联合监护预测脐带绕颈的临床价值

目的采用B超、胎心电子监护、彩色多普勒脐血流联合监护预测脐带绕颈及胎儿在宫内的缺氧状态,指导医务人员选择适当的分娩方式.方法 2004年7 ～ 12月间住院分娩的孕妇1 233例,于35 ～ 38周间行B超检查,对提示脐带绕颈的291例孕妇再进行胎心电子监护和彩色多普勒脐血流联合监护.结果产前B超脐带绕颈预测准确率为76.98%,S/D≥3.0的81例孕妇产后证实均有1 ～ 3周绕颈,脐带绕颈的难产率随着绕颈周数增加而上升,新生儿轻度窒息5例,无重度窒息儿.结论脐带绕颈对围产儿存在严重危害,采用联合监护可预测脐带绕颈胎儿的宫内缺氧状态,对分娩方式的选择有很大的帮助.     

B超联合胎心监护检查胎儿脐带绕颈的预后分析

目的探讨B超联合胎心监护检查预测胎儿脐带绕颈的应用价值。方法对98例确诊为胎儿脐带绕颈的孕妇(A组)应用彩超测定脐动脉血流速度S/D值和胎心无负荷试验(NST),与98例无胎儿脐带绕颈孕妇(B组)妊娠晚期情况进行比较分析。结果A组NST无反应型或S/D值≥3发生率,比B组明显增高(P<0.01),胎儿宫内窘迫和剖宫产发生率明显增高(P<0.05),但两组新生儿重度窒息发生率无显著性差异(P>0.05)。结论胎心监护联合B超检查可以提高脐带绕颈胎儿宫内缺氧状态的诊断,为临床选择分娩方式提供更为可靠的依据。     

B超联合胎心监护检查胎儿脐带绕颈的预后分析

目的 探讨B超联合胎心监护检查预测胎儿脐带绕颈的应用价值。方法 对98例确诊为胎儿脐带绕颈的孕妇（A组）应用彩超测定脐动脉血流速度S／D值和胎心无负荷试验（NST），与98例无胎儿脐带绕颈孕妇（B组）妊娠晚期情况进行比较分析。结果 A组NST无反应型或S／D值1〉3发生率，比B组明显增高（P〈0．01），胎儿宫内窘迫和剖宫产发生率明显增高（P〈0．05），但两组新生儿重度窒息发生率无显著性差异（P〉0．05）。结论 胎心监护联合B超检查可以提高脐带绕颈胎儿宫内缺氧状态的诊断，为临床选择分娩方式提供更为可靠的依据。     

脐动脉S／D值联合胎心监护在胎儿脐带缠绕预后的临床价值

目的探讨胎儿脐血流监测与胎心监护在预测胎儿脐带缠绕妊娠结局的临床价值。方法孕晚期B超诊断为胎儿脐带绕颈的孕妇452例行胎心监护、脐血流S／D值测定,并记录分娩方式、产时羊水情况及新生儿Apgar评分。结果胎监异常同时脐血流S／D比值〉3在羊水过少发生率、胎盘功能低下发生率、胎儿窘迫发生率、羊水污染发生率、剖宫产率、新生儿窒息率均明显高于胎监及S／D比值正常的孕妇。结论对胎儿脐带缠绕孕妇联合应用胎心监护与脐血流测定,可减少新生儿窒息,改善围产儿预后具有积极的临床意义。     

彩色多普勒诊断胎儿脐带绕颈的实用价值

目的探讨彩色多普勒对脐带绕颈诊断的实用价值。方法选择彩色多普勒诊断的126例脐绕颈孕妇,孕周35周～42周。检测其相关数据及脐动脉血流阻力指标,并与分娩后的结果对照分析。结果彩色多普勒对胎儿脐绕颈的检出符合率97.6%,绕颈较松符合率94%,绕颈较紧符合率88%,胎儿宫内窘迫的符合率86%。结论彩色多普勒是目前诊断胎儿脐带绕颈最准确、方便、可靠的方法。可为临床分娩的选择提供很大的参考价值,有利于降低围生儿的病死率。     

胎儿脐带绕颈829例临床分析

目的：探讨胎儿脐带绕颈与胎儿宫内缺氧及出生窒息的关系,指导临床正确处理和采取合适的分娩方式,保障母婴安全。方法对2012－01～2013－09间我院入院分娩,最后一次B超检查诊断头位胎儿脐带绕颈的孕产妇资料进行统计、分析。结果胎儿脐带绕颈发生率为19．01％;绕颈1周占胎儿脐带绕颈的73．94％;脐带绕颈胎儿宫内窘迫、新生儿窒息发生率远比无绕颈高;胎儿脐带绕颈周数与胎儿宫内窘迫和新生儿窒息发生率呈正相关;胎儿脐带绕颈三周及以上,剖宫产、胎儿、新生儿死亡率均明显高于其他组。结论胎儿脐带绕颈不是剖宫产的指征,孕妇掌握自我监护,分娩时加强监测,异常情况及时处理,根据脐带绕颈和临床情况,适时采取合适的分娩方式,对确诊胎儿脐带绕颈3周及以上者应放宽剖宫产指征,是降低胎儿宫内窘迫、死胎、死产和新生儿窒息的保障。     

联合方法诊断脐带绕颈的应用

脐带绕颈是产程中造成急性胎儿窘迫的重要因素之一。脐绕颈占分娩总数的 13%～ 2 5 % [1] ,严重时可使胎儿猝死宫内或导致新生儿窒息甚至死亡。如能早期诊断 ,恰当处理 ,可降低围产儿病死率[2 ] 。因而我院对部分孕妇采用超声波多普勒胎音仪与B超检查联合的方法诊断脐带绕颈 ,对诊断脐绕颈者行脐动脉血流测定及胎心监护 ,以便发现异常情况 ,及时处理 ,达到降低围产儿死亡率的目的 ,现将该方法介绍如下。1　资料与方法1 1　一般资料从 2 0 0 0年 1月～ 2 0 0 1年 1月间于我院住院分娩者 14 0 3例 ,其中有 79例曾于我院门诊行超声波多普勒胎…     

彩色多普勒诊断胎儿脐带绕颈的实用价值

目的探讨彩色多普勒对脐带绕颈诊断的实用价值。方法选择彩色多普勒诊断的126例脐绕颈孕妇，孕周35周～42周。检测其相关数据及脐动脉血流阻力指标，并与分娩后的结果对照分析。结果彩色多普勒对胎儿脐绕颈的检出符合率97．6％，绕颈较松符合率94％，绕颈较紧符合率88％，胎儿宫内窘迫的符合率86％。结论彩色多普勒是目前诊断胎儿脐带绕颈最准确、方便、可靠的方法。可为，临床分娩的选择提供很大的参考价值，有利于降低围生儿的病死率。     

产科特殊检查

正常胎儿肺静脉血流多普勒频谱分析及其临床意义；多普勒彩色超声诊断62例胎儿脐带绕颈的临床分析；彩色多普勒超声诊断胎儿水囊状淋巴管瘤伴胸腔积液1例；经阴道超声在异位妊娠诊断的临床价值；胎儿脐血流监测联合连续胎心监护预测由脐带绕颈引起的胎儿宫内窘迫60例；人白细胞抗原TAP等位基因多态性与先兆子痫的关联性研究。     

脐带绕颈对分娩的影响

目的：探讨脐带绕颈对分娩的影响。方法：选择脐带绕颈214例分析其：①B超诊断符合率，②绕颈周数与分娩方式的关系，③绕颈周数与手术指征的关系，④脐血流图S／D比值在诊断胎儿宫内窘迫的意义。结果：B超诊断符合率为70．1％。脐带绕颈1周与脐带绕颈2周的分娩方式及手术指征差异无显著性(P＞0．05)。而脐血流S／D比值与胎儿宫内窘迫的发生有关(P＜0．05)。结论：单一脐带绕颈不是剖宫产指征，脐带的安全长度是引起急性胎儿宫内窘迫的决定因素，脐血流S／D比值，可间接反映脐带绕颈的松紧。     

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.