超声心动图在倍频Nd:YAG/532激光心肌血运重建术实验研究中的应用

目的　应用超声心动图技术评价倍频Nd :YAG/5 3 2 (KTP)激光心肌血运重建术 (TMLR)对急性心肌梗死犬心脏功能的影响。方法　家犬 12条 ,随机分为TMLR组和对照组 ,每组 6条 ,结扎左前降支中段 ,造成急性心肌梗死犬模型 ,TMLR组在梗死区以KTP激光行TMLR。术后动物饲养 2～ 3月 ,以超声心动图经体表检测左室射血分数 (EF)、左室短轴缩短率 (FS)、室壁运动指数 (WMSI)、心输出量 (CO)作为左室收缩功能的指标。测量二尖瓣口舒张早期和舒张晚期血流速率 (Ve ,Va)及E/A作为左室舒张功能的指标。以局部室壁收缩增厚率 (ΔT)和心肌运动速率 (S、E和A峰 )代表梗死局部心肌的功能。结果超声心动图检查发现 ,反映动物心脏整体收缩功能和整体舒张功能的指标两组之间比较差异均无显著意义 (均P >0 .0 5 ) ;而反映梗死区局部收缩和舒张功能的指标 ,TMLR组明显好于对照组 ,两组之间差异有显著性意义 (均P <0 .0 5 )。结论　KTP激光TMLR对梗死局部心肌功能有改善作用 ,但对心脏整体功能则无明显作用     

急性心肌缺血激光打孔心肌内埋植碱性成纤维生长因子缓释栓对心肌存活性影响的实验研究

目的　检测急性心肌缺血犬模型行激光打孔心肌内埋植碱性成纤维生长因子缓释栓后缺血心肌的存活性 ,以评价该方法对缺血心肌灌注的影响。方法　 18条健康杂种犬随机分成 3组 ,即急性心肌缺血组(AMI组 )、激光打孔组 (TMLR组 )和激光打孔联合碱性成纤维生长因子缓释栓组 (bFGF FG组 )。所有实验犬均结扎左前降支中段造成急性心肌缺血模型 ,TMLR组和bFGF FG组在冠脉结扎后 3 0min于缺血区心肌用KTP激光打孔 ,bFGF FG组并于打孔的心肌隧道内埋植碱性成纤维生长因子缓释栓。术后 2个月用多普勒组织成像结合小剂量多巴酚丁胺负荷超声评价缺血心肌的存活性。结果　 3个实验组各有 1条犬死亡。静脉输注多巴酚丁胺后 ,AMI组左室前壁及前室间隔增厚率 (ΔT % )、左室前壁运动幅度 (MA)及舒缩速率参数收缩期峰值速率 (s)、舒张早期与晚期峰值速率比值 (e/a)以及二尖瓣瓣环运动速率参数e/a ,随着多巴酚丁胺剂量的增大逐渐降低 ,室壁运动记分指数 (WMSI)逐渐升高 (P <0 .0 5或P <0 .0 1) ;二尖瓣瓣环运动速度参数s无明显变化 (P >0 .0 5 )。TMLR组在静脉输注 5 μg·kg-1·min-1多巴酚丁胺后 ,ΔT %、MA、左室前壁及二尖瓣瓣环s和e/a升高 ,WMSI降低 (P <0 .0 5或P <0 .0 1) ;当多巴酚丁胺剂量增大到 10 μg·kg-1·m     

KTP激光心肌血运重建术对急性心肌梗死犬左室功能的影响

目的：研究KTP激光心肌血运重建术（TMLR）对急性心肌梗死犬心脏功能的影响。方法：家犬12只，随机分为TMLR组和对照组，每组6只，结扎左前降支中段，造成急性心肌梗死模型，TMLR组在梗死区以KTP激光行TMLR。术后动物饲养2－3个月。以超心动图经体表检测左室射血分数（EF）、搏出量（SV）、心输出量（CO）、室壁运动指数（WMSI）作为左室收缩功能的指标。测量二尖瓣口Ve,Va及E／A作为左室舒张功能的指标。以局部室壁收缩增厚度（△T%）和心肌运动速度（S、E和A峰）代表梗死局部心肌的功能。结果：超声心动图检查发现，反映动物心脏整体收缩功能和整体舒张功能的指标，两组之间比较差异均无显著性意义。而反映梗死区局部收缩和舒张功能的指标。TMLR组明显好于对照组，两组之间差异有显著性意义。结论：KTP激光TMLR对梗死局部心肌功能有改善作用。但对心脏整体功能则无明显作用。     

负荷超声心动图检测KTP激光心肌血运重建术后心肌存活性

目的　研究KTP激光心肌血运重建术 (TMLR)对梗死局部心肌存活性的影响。方法　家犬 12只 ,随机分为TM LR组和对照组 ,每组 6只 ,结扎左前降支中段 ,造成急性心肌梗死犬模型 ,TMLR组在梗死区以KTP激光行TMLR。术后动物饲养 2～ 3个月 ,采用多巴酚丁胺负荷超声心动图 ,检测心肌的存活性。结果　负荷超声心动图检查发现 ,TMLR组给予5 μg/(kg·min)多巴酚丁胺后室壁收缩增厚率、室壁运动幅度和室壁运动速度均有不同程度的改善 ,但当多巴酚丁胺剂量增大到 10 μg/(kg·min) ,前壁的室壁收缩增厚率、室壁运动幅度和室壁运动速度反而又减低 ;而对照组给予多巴酚丁胺 5 μg/(kg·min)和 10 μg/(kg·min)后 ,室壁收缩增厚率、室壁运动幅度和室壁运动速度进行性减低。 结论　KTP激光TMLR后梗死局部部分心肌保持存活。     

急性心肌缺血激光打孔与碱性成纤维生长因子联合应用后心脏功能变化的实验研究

目的：运用超声技术评价急性心肌缺血激光打孔与碱性成纤维生长因子缓释联合应用后心脏局部和整体功能的变化。方法：18条健康杂种犬随机分成三组：即急性心肌缺血组（AMI组），激光打孔组（TMLR组）和激光打孔联合碱性成纤维生长因子组（bFGF-FG组），所有实验犬均结扎左前降支中段造成急性心肌缺血模型，TMLR组和bFGF-FG组在冠状结扎后30分钟于缺血区心肌用KTP激光打孔（TMLR），bFGF-FG组并于打孔的心肌隧道内埋植碱性纤维生长因子缓释栓（bFGF-FG）。术后2个月用二维，M型及多普勒组织成像（DTI）等超声左室乳头肌水平前壁及前间壁厚度（TLVAW，TAIVS）增厚度（△T%）及前壁运动幅度（MA），左室短轴缩短率（FS），面积缩小分数（FAC），射血分数（EF），每搏量（SV）和心输出量（CO），在AMI，TMLR和bFGF-FG三组依次增大，其中TMLR组MA和EF与AMI组之间的差异有显著性意义（P＜0．05或P＜0．01），bFGF-FG组TVAW，△T%，MA，FAC，EF，SV和CO和AMI组之间以及TLVAW，MA，SV和EF与TMLR组之间的差异亦有显著性意义（P＜0．05或P＜0．01），余参数各组之间无明显差异（P＞0．05），室壁运动记分指数（WMSI）在AMI，TMLR和bFGF-FG三组依次降低，且三组裼 差异均有显著性意义（P＜0．05或P＜0．01）。左室前壁心肌和二尖瓣瓣环DTI参数s及e/a在AMI，TMLR和bFGF-FG三组亦依次半大，其中TMLR组左室前壁e/a与AMI组之间，bFGF-FG组左室前壁s和e/a与AMI组之间以及左室前壁e/a与TMRL组之间的差异均有显著性意义（P＜0．05或P＜0．01），余参数各组之间无明显差异（P＞0．05）。结论：激光打孔心肌内埋植碱性成纤维生长因子缓释，能够阻止急性心肌缺血心脏局部及整体功能的进一步损害，是TMLR方法学上的一个拓展。     

纤维蛋白胶控制bFGF在激光心肌隧道内释放对急性缺血心肌重构的影响

目的　评价纤维蛋白胶 (FG)控制bFGF在激光心肌打孔隧道内释放对犬急性缺血心肌重构的影响。方法　 18只健康杂种犬结扎左前降支中段造成急性缺血心肌模型 ,随机分成三组 ,即单纯冠脉结扎组 (AMI组 )、冠脉结扎加激光心肌打孔组 (TMLR组 )和冠脉结扎加激光心肌打孔隧道注入碱性成纤维细胞生长因子纤维蛋白胶组 (bFGF组 )。术后 2个月用超声和显微病理技术观察缺血心肌形态及结构的变化。结果　左房室腔内径三个实验组之间无统计学差异 (P >0 .0 5 )。AMI组有 2只犬、TMLR组有 1只犬存在心尖部室壁瘤 ,bFGF组无室壁瘤现象。左室前壁及前室间隔厚度 (TL VAW、TAIVS)在bFGF组、TMLR组和AMI组依次减小 ,其中bFGF组TLVAW与AMI和TMLR组之间的差异有显著性意义 (P <0 .0 5 )。AMI组缺血区存在大量的坏死心肌细胞 ,TMLR组部分心肌细胞变性坏死、部分结构正常 ,bFGF组大部分心肌细胞结构正常 ,小部分变性坏死。结论　用FG控制bFGF在激光心肌打孔隧道内释放 ,能够减轻或阻止心肌缺血性损害以及缺血心肌的重构。     

激光心肌打孔隧道埋植bFGF缓释胶对急性缺血心肌血管生成及血流灌注的影响

目的评价急性心肌缺血犬模型行激光打孔隧道埋植碱性成纤维细胞生长因子纤维蛋白胶对缺血心肌血管生成及血流灌注的影响.方法18只健康杂种犬随机分成三组,即单纯冠脉结扎组(AMI组)、冠脉结扎加激光打孔组(TMLR组)和冠脉结扎加激光心肌打孔隧道埋植碱性成纤维细胞生长因子纤维蛋白胶组(bFGF组).所有实验犬均结扎左前降支中段造成急性心肌缺血模型,TMLR组和bFGF组在冠脉结扎后30 min于缺血区心肌行激光打孔(TMLR),bFGF组并于激光打孔的心肌隧道内埋植碱性成纤维生长因子纤维蛋白胶(bFGF-FG).术后2个月用冠脉血流显像检测缺血区心外膜表面冠脉侧支及心肌内血流,用免疫组化Ⅷ因子相关抗原染色定量缺血心肌内微血管密度及Ⅷ因子表达.结果TMLR组及bFGF 组缺血打孔区冠脉侧支及心肌内血流的彩色信号面积及平均吸光度均大于AMI组,以bFGF组为显著(P均<0.01),且bFGF组的上述两项指标高于TMLR组(P均<0.05);TMLR组和bFGF组缺血打孔区心肌内微血管密度及Ⅷ因子相关抗原显色面积、平均吸光度均大于AMI组(P＜0.05或0.01),且bFGF 组三项指标高于TMLR组(P均<0.05).结论激光心肌打孔隧道内埋植碱性成纤维细胞生长因子纤维蛋白胶,能够进一步促进缺血心肌内新生血管的生成,加强改善缺血心肌的血流灌注.     

早期亚低温对家兔持续性心肌梗死的影响

目的探讨早期亚低温疗法对家兔持续性心肌梗死的影响。方法36只家兔分为3h结扎组和24h结扎组,各自再随机分为常温组和亚低温组,开胸持续结扎心脏前降支建立急性心肌梗死模型。亚低温组物理降温使结扎后30min体温降到35℃以下,保持在(33~35)℃之间,24h结扎组动物3h后自然复温;常温组体温维持在38℃以上。动物处死后取心染色切片,计算梗死心肌和左室心肌重量。结果(1)3h结扎组的亚低温组梗死心肌的重量明显低于常温组[(0·33±0·06)g比(0·52±0·04)g;P<0·01],其占左室心肌重量的百分比也明显低于常温组[(6·5±1·3)比(11·3±3·7)%;P<0·01)。(2)24h结扎组的亚低温组梗死心肌重量与常温组相近[(0·57±0·05)g比(0·60±0·09)g,P>0·05],占左室心肌重量的比例也相近[(16·0%±1·3%)比(16·3%±1·1%);P>0·05]。(3)3h及24h结扎组亚低温组梗死24h血清CK-MB活力低于常温组,差异接近显著。结论亚低温可以在心肌梗死早期延缓缺血心肌坏死速度,而不能缩小最终心肌梗死面积。     

产科早期弥漫性血管内凝血患者止凝血功能的研究

目的研究正常孕妇不同孕期和产科早期弥漫性血管内凝血(DIC)患者的凝血、抗凝、纤溶和血管内皮系统的功能,了解所用分子标志物在早期诊断产科DIC中的价值和意义。方法检测了31例早孕、14例中孕、62例晚孕、34例产科早期DIC和31名正常对照的常规止凝血功能指标凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血小板(PLT)和分子标志物凝血酶原片段(F1+2)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤维蛋白单体(FM)、血栓调节蛋白(TM)和D-二聚体(D-dimer)。结果PT、APTT在各实验组间差异无统计学意义(P>0·05),早期DIC组PLT(155±60)×109/L低于对照组(241±63)×109/L和妊娠各期组[分别为早孕组(233±64)×109/L、中孕组(203±50)×109/L、晚孕组(216±55)×109/L](P<0·05),Fbg、F1+2、TAT、FM、TM、D-dimer随着妊娠时间的延长浓度逐渐升高(P<0·05),早期DIC组Fbg(4·0±1·0)g/L与中孕组(3·8±0·8)g/L、晚孕组(4·1±0·5)g/L相比差异无统计学意义(P>0·05),早期DIC组TAT7·40(14·01)μg/L与中孕组6·41(5·51)μg/L、晚孕组8·58(5·84)μg/L相比差异无统计学意义(P>0·05)。早期DIC组F1+2(4·43±1·43)nmol/L、TM(31·5±8·5)μg/L、FM(43·7±16·8)mg/L、D-dimer(630±479)μg/L浓度显著升高,明显高于对照组和妊娠各期组(P<0·05)。除PLT和Fbg之间不存在直线相关关系外,指标F1+2、TAT、FM、TM、D-dimer、PLT、Fbg间均存在直线相关关系或等级相关关系(P<0·05)。结论TAT、Fbg可反映机体高凝状态,但不能早期诊断产科DIC。F1+2、FM、TM、D-dimer可作为早期诊断产科DIC的敏感指标。     

白细胞介素-6基因型及血清水平与急性心肌梗死的关系

目的分析急性心肌梗死患者白细胞介素-6(IL-6)基因启动子-572C/G、-634C/G的多态性,探讨IL-6的基因型及其血清水平与急性心肌梗死的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的分析方法,检测了128例急性心肌梗死患者和145例健康对照者IL-6基因多态性,同时采用酶联免疫吸附试验检测IL-6的血清水平。结果急性心肌梗死组IL-6水平显著高于对照组(P<0·01),IL-6-572C/G基因型和等位基因频率在急性心肌梗死组和对照组比较,差异有显著性(P<0·05),与健康对照组相比,发现G等位基因携带者患急性心肌梗死的的相对风险度增加1·740倍(OR=1·740,95%CI=1·135~2·668)。携带G等位基因的急性心肌梗死患者血清IL-6水平显著高于不携带者(P<0·01)。IL-6基因-634C/G多态性在急性心肌梗死组和对照组之间比较差异无显著性(P>0·05)。结论IL-6基因-572C/G多态性与急性心肌梗死之间存在相关关系,其中G等位基因可能是急性心肌梗死发病的遗传易感基因;携带G等位基因的个体可能通过促进IL-6的高度表达进而增加了急性心肌梗死的发病风险。     

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.     

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.     

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.