多普勒超声对双胎输血综合征外周血流变化的研究

双胎输血综合征（ＴＴＴＳ）近年来已越来越引起妇产科临床的关注。本文应用多普勒超声对１１例ＴＴＴＳ胎儿的外周血流进行评价，以探讨两胎儿间不同的血流动力学形式及对妊娠后期危险性预测，结果：１、供、受血儿脐动脉搏动指数（ＰＩ）值明显高于正常组（Ｐ＜０．０１）；２、外周动脉－降主动脉（ＤＡＯ）及大脑中动脉（ＭＣＡ）ＰＩ值和峰值（Ｖｍ）降低（Ｐ＜０．０１）；３、妊娠晚期受血儿充血性心衰加重时脐静脉出现搏动性血流及心内房室瓣返流，结论：外周血流多普勒频谱改变为ＴＴＴＳ的诊断和治疗提供了准确的资料，ＴＴＴＳ胎儿的多普勒超声监测有助于降低围产期死亡率     

孕期微创手术中胎儿的麻醉方法:附6例次报告

目的:探讨孕期微创手术中安全有效的胎儿麻醉方法。方法:回顾分析6例次接受宫内输血术的胎儿及母体的一般资料、麻醉用药、给药途径、术中监测情况等相关资料。结果:6例次孕期微创手术、胎儿麻醉操作均成功,其中1例次孕期微创手术采用母体静脉麻醉,术中胎儿胎动频繁、胎心率较快,影响操作;4例次采用胎儿静脉注射麻醉以及1例次采用胎儿肌内注射麻醉的胎儿胎动控制良好。应用肌松药可抑制胎动,加用镇痛药可维持胎心率平稳。结论:对于接受孕期微创手术的胎儿,建议应用肌松药;对于孕中期的胎儿,则推荐加用阿片类镇痛药。     

The Fetal Patient: Coordinated Care for Families

Complete and accurate knowledge is critical to parent decision making for families with complex and/or life-threatening fetal conditions. Comprehensive fetal centers are available to provide multidisciplinary specialized assessment, evaluation, diagnosis, and nondirectional counseling. Interventional option may include fetoscopic procedures, open fetal surgery, and ex utero intrapartum treatment. The nurse coordinator serves as the family and health care provider liaison for arrangement of services and communication of the plan of care.     

系统产前超声检查在双胎妊娠产前筛查中的应用价值

目的探讨系统产前超声检查在双胎妊娠产前筛查中的应用价值。 方法对2012年10月至2017年12月在咸阳市妇幼保健院进行系统产前超声检查的393例双胎妊娠资料进行回顾性分析,将其中27例双胎妊娠畸形病例纳入研究。通过将双胎妊娠畸形病例产前超声检查资料与随访及病理解剖结果进行对比,分析双胎妊娠系统产前超声检查胎儿畸形检出率及诊断符合率。 结果纳入研究的27例双胎妊娠畸形病例中19例为胎儿结构畸形,8例为双胎妊娠特有畸形。19例胎儿结构畸形均为双胎之一胎儿的单一畸形,8例双胎妊娠特有畸形多为两个胎儿同时受到累及。系统产前超声检查检出17例胎儿结构畸形和8例双胎妊娠特有畸形均与病理诊断符合,系统产前超声检查诊断符合率100%（25/25）;漏诊胎儿结构畸形2例,胎儿畸形检出率92.6%（25/27）。 结论系统产前超声检查应用于双胎妊娠产前筛查有较高的畸形检出率及诊断符合率,具有重要的临床应用价值。     

减痛综合护理程序在腹部术后患者的应用与探讨

目的 探讨减痛综合护理程序（SPPN）在外科腹部手术患的临床应用。方法 实施（SPPN）方案手术患共（919例）与实施前1年同病房患共772例进行对比，两组阶段性各随机抽取50例患进行术后疼痛感觉自评表进行统计比较。结果 实验组患对术后疼痛护理满意度明显好于对照组（P＜0.01）。结论 实施SPPN术后患能有效改善疼痛。     

The Ex Utero Intrapartum Treatment (EXIT) Procedure for Fetal Head and Neck Masses

A congenital head or neck mass increases the risk of airway obstruction and imminent respiratory failure at birth. The ex utero intrapartum treatment (EXIT) procedure is an option to secure the infant's airway in some clinical situations when an antenatal diagnosis of a head or neck mass or potential airway obstruction has been established.This article discusses an EXIT procedure performed on a maternal patient whose 38-week gestational age fetus was diagnosed with a lymphatic malformation. Planning and coordination between surgical teams at two clinical sites allowed the multidisciplinary teams to achieve a safe, successful outcome for the mother and child. AORN J 90 (November 2009) 661-672. © AORN, Inc, 2009.     

Assessment of right ventricular function in recipient twin of twin to twin transfusion syndrome with speckle tracking echocardiography

This study was undertaken to evaluate the right ventricular myocardial systolic function and its relation to the fetal volume and pressure overload in recipient twin of twin to twin transfusion syndrome with speckle tracking echocardiography. Longitudinal peak systolic strains of the right ventricle were measured by speckle tracking echocardiography in 17 patients with twin-to-twin transfusion syndrome (TTTS) and 19 normal monochorionic diamniotic pregnancies. The right ventricular free wall thickness in recipient twin (0.43 ± 0.14 cm) was significantly larger than that in the donor (0.21 ± 0.04 cm, p < 0.05) and the control group (0.18 ± 0.03 cm, p < 0.05 for larger twin and 0.17 ± 0.02 cm, p < 0.05 for smaller twin). Although there were no significant differences in the right ventricular fractional shortening and cavity area percent change among control and the TTTS groups, the absolute value of peak systolic strains of ventricular septum, right ventricular free wall and global right ventricle in recipients were all significantly lower than those of the donors and the control group. Besides, the global right ventricular peak systolic strain correlated well with gestational age adjusted right ventricular free wall thickness (r = 0.65, p = 0.04) but not with gestational age adjusted right ventricular end-diastolic dimension (r = 0.38, p = 0.28) and cavity area percent change (r = 0.33, p = 0.35). Right ventricular systolic dysfunction measured with decreased right ventricular peak systolic longitudinal strain exists despite the absence of diminished fractional shortening and cavity area percent change and this reduced systolic function correlates with the right ventricular pressure overload as shown by increased right ventricular free wall thickness.     

Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) can be a very confusing diagnosis. The goal of this article is to familiarize the audience with the diagnosis, treatment, and outcome of TTTS. An overview of twinning mechanics, as well as the pathophysiology, staging, treatment options, and outcomes of TTTS, will be discussed. It is important for nurses to understand all of the treatment options available so that support can be given regardless of the path families have chosen.     

自由体位对硬膜外麻醉腹部术后患者舒适度的影响

目的探讨自由体位对硬膜外麻醉腹部术后患者舒适度的影响。方法将行硬膜外麻醉腹部术后患者200例按手术单双日组和观察组各100例,对照组按常规去枕平卧位6 h;观察组按患者以往习惯协助其垫枕或去枕,按需协助患者取左侧卧位、右侧卧位或半卧位。观察术后1 d两组患者的头痛发生率、颈肩腰背不适感、切口渗血情况及术后尿潴留情况。结果两组患者头痛、切口渗血情况差异无统计学意义(P>0.05),颈肩腰背不适感及术后尿潴留情况两组比较差异有统计学意义(P<0.01)。结论硬膜外麻醉腹部术后患者在麻醉穿刺过程顺利、生命体征平稳情况下可采取自由体位,以改善患者术后舒适度。     

Fetoscopic Therapy for Severe Pulmonary Hypoplasia in Congenital Diaphragmatic Hernia: A First in Prenatal Regenerative Medicine at Mayo Clinic

Objective

To introduce the prenatal regenerative medicine service at Mayo Clinic for fetal endoscopic tracheal occlusion (FETO) care for severe congenital diaphragmatic hernia (CDH).

The Association of Neurocognitive Decline and Other Variables With Return to Work,Hobbies, and Activities of Daily Living After Coronary Artery Bypass Graft Surgery

ABSTRACT

Purpose: Coronary artery bypass graft (CABG) surgery is an integral method of palliative treatment for coronary artery disease. Despite many advances in surgical techniques, some patients continue to have neurocognitive deficits after surgery. The impact of these deficits on the patient's ability to return to work (RTW), daily activities of life, and hobbies has not been evaluated fully. The goal of this research project is to describe variables associated with the patients’ ability to RTW and necessary and essential activities. Methods: Sixty-three subjects who had CABG surgery with cardiopulmonary bypass (CPB) and who participated in neurocognitive testing preoperatively and postoperatively were interviewed by telephone 7–8 years after CABG surgery. Information was obtained on functional status measured by the Nottingham Health Profile (NHP), symptoms of depression measured by the Center for Epidemiological Studies Depression Scale, RTW status, and ability to participate in hobbies and activities of daily living (ADL) after CABG surgery. Bivariate and multivariate analyses were used to describe the relationship of neurocognitive, clinical, and social variables to RTW, hobbies, and ADL. Results: The ability to return to hobbies and ADL did not vary between individuals who experienced neurocognitive decline and those who did not (p = 0.755). Age and presence of angina were significantly associated with difficulty in returning to work (p = 0.009, p = 0.042). Higher scores on the Center for Epidemiological Studies Depression Scale after surgery were significantly associated with higher NHP scores (p = 0.000) and presence of shortness of breath (p = 0.000). Presence of angina (p = 0.035) was significantly associated with higher scores on the NHP. Conclusions: The relationship of neurocognitive decline after CABG surgery with RTW and activities remains unclear. Studies with larger sample size will further elucidate these relationships.     

基于奥马哈系统的连续性护理模式在脊柱结核手术患者中的应用

目的:探讨基于奥马哈系统的连续性护理模式在脊柱结核手术患者中的应用效果。方法:将2017年1月1日~12月31日80例脊柱结核手术患者随机分为干预组和对照组各40例,对照组患者采用脊柱结核手术常规护理措施,干预组在对照组基础上采用基于奥马哈系统的连续性护理模式。比较两组手术后第7天、出院后12个月时的视觉模拟评分法(VAS)评分、功能锻炼依从性,Barthel指数评分。结果:干预组术后第7天、出院后12个月时的VAS评分低于对照组,功能锻炼依从性及Barthel指数评分均高于对照组(P<0.05)。结论:基于奥马哈系统的连续性护理模式可以缓解脊柱结核手术患者的疼痛,提高其功能锻炼依从性及日常生活活动能力。     

Max dD/Dt: A Novel Parameter to Assess Fetal Cardiac Contractility and a Substitute for Max dP/Dt

Aortic pulse waveforms are composed of a forward wave from the heart and a reflection wave from the periphery. We focused on this forward wave and suggested a new parameter, the maximum slope of aortic pulse waveforms (max dD/dt), for fetal cardiac contractility. Max dD/dt was calculated from fetal aortic pulse waveforms recorded with an echo-tracking system. A normal range of max dD/dt was constructed in 105 healthy fetuses using linear regression analysis. Twenty-two fetuses with suspected fetal cardiac dysfunction were divided into normal and decreased max dD/dt groups, and their clinical parameters were compared. Max dD/dt of aortic pulse waveforms increased linearly with advancing gestational age (r?=?0.93). The decreased max dD/dt was associated with abnormal cardiotocography findings and short- and long-term prognosis. In conclusion, max dD/dt calculated from the aortic pulse waveforms in fetuses can substitute for max dP/dt, an index of cardiac contractility in adults.