B超检测妊娠晚期羊水过少的临床意义

目的分析足月妊娠时B超产前诊断羊水过少的方法及标准,以及羊水过少对围产期结局的影响。方法采用羊水指数法(AFI)测量羊水量,比较分析11例B超诊断羊水过少(观察组)和111例B超诊断羊水正常的足月妊娠妇女(对照组)B超测量羊水量与实际过少的符合率、分娩情况及新生儿预后。结果羊水过少高发于40～41 6／7孕周间,羊水过少(观察组)与羊水正常(对照组)比较,两组分娩方式及新生儿轻度窒息率差异有显著性,P<0．05。结论B超诊断羊水过少是比较可靠的方法,羊水过少易发生不良围产儿结局,严重影响围产儿的预后。发现羊水过少者应高度重视,加强监护,尽量避免不良围产儿结局的发生。     

羊水过少对围产儿预后的影响

目的 探讨晚期妊娠羊水过少对围产儿预后的影响.方法 2003年7月至2005年1月我院应用B超测定羊水最大暗区垂直深度(AFV),及人工破膜、产时羊水总量<300ml的52例妊娠妇女临床情况及围生期结局进行分析.结果 羊水过少高发于孕40-42+6周,占8.64%(19/220);有妊娠合并症、并发症的高危孕妇羊水过少多发生于孕37-39+6周,占6.09%(30/493).用超声测定羊水最大暗区深度作为检测羊水量的指标,符合率为91.67%(44/48),剖官产率为76.92%(40/52).结论 羊水过少严重影响围产儿预后,确诊为羊水过少的孕妇,应根据综合检查结果及妊娠是否存在高危因素,选择最佳分娩方式,及时终止妊娠,可以明显改善围产儿预后.     

围产期监护和新生儿

031763羊水过少对围产期结局的影响尸弓长丽萍…//贵州医药一2003,27(2)一149一151 分娩孕产妇共1936例,其中诊断为羊水过少者125例,发生率6.45%。诊断标准:以分娩时羊水量<300ml者为羊水过少。羊水指数(AFI)<5 .0诊断为羊水过少(绝对值);AFI(scm诊断为羊水过少(临界值)。125例孕妇按孕周分成3组:37孕周为A组,37一396刀孕周为B组;40一42十孕周为C组。结果:C组与A、B两组相比较,羊水过少发生率明显增高,差异有显著性(P<0.01),妊娠合并高危因素,多发生在37一396n孕周,占68 .12%。B超是产前诊断羊水过少的重要手段,本研究显示孕周>40周隋…     

羊水过少对围生儿的影响

目的 探讨晚期妊娠羊水过少对围生儿结局的影响.方法 对我院通过超声测定羊水指数(AFI)诊断羊水过少的260例晚期妊娠妇女临床情况及围生儿结局进行分析.结果260例羊水过少妇女中148例为40～42+6W(占56.92%),有妊娠合并症、并发症的高危妊娠羊水过少的多发生于37～39+6W,占66.96%(75/112).260例中死胎1例,占38.46/万.B超测定羊水指数诊断羊水过少符合率为98.84%(256/259).剖腹产率为80.00%(208/260).结论超声测定羊水指数是及时诊断羊水过少的可靠指标;羊水过少严重影响围生儿的预后,选择最佳分娩方式及时终止妊娠,预防和降低围生儿死亡率.     

羊水过少对围生期结局的影响

目的：探讨妊娠晚期羊水过少对围生期结局的影响。方法：2005年1月至2007年12月汕头市妇女儿童医院应用B型超声测定羊水指数（AFI）,对估计羊水量及分娩时直接测定羊水总量〈300m l的371例妊娠妇女临床情况及围生期结局进行分析。结果：羊水过少高发于孕40-42＋6周,占10.07%（154/1529）;有妊娠合并症、并发症的高危妊娠羊水过少大多数发生于孕37-39＋6周,占72.09%（124/172）,围生儿死亡率为53.9/万。应用B型超声测定羊水指数作为监测羊水量的指标,符合率为95.89%（303/316）,剖宫产率为71.43%（265/371）。结论：诊断羊水过少的孕妇,应依据综合检查结果及妊娠是否存在高危因素选择最佳分娩方式及时终止妊娠,可以明显改善围生儿预后。     

羊水过少对围产儿的影响

目的:探讨妊娠晚期羊水过少对围产儿的影响。方法:收集B超测定羊水指数(AFI)≤8 cm及产时羊水量<300 mL的176例妊娠妇女临床情况及围产儿结局进行回顾性分析。结果:羊水过少多发生于妊娠41周以后,占8.03%;B超测定羊水量的符合率为94.08%;剖宫产率为71.59%;有妊娠并发症的羊水过少的发生率高于正常;经过分析发现羊水过少时羊水量愈少,羊水粪染、胎儿窘迫、新生儿窒息的发生率愈高。结论:羊水过少可导致不良的围产儿结局,一旦确诊,应严密监测,果断采取必要措施,选择最佳分娩方式,避免胎儿窘迫的程度加重,从而降低新生儿窒息的发生率。     

羊水过少对围生儿预后的影响

目的探讨晚期妊娠羊水过少对围生儿预后的影响。方法2006年7月—2009年1月我院应用B超测定羊水最大暗区垂直深度（AFV）,对人工破膜、产时羊水总量〈300mL的52例妊娠妇女临床情况及围生期结局进行分析。结果羊水过少高发于孕40周～42＋6周,占8.64%（19/220）;有妊娠合并症、并发症的高危孕妇羊水过少多发生于孕37周～39＋6周,占6.09%（30/493）。用超声测定羊水最大暗区深度作为检测羊水量的指标,符合率为91.67%（44/48）,剖宫产率为76.92%（40/52）[张首杰,等.妊娠晚期B超测量羊水量的意义[J].中华妇产科杂志,1988,23（5）：299.]。结论羊水过少严重影响围生儿预后,确诊为羊水过少的孕妇,应根据综合检查结果及妊娠是否存在高危因素,选择最佳分娩方式,及时终止妊娠,可以明显改善围生儿预后。     

羊水过少126例临床分析

目的 探讨羊水过少对母婴的影响,寻找正确的处理方法 ,降低围产儿病死率.方法 对2008年7月～2009年3月在我院住院分娩的126例羊水过少的妊娠妇女的围产期结局进行回顾性分析.结果 羊水过少高发于妊娠40周后;B超对羊水过少的估计准确率高达96%;羊水过少出现最多的妊娠并发症为妊娠高血压疾病和胎儿生长受限,有统计学意义;羊水过少,胎儿窘迫及新生儿窒息率明显高于对照组,有统计学意义.结论 对羊水过少确诊后适时选择剖宫产为宜.     

羊水过少106例临床分析

目的探讨羊水过少的妊娠结局,提高围产期质量.方法常规B超检查,以最大羊水池垂直平段＜3 cm、羊水量＜300ml为标准诊断羊水过少106例,符合率达90.08%,提示可作为及早发现羊水过少的可靠方法之一.结果 106例羊水过少者,行剖宫产术82例,出现胎儿窘迫38例,低Apgar评分者8例,无1例围产儿死亡;24例经阴道分娩者,2例国产儿死亡.结论羊水过少适时剖宫产结束分娩,能显著改善围产儿预后.     

羊水过少158例临床分析

目的　探讨羊水过少的临床意义 ,减少围产儿不良结局的发生。方法　将 1 5 8例羊水过少产妇作为研究对象 ,随机抽取 1 5 8例羊水正常产妇为对照组 ,分别就羊水过少与妊娠并发症及围产儿死亡的关系、羊水指数 (AFI)与胎儿窘迫的关系、羊水过少不同分娩方式与新生儿情况等方面进行统计学分析。结果　羊水过少的妊娠并发症发生率达 48.1 0 %,围产儿死亡率达 4.43 %,明显高于羊水正常组 ,有统计学意义 (P <0 .0 0 5 )。AFI值越小 ,胎儿窘迫的发生率愈高 (P <0 .0 1 )。羊水过少剖宫产终止妊娠的新生儿窒息率为 6 .89%,经阴道分娩的新生儿窒息率为 3 0 .95 %,两者比较 ,有统计学意义 (P <0 .0 0 5 )。剖宫产组的围产儿死亡率为零 ,阴道分娩组的围产儿死亡率为 6 .2 5 %。结论　羊水过少严重威胁胎儿、新生儿的生命安全 ,一经确诊 ,宜尽早终止妊娠 ,以剖宫产为宜。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.