊。     

丙型肝炎病毒感染对维持性血液透析患者炎症因子及糖代谢的影响

目的探讨丙型肝炎病毒(hepatitis C virus,HCV)感染对慢性肾衰竭维持性血液透析患者的微炎症状态及糖代谢的影响。方法单中心、有对照、横断面研究,比较21例HCV抗体阳性维持性血液透析患者(阳性组)与51例HCV抗体阴性患者(阴性组)的空腹血糖、空腹胰岛素和C肽水平及胰岛素抵抗指数(稳态模式评估法,homeostasis model assessment of insulin resistance index,HOMA-IR)等糖代谢指标以及C反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子á(tumor necrosis factor-á,TNF-á)等炎症指标,所有患者均维持性血液透析6个月以上,透析开始前均无糖尿病史和器官移植史,6个月内无使用糖皮质激素和免疫抑制剂史,2周内无发热和感染史。两组患者年龄、性别比例及体质量指数差异均无统计学意义(P0.05)。结果阳性组平均透析治疗时间较阴性组长,分别为(53±21)月和(32±18)月。阳性组丙氨酸氨基转移酶较阴性组高,分别为(33±19)U/L和(14±14)U/L,差异有统计学意义(t=1.85,P=0.034)。两组患者的血浆白蛋白、空腹血糖和C肽水平差异均无统计学意义(P0.05),但阳性组空腹胰岛素水平高于阴性组,分别为(12.18±3.05)pmol/L和(10.52±2.98)pmol/L,差异有统计学意义(t=2.12,P=0.037);阳性组HOMA-IR也显著高于阴性组,分别为2.67±0.87和2.21±0.75,差异有统计学意义t=2.36,P=0.027);阳性组和阴性组CRP分别为(0.34±0.11)mg/dl和(0.12±0.04)mg/dl,差异有统计学意义(t=2.65,P=0.009);TNF-á分别为(22.09±7.16)pg/ml和(10.31±4.87)pg/ml,差异有统计学意义(t=2.07,P=0.045)。而且空腹胰岛素水平和HOMA-IR均与TNF-á、CRP水平呈显著的正相关。结论合并HCV感染会进一步加重慢性血液透析患者的炎症状态,并进一步导致胰岛素抵抗。     

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.     

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.     

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.