14年剖宫产率及主要剖宫产指征变化分析

回顾性分析吴江市第一人民医院近14年来剖宫产的临床资料。总结14年来剖宫产率及剖宫产指征的变化，寻求降低剖宫产率的方法。结果：（1）剖宫产率逐年上升，从1990年的13．12％上升到2003年的38．14％（P〈0．01）。（2）1990年至1999年剖宫产指征第1位是难产，2000年至2003年社会因素已跃居至第1位。（3）以难产、胎儿窘迫、妊娠合并症及并发症、臀位为指征的剖宫产增加。提示剖宫产指征普遍放宽，社会因素致剖宫产显著增加是造成剖宫产率上升的主要原因，降低剖宫产率的关键是严格掌握刮宫产指征，控制因社会因素而行的不必要剖宫产。     

5年剖宫产率及剖宫产指征变化分析

目的总结近5年剖宫产率及剖宫产指征的变化。方法回顾性分析我院近5年来剖宫产孕妇的临床资料。结果（1）剖宫产率逐年升高;（2）2005～2006年,剖宫产指征以难产占第一位,而2008～2009年以社会因素占第一位、第二位。结论严格掌握剖宫产指征,尽量减少因社会因素而行剖宫产术。     

剖宫产率及剖宫产指征10年变化的临床分析

目的 总结剖宫产率及剖宫产指征的10年变化。方法 回顾性分析我院近10年来剖宫产孕妇的临床资料。结果 ①剖宫产率逐年升高，1995年为26．2％，2004年为57．2％。②剖宫产指征中，社会因素所占比例逐年升高，1995年为8．3％，2004年为33．2％。结论 剖宫产率升高主要为无医学指征行剖宫产术增多所致，降低剖宫产率的关键是严格掌握剖宫产指征，尽量减少因社会因素而行的剖宫产术。     

我院10年剖宫产指征变化的临床分析

目的:总结近10年剖宫产率及剖宫产指征的变化。方法:回顾性分析我院2000-2009年剖宫产产妇的临床资料。结果:2000年剖宫产率为31.4%,2009年上升至46.7%,剖宫产率明显升高。2000-2004年剖宫产指征以难产为第一位,2005-2009年社会因素占首位。结论:剖宫产率升高主要为无医学指征行剖宫产术增多所致。降低剖宫产率的关键是严格掌握剖宫产指征,加强宣教,尽量减少因社会因素而行的剖宫产术。     

剖宫产率及指征变化的分析与对策

目的观察10年剖宫产指征的变化，分析剖宫产率升高的原因，寻找降低刮宫产率的对策，探讨剖宫产合理应用。方法对1996年1月～2005年12月5638例住院分娩产妇的剖宫产病例资料进行回顾分析。结果（1）剖宫产率呈逐年丌高趋势，1996年为16．2％，2005年为60．2％；（2）1995～2001年剖宫产指征以胎儿宫内窘迫为第一位，而近两年社会凶素占第一位。结论剖宫产牢升高主要为无医学指征而剖宫产术增多所致，冈此提高对剖宫产的认识、鼓励产妇阴道分娩、正确掌握剖官产指征是降低剖宫产率的关键。     

剖宫产率居高不下及相关指征变化的分析和对策

目的总结近5年剖宫产率及剖宫产指征的变化。方法分析我院近5年来剖宫产孕妇的临床资料。结果①剖宫产率居高不下且呈明显上升趋势，2004年为56．66％，2008年上升为69．86％。②剖宫产指征社会因素在2004～2008年5年中影响一直较大，逐年升高。结论剖宫产率升高主要为无医学指征行剖宫产术增多所致，严格掌握剖宫产指征，尽量减少在社会因素而行的剖宫产术是降低剖宫产率的有效途径。     

降低剖宫产率对策的探讨

目的：了解本院和全市接产医院剖宫产率及指征情况,为降低剖宫产率提供依据。方法：对本院2000年剖宫产情况与全市抽样调查情况进行比较分析。结果：2000年本院剖宫产率为60．11％,高于全市剖宫产率47．44％;主要指征构成依次为：社会因素（38．9％）、胎儿窘迫（13．6％）、臀位（7．2％）及相对性头盆不称（5．9％）。2000年全市剖宫产主要指征构成依次为：胎儿窘迫（22．41％）、社会因素（16．93％）、相对性头盆不称（9．78％）及臀位（6．84％）。结论：本院剖宫产率高于全市平均水平,社会因素剖宫产显著高于全市。为降低剖宫产率,提出3方面的措施：①产科医务人员应正确掌握剖宫产指征;②对孕产妇及其家属进行深入宣教,使他们正确认识剖宫产的利弊,改变对剖宫产的盲目追求而减少社会因素剖宫产;③转变产时服务模式,推广导乐陪伴分娩及分娩镇痛法,为自然分娩提供有利条件。     

剖宫产率增高的社会因素分析

目的 探讨产科剖宫产率增高的社会因素。方法回顾性分析某妇产科医院1982年-2006年剖宫产率变化特点和近5年来剖宫产手术指征资料。结果（1）25年来剖宫产率呈明显上升趋势（P〈0．001），2004年高达76．12％。（2）2002年-2006年剖宫产手术指征中，社会因素高居第一位。（3）患方因社会因素选择剖宫产术的原因中，基于安全考虑者居第一位（35．8％）。结论应加强医患沟通，避免各种暗示及误导。合理掌握剖宫产手术指征，减少社会因素的干预，开展无痛分娩，鼓励产妇经阴道分娩，降低产科合并症。     

6年剖宫产率和剖宫产指征的回顾性分析

目的总结近6年我院剖宫产术指征及剖宫产率的变化。方法回顾性分析我院近6年来行剖宫产孕妇的临床资料。结果剖宫产率逐年升高。2000年为23.22%,2005年上升至45.86%,且剖宫产指征中,社会因素由原来的倒数第二位逐渐成为首位。结论剖宫产率升高的主要原因是无医学指征的剖宫产术增多。应严格掌握剖宫产术指征,减少因社会因素行剖宫产术。     

剖宫产指征及剖宫产率变化与相关因素分析

目的 总结近4年剖宫产率及剖宫产指征变化，探讨高剖宫产率的原因，分析剖宫产各项指征的合理性，寻找降低剖宫产率的对策。方法 回顾分析该院2002年1月1日-2005年12月31日剖宫产病例的临床资料。结果 剖宫产率逐年升高，2002年为41.9％，2005年为61．04％，显著高于who提出的目标，2002年剖宫产指征以难产为第1位，而近2年社会因素占第1位。结论 剖宫产率升高主要与医患双方有关，降低剖宫产率应从医患双方着手。     

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.