多维分娩镇痛模式护理对初产妇产程及妊娠结局的影响

目的探讨多维分娩镇痛模式护理对初产妇产程及妊娠结局的影响。方法选取2018年1—12月驻马店市中心医院收治的80例初产妇,按随机数表法分为对照组(40例)和观察组(40例)。对照组接受常规分娩护理,观察组接受多维分娩镇痛模式护理。比较两组产程、阴道分娩率、新生儿窒息率。借助视觉模拟评分法(VAS)评估产妇干预前后疼痛程度。结果观察组第一产程、第二产程和总产程时间均短于对照组,差异有统计学意义(均P<0.05)。两组第二产程时间比较,差异无统计学意义(P>0.05)。干预后,两组VAS评分低于干预前,观察组VAS评分低于对照组,差异有统计学意义(均P<0.05)。观察组阴道分娩率高于对照组,新生儿窒息率低于对照组,差异有统计学意义(均P<0.05)。结论多维分娩镇痛模式可缩短初产妇产程,减轻疼痛度,改善妊娠结局。     

穴位按摩镇痛法对第一产程活跃期宫缩压的影响

目的:通过在第一产程活跃期时,对产妇实施穴位按摩方法,探讨此法对宫缩压及分娩疼痛的影响.方法:将90例无显著个体差异的产妇随机分为2组,治疗组45例,按中医理论对个体进行辨证后,采用穴位按摩法给予镇痛;另45例对照组,进行自然分娩.后将两组数据统计对比分析.结果:治疗组中第一产程宫缩期压力低于对照组,且P<0.05,有统计学意义.治疗组采取穴位按摩镇痛法后疼痛缓解率为66.67%,明显高于对照组16.67%,且两组相比P<0.01,有显著差异.结论:第一产程活跃期进行穴位按摩镇痛可以有效降低宫缩压,并减轻分娩疼痛.宫缩期压力降低对胎儿情况、总产程及新生儿等方面有否影响,需待进一步研究.     

硬膜外麻醉在初产妇分娩镇痛中的效果及对产程、分娩结局和新生儿的影响

目的 探讨初产妇分娩期间实施硬膜外麻醉对分娩镇痛的效果及对产程、分娩结局及新生儿结局的影响。方法 便利选取2021年5月—2023年5月于南京市六合区人民医院分娩的85例初产妇作为研究对象。按照手环编号单双数分为对照组（43例）观察组（42例）,对照组产妇实施常规分娩,观察组产妇实施硬膜外麻醉分娩镇痛;比较两组产妇分娩各个产程疼痛程度、分娩产程所用时间、分娩结局及新生儿结局情况。结果 观察组产妇第一、二、三产程疼痛评分均低于对照组,同时观察组产妇分娩第一、二、三及总产程所用时间均短于对照组,差异有统计学意义（P<0.05）;观察组产妇自然分娩率高于对照组,观察组剖宫产及术后产褥感染发生率均低于对照组,差异有统计学意义（P<0.05）;观察组分娩新生儿宫内窘迫、新生儿窒息的总发生率低于对照组,差异有统计学意义（P<0.05）。结论 初产妇分娩期间通过硬膜外麻醉分娩镇痛可有效减轻分娩期间痛感,促进产程进展,改善分娩及新生儿结局。     

穴位按摩联合导乐分娩对初产妇心理状态、分娩情况及母婴结局的影响

目的 探究穴位按摩联合导乐分娩对初产妇心理状态、分娩情况及母婴结局的影响.方法 选取我院妇产科收治的初产妇94例,采用随机数字表将患者随机分为2组,各47例,对照组给予常规分娩护理,观察组则在对照组基础上应用中医穴位按摩联合导乐分娩.护理结束后,比较2组产妇护理前后的心理状态,产妇产程及母婴结局的差异.结果 经护理后2组产妇心理状态均有改善,且观察组产妇的焦虑、抑郁情绪发生率及产后SAS、SDS分数低于对照组(俨＜0.05);观察组第一产程及第二产程时间＜对照组(P＜0.05);观察组剖宫产率＜对照组(P＜0.05),产后出血量低于对照组(P＜0.05);观察组分娩的新生儿阿氏评分≤7分的发生率低于对照组(P＜0.05);观察组疼痛感及镇痛分娩比例低于对照组(P＜0.05).结论 穴位按摩联合导乐分娩能够降低初产妇抑郁及焦虑评分,改善心理状态,缩短产程,提高自然分娩率,降低分娩疼痛和产后出血量,减少对新生儿的影响.     

穴位按摩辅助椎管内麻醉对初产妇分娩镇痛效果及新生儿结局的影响

目的 探究穴位按摩辅助椎管内麻醉对初产妇分娩镇痛效果及新生儿结局的影响。方法 选取2021年2月—2022年2月会昌县妇幼保健院分娩的92例初产妇,按照随机数字表法分为对照组与研究组,对照组采用椎管内麻醉,研究组在对照组基础上辅助进行穴位按摩,观察2组初产妇分娩镇痛效果及新生儿结局。结果 研究组新生儿阿普加（Apgar）评分高于对照组,研究组产后住院时间、产后疼痛指数、血流动力学指标与不良反应发生率均低于对照组（P<0.05）。结论 穴位按摩辅助椎管内麻醉能够有效缓解初产妇分娩时的疼痛程度,提高麻醉质量,并且可以改善新生儿结局,缩短产后住院时间,临床应用价值较高。     

助产士导乐陪伴分娩护理在自然分娩初产妇中的应用效果

目的：观察助产士导乐陪伴分娩护理在自然分娩初产妇中的应用效果。方法：选取2020年1月至2021年6月该院收治的106例自然分娩初产妇进行前瞻性研究,采用随机数字表法将其分为观察组与对照组各53例。对照组采用常规助产护理,观察组采用助产士导乐陪伴分娩护理。比较两组各产程时间、宫缩疼痛程度[视觉模拟评分法（VAS）]评分、分娩自我效能感[简化中文版分娩自我效能量表（CBSEI-C32）]评分、不良妊娠结局发生率、产后2 h阴道出血量、新生儿1 min Apgar评分和护理满意度。结果：观察组第一产程、第二产程、第三产程、总产程均短于对照组,差异有统计学意义（P<0.05）;观察组VAS评分低于对照组,CBSEI-C32评分高于对照组,差异均有统计学意义（P<0.05）;两组中转剖宫产、会阴裂伤、产后尿潴留发生率比较,差异均无统计学意义（P>0.05）;观察组产后2 h阴道出血量少于对照组,差异有统计学意义（P<0.05）;两组新生儿1min Apgar评分比较,差异无统计学意义（P>0.05）;观察组护理满意度为100.00%(53/53),高于对照组的83...     

探讨椎管内阻滞镇痛分娩对潮汕地区初产妇母儿的影响

目的 探究镇痛分娩对潮汕地区初产妇产程时间、分娩结局、产后抑郁风险的影响,分析可能影响产后抑郁的因素,并对爱丁堡产后抑郁量表的优化进行探究。方法 采用回顾性分析法选择2018—2019年在本院分娩的潮汕地区初产妇180例为研究对象,分为实验组和对照组两组,每组各90例。实验组进行镇痛分娩,对照组进行非镇痛分娩组。选用一般情况调查表、抑郁自评量表（SDS）和爱丁堡产后抑郁量表（EPDS）对180例初产妇进行心理评估;观察比较两组产妇产程时间、宫缩乏力情况、产时产后出血量（产后2小时）、新生儿Apgar评分。结果 两组产前SDS评分比较,差异无统计学意义（P>0.05）。实验组的总产程时间、第一产程时间、第二产程时间均长于对照组（P<0.05）,第三产程时间两组比较差异无统计学意义（P>0.05）;实验组在第一产程宫缩乏力的发生率高于对照组,差异有统计学意义（P<0.05）。实验组和对照组在产时产后出血量（产后2小时）、新生儿Apgar评分上差异无统计学意义（P>0.05）。实验组产后一周和产后六周的EPDS评分低于对照组,差异有统计学意义（P<0.05...     

综合护理干预对初产妇产程及分娩质量的影响观察

目的：探讨综合护理干预对初产妇产程及分娩质量的影响。方法以82例初产妇为研究对象,分为干预组和对照组各41例,分别给予常规护理及综合护理干预,观察不同护理措施对分娩的影响。结果干预组产妇从潜伏期到活跃期SAS评分没有上升,对照组上升明显,2组差异有统计学意义（P<0.05）。干预组各个产程的平均持续时间均短于对照组（P<0.01）。干预组新生儿Apgar评分（9.3±0.6）分高于对照组的（9.0±0.7）分（P<0.01）,手术助产产妇比例（4.9%,2/41）低于对照组（17.1%,7/41）。结论对初产妇实施心理干预配合产程中的干预,能有效改善产妇的分娩状态,减少手术助产率,提高分娩质量。     

体位管理及穴位按摩对校正枕后位临床观察

目的:探讨在产程中进行体位管理及穴位按摩对枕后位初产妇胎位校正情况、分娩方式及母儿结局的影响。方法:选择2014年6月—2015年7月在中国医科大学附属盛京医院第一分娩室适合进行试产的232例枕后位初产妇为研究对象,并随机分为观察组和对照组。观察组于第一及第二产程对产妇进行相关体位指导、管理及穴位按摩,胎头拔露后回产床半卧位至胎儿娩出。对照组不限制体位,宫口开全后回产床半卧位至胎儿娩出,其他干预措施一致。结果:观察组纠正为枕前位的例数多于对照组,差异有统计学意义(P0.05);观察组经阴道分娩率大于对照组,产钳助产率、剖宫产率小于对照组,差异有统计学意义(P0.05);观察组第一产程及第二产程时间小于对照组,差异有统计学意义(P0.05);观察组疼痛感及镇痛分娩比例低于对照组,差异有统计学意义(P0.05);产后出血量低于对照组,差异有统计学意义(P0.05);新生儿窒息率低于对照组,差异有统计学意义(P0.05)。结论:产程中对枕后位初产妇合理进行体位管理可纠正枕后位,进行适当的穴位按摩,可促进气血流通、降低分娩疼痛,二者合用是提高阴道分娩率、缩短产程、缓解产痛、降低产后出血量及新生儿窒息率的有效方法。     

不同时机分娩镇痛对初产妇产程及分娩结局的影响

目的 探讨初产妇分娩过程中不同时机分娩镇痛对产程及分娩结局的影响。方法 回顾性选取2020年1月—2021年12月在南京市江宁医院分娩的初产妇220例的临床资料,根据分娩镇痛方式差异分为观察Ⅰ组（宫口扩张<3 cm时实施分娩镇痛,58例）、观察Ⅱ组（宫口扩张≥3 cm时实施分娩镇痛,52例）与对照组（未行分娩镇痛,110例）。记录各组产妇产程用时情况,对比3组初产妇分娩方式选择及新生儿评分情况。结果 观察Ⅰ组、Ⅱ组初产妇第一、二产程用时均明显长于对照组,差异有统计学意义（P<0.05）;观察Ⅰ组产妇第一产程用时长于观察Ⅱ组,差异有统计学意义（P<0.05）;观察Ⅰ组第二产程用时与观察Ⅱ组比较,差异无统计学意义（P>0.05）;3组产妇第三产程用时比较,差异无统计学意义（P>0.05）;观察Ⅰ组与Ⅱ组产妇自然分娩率高于对照组,剖宫产率低于对照组,差异有统计学意义（P<0.05）;观察组Ⅰ组与观察Ⅱ组自然分娩率比较,差异无统计学意义（P>0.05）;3组新生儿1、5 min评估Apgar评分比较,差异无统计学意义（P>0.05）。结论 初产妇...     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.