血浆脑钠素和心钠素在心力衰竭中的诊断价值及评价

目的 探讨血浆脑钠素(BNP)、心钠素(ANP)浓度变化对心力衰竭的诊断价值.方法 分别采用酶联免疫法和放射免疫法检测75例心力衰竭患者(NYHAⅡ～Ⅳ级)和25名健康对照者的血浆BNP和ANP浓度,同时采用纽约心脏病学会(NYHA)标准对心功能分级和用超声心动图检查评定患者心功能.结果 心力衰竭组血浆BNP浓度为(1 794.1±724.5) ng/L、ANP浓度为(948.5 ± 520.7) ng/L,与正常对照组BNP(90.5±55.8) ng/L、ANP(121.7±71.1 ) ng/L比较差异有统计学意义(P＜0.01).BNP浓度心功能Ⅱ级为(552.9 ±339.6) ng/L、Ⅲ级(1 303.9±566.4 ) ng/L、Ⅳ级(3 625.5±1 069.2) ng/L,两两比较差异有统计学意义(P＜0.05);ANP浓度Ⅱ级为(518.8±376.3) ng/L、Ⅲ级(1 061.9±521.3) ng/L、ⅣV级(1 264.7±798.1) ng/L,Ⅱ级与Ⅲ级、Ⅳ级比较差异有统计学意义(P＜0.05),而Ⅲ级和Ⅳ级比较差异无统计学意义(P＞0.05).左心室射血分数LVEF＞40%的患者BNP为(1 096.7±656.6) ng/L、ANP为(931.6±320.9 ) ng/L,LVEF＜40%的患者BNP(2 659.4±743.5 ) ng/L、ANP(974.3±555.6 ) ng/L,两组患者血浆BNP浓度差异有统计学意义(P＜0.05);而ANP差异无统计学意义(P＞0.05).BNP和ANP在受试者工作特征(ROC)曲线下的面积分别为0.97和 0.85,两者曲线下面积差异有统计学意义(P＜0.01).结论 血浆BNP比ANP对心力衰竭患者的诊断具有更高的准确性,BNP与超声心动图反映的血流动力学状况指标LVEF及NYHA分级具有较好的相关性,可以作为心力衰竭分级的一个良好的诊断指标.     

慢性心力衰竭患者血浆Elabela水平变化及意义

目的探讨不同NYHA心功能分级慢性心力衰竭患者血浆Elabela(ELA)表达水平差异及意义。方法慢性心力衰竭患者62例,其中NYHA心功能Ⅰ级17例,Ⅱ级14例,Ⅲ级18例,Ⅳ级13例,入院次日采集空腹静脉血,采用电化学发光法检测血浆N末端脑钠肽前体(nitrogen-terminal pro-brain natriuretic peptide,NT-proBNP)水平,采用ELISA法测定血浆ELA水平,应用彩色多普勒超声测定左室射血分数(left ventricular ejection fraction,LVEF);Spearman相关分析血浆ELA水平与NT-proBNP、LVEF的相关性。结果血浆ELA、NT-proBNP水平在NYHA心功能Ⅱ级患者[4.69(2.50,5.87)μg/L、1 022(776,1 760)ng/L]、Ⅲ级患者[8.66(6.81,9.65)μg/L、3 265(2 800,4 115)ng/L]、Ⅳ级患者[23.37(16.91,37.88)μg/L、7 817(6 959,9 636)ng/L]高于Ⅰ级患者[2.75(1.87,3.82)μg/L、318(219,537)ng/L],且NYHA心功能Ⅳ级患者高于Ⅱ级、Ⅲ级患者,Ⅲ级患者高于Ⅱ级患者(P0.05);NYHA心功能Ⅲ、Ⅳ级患者LVEF水平[(37.33±4.63)%、(34.00±4.47)%]低于Ⅰ级患者[(45.25±4.44)%](P0.05),Ⅲ级与Ⅳ级、Ⅰ级与Ⅱ级患者LVEF水平比较差异无统计学意义(P0.05);Spearman相关分析结果显示,慢性心力衰竭患者血浆ELA水平与NT-proBNP呈正相关(r=0.86,P0.001),与LVEF水平呈负相关(r=-0.61,P0.001)。结论随NYHA心功能分级增高,慢性心力衰竭患者血浆ELA表达明显增高,血浆ELA可作为判断心力衰竭严重程度的生物学标志物。     

充血性心力衰竭患者血浆脂联素和脑钠肽的相关性研究

目的 探讨充血性心力衰竭(CHF)患者血浆脂联素(APN)、脑钠肤(BNP)水平的变化及临床意义.方法 应用酶联免疫吸附法(ELISA)分别测定70例扩张型心肌病CHF患者治疗前、治疗后及20例正常人血浆APN和BNP水平,并进行统计学分析比较.结果 ①CHF组APN、BNP水平分别为(11.66±4.59)mg/L、(1079.78±550.76)ng/L明显高于正常对照组(1.38±0.47)mg/L、(59.63±22.43)ng/L(均P＜0.01);②心功能Ⅱ、Ⅲ、Ⅳ级组APN分别为(5.59±1.85)mg/L、(11.27±3.00)mg/L及(15.19±3.81)mg/L,BNP水平分别为(463.78±169.50)ng/L、(917.05±290.19)ng/L及(1 595.72±481.76)ng/L,随着心功能恶化二者水平显著升高(均P＜0.01).③CHF组治疗后APN(5.88±2.55)mg/L、BNP(547.25±234.88)ng/L明显低于治疗前水平,(11.66±4.59)mg/L、(1 079.78±550.76)ng/L(均P＜0.01);④CHF组血浆APN水平与BNP呈正相关(r=0.680,P＜0.01).结论 CHF患者血浆APN和BNP水平明显高于正常对照组且随着心功能恶化而显著升高.CHF患者经治疗后随心功能好转血浆APN和BNP水平可降低.CHF患者血浆APN和BNP呈正相关.     

充血性心力衰竭患者激活素A、基质金属蛋白酶9及N端脑钠肽前体水平的变化及其临床意义

目的 探讨充血性心力衰竭(CHF)患者血浆激活素A(ACT-A)、基质金属蛋白酶9(MMP-9)和N端脑钠肽前体(NT-proBNP)水平变化及临床意义.方法 应用酶联免疫吸附法(ELISA)分别测定86例CHF患者治疗前后及30例正常人血浆ACT-A、MMP-9和NT proBNP水平,并进行统计学分析比较.结果 ①CHF组ACT-A、MMP 9和lgNT-proBNP水平分别为(2.94±1.44) μg/L、(260.01±88.23) μg/L和(5.51±1.73) ng/L明显高于对照组(1.03±0.27) μg/L、(80.51±28.66)μg/L和(4.11±0.16) ng/L(均P＜0.01);②心功能Ⅱ、Ⅲ、Ⅳ级组ACT-A分别为(1.72±0.25) μg/L、(2.33±0.51)μg/L及(4.78±0.78) μg/L,MMP-9水平分别为(142.60±50.43) μg/L、(225.14±33.03) μg/L及(310.27±75.77) μg/L,lgNT-proBNP水平分别为(4.67±0.35) ng/L、(5.48±1.07) ng/L及(5.91±1.47) ng/L,以上指标均为CHFⅢ级高于CHFⅡ级,CHFⅣ级高于Ⅱ级和Ⅲ级(均P＜0.01).③CHF组治疗后血浆ACT A、MMP-9和lgNT-proBNP水平分别为(2.17±0.79) μg/L、(184.50±52.40) μg/L和(4.39±0.87) ng/L显著低于治疗前水平(2.94±1.44) μg/L、(260.01±88.23) μg/L和(5.51±1.73) ng/L(均P＜0.01).④CHF组血浆ACT A、MMP-9与lgNT-proBNP呈正相关(r＝0.732、0.771,P＜0.05).结论 CHF患者血浆ACT-A、MMP-9和NT-proBNP水平较正常人显著升高,且这些指标随着心功能恶化而明显升高.对其血浆浓度的测定有助于CHF的早期诊断和分级.     

新生儿先天性心脏病心力衰竭与血管紧张素Ⅱ以及心房利钠肽的关系研究

目的 探讨新生儿先天性心脏病患儿的血管紧张素Ⅱ(AngⅡ)、心房利钠肽(ANP)激活状况以及与心力衰竭的关系及其临床意义.方法 选取100例新生儿先天性心脏病患儿(NYHA心功能分级Ⅰ级组30例,Ⅱ级组40例以及Ⅲ和Ⅳ级组30例),另选取年龄及性别与之相匹配的正常体检新生儿30名作为对照组,检测AngⅡ、ANP浓度.结果 新生儿先天性心脏病患儿血循环中的AngⅡ与对照组比较明显增高,心功能分级3个亚组随着疾病严重程度的加重,AngⅡ的激活就越明显,其中Ⅲ和Ⅳ级组增高最明显[(119.19±5.54) ng/L与(30.72±1.34) ng/L,P＜0.01];AngⅡ与心功能分级呈明显正相关(r=0.85,P＜0.01).ANP与对照组比较明显增高,心功能分级3个亚组随着疾病严重程度的加重,ANP的增高越明显,其中Ⅲ和Ⅳ级组增加最明显[(9.00±2.37) pmol/L与(1.15±0.09) pmol/L,P＜0.01];ANP与心功能分级呈明显正相关(r=0.79,P＜0.01).结论 新生儿先天性心脏病存在AngⅡ及ANP的明显激活,并与疾病的严重程度密切相关;检测AngⅡ及ANP浓度可推测患儿的心功能状况.     

慢性阻塞性肺疾病急性加重期合并心力衰竭患者N端脑钠肽前体及降钙素原检测

目的 探讨N端脑钠肽前体(NT-proBNP)与降钙素原(PCT)水平在慢性阻塞性肺疾病急性加重期(AECOPD)合并心力衰竭患者血清中的变化及临床意义.方法 选择慢性阻塞性肺疾病(COPD)缓解期患者作为对照组(n=40),AECOPD合并心力衰竭患者作为观察组(n=60),观察组患者根据心功能不全程度分为纽约心脏病协会(NYHA)心功能 Ⅱ级(n=20),NYHA心功能Ⅲ级(n=20),NYHA心功能 Ⅳ级(n=20),检测对照组患者NT-proBNP与PCT水平及观察组患者治疗前后NT-proBNP与PCT水平.结果 观察组患者治疗前的NT-proBNP与PCT水平(4 987±2 618) ng/L,(0.592±0.490) μg/L均显著高于对照组(408±171) ng/L,(0.097±0.118) μg/L(P＜0.05).观察组的3个亚组间NT-proBNP水平(2 547±533) ng/L、(4 430±693) ng/L、(7 982±2 117) ng/L与PCT水平(0.204±0.097) μg/L、(0.439±0.152) μg/L、(1.132±0.471) μg/L差异有统计学意义(P＜0.05),且NT-proBNP与PCT水平随心力衰竭严重程度的加重而升高,3个亚组患者治疗后NT-proBNP(494±82) ng/L、(842±299) ng/L、(1 392±422) ng/L及PCT(0.068±0.295) μg/L、(0.097±0.035) μg/L、(0.170±0.059) μg/L的水平均明显低于治疗前水平(P＜0.05).结论 NT-proBNP与PCT是AECOPD合并心力衰竭患者病情严重程度和治疗效果的评价指标.     

血清卵泡抑素样蛋白1在慢性心力衰竭患儿诊断中的应用研究

目的探讨血清卵泡抑素样蛋白1(FSTL-1)在慢性心力衰竭(CHF)患儿诊断中的应用价值。方法选取2013年1月至2016年1月住院就诊的CHF患儿60例作为观察组,治疗前依据患儿心功能分级将观察组分为3个不同亚组,即心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组,每个亚组各20例患儿。另选60例健康儿童作为对照组,分别检测各组FSTL-1、血清氨基末端脑利钠肽前体(NT-proBNP)水平及超声心动图指标左心室质量指数(LVMI)。分析比较各组上述检测指标的差异及相关性。结果心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组的FSTL-1、NT-proBNP水平及LVMI均显著高于对照组,其差异具有统计学意义(P0.05);不同心功能亚组之间两两比较,其FSTL-1、NT-proBNP水平及LVMI随着心功能分级的升高而升高,差异具有统计学意义(P0.05),且FSTL-1与NT-proBNP及LVMI呈正相关。FSTL-1诊断小儿CHF的确诊率为96.67%,与金标准对比差异无统计学意义(P0.05)。结论血清FSTL-1在CHD患儿中随着病情的加重而升高,对儿童CHF的诊断及病情监测具有重要意义,值得临床上进一步应用推广。     

B型钠尿肽在充血性心力衰竭的诊断价值

目的探讨B型钠尿肽(BNP)在充血性心力衰竭(CHF)的诊断价值。方法选取2010年至2014年慢性充血性心力衰竭患者80例,心功能分级为Ⅱ级24例,Ⅲ级34例,Ⅳ级22例。测定其血浆BNP。结果不同原发疾病心力衰竭患者的血浆BNP水平比较差异无统计学意义(P0.05);不同心功能等级患者治疗前后血浆BNP水平及左心舒张末期内径比较差异有统计学意义(P0.05)。结论心室结构与血浆BNP水平密切相关,可将血浆BNP水平作为临床诊治CHF患者的有效指标。     

新生儿先天性心脏病心力衰竭与内皮素1和心房利钠肽的关系

目的 探讨新生儿先天性心脏病患儿是否存在内皮素1 （ET-1）和心房利钠肽（ANP）的明显激活及其临床意义.方法 选取100例新生儿先天性心脏病患儿（按心功能分级标准将患者分成几个亚组：Ⅰ级组30例、Ⅱ级组40例、Ⅲ-Ⅳ级组30例）,并选取年龄、性别与之相匹配的正常体检新生儿30名作为对照组.检测其ET-1、ANP浓度.结果 新生儿先天性心脏病Ⅲ-Ⅳ级组患儿血循环中的ET-1为（132.35±5.26） ng/L、ANP为（9.25±2.37） pmol/L,与对照组[ET-1（53.62±3.81） ng/L、ANP（1.15±0.09） pmol/L]比较明显增高（P＜0.01）.3个亚组随着疾病严重程度的加重,ET-1、ANP的激活就越明显,ET-1与心功能分级呈明显正相关（r=0.35;P ＜0.01）;ANP与心功能分级呈明显正相关（r =0.72,P＜0.01）.结论 新生儿先天性心脏病患儿的ET-1、ANP明显激活,并具有慢性心力衰竭的特征,其与疾病的严重性密切相关.     

同型半胱氨酸与舒张性心力衰竭的相关性

目的 研究血浆同型半胱氨酸(Hcy)与舒张性心力衰竭(DHF)的相关性.方法 选择DHF患者70例以及同一年龄段的健康对照组70例,检测两组的Hcy、N-末端脑钠素前体(NT pro-BNP)的水平以及左心室射血分数(LVEF)的变化情况.结果 与健康对照组比较,DHF患者血浆NT pro-BNP及Hcy明显增高(1 795.02±981.65) ng/L vs (67.54±24.55) ng/L,(15.00±2.11) μmol/L vs (10.46±1.38) μmol/L(P<0.05),两组间LVEF差异无统计学意义(P>0.05);DHF患者中,随着纽约心脏协会(NYHA)心功能分级增加,血浆Hcy浓度以及NT pro-BNP水平逐渐增高(P<0.05),在NYHA心功能Ⅱ级与Ⅲ级、Ⅲ级与Ⅳ级之间比较差异均有统计学意义(P<0.05);DHF患者中,NT pro-BNP与血浆Hcy浓度呈明显正相关(r=0.936,P<0.05).结论 Hcy参与了DHF的病理生理过程,可能成为DHF的治疗靶点以及诊断标志物.     

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.