格拉司琼对腹腔手术患者术后恶心呕吐预防作用的临床观察

目的:探讨格拉司琼对腹腔全麻手术后镇痛引起恶心呕吐的预防作用,以积累经验,指导临床工作。方法:收集200例腹腔镜全麻并需术后镇痛的患者,随机分为观察组(100例)与对照组(100例),观察组在手术结束前5分钟静脉输入格拉司琼3mg,对照只在术后镇痛,观察二组恶心、呕吐的发生率及不良反应。结果:观察组患者恶心呕吐的发生率明显低于对照组发生率,不良反应低,临床中可以应用。     

恩丹西酮、氟哌利多及地塞米松联合预防腹腔镜妇科手术后胃肠反应的临床观察

腹腔镜下行妇科手术以创伤小、恢复快、能缩短住院时间甚至不住院而越来越受到欢迎。但是其术后恶心呕吐发生率较高，严重影响着病人恢复的质量和速度，增加了医药费用。因此腹腔镜术后的胃肠反应的预防工作日益受到重视。本文旨在观察恩丹西酮、氟哌利多及地塞米松分别与联合用于妇科腹腔镜手术的病人，预防术后恶心呕吐的临床效果。     

盐酸丁丙诺菲用于小儿PCIA术后镇痛的应用

目的:产盐酸丁丙诺菲(沙菲)用于术后小儿PCIA镇痛效果和不良反应。方法:选择ASA,Ⅰ-Ⅱ级择期手术患儿,80例,年龄7～10岁,术后采用0.9mg盐酸丁丙诺菲+1mg氟哌利多+生理盐水43ml,配制成50ml镇痛液。PCIA模式为负荷剂量5ml,持续剂量2ml/h,单次剂量锁定时间为0.5ml/15min,镇痛时间24h,于术毕患儿清醒,将一次性镇痛泵接与静脉,并静注镇痛液5ml负荷量,随即开启PCIA开关。结果:80例患儿,采用盐酸丁丙诺菲+氟哌利多PCIA镇痛均取得满意疗效,所有患儿均未出现呼吸抑制、眩晕、嗜睡、头痛等严重不良反应,其中3例出现呕吐、2例出现恶心、1例出现皮肤瘙痒。结论:国产盐酸丁丙诺菲镇痛效果明显,不良反应轻,成瘾小,患者容易接受,可安全有效的用于术后患儿PCIA镇痛。     

腹腔镜子宫切除术对机体非特异性细胞免疫的影响

目的 研究腹腔镜子宫切除术对机体非特异性细胞免疫功能的影响.方法 2006年1月至2007年11月在中国医科大学附属第四医院随机选取38例腹腔镜子宫切除术(LH)患者为研究组,选取同期经腹子宫切除术(AH)的患者42例为对照组.术前1d、术后1、3及5d分别抽取肘静脉血,用散射比浊法测定血清C反应蛋白(CRP)水平;用流式细胞仪测定CD3+(T细胞总数)、CD4+(T辅助/诱导细胞)、CD8+(T抑制/杀伤细胞)、CD56+(NK细胞)数量.结果 术后1d、3d、5d患者的血清CRP水平,LH组分别为(26.26±9.37)mg/L,(30.71±8.53)mg/L、(29.52±8.15)mg/L;AH组分别为(67.53±35.7)mg/L、(82.23±24.64)mg/L、(80.23±25.23)mg/L.两组血清CRP水平与术前相比均明显升高(P<0.01);两组术后血清CRP水平,LH组升高幅度明显低于AH组(P<0.01).LH组患者的外周血T淋巴细胞亚群和NK细胞在手术前后无明显改变(P>0.05).AH组患者术前CD3+、CD4+、CD8+分别为(67.56±9.76)%、(42.46±4.77)%、(26.12±6.87)%,NK细胞为(13.82±3.79)%.术后1dCD3+、CD4+、CD8+分别为(50.32±8.90)%、(31.44±9.27)%、(19.12±4.58)%,NK细胞为(11.02±2.96)%.均较术前明显下降(P<0.05),术后3d有所回升,但仍低于术前,术后5d基本恢复正常.AH组NK细胞无明显变化(P>0.05).结论 腹腔镜手术创伤小,时机体免疫功能影响小.     

口服雌、孕激素对绝经期妇女子宫内膜的作用

对于绝经期妇女,且有典型绝经期症状和体征者,给与雌激素并加用孕激素或安慰剂,观察其子宫内膜形态学改变及出血方式,阐明宫内膜对药物的反应,并提出替代疗法中,雌孕激素联合应用的合理方案。患者95人,随机分成四组,A组:0.625 mgCE(结合雌激素)+5 mg MPA(醋酸甲孕酮);B组:0.625mg CE+安慰剂;C组:1.25mgCE+5 mg MPA;D组:1.25mg CE+安慰剂。     

腹腔镜下不同子宫切除术2272例临床分析

目的　评价腹腔镜鞘膜内子宫切除术 (LISH)、腹腔镜子宫次全切除术 (LSH)、腹腔镜全子宫切除术(LTH)和腹腔镜辅助阴式子宫切除术 (LAVH)4种术式的临床效果。方法　回顾性分析各种腹腔镜子宫切除术 2272例的手术时间、出血量、并发症及术后恢复情况等。结果　保留子宫颈的两种术式中,LISH1323例(LISH组),手术时间为(91±21)min,出血量为 (93±23)ml,并发症发生率为 4 1%;LSH229例(LSH组),手术时间为(70±18)min,出血量为 (69±17)ml,无一例并发症发生;LISH组的手术时间、出血量及并发症发生率均高于LSH组,差异有统计学意义 (P<0.01)。去除子宫颈的两种术式中,LAVH588例(LAVH组),手术时间为(119±28)min,出血量为 (156±23)ml,并发症发生率为 1 0%;LTH132例(LTH组),手术时间为 (121±30)min,出血量为 (193±38)ml,并发症发生率 1 5%;LAVH组的手术时间、并发症发生率与LTH组比较,差异无统计学意义(P>0.05),而术中出血量LTH组明显多于LAVH组,差异有统计学意义(P<0.01)。结论　4种术式均为腹腔镜下子宫切除的有效术式,且各有利弊;应根据患者的具体情况选择适宜术式。     

经阴道腹腔镜下全子宫切除术用于子宫良性疾病的临床研究

目的:通过比较经阴道腹腔镜下全子宫切除术(tVNOTEH)及传统腹腔镜下子宫切除术两种手术方式,为患者寻求更适合、更微创的治疗方案.方法:选取2019年1月至2020年5月江西省妇幼保健院收治的全子宫切除术患者102例,将患者随机分为tVNOTEH组(54例)及传统腹腔镜组(48例),比较两组患者的手术效果.结果:tV...     

布比卡因和罗哌卡因在瘢痕子宫剖宫产术中的应用对比

目的:观察布比卡因、罗哌卡因在瘢痕子宫剖宫产术中的应用。方法:将腰硬联合麻醉下择期行瘢痕子宫剖宫产术的健康产妇120例随机分为三组(n=40):0.5%罗哌卡因10mg组(R_1组)、0.5%罗哌卡因15mg(R_2组)和0.5%布比卡因10mg(B组)。采用针刺法测定感觉阻滞平面,改良Bromage评分法测定下肢运动神经阻滞程度,比较三组患者感觉和运动阻滞效果,肌肉松弛满意度和不良反应。结果:与B组比较,R_1和R_2组的感觉阻滞起效时间、运动阻滞起效时间延长(P0.05);R1和R2的感觉阻滞恢复时间、运动阻滞恢复时间明显缩短(P0.05);R_1和R_2组的低血压、心率缓慢、恶心呕吐、寒颤发生率较低(P0.05)。R_1组肌肉松弛效果不满意。结论:0.5%罗哌卡因15mg与0.5%布比卡因10mg腰硬联合麻醉用于瘢痕子宫剖宫产术麻醉效果满意,罗哌卡因运动阻滞维持时间短,对循环影响小,更适合瘢痕子宫剖宫产。     

腹腔镜下和经腹广泛子宫切除及盆腔淋巴结清扫术治疗早期子宫恶性肿瘤的近期疗效分析

目的:探讨腹腔镜下广泛子宫切除加盆腔淋巴结清扫术治疗子宫恶性肿瘤的近期疗效及应用价值.方法:对协和医院妇产科2008年3月至2009年4月间的70例早期子宫恶性肿瘤患者行腹腔镜下广泛子宫切除加盆腔淋巴结清扫术(TLRH+LPL组),并与同期48例经腹广泛子宫切除术和淋巴结清扫术(ARH+APL组)的病例作为对照,比较两种术式的术中、术后情况及并发症等.结果:行腹腔镜手术的70例患者,有2例中转开腹,中转率为2.9%.TLRH+LPL组在手术时间、术中出血量、淋巴结切除数目和术后体温恢复正常平均时间上与ARH+APL组相比,具有明显优势,差异均有高度统计学意义(P<0.01);但膀胱功能恢复时间及术后并发症的发生率,两组比较差异无统计学意义(P>0.05).结论:腹腔镜下广泛子宫切除加盆腔淋巴结清扫术具有同常规的经腹手术同样的安全性和有效性,同时缩短了手术时间,减少了手术创伤,为微创手术治疗妇科恶性肿瘤提供了良好的应用前景.     

阴式与腹腔镜子宫全切除术的临床效果比较

目的比较阴式子宫全切除术和腹腔镜子宫全切除术的临床效果。方法收集我院2002年1月至2004年6月接受以上不同途径子宫切除术的病例共301例的临床资料,其中阴式子宫全切除术197例(阴式组),腹腔镜子宫全切除术104例(腹腔镜组),比较两组疾病种类、手术时间、术中出血量、住院时间、医疗费用及术后恢复情况等。结果(1)疾病种类:宫颈非典型增生阴式组19例、腹腔镜组3例;子宫腺肌病、合并附件疾病或盆腔子宫内膜异位症,阴式组分别为58例、9例、8例,腹腔镜组分别为45例、33例、13例;(2)手术时间:阴式组(76±28)min、腹腔镜组(139±52)min;(3)术中出血量:阴式组(170±125)ml、腹腔镜组(206±153)ml;(4)肌瘤或腺肌瘤最大直径:阴式组(49±17)mm、腹腔镜组(57±22)mm;(5)手术费用:阴式组(1073±203)元、腹腔镜组(1526±676)元。以上各指标两组比较,差异均有统计学意义(P<0·05);(6)住院时间:阴式组(5·6±1·2)d、腹腔镜组(5·7±2·4)d;(7)子宫重量:阴式组(235±115)g、腹腔镜组(256±158)g;(8)手术并发症发生率:阴式组为2·54%、腹腔镜组为2·88%。住院时间、切除子宫重量及手术并发症发生率等两组比较,差异均无统计学意义(P>0·05)。结论无明显盆腔粘连和附件疾病的子宫全切除术可选择阴式途径,子宫大小并非选择术式的决定因素。     

Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups. Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05). Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition.     

Diagnosis and management of Candida of the nipple and breast

Diagnosis and treatment of ductal and/or nipple candidiasis in breastfeeding women is complicated by the variety of symptoms women experience. The differential diagnosis includes candidiasis of the nipple, candidiasis of the breast, bacterial infection of either nipple or breast, and other less common problems such as Raynaud's syndrome. Diagnosis and treatment are based on history, physical examination, and presenting symptomatology because cultures of breast milk are often inconclusive. Differential diagnoses and treatment options are reviewed.     

关于妇产科综合征的理解和应用

综合征(syndrome)来源于希腊语syn("一起"、"共同"之意)和drómos(事件),并起意为"同时发生或同时发生的事件"(concurrence).其实,这也是医学词汇里最古老的名词之一,可以追溯到希腊的波克拉底和盖伦时代,就已被用于描述同时发生的一组症状[1].     

Vitamin and homocysteine status of mothers and infants and the risk of nonsyndromic orofacial clefts

OBJECTIVE: This study was undertaken to investigate the involvement of maternal and infant B vitamins and homocysteine as risk factors for orofacial clefting. STUDY DESIGN: Venous blood samples were taken from 96 infants with nonsyndromic orofacial clefts and 88 infants without a congenital malformation and from their mothers at approximately 14 months after the index pregnancy. Red blood cell and serum folate, serum vitamin B(12), whole blood vitamin B(6) as pyridoxal-5'-phosphate (PLP), and plasma homocysteine concentrations were measured. RESULTS: A vitamin B(12) concentration of 185 pmol/L or less and a PLP concentration of 44 nmol/L or less in mothers increased the risk of having a child with an orofacial cleft (odds ratio [OR]=3.1; 95% CI: 1.3-7.4, OR=2.9; 95% CI: 1.2-7.1, respectively). Infants with orofacial clefts had a 15% lower serum folate concentration compared with controls (P=.06). CONCLUSION: A low vitamin B(12) and PLP concentration in mothers increased the risk of orofacial clefts in the offspring. A possible role of the infant's folate status is suggested.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

植物雌激素与中老年女性骨质疏松症

大多数的临床试验结果提示植物雌激素可以增加中老年女性腰椎骨密度,降低骨吸收指标尿脱氧吡啶啉（urine deoxypyridinoline,DPD）水平,从而降低中老年女性骨折的风险。但是,现有的研究证据还不足以推荐植物雌激素作为治疗中老年女性骨质疏松症的标准方案,仅可作为个体化治疗的一种有益的选择。     

Accuracy and correlates of maternal recall of birthweight and gestational age

Objective  To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates.
Design  Comparison of data from the DBR and the European Youth Heart Study (EYHS).
Setting  Schools in Odense, Denmark.
Population  A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women.
Method  The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland–Altman's plots. The misclassification of the various BW and GA categories were also estimated.
Main outcome measures  Differences between recalled and registered BW and GA.
Results  There was high agreement between recalled and registered BW (MD =−0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =−5.5 g; ICC = 0.93), and reliability remained high across subgroups.
Conclusion  Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.     

Irisin与糖脂代谢性疾病的研究进展

Irisin是一种新发现的肌肉因子,其前体物质为Ⅲ型纤连蛋白结构域5(FNDC5)。运动使骨骼肌中的过氧化物酶体增殖活化受体γ(PPARγ)辅助激活因子1α(PCG-1α)的表达增加,PCG-1α能诱导FNDC5表达,FNDC5断裂后可形成分泌性的肌肉因子Irisin,从而诱导白色脂肪棕色化,导致能量消耗增多,体质量减轻,改善糖耐量和胰岛素抵抗,调节糖脂代谢和能量代谢。因此,Irisin有望成为治疗糖脂代谢性疾病的新靶点。本文对Irisin与糖脂代谢性疾病的相关性研究进行综述。