人急性B淋巴细胞白血病-NOD/SCID/IL2rγnull新生小鼠异种移植模型的建立

本研究旨在应用NOD/SCID/IL2rγnull新生小鼠建立人急性B淋巴细胞白血病(B-ALL)的异种移植模型。NOD/SCID/IL2rγnull新生期(出生48 h之内)小鼠经亚致死剂量(100 cGy)137Cs全身照射后,由面静脉输注FACSAria流式细胞仪分选纯化的B-ALL患者骨髓CD3-CD4-CD8-CD34+CD19+细胞,于移植后8-12周用流式细胞术检测受鼠外周血、骨髓和脾脏中人源细胞的植入水平及其免疫表型,并通过HE染色评价人源B-ALL细胞在受鼠各组织器官中的迁移浸润能力。结果表明,在接受B-ALL患者CD34+CD19+细胞移植的受鼠外周血、骨髓和脾脏细胞中,不仅检测到了不同程度的人源B-ALL(huCD45+CD19+)细胞的植入〔(83.36±10.05)%,(93.88±5.05)%,(88.31±5.01)%〕,而且植入细胞具有与B-ALL患者相似的细胞形态和免疫表型特征。此外,人源B-ALL细胞广泛迁移浸润到受鼠的肝脏、肺脏、肾脏和脑等组织器官中。结论:NOD/SCID/IL2rγnull新生小鼠模型能够支持B-ALL患者CD34+CD19+细胞的高水平植入,是对人B-ALL进行体内功能性研究的新型异种移植模型。     

三种人多发性骨髓瘤细胞系移植小鼠模型的建立和比较北大核心CSCD

目的利用人骨髓瘤细胞系ARP1、MM.1S和NCI-H929建立异种移植模型, 并对三种细胞移植后生长周期、肿瘤负荷和生物学特点进行比较。方法将ARP1、MM.1S和NCI-H929细胞分别由皮下或尾静脉植入经137Cs照射后的NOD/SCID小鼠, 每周观察小鼠的生存情况, 监测肿瘤负荷。应用流式细胞术检测小鼠肿瘤组织或骨髓中CD138+细胞的比例。采用免疫荧光检测肿瘤组织细胞的CD138和免疫球蛋白轻链表达。ELISA法检测骨髓和外周血中的免疫球蛋白轻链, micro-CT评价骨病变。结果皮下移植ARP1、MM.1S和NCI-H929细胞的小鼠在两周内均可形成局部肿瘤, 免疫荧光检测支持浆细胞肿瘤。尾静脉移植后第20天时可在ARP1组小鼠外周血中检测出κ轻链[(8.2±1.0)ng/ml]。尾静脉移植6周左右, ARP1组小鼠出现体重下降、精神萎靡、下肢逐渐瘫痪等表现, 骨髓中能检测到人CD138+CD38+细胞群, 予硼替佐米治疗可显著降低肿瘤负荷[(5.7±0.2)%对(21.3±2.1)%, P<0.01]。MM.1S和NCI-H929组小鼠骨髓中未检测到人CD138+CD38+细胞群。结论 ARP1、MM.1S和NCI-H929细胞系构建的小鼠模型可作为MM发病机制及临床研究的良好模型。     

小鼠骨髓腔内输注人脐血造血干/祖细胞植活水平的观察

目的 探讨小鼠骨髓腔内输注能否增强人脐血造血干/祖细胞(HS/PC)异种移植的植活能力.方法 将不同数量(1×103、1×104、0.5×105、1×105、5×105)的人脐血CD34+细胞经尾静脉和骨髓腔途径移植入经亚致死剂量照射的NOD/SCID小鼠.于指定时间点处死小鼠,用PCR法检测人17号染色体α-微卫星特异性片段及用流式细胞术检测人源CD45+细胞,观察脐血CD34+细胞在移植小鼠左、右两侧胫骨和股骨及脾脏等部位的归巢及其长期植活能力.结果 异种移植后24h,经骨髓腔移植5×105 CD34+细胞的小鼠肝、脾、肺组织,外周血,左右两侧胫骨和股骨、骨髓细胞均表达人17号染色体α-卫星特异性片段.不同数量的人脐血CD34+细胞经骨髓腔途径移植入NOD/SCID小鼠后,8周时其植活良好(检测部位包括输注部位右侧胫骨,以及非输注部位右侧股骨、左侧胫骨、左侧股骨、脾脏及外周血).分别经尾静脉和骨髓腔两种途径输注同一来源的人脐血CD34+细胞1.0×105,8周时两组间人造血细胞植活水平分别为(44.063±20.095)%和(45.881±22.316)%,差异无统计学意义(P＜0.05);而将移植CD34+细胞数降至1.0×104时,则经骨髓腔途径输注的人脐血CD34+细胞小鼠植活水平(54.019±31.338)%显著优于尾静脉输注途径[(12.197±10.350)%,P＜0.01)];当CD34+细胞输注量降至1.0×103时,仅有骨髓腔内输注组小鼠能见到人脐血CD34+细胞植活,且植活部位通常为非输注部位骨骼.结论 小鼠骨髓腔内移植能够增强人脐血造血干/祖细胞的植活水平.     

间充质干细胞与人脐血CD34+细胞共移植对NOD/SCID小鼠造血重建的影响

目的 观察间充质干细胞(MSC)与不同比例脐血CD34+细胞共移植对NOD/SCID小鼠造血重建的影响,明确MSC与脐血CD34+细胞共移植的最适数量.方法 给60Coγ射线照射的雌性NOD/SCID小鼠共移植人MSC和不同比例的脐血CD34+细胞,观察共移植后42 d内小鼠外周血白细胞和血小板变化,并于移植后42 d处死小鼠,用流式细胞术检测外周血、骨髓和脾脏人源细胞含量.结果 与单纯脐血CD34+细胞移植相比较:①脐血CD34+细胞与1、5和10倍数量的MSC共移植时,可明显减轻外周血白细胞和皿小板的下降幅度(P<0.01),提前1周使白细胞和血小板恢复至正常水平(P<0.05),三组间差异无统计学意义(P>0.05);②MSC与不同比例的脐血CD34+细胞共移植均可明显提高外周血、骨髓和脾脏造血细胞植入率.比例为10:1时,外周血、骨髓和脾脏中的人源细胞(huCD45+细胞)含量分别增加了(2.8±0.6)倍、(3.5±0.9)倍和(5.2±0.6)倍,增加倍数差异均有统计学意义(P<0.01),达到了最佳的植入效果.结论 脐血CD34+细胞与10倍数量的MSC共移植可达到最佳的促进造血重建作用.     

脐带间充质干细胞对CD34+细胞在小鼠体内归巢的影响及其机制研究

目的 探讨脐带来源间充质干细胞(MSC)对脐血来源CD34+细胞在NOD/SCID小鼠体内归巢的影响及其可能的机制.方法 将CD34+细胞与MSC细胞共移植入经放射线照射后的NOD/SCID小鼠,采用流式细胞术和RT-PCR检测移植后20 h NOD/SCID小鼠骨髓及脾脏中人CD34+细胞,计算其相应的骨髓和脾脏的归巢效率.将脐血CD34+细胞与脐带MSC体外共培养,检测MSC细胞对CD34+细胞趋化功能的影响;并于培养4、7 d检测培养后CD34+细胞表面CD49e、CD31、CD62L、CD11a等归巢相关黏附分子表达情况.结果 ①移植后20 h采用流式细胞术成功在小鼠骨髓和脾脏中检测到人CD45+细胞.共移植组CD34+细胞骨髓归巢率[(7.2±1.1)%]高于单移植组[(5.4±0.9)%](P<0.05).②RT-PCR结果 显示共移植组小鼠骨髓细胞和脾脏细胞,单移植组小鼠脾脏细胞扩增得到人GAPDH基因片段,而单移植组小鼠骨髓细胞未见明显扩增条带.③MSC存在时,CD34+细胞的体外迁移能力为(35.7±5.8)%,显著高于CD34+细胞自发迁移率[(3.5±0.6)%,P<0.05].④CD34+细胞与MSC体外共培养后细胞表面CD49e、CD31和CD62L黏附分子的表达水平高于CD34+细胞单独培养组.结论 MSC细胞与CD34+细胞共移植有利于CD34+细胞向骨髓、脾脏等造血器官归巢,这可能与MSC促进CD34+细胞迁移以及维持CD34+细胞表面归巢相关黏附分子的表达相关.     

抗小鼠CD122抗体促进脐血CD34^＋细胞在NOD/SCID小鼠体内的重建

本研究旨在探讨抗小鼠CD122抗体促进人脐血CD34^＋造血干细胞在非肥胖糖尿病/重症联合免疫缺陷（NOD/SCID）小鼠体内的重建能力。对NOD/SCID小鼠进行半致死剂量γ射线照射,照射后腹腔注射200μg同型对照抗体或者抗小鼠CD122抗体,6-8 h后经尾静脉注射人脐血CD34^＋细胞或者注入PBS作为对照。处理后第2、3、4周取仅注射抗小鼠CD122抗体或同型对照抗体的小鼠外周血,动态监测小鼠NK细胞比例变化。在经过脐血CD34^＋细胞移植的小鼠中,利用流式细胞术对移植后小鼠骨髓中人CD45^＋比例以及CD45^＋细胞亚群中人CD34,CD19和CD33比例进行分析,观察抗小鼠CD122抗体对人造血干细胞在小鼠体内重建能力的影响。结果表明,用抗CD122抗体处理后2周和3周时,小鼠外周血中NK细胞比例分别为（4.6±0.6）%和（5.7±1.7）%,与注射同型对照抗体的NOD/SCID小鼠（12.2±1.4）%和（13.3±1.2）%相比下降约60%。在移植了人脐血CD34^＋细胞的小鼠中,同时用CD122抗体处理组在移植后6周和8周时小鼠骨髓中h CD45^＋比例分别为（63.0±12.2）%和（53.2±16.3）%,明显高于同型对照抗体组中h CD45^＋比例（7.7±3.6）%和（6.1±2.4）%。此外,经过抗CD122抗体处理组的小鼠移植8周后骨髓中仍能够明显的检测到人CD34^＋细胞的存在。结论：抗小鼠CD122抗体通过降低NOD/SCID小鼠的NK细胞的比例,大大促进了人脐血CD34^＋造血干细胞在免疫缺陷小鼠体内的重建能力。     

人脐血间充质干细胞促进脐血CD34+细胞在NOD/SCID小鼠体内植入的实验研究

目的探讨人脐血间充质干细胞(MSC)联合人脐血CD34+细胞移植,能否促进CD34+细胞在NOD/SCID小鼠体内植入及加速其造血恢复.方法NOD/SCID小鼠于60Co 2.5 Gy照射后24h内由尾静脉输注胎儿脐血CD34+细胞1×105/只(低细胞量移植组)或1×106/只(高细胞量移植组),联合移植组同时输注脐血MSC 1×106/只.动态观察移植后小鼠外周血白细胞、血红蛋白和血小板恢复情况,于移植后第8周用流式细胞术检测存活小鼠骨髓中人CD45+、CD45+CD3+、CD45+CD19+和CD45+CD33+细胞的含量.结果①低细胞量移植时,联合移植组的植入率明显高于单纯移植组,分别为26.02%和16.52%(P＜0.05);高细胞量移植时,联合移植组和单纯移植组的植入率相近,分别为43.71%和39.23%(P＞0.05).②高细胞量联合移植组和单纯移植组的存活率分别为80%和70%;低细胞量联合移植组和单纯移植组的存活率分别为70%和50%.③无论高细胞量还是低细胞量组,联合移植小鼠白细胞、血红蛋白和血小板的恢复明显早于单纯移植组.④移植8周后,小鼠骨髓中人CD45+CD19+、CD45+CD33+细胞含量在低细胞量移植时,联合移植组高于单纯移植组;但在高细胞量移植时,两组之间差异无统计学意义.CD45+CD41a+细胞的含量无论在低细胞量和高细胞量移植时,联合移植组均高于单纯移植组.各组小鼠骨髓中CD45+CD3+细胞的含量均较少,且各组之间差异无统计学意义.结论①低细胞量移植时,人脐血MSC联合移植可提高人脐血CD34+细胞在小鼠体内的植入率.②人脐血MSC与人脐血CD34+细胞联合移植,加速NOD/SCID小鼠各系造血恢复,提高移植小鼠存活率.③MSC联合移植可促进人脐血CD34+细胞在NOD/SCID小鼠体内向粒系、B淋巴系和巨核系定向分化.     

人骨髓基质细胞促进脐血CD34+细胞的体外扩增和对NOD/SCID小鼠的植入

目的 研究人骨髓基质细胞(MSC)促进脐血CD34+细胞体外扩增及植入能力的作用.方法 分离、培养正常人的MSC作为滋养层细胞.在TPO、SCF、FL和G-CSF刺激下,比较有、无MSC滋养层细胞对扩增脐血CD34+细胞后,CD34+细胞和CFU数的增加倍数,以及植入非肥胖性糖尿病/重症联合免疫缺陷(NOD/SCID)小鼠的能力.结果 以骨髓MSC为滋养层细胞的培养体系可以更加有效地扩增脐血CD34+细胞.体外扩增1周总细胞数(TNC)、CD34+细胞和CFU的均数分别增加111.6、19.3和58.0倍;体外扩增2周后TNC、CD34+细胞和CFU的均数分别增加532.8、41.3和563.5倍.脐血细胞输入NOD/SCID小鼠6周后,移植未扩增脐血细胞的对照组小鼠骨髓细胞中人CD45+细胞比例仅为1.2%～3.7%;移植单纯细胞因子刺激扩增组小鼠骨髓中,人CD45+细胞比例为7.6%～12.1%;以MSC为滋养层扩增的脐血细胞移植组,人CD45+细胞比例达到45.3%～59.1%.结论 以人骨髓MSC为作为饲养层细胞,不但可以更加有效扩增脐血CD34+细胞,而且可以促进脐血细胞植入NOD/SCID小鼠的能力,有潜在的临床应用价值.     

利用动员的外周血造血干细胞建立人源化小鼠模型

目的:观察粒细胞集落刺激因子(G-CSF)动员的人外周血中CD34~+造血干细胞(HSC)在免疫缺陷NPG~(TM)(NOD.Cg-Prkdcscid II2rgtm1vst/vst)小鼠模型上造血重建的水平。方法:用免疫磁珠分选G-CSF动员人外周血CD34~+的造血干细胞,经骨髓腔移植到亚致死剂量照射的NPG小鼠。移植后2、4周观察小鼠血象恢复情况;移植后4、6、8、10、12周用流式细胞仪动态监测小鼠外周血人源CD45~+、CD19~+细胞表达;12周后处死各组小鼠,检测骨髓、肝脏、脾脏中细胞表面CD45~+、CD19~+细胞表达;用PCR方法检测小鼠骨髓细胞人Alu基因的有无。结果:免疫磁珠分选人的CD34~+造血干细胞纯度可达96.3%;NPG小鼠经过照射后骨髓腔内有核细胞及巨核细胞数量均明显减少或消失,达到了清髓的效果;移植组小鼠4周外周血各系血细胞恢复到移植照射前水平;所有小鼠全部存活,移植组小鼠在4、6、8、10、12周均检测到人源CD45~+、CD19~+细胞;应用PCR方法检测移植组小鼠人Alu基因均为阳性。结论:经骨髓腔途径移植G-CSF动员的人外周血CD34~+干细胞至NPG小鼠,可以建立人鼠嵌合模型。     

人-NOD/SCID小鼠异种急性移植物抗宿主病模型的建立

目的 建立一种人-NOD/SCID小鼠嵌合的异种急性移植物抗宿主病(aGVHD)模型.方法 NOD/SCID小鼠给予亚致死剂量的60Coγ射线全身照射后经尾静脉输注动员后人外周血单个核细胞(PBMNC),移植后每周检测血常规,采用流式细胞术检测人CD45+细胞的比例,分析人淋巴细胞亚群,取各脏器组织检测人、鼠保守基因序列片段,并进行免疫病理分析.结果 移植后1周起NOD/SCID小鼠的血细胞中有明确的人CD45抗原表达,随人CD45+细胞比例增高逐渐出现以体重减轻和血细胞减少为主要表现的异种急性移植物抗宿主病(X-GVHD),人-NOD/SCID嵌合体的基因组DNA中可扩增出入β-globin及小鼠保守基因HYPSIN序列片段,移植后6周生存率约为14%;人-NOD/SCID嵌合体中以人T淋巴细胞的植人为主,CD4+/CD8+细胞比例倒置;X-GVHD以人的淋巴细胞浸润为主,肝脏与肺脏是主要靶器官.结论 NOD/SCID小鼠预先给予亚致死剂量照射,再经尾静脉输注入PBMNC,能够建立X-GVHD模型.临床表现主要为植入率相关的体重减轻和血细胞减少,病理表现靶器官主要为肝脏和肺脏.该模型建立方法简便,X-GVHD发生时间(2～3周)较早,发生率(94%)高,便于在此基础上进行aGVHD防治的动物实验研究.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.