新式剖宫产术的临床应用效果观察

Stark从 80年代开始研究新式剖宫产的手术方式 ,1996年传入我国 ,我院自 1998年 9月开始应用此种剖宫产术。 Stark的新式剖宫产[1] 采用子宫肌层一层缝合及不缝合腹膜、膀胱腹膜返折的方法。关腹方法的特点是连续缝合筋膜、皮肤及皮下脂肪组织。我院自应用此项新技术以来取得了良好的效果 ,现报道如下 :1　临床资料及方法1.1　一般资料　Stark新式剖宫产术 150例 ,年龄 2 3～ 36岁 ,平均 2 7.4岁 ,初产妇 112例 ,经产妇 38例 ,孕周 35～ 4 2 3周 ,150例均为首次剖宫产 ,剖宫产指征与传统剖宫产指征相同。1.2　手术方法　 1切口的选择 :手…     

改良新式剖宫产术50例临床分析

剖宫产术是临床上处理高危妊娠及难产的重要手段之一。如何改进术式 ,减少手术并发症是产科工作者共同努力的方向。以色列Stark医生 1988年创立了新式剖宫产术[1]并在 19个国家推广应用。我院自 2 0 0 0年 6月起应用新式剖宫产术 ,并逐渐在此方法上加以改进 ,与同期腹壁纵切口剖宫产术相比较 ,取得了良好的手术效果 ,现报告如下。1　资料与方法1.1.　一般资料　 2 0 0 0年 12月— 2 0 0 2年 2月在我院住院有剖宫产指征的初产妇随机分成 3组 :①改良新式剖宫产组 (简称改良组 ) 5 0例 ,年龄 2 3～ 38岁 ,孕周 37～ 4 2 + 2 周 ;②新式剖宫产…     

改良新式剖宫产术后行开腹手术的疗效分析

目的:探讨改良新式剖宫产术后行再次剖宫产开腹手术产妇的临床效果。方法:选取我院2008年1月至2010年12月在我院行再次开腹剖宫产手术的孕妇148例,根据产妇首次剖宫产手术的术式不同将产妇分为新式剖宫产组与改良新式剖宫产组。结果:改良新式剖宫产组产妇再次剖宫产的胎儿分娩时间、手术时间、术中出血量相比新式剖宫产组明显减少(P0.05),改良新式剖宫产组术后粘连发生率相比新式剖宫产组显著降低(P0.05)。结论:改良新式剖宫产术后再次行开腹剖宫产分娩能够有效减少再次手术时间,减少术中伤害,降低术后并发症,具有良好的临床效果。     

首次剖宫产术式选择对下次剖宫产的影响分析

目的:对首次剖宫产术式选择对下次剖宫产的影响进行分析。方法:选取我院2009年11月~2013年4月收治的2次剖宫产患者200例,依据首次剖宫产术式分为2组患者,常规切口(腹壁竖切口)组患者100例,新式切口组(腹壁横切口)患者100例,对2组患者2次剖宫产手术情况进行分析和对比。结果:新式切口组患者2次剖宫产手术住院治疗时间对比常规切口组患者,无明显差异性,无统计学意义(P>0.05)。新式切口组患者手术操作时间、术后排气时间、术中出血量、术中腹壁粘连情况、术后患者满意度均显著优越于常规手术切口组患者,差异性明显,具有统计学意义(P<0.05)。2组患者均未发生因手术操作导致的严重不良后果。结论:首次剖宫产手术采用新式切口可显著缩短手术操作时间、术后排气时间、减少术中出血量、减轻术中腹壁粘连情况,增加患者满意度,安全性较高,如能够预计产妇有2次剖宫产可能,在首次剖宫产手术时应尽量选择新式手术切口剖产手术治疗。     

两种术式二次剖宫产482例临床分析

目的 探讨两种剖宫产术式的影响,以期改良手术方式,减少或减轻并发症的发生.方法 回顾性分析482例首次为新式剖宫产及传统子宫下段剖宫产术后第二次剖宫产术中及术后情况的比较.结果 与传统子宫下段剖宫产组比较,新式剖宫产再次剖宫产术中开腹时间长,术中粘连程度重,术中出血量多,术后排气迟,差异有统计学意义(P＜0.05).结论 新式剖宫产术导致的粘连较传统子宫下段剖宫产术严重,给再次手术增加了难度.     

新式剖宫产术50例临床分析

近年来,随着剖宫产术的广泛应用,剖宫产率有所上升,剖宫产技术亦不断提高。新式剖宫产术是以色列耶路撒冷Misgav Landach医院Stark教授经过10年的临床实践逐渐形成的剖宫产术［１］。我院自1998年12月1日起使用了新式剖宫产术,取得了良好的效果。1 资料与方法１．１ 病例选择 随机抽取1998年12月1日-1999年8月30日在我院行新式剖宫产术的产妇50例,行新式剖宫产术,作为观察组;随机抽取同期行传统剖宫产术50例作为对照组。两组产妇均为初产妇,在年龄、身高、体重均无显著差异。１．２ 手术方法 1.2.1 新式剖宫产术 取两侧髂前上棘连…     

新旧两种剖宫产方式的临床应用比较

新式剖宫产是经以色列医生M．Stark改进的子宫下段剖宫产,以Stark医生所工作的医院命名为“The Misgav Ladach Method”剖宫产术。自1996年Stark医生在北京医科大学第一医院进行手术示范以来,新式剖宫产以其独具的手术方式受到我国产科医生的欢迎,在许多医院都采用此方法施行剖宫产术。我院妇产科自2005年12月以来采用新式剖宫产术式做剖宫产70例,取得了较满意效果。现报道如下。     

剖宫产术式及技巧对再次剖宫产的影响

目的探讨初次剖宫产术式及技巧对再次剖宫产的影响。方法将该院2010年收治的75例首次剖宫产术式为新式剖宫产的再次妊娠产妇作为实验组,将该院2010年同期收治的68例首次剖宫产术式为传统子宫下段剖宫产术再次妊娠妇女作为对照组,进行妊娠期并发症、分娩时间、术中观察子宫愈合情况、术后排气时间、手术开腹时间、术中出血量、腹壁各层的粘连等多项指标的对照观察。结果新式剖宫产实验组与传统剖宫产术对照组再次妊娠的开腹时间、手术总时间、开腹出血量、腹腔粘连程度、子宫愈后情况、术后排气时间、住院时间均有显著差异,只有术中出血量、术后并发症两组之间大致相当。结论对于再次剖宫产手术来说,首次剖宫产术式,新式剖宫产与传统子宫下段剖宫产相比,新式剖宫产引起粘连较严重,进腹时间延长,手术总时间过长,开腹出血量过多,子宫愈后情况不好等种种因素都增加了手术的难度。     

新旧两种剖宫产方式的临床应用比较

新式剖宫产是经以色列医生M.Stark改进的子宫下段剖宫产,以Stark医生所工作的医院命名为"The Misgav Ladach Method"剖宫产术.自1996年Stark医生在北京医科大学第一医院进行手术示范以来,新式剖宫产以其独具的手术方式受到我国产科医生的欢迎,在许多医院都采用此方法施行剖官产术[1].我院妇产科自2005年12月以来采用新式剖宫产术式做剖宫产70例,取得了较满意效果.现报道如下.     

新式剖宫产后再次手术的临床观察

自从1996年Stark新式剖宫产术引入我国,其独有的剖宫产方法,以术中不缝合子宫膀胱反折腹膜及腹壁腹膜的简捷性,被许多医院广泛采用。我院自1998年1月开始应用Stark新式剖宫产术式,至今先后完成230例剖宫产手术。近年来对其剖宫产手术后,是否容易产生盆腔粘连的现象,也引起大家的注意,我们通过再次手术56例患者进行了观察对比,对其产生盆腔粘连问题进行探讨。1资料与方法1·1资料回顾我院1998年1月至2004年8月行新式剖宫产术后再次开腹手术患者56例。其中剖宫产术者41例,子宫肌瘤切除术3例,卵巢囊肿切除术6例,黄体破裂手术2例,输卵管结扎2例…     

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.