笑气吸入无疼分娩临床研究

目的 观察笑气吸入分娩镇痛的临床效果。方法 选取100例笑气吸入分娩镇痛者作为观察组,另随机选取100例未用笑气分娩者作为对照组。观察分娩疼痛、产程时间、分娩母亲动脉、脐动脉血气分析、分娩方出血量、新生儿Apgar评分、式及副作用等指标。结果 现察组分娩疼痛1级75例,2级25例,3级0,对照组分别为4、70、26例(P<0.01=)差异有极显著意义。观察姐产程活跃期2.36±1.41(小时),第二产程0.68±0.38(小时),对照纽分别为3.23±1.68,0.96±0.36(小时)(P<0.05),差异有显著性。分娩方式观察组顺产75例,剖宫产22例,对照组分别为59、37例(P<0.05),差异有显著性。两蛆血气分析pH、Pco2、PO2、BE差异无显著性(P>0.05)。两组新生儿Apgar评分差异无显著性(P>0.05)。两组出血量分别为250±38ml、270±24ml,(P<0.05),差异无显著性。观察组剖宫产22例,对照组37例,差异有显著性(P<0.05)。有7例出现轻微的头晕、乏力。结论 笑气吸入用于无痛分娩效果肯定,副作用少。     

笑气吸入在分娩镇痛中的应用

目的探讨笑气吸入在分娩镇痛中的效果和对母儿的影响.方法对136例产妇在产程中给予吸入50%氧化亚氮(笑气)和50%氧气组成的混合气体实行镇痛分娩(研究组),另选择200例产妇在产程中不给予笑气吸入(对照组),观察两组产妇疼痛的程度、产程时间、分娩方式、羊水情况、产后出血量和新生儿Apgar评分等.结果研究组的镇痛有效率和自然分娩率高于对照组;总产程时间短于对照组,两组比较差异有显著性(P＜0.05).羊水污染、新生儿窒息率和产后出血,两组比较差异无显著性(P＞0.05).结论吸入50%氧化亚氮(笑气)和50%氧气组成的混合气体用于分娩镇痛可有效地缓解分娩疼痛,缩短产程时间,对母儿无不良影响,是一种安全、有效、简便的镇痛方法.     

GC-MS衍生化法检测先天性畸形羊水中的非极性氨基酸

目的利用气相色谱质谱(GC-MS)衍生化法对孕先天性畸形儿孕妇羊水中的非极性氨基酸,包括丙氨酸(Ala)、亮氨酸(Leu)、异亮氨酸(Ile)、脯氨酸(Pro)和苯丙氨酸(Phe)进行定量检测;探讨疾病组与正常组孕妇羊水中非极性氨基酸的差异及其意义。方法取100μL羊水上清液,加入甲醇去蛋白后提取上层清液吹干,进行MSTFA衍生化,利用GC-MS检测并分析检测结果。结果该方法具有良好的灵敏度、精密度、准确度以及回收率。在最优化的检测条件下,被检测氨基酸最低检出限为0.12~0.38 mg/L,线性范围为0.5~10 mg/L,添加回收率为91.12%~104.41%,日内及日间相对标准偏差(RSD)为0.84%~9.33%。用建立的方法对17例疾病组和13名正常组孕妇的羊水样本进行测定,统计分析结果表明,疾病组孕妇羊水中亮氨酸和异亮氨酸含量显著降低(P0.01),其余3种氨基酸水平无明显差异。结论本方法经方法学验证,可作为羊水中氨基酸含量的测定方法,具有良好的应用前景;亮氨酸的减少可能参与了先天性畸形的发生。     

异氟醚分娩镇痛的效果及其对母儿影响的研究

目的：探讨异氟醚用于第一产程活跃期镇痛的有效性及其对分娩、母体、胎儿和新生儿的影响。方法：将１００ 名初产妇随机分为Ａ、Ｂ、Ｃ、Ｄ组,分别为笑气异氟醚合用组、笑气组、异氟醚组及对照组,每组２５ 例;产妇采用半紧闭法间断吸入药物;以视觉模拟评分（ＶＡＳ）评价镇痛的效果;观察分娩各产程时间、分娩方式、产后出血、脐血血气分析及新生儿神经适应能力评分等;测定用药前后氟离子浓度。结果：用药后Ａ、Ｃ组的疼痛分数显著低于Ｂ组,Ａ、Ｃ两组间差异无显著性;其它各项指标四组间差异均无显著性。结论：吸入镇痛浓度的异氟醚或与笑气合用,是一种安全有效的镇痛法。     

412例妊娠中期羊水细胞检测孕妇的指征及结果分析

目的通过对实施妊娠中期羊水细胞检测孕妇的指征及结果的分析,探讨本地区羊水细胞检测的应用价值。方法回顾性分析412例进行孕中期羊膜腔穿刺并收集羊水细胞进行检测的孕妇的病历资料,分析检测的指征及结果。所有病例均进行了羊水细胞核型分析;24例需要或要求进行地中海贫血产前诊断的进行了地中海贫血基因产前诊断。结果 412例孕妇中,检测指征按由高到低顺序依次为高龄孕妇;血清学筛查高危;地中海贫血基因携带者;超声筛查高危;非整倍体胎儿妊娠史;孕早期服药或放射线接触史。羊水细胞核型分析共检出26例胎儿染色体异常,发生率为6.31%;包括21例染色体数目异常（含1例嵌合体）和5例染色体结构异常（含3例嵌合体）。地中海贫血产前诊断检出患病纯合子胎儿4例。结论孕中期羊水细胞检测对本地区人群进行产前诊断的价值是肯定的。随着高龄孕妇在产前诊断人群中所占比例的增加,应该制定更为合适的产前检查方案。     

Macrophage colony-stimulating factor levels in amniotic fluid before and after the onset of labor do not differ in normal pregnancies

PROBLEM: Macrophage colony-stimulating factor (M-CSF) promotes placental growth and maintenance. M-CSF also regulates trophoblast invasion into the placental bed. We evaluated whether M-CSF levels in amniotic fluid during labor contributing to subsequent delivery differed from those before the onset of labor in normal pregnancies. METHOD OF STUDY: This study enrolled 48 Japanese women experiencing normal pregnancies with single fetuses who had no infection. Of these pregnancies, 24 were women during labor: 22 led to subsequent term delivery (labors); two had premature delivery. The other 24 were women without labor underwent cesarean section (controls). These two groups (22 labors and 24 controls) were compared. The average gestational age at entry was 38 weeks of gestation. The women's ages and gestational ages did not differ significantly between the two groups. Amniotic fluid was collected and the M-CSF levels were compared between two groups. The M-CSF level was determined by the sandwich enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The levels of M-CSF in amniotic fluid did not differ significantly between the women during labor and those without labor. CONCLUSIONS: M-CSF in amniotic fluid may not contribute to the onset of labor in term pregnancy and/or labor resulting in subsequent delivery may not induce the production and secretion of M-CSF into amniotic cavity.     

孕晚期羊水量的减少与妊娠结局的临床分析

目的探讨羊水量减少孕妇发生妊娠不良结局的危险。方法2007年3月至2007年9月在新疆医科大学第一附属医院住院分娩的羊水减少的孕妇60例,羊水指数（AFI）5.1cm-8cm为羊水量减少,研究组和对照组均进行产前检查,包括：胎心监护,S/D比值测定,B超检查。妊娠结局包括分娩孕周,新生儿出生体重,胎盘钙化,分娩方式,羊水污染,新生儿窒息,围生儿死亡。结果羊水减少组新生儿体重明显低于羊水正常组（P〈0.05）,2组羊水污染有统计学意义（P〈0.05）,羊水减少组剖宫产率高于羊水正常组,2组终止妊娠时间,新生儿窒息的差异无统计学意义（P〉0.05）,2组均无围生儿死亡。羊水减少（5.1-6.5）A1组与羊水减少（6.6-8.0）A2组相比较,终止妊娠时间、分娩方式,羊水污染,新生儿窒息、新生儿出生体重及围生儿死亡的发生,差异无统计学意义（P〉0.05）,胎盘钙化A1组和A2组有统计学意义（P〈0.05）。结论羊水量的减少是妊娠不良结局的一个危险信号,为减少妊娠不良结局的发生,应重视对羊水量减少孕妇的监测。     

Opioid mediation of amniotic fluid effects on chemosensory responsiveness in the neonatal rat

The present study investigated if oral exposure to milk or amniotic fluid (AF) alters responsiveness to sensory stimulation in the neonatal rat, and whether these effects are mediated by the opioid system. Facial wiping evoked by intraoral lemon infusion was used as a measure of sensory responsiveness. Pups were tested in a supine posture, because they showed more paw-face strokes during facial wiping than pups tested prone (Experiment 1). Moreover, pups orally exposed to milk (Experiment 2) or AF (Experiment 3) showed a diminished wiping response to lemon compared to controls exposed to water. Blockade of opioid receptors with the nonselective antagonist naltrexone (Experiment 4) or the kappa antagonist nor-binaltorphimine (Experiment 5) reinstated higher levels of facial wiping after AF exposure. These findings confirm developmental continuity between fetal and neonatal behavioral responses to AF and the ability of AF to induce activity at kappa receptors of the endogenous opioid system.