针刺分娩镇痛的临床试验研究*

【目的】研究针刺分娩镇痛的作用机制。【方法】以Keele标尺图评级法及视觉模拟评分法（VRS）疼痛分级法作为针刺分娩镇痛效果评定方法，并通过记录产妇产程等来观察针刺对母婴的影响，通过观察针刺前后及相应时间产妇外周血中β-内啡肽（β-EP）及5-羟色胺（5-HT）浓度变化，探讨该方法的镇痛机制。【结果】针刺能有效减轻第一产程分娩疼痛，与自然分娩对照组相比有显著性差异（P〈0．05），对母婴无不良影响且能缩短产程。该方法能明显提高产妇外周血中β-EP及5-HT浓度。【结论】以针刺作为分娩镇痛手段，具有操作方便、安全，镇痛效果可靠，无副作用等优点，其镇痛效果可能是通过中枢镇痛系统与对子宫的直接作用共同实现的。     

腰麻复合硬膜外阻滞和笑气吸入用于无痛分娩的效果评估

目的腰麻复合硬膜外阻滞(CSEA)和笑气吸入无痛分娩的效果评估.方法90名足月初产孕妇随机分为实验组Ⅰ、实验组Ⅱ及对照组,前两组孕妇宫口开至3 cm后,分别行CSEA及笑气吸入分娩镇痛,监测镇痛效果、产程各指标及测定β-内啡肽(β-EP).结果实验组镇痛效果好于对照组,而实验组Ⅰ镇痛效果好于实验组Ⅱ.实验组Ⅰ活跃期短于对照组活跃期,实验组Ⅱ潜伏期后各产程均短于对照组.实验组Ⅰ与Ⅱ各产程无明显差异.宫缩强度、产钳率、剖宫产率、产后出血,胎儿窘迫、新生儿Apgar评分,三组无显著性差异.三组产妇β-EP浓度时均高于产后.产时β-EP实验组Ⅰ最低,实验组Ⅱ与对照组无差异;而产后β-EP实验组Ⅱ最高.结论CSEA及笑气吸入用于分娩镇痛,能缓解产痛,缩短产程,不影响产程中各因素.β-EP在分娩应激状态下升高,产后显著下降,提示β-EP参与分娩镇痛.     

无痛分娩临床应用效果观察

[目的]探讨分娩镇痛的效果及对产程、母婴预后的影响。[方法]在产妇宫口张开2~3cm时,采取镇痛措施:观察1组160例吸入笑气镇痛,观察2组150例硬膜外麻醉阻滞术(PCEA)镇痛,对照组140例给予静脉注射安定。分别观察镇痛效果、产程时间、分娩方式、分娩并发症等情况。[结果]观察1组和2组在镇痛效果、分娩方式、产程、继发宫缩乏力方面与对照组相比差异有显著意义(P<0.05)。[结论]笑气吸入应用于无痛分娩,产妇自由控制,无创伤,方便易掌握,不影响活动,且镇痛效果可靠,对母婴无不良影响,操作技术要求不高,更适合于基层推广应用。     

产程中镇痛分娩配合体位护理临床观察

目的 探究产程中孕妇镇痛分娩配合体位护理对疼痛效果、产程时间、母婴并发症发生情况的影响。方法 选取2018年1月～2021年12月本院收治的产妇1000例,随机分为实验组、对照组,每组500例。对照组采用常规硬膜外分娩镇痛护理,实验组采用硬膜外镇痛分娩配合体位护理。比较两组疼痛评分、产程时间、母婴并发症发生情况。结果 与对照组比较,实验组镇痛效果较好,产程缩短,产妇产后出血及新生儿窒息发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 镇痛分娩配合体位护理可有效减轻产妇疼痛感,缩短产程,有助于改善母婴结局,提高分娩质量,较传统无痛分娩配合常规护理的临床应用效果好。     

微泵法硬脊膜外自控镇痛分娩540例分析

目的　探讨微泵法硬脊膜外自控镇痛 (PCEA )用于分娩镇痛的效果及对产程、胎儿的影响。方法　采用PCEA的产妇 5 40例作为观察组 ,将未采用分娩镇痛的产妇 40 5例作为对照组 ,分别观察产程、分娩方式、催产素使用率、不良反应、产后出血及新生儿窒息情况。结果　观察组镇痛后 95 .6%的产妇疼痛明显减轻 ,两组产程活跃期、总产程比较均有显著性差异 (均为P <0 .0 5 ) ;剖宫产率观察组显著低于对照组 (P <0 .0 5 ) ;两组新生儿窒息、产后出血及催产素使用率比较无显著性差异 (均为P >0 .0 5 )。结论　PCEA用于分娩镇痛效果明显 ,加速了产程 ,降低了剖宫产率 ,对母婴安全     

普消痛在镇痛分娩中的效果观察

目的探讨普消痛镇痛分娩的效果及对产程、母婴的影响.方法以普消痛进行镇痛分娩的400例产妇为观察组,未行镇痛分娩的406例产妇作为对照组,比较两组的疼痛程度、产程时间、分娩方式、产后出血、胎儿窘迫、新生几窒息及不良反应.结果观察组镇痛效果明显,且第一产程活跃期、总产程明显短于对照组,差异有显著性(P＜0.05).两组分娩方式、产后出血量、胎儿窘迫和新生儿窒息发生率比较,无显著性差异(P＞0.05).结论普消痛用于镇痛分娩,效果可靠,对母婴无不良影响,是一种既能解除分娩疼痛又能保障母婴安全的方法,值得推广应用.     

心理诱导加蛛网膜下腔-硬膜外联合阻滞麻醉用于分娩镇痛观察

[目的]探讨心理诱导加蛛网膜下腔－硬膜外联合阻滞麻醉用于分娩镇痛的效果，及对产程、母婴状况的影响。[方法]由产科医师于临产时、麻醉实施前、宫口开全时进行心理诱导，结合运用蛛网膜下腔－硬膜外联合阻滞，用于分娩镇痛的产妇36例为联合组，将未运用任何镇痛方法而进入产程自然分娩孕妇36例为对照组，分别观察产程时间、产后出血，胎儿窘迫及新生儿窒息情况。[结果]两组产程相比较，联合组效果理想，胎儿窘迫、新生儿窒息及产后出血发生率无增加。[结论]此方法用于分娩镇痛，镇痛效果显，且加速第一产程活跃期及第二产程进展，对母婴均无明显不良影响。     

全产程分娩镇痛在阴道分娩中的应用效果

目的 探讨全产程分娩镇痛在阴道分娩过程中的应用效果.方法 选取2017年12月至2019年2月柘城中医院收治的80例阴道分娩产妇作为研究对象,按随机数表法分为对照组与观察组,各40例.对照组接受第一产程分娩镇痛,观察组接受全产程分娩镇痛,比较两组中转剖宫产率、分娩疼痛[视觉模拟评分量表(VAS)评分]及新生儿1分钟Ap...     

硬膜外镇痛分娩50例临床观察及护理

目的　探讨分娩镇痛的效果及对产程、母婴的影响。方法　采用患者自控硬膜外镇痛(PCEA)应用于分娩镇痛的产妇 5 0例作为观察组 ,将未采用任何分娩镇痛药物自然进入产程的产妇 5 0例作为对照组 ,观察比较两组的产痛程度、产程时间、分娩方式、产后出血量、新生儿Apgar评分。结果　观察组的阵痛强度评分明显低于对照组 (P <0 .0 0 1) ,两组产程时间、分娩方式、产后出血量及新生儿Apgar评分差异无显著性 (P >0 .0 5 )。结论　PCEA分娩镇痛对产程及母婴均无不良影响 ,是一种理想的分娩镇痛方法     

“普消痛”在镇痛分娩中效果观察

目的研究镇痛分娩的效果及对产程、母婴的影响。方法采用“普消痛”对400例产妇进行镇痛分娩，作为观察组；未行镇痛分娩406例产妇作对照组，比较两组的产程时间、分娩方式、产后出血、胎儿窘迫、新生儿窒息情况。结果两组第一产程活跃期，总产程比较有显著性差异。两组分娩方式、产后出血、胎儿窘迫、新生儿窒息发生率比较，无显著性差异。结论“普消痛”用于镇痛分娩，效果可靠，对母婴无不良影响，是一种既能解除分娩疼痛又能保障母婴安全的方法，值得推广应用。     

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.     

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.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

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.