359例妊娠晚期胎死宫内原因分析

目的:探讨妊娠晚期突发胎死宫内原因,降低围生儿死亡率。方法:回顾性分析2006年1月～2011年9月该区行死胎引产的妊娠晚期突发胎死宫内359例患者资料,将围生儿死亡分为3种:①不可避免死亡;②创造条件可以避免死亡;③可以避免死亡。所有病例均参加了区级围生儿死亡评审,按上述对每例死亡的病因、处理过程进行全面的临床分析。结果:综合评定结果:不可避免死亡189例,创造条件可以避免死亡110例,可避免死亡60例。脐带因素造成的死因孕周≥35 W明显高于28～34+6W(P<0.05)。结论:发展和提高产前诊断和产前保健技术,加强对患者孕期知识的健康教育,加强Ⅰ级医院医务人员的基础理论知识的培训,加强高危妊娠的管理,积极防治妊娠并发症是降低围生儿死亡的重要措施。     

182例围产儿死亡情况分析

目的:探讨近10年北京协和医院作为三甲医院在围产保健方面的特点,以进一步提高保健水平,降低围产儿死亡率。方法:回顾性分析2001～2010年协和医院17 532名围产儿中死亡的个案资料。结果:2001～2005年围产儿死亡率为9.29‰,2006～2010年围产儿死亡率11.03‰,平均10.38‰。孕产妇年龄<25岁者及>35岁者围产儿死亡率明显增高,随孕周增加围产儿死亡率下降。出生体重<2 500 g者围产儿死亡率达8.47%,是正常体重儿的32.8倍。足月新生儿死亡中出生缺陷为最主要的死因,医源性早产中最主要的死因则为重度子痫前期/子痫(占47.8%)。死胎前三位的死因分别为妊娠合并症及并发症、出生缺陷、脐带因素。结论:做好出生缺陷地三级预防,加强对农村地区及城市流动人口孕产妇的健康教育及产前检查是降低围产儿死亡率的关键。     

上海市浦东新区围产期妇女生命质量评价

目的了解上海市浦东新区围产期妇女的生命质量状况。方法应用健康调查简表(SF-36量表)对浦东新区围产期妇女分为产前、产后两组人群分别进行生命质量评价。将产前妇女的生命质量与浦东新区社区居民中年轻女性进行比较,产后妇女的生命质量与产前妇女进行比较。结果产前妇女生命质量的总评分为70.04分,产后妇女生命质量的总评分为73.18分。产前妇女的生命质量比社区年轻女性差,产后妇女的生命质量好于产前妇女。结论围产期妇女的生命质量状况不容乐观。建议在家庭的参与下,提高围产期妇女的知信行水平,有利于改善围产期妇女的生命质量。     

169例早产的临床分析

目的: 探讨早产的原因及影响早产儿预后的相关因素。方法: 对 2年间 169例早产患者的临床资料进行分析并随机抽取足月分娩 30例进行有关对照。结果: 胎膜早破、妊高征、妊娠期胆汁淤积症、多胎妊娠及产前出血占据早产病因的前5位; 不明原因的自然早产者中性粒细胞百分比明显高于足月产 (P<0 05); 妊高征和产前出血是医源性早产的主要原因; 早产儿病率与孕周、体重呈负相关 (P<0 005), 产前皮质激素运用的次数明显地改善了新生儿的预后 (P<0 05)。结论: 早产病因复杂, 是导致围产儿病率和围产儿死亡的最主要因素。提高早产的预防、诊断及治疗水平, 对围产医学质量的提高有着十分重要的意义。     

207例围产儿死亡病例分析

目的:了解围产儿死亡相关因素,降低围产儿病死率。方法:回顾2001年8月～2003年6月间围产儿死亡病例207例,进行死亡原因分析。结果:围产儿病死率为3.09%,死胎、死产、新生儿死亡构成分别为35.75%、26.09%、38.16%。早产、胎儿畸形、妊娠高血压综合征是围产儿死亡的主要因素。35岁以下孕妇新生儿死亡占首位,35岁以上孕妇以宫内死胎为主。结论:加强孕期监护及自我保健意识,提高产前诊断技术,有效治疗妊娠并发症,以及提高新生儿抢救水平,是降低围产儿病死率,提高生存质量的有效措施。     

Effects of Prenatal Nicotine Exposure on Infant Language Development: A Cohort Follow Up Study

Objectives To study the longitudinal effects of prenatal nicotine exposure on cognitive development, taking into consideration prenatal and postnatal second-hand smoke exposure. Methods A cohort follow up study was carried out. One hundred and fifty-eight pregnant women and their infants were followed during pregnancy and infant development (at 6, 12, 30 months). In each trimester of pregnancy and during postnatal follow-up, a survey was administered to obtain sociodemographic data and the details of maternal and close familial toxic habits. Obstetric and neonatal data were obtained from hospital medical records. To assess cognitive development, the Bayley Scales of Infant Development were applied at 6, 12 and 30 months; to assess language development, the MacArthur-Bates Communicative Development Inventories were applied at 12 months and the Peabody Picture Vocabulary Test at 30 months. Results After adjustment for confounding variables, the results showed that infants prenatally exposed to cigarette smoke recorded poor cognitive development scores. Language development was most consistently affected, specifically those aspects related to auditory function (vocalizations, sound discrimination, word imitation, prelinguistic vocalizations, and word and sentence comprehension). Conclusions for Practice Irrespective of prenatal, perinatal and sociodemographic data (including infant postnatal nicotine exposure), prenatal exposure to cigarette smoke and second-hand smoke affect infant cognitive development, especially language abilities.     

智力低下儿童的病因及相关致病因素分析

目的:了解2005~2009年温州市6~11岁智力低下(mental retardation,MR)儿童的病因构成特点及相关致病因素。方法:对就诊患儿采用儿童韦氏智力量表进行诊断,并进行病例对照研究及COX回归分析。结果:诊断MR儿童268例,病因明确者202例,占75.30%。其中生物医学因素所致164例,占61.10%;社会心理因素38例,占14.17%。农村MR儿童染色体病的人数高于城市,城市MR儿童受社会心理因素影响致病的人数高于农村(P均<0.01)。产前、产时和产后各种病因在农村和城市间差异无统计学意义(P均>0.05);病例对照生物危险因素分析及COX回归分析结果显示,早产、出生时窒息、母孕期接触化学物质和近亲结婚可使MR发生的风险增高。结论:加强孕期保健和产前诊断,提高产科质量,积极防治后天获得性疾病是预防MR的关键。     

Risk factors related to deaf-mutism among pupils attending the Alexandria governmental deaf-mute schools

Childhood deafness interferes with the cognitive development of the child, so it is considered a major handicap. The present work was carried out to reveal possible risk factors of deaf-mutism and the magnitude of each. The case control design was chosen as a research methodology. A 50% sample of deaf-mute pupils at the primary level were selected at random from each of the two governmental schools for the deaf-mutes in Alexandria (boys=96, & girls=76). A control group chosen at random from a main stream governmental school and matched by age and sex of the pupils as well as with education and occupation of the father. Matching was carried out at the sampling phase, pairing each case to its control. Data were collected by interviewing the mothers using an interviewing schedule. Matched analysis was carried out where pairing of cases and controls was retained. The likelihood estimate of Odds ratio conditional on the number of discordant pairs was estimated using McNemer's test. The 5% level was chosen as the level of significance. The study revealed 172 deaf-mute pupils. Their mean age was 9.48+/-1.981 years. Boys outnumbered girls (55.8% and 44.2% respectively). In 59.4% parents were cousins. Deafness was first noticed at 6 to 60 months of age with a mean of 14.70+/-10.2 months. Most fathers and mothers were illiterate (48.84% and 61.63%). Heredity was a risk factor, where 84.82% of cases had a positive family history compared to none of the controls. Moreover, in case of consanguinity the Odds ratio=5.60. Acquired deafness constituted the second important group of all causes of deafness. Meningitis featured as the most important cause of acquired deafness with an estimated relative risk of 18.5, followed by fever (Odds ratio=4.67), then repeated attacks of acute tonsillitis and ear disease where the case control percent difference was 8.72% and 4.65% respectively.     

巨细胞病毒感染的产前诊断及预防研究进展

巨细胞病毒感染是围生期最常见的病毒感染之一,妊娠期感染可发生垂直传播而感染胎儿,活产儿中约有0.4%～2.3%发生先天性巨细胞病毒感染。先天性巨细胞病毒感染对新生儿危害较大,可造成新生儿不同程度的神经发育障碍以及多器官损伤。由于巨细胞病毒感染对胎儿造成的损伤不可逆转,当前又没有切实有效的治疗方法,故对巨细胞病毒感染进行产前诊断,做好妊娠期预防,防止先天性感染儿出生,对提高人口素质有重要意义。本文就巨细胞病毒感染的产前诊断及预防进展综述如下。     

围产儿死亡分析

目的:探讨影响围产儿死亡的主要原因及预防措施。方法:回顾性分析2003~2005年广州开发区围产儿死亡病例的一般情况、死因分布、产前检查和高危妊娠情况,比较不同级别医院围产儿死亡构成比。结果:围产儿死亡的前3位死因依次为畸形、新生儿窒息、脐带因素;围产儿死亡病例中,超过4/5的孕妇没有接受定期产检;高危妊娠使围产儿死亡的风险增加,OR为8.21;二级、一级医院围产儿死亡构成比不同,差异有显著性意义。结论:降低围产儿死亡率必须采取综合措施,从提高人群的健康意识、加强和完善社会医疗保障体系、提高围产期保健质量三方面着手。定期产检、加强高危妊娠监测是降低围产儿死亡率的有力措施,不同级别的医院采取的措施应各有侧重。     

Perinatal mortality in Turkey

A prospective study was conducted to investigate perinatal mortality rate, stillbirth rate and early neonatal mortality rate in 29 centres throughout Turkey between 1 January 1999 and 31 December 1999. The most frequent causes of mortality were determined according to the modified Wigglesworth classification, and the results were evaluated with respect to the differences between the centres and the regions. The total number of births from all centres was 92 587. Perinatal mortality rate was 34.9 per 1000, stillbirth rate 18 and early neonatal death rate 17.2 per 1000. Perinatal mortality rates were highest with 71.9 and 62.9 per 1000 in the regions that have low socio-economic status and are predominantly rural and semi-urban. The rate was lowest (27.3 per 1000) in the region that is economically more developed. In 23 out of 29 centres, the causes of death were clearly determined. The most important causes of death according to the modified Wigglesworth classification were antepartum stillbirths (42.7%), prematurity (26.0%) and lethal congenital malformations (13.2%). In conclusion, reduction in the perinatal mortality rate in Turkey is likely to be possible only with the co-ordination of the government, universities, obstetricians and neonatologists and improvement of prenatal, delivery and postnatal care and prevention of prematurity. Perinatal mortality studies should be extended and better organised regionally in Turkey.     

四维超声检查在胎儿畸形检查中的作用分析

目的探讨四维彩色超声在胎儿畸形检查中的临床应用价值。方法2008年6月至2009年12月在我科行产前检查的孕妇,在妊娠11—40W用GEVOLUSON730EXPERT型超声诊断仪进行胎儿检查。结果共检查出胎儿畸形99例,其中颜面部畸形居多;其次是神经系统,泌尿系统。结论四维彩色超声在胎儿中晚孕期进行的畸形检查是必要的,是围产期检查的重要手段．对胎儿优生优育有着重要意义。     

孕妇学校规范化管理成效和改进方向

随着我国居民生活水平的不断提高和二胎政策的全面放开,孕产妇对优生优育知识的需求日益激增。孕妇学校作为围产期保健的重要环节,是孕产妇接受孕期健康教育的重要场所。通过为孕产妇及其家庭成员提供科学专业的健康教育、健康咨询与指导服务,有利于孕产妇了解孕产期保健知识,保持孕期身心健康、提高其自我护理和管理的能力,降低剖宫产率,提高母乳喂养率。同时,孕妇学校在一定程度上可体现出一个地区的围产期保健服务水平。     

危重孕产妇抢救原因及抢救结局分析

目的:探讨危重孕产妇的母婴结局、孕产期保健和构成情况,以降低危重孕产妇的发生率,提高危重孕产妇救治成功率。方法:回顾性分析2003～2007年72例抢救危重孕产妇的资料。结果:72例患者中抢救成功70例(97.22%),围产儿死亡8例(11.11%),其中经产妇55例(76.39%),流动人口66例(91.67%),未做产前检查者59例(81.94%),有高危因素者41例(56.94%),产科出血36例(50.00%),子痫、重度子痫前期并发严重并发症31例(43.06%)。结论:畅通的急救"绿色通道"、各级领导的强有力的支持是确保危重孕产妇抢救成功的关键,同时加强流动人口孕产妇的保健管理是减少孕产妇重危疾病发生的重要一环。     

农村盆困地区围产保健服务情况及其对孕产妇和新生儿死亡率的影响

目的：探讨农村地区围产保健服务与孕产妇和新生儿死亡的关系。方法：对1997年5省113县有关孕产妇死亡和新生儿死亡的县级资料及相应的人口、经济1围产保健资料进行多因素、多水平分析。结果：平均孕产妇死亡率（MMR）为159．30／10万,平均新生儿死亡率（NMR）为39．76‰;平均产前检查覆盖率60．90％,住院分娩率30．57％,新法接生率58．03％,产后访视率33．77％;住院分娩及新法接生对孕产妇死亡有保护作用,产前检查对新生儿死亡有保护作用。结论：5省农村贫困地区围产保健服务水平较低,提示提高住院分娩率、新法接生率及加强产前检查是降低两个死亡率的重要措施。     

社区健康服务试点地区孕产期保健服务现状分析

社区健康服务项目试点城市１２００名学龄前儿童母亲的孕产期保健情况调查结果：早孕检查率为６２．０％,产前检查率为９６．９％,产前检查次数≥８次占５７．２％,住院分娩率为９７．５％,产后访视≥３次占３０．３％,４个月婴儿纯母乳喂养率为６１．０％,孕产期母乳喂养健康教育覆盖率为４６．９％,孕期营养指导率为５８．７％,同时对影响产前检查次数的因素进行了分析。结果提示：试点地区在保持和提高孕产期服务覆盖率的同时,应重点规范产前检查和产后访视内容,提高服务质量;应加强孕产期健康教育,提高母乳喂养率;在经济文化条件有限的情况下,探索适宜的孕产期服务方式,为群众提供优质便利且经济上可承受的保健服务     

Aetiology of childhood vision impairment, metropolitan Atlanta, 1991-93

Data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) were used to describe the underlying causes of vision impairment (VI; corrected visual acuity in the better eye of 20/70 or worse) in young children (n = 228) in metropolitan Atlanta in 1991-93. Children with VI were identified through record review at multiple educational and medical sources. Children were categorised as having isolated VI or multiple disabilities (i.e. VI plus one or more of four additional developmental disabilities) and as having low vision (visual acuity 20/70-20/400) or blindness (visual acuity worse than 20/400). Medical conditions abstracted from MADDSP sources were reviewed to determine the probable aetiology of a child's VI. Aetiologies were assigned to one of three developmental time periods: prenatal, perinatal, or postnatal. Prenatal aetiologies were identified in 43% of the children; 38% of the prenatal aetiologies were genetic. Perinatal aetiologies were found in 27% of the children. Postnatal aetiologies were rare. Prenatal aetiologies were more common in children with isolated VI; perinatal and postnatal aetiologies were more common in children with multiple disabilities. Children with prenatal aetiologies tended to have less severe vision loss than did children with perinatal or postnatal aetiologies. The distribution varied by birthweight, but did not differ significantly by sex or race.     

Persistent hematologic and immunologic disturbances in 8-year-old Dutch children associated with perinatal dioxin exposure

Perinatal exposure to Dutch "background" dioxin levels in 1990 was high, but comparable with that of other industrialized Western European countries. Exposure during the sensitive perinatal period may cause permanent disturbances. Therefore, we assessed the health status and various hematologic and immunologic parameters among our longitudinal cohort. A medical history was taken and venipuncture performed in a longitudinal cohort of 27 healthy 8-year-old children who had documented perinatal dioxin exposure. Linear regression revealed a decrease in allergy in relation to prenatal (p = 0.02) and postnatal (p = 0.03) dioxin exposure. Increases in CD4+ T-helper cells (p = 0.006) and in CD45RA+ cells (p = 0.02) were seen in relation to postnatal exposure. A persistently decreased platelet count (p = 0.04) and increased thrombopoietin concentration (p = 0.03) were seen in relation to postnatal exposure. This follow-up has shown a decrease in allergy, persistently decreased thrombocytes, increased thrombopoietin, and increased CD4+ T-helper and increased CD45RA+ cell counts. This study provides indications of effects at the stem cell level of perinatal dioxin exposure, persisting until minimally 8 years after birth.     

1991至2015年上海市围产儿死亡情况分析

目的 通过对上海市1991至2015年近25年围产儿死亡个案进行分析,了解围产儿死亡趋势、原因,总结经验,为探索进一步健全围产保健制度提供依据.方法 回顾性分析1991至2015年上海市围产儿死亡个案,分析死亡趋势、特征及死因.结果 ①近25年围产儿死亡率平均为5.97‰,其中户籍人口平均为4.80‰,非户籍人口平均为7.41‰,近25年间围产儿死亡率逐年下降;②近25年围产儿死亡以非户籍为主,占55.45%,其母亲产次为2次以上的比例逐年上升,从18.80%升至40.76%,双胎死亡比例逐年缓慢上升,2010年开始超过10.00%,2015年达最高水平13.00%;③围产儿死亡中死胎、死产和早期新生儿死亡构成分别为53.35%、8.33%和38.32%,死产死亡构成和新生儿死亡构成逐年下降.死胎率从1991年的4.35‰下降到2015年的1.85‰(χ2=732.383,P=0.000),死产率从1991年的1.18‰下降到2015年的0.12‰(χ2=879.183,P=0.000),新生儿死亡率从1991年的4.90‰下降到2015年的1.18‰(χ2=2 040.316,P=0.000);④围产儿死亡原因顺位中前四位分别为早产儿、严重畸形、宫内窘迫和原因不明,其中先天畸形比例占死亡总数的12.63%.结论 上海市围产儿死亡率处于中等发达国家水平,与上海市近20年的孕产期保健措施密不可分,为了进一步控制围产儿死亡率,需加强出生缺陷三级预防、提高孕产妇保健精细化管理和人才培养.     

Tinnitus in noise-exposed workers

Tinnitus is said to be a common complaint of workers who areexposed to noise. We studied the prevalence and characteristicsof tinnitus in 647 noise-exposed workers who had been notifiedas cases of noise-induced deafness. One hundred and fifty-onehad tinnitus, givng a prevalence of 23.3 per cent. The tinnituswas bilateral in 42.4 per cent of cases, and of high frequencyin 44.4 per cent. In 23.8 per cent it was associated with othersymptoms. About 30 per cent of those with tinnitus complainedthat it interfered with daily activities like telephone conversationand sleep. The workers with tinnitus had consistently higherhearing thresholds at both high and low frequencies than thosewith no tinnitus. This finding remained even after adjustingfor differences in sex, age and ethnic group composition andin the noise exposure duration. Workers are often told thatnoise exposure causes deafness, but little is mentioned abouttinnitus. Awareness of the possible occurrence of tinnitus mayencourage workers to cooperate more actively in a company hearingconservation programme.