2型糖尿病患者血清晚期氧化蛋白产物水平与心血管危险因素的关系

目的 探讨2型糖尿病患者血清晚期氧化蛋白产物(AOPP)水平与心血管危险因素的关系.方法 选择2006年1月至2007年12月我院内分泌科就诊2型糖尿病患者90例,健康体检者60名.采用分光光度法测定血清AOPP水平,全自动生化分析仪检测空腹血浆血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇以及高密度脂蛋白胆固醇水平,微柱亲和层析法测定糖化血红蛋白水平,化学发光法测定空腹胰岛素水平,高分辨超声测定大动脉内膜-中层厚度.根据检测结果将2型糖尿病组分成不同亚组,比较各亚组间血清AOPP水平及各相关指标的变化.结果 血清AOPP水平在2型糖尿病组[(80.32±12.65)μmol/L]显著高于对照组[(41.80±17.09)μmoL/L,P<0.01];血糖控制不良组[(91.30±15.52)μmol/L]显著高于血糖良好控制组[(73.16±13.45)μmoL/L,P<0.05];胰岛素抵抗组[(89.07±11.24)μmol/L]显著高于非胰岛素抵抗组[(74.94±12.15)μmol/L,P<0.05];有大血管并发症组[(89.69±12.58)μmol/L]显著高于无大血管并发症组[(75.10±13.09)μmol/L,P<0.01].相关分析显示血清AOPP水平与空腹血浆血糖、糖化血红蛋白、甘油三酯、体重指数以及胰岛素抵抗指数正相关(r=0.286,P=0.03;r=0.310,P=0.01;r=0.461,P=0.001;r=0.257,P=0.04;r=0.461,P=0.001).Logistic回归分析显示年龄、平均动脉压、AOPP是2型糖尿病患者大血管并发症发生的独立危险因素(β=0.508,P<0.001;β=0.326,P<0.001;β=0.339,P<0.001).结论 2型糖尿病患者蛋白氧化应激增强,血清AOPP水平与2型糖尿病患者多种心血管危险因素相关,是2型糖尿病患者大血管并发症发生的独立危险因素.     

老年人脉压与动脉粥样硬化的关系

目的 探讨老年人脉压与动脉粥样硬化的关系.方法 以杨浦区中心医院及杨浦区11个街道社区卫生服务中心随访的老年人为对象,选取年龄>160岁患有动脉粥样硬化危险因素的患者2358人,记录入选者的基本情况:年龄、性别、身高、体重、吸烟史,血压、心率、冠心病、缺血性脑卒中、慢性肾脏病、糖尿病等病史.测定空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐、尿酸、丙氨酸氨基转移酶.根据脉压将入选者分为脉压<60 mm Hg组和≥60 mm Hg组.分析2组脉压与年龄、体重指数、收缩压、舒张压、心率、空腹血糖、血脂、血肌酐、尿酸、丙氨酸氨基转移酶、肌酐清除率、冠心痛、缺血性脑卒中、慢性肾脏病、糖尿病等关系.结果 脉压≥60 mm Hg组与脉压<60 mm Hg组比较,血糖[(6.3±2.6)mmol/L与(5.6±1.7)mmol/L]、总胆固醇[(4.8±1.2)mmol/L与(4.3±1.3)mmol/L]、甘油三酯[(1.9±1.1)mmol/L与(1.5±1.2)mmol/L]、低密度脂蛋白胆固醇[(2.9±1.2)mmoL/L与(2.5±1.1)mmol/L]、尿酸[(291.4±133.6)μmol/L与(246.8±131.2)μmoL/L]均明显升高(P均<0.01).脉压≥60mm Hg组与脉压<60 mm Hg组比较,冠心病(17.8%与10.8%)、缺血性脑卒中(31.7%与26.0%)、慢性肾脏病(16.9%与12.4%)、糖尿病(23.8%与17.6%)患病率均明显升高(P均<0.01).Logostic多元线性逐步回归分析结果 显示脉压与血糖、体重指数、年龄、低密度脂蛋白胆固醇、尿酸、高密度脂蛋白胆固醇密切相关(β分别为0.103、0.093、0.097、0.089、0.076、-0.057,P均<0.05).结论 有动脉粥样硬化基础的老年人,脉压高可促进动脉粥样硬化的发展,促进心脑血管及肾脏疾病的发生、发展.     

哈萨克族原发性高血压伴肥胖患者血脂、血糖及血清尿酸分析

目的:分析哈萨克族原发性高血压伴肥胖患者血脂、血糖及血清尿酸的水平。方法:于2003-06/2004-10选择哈萨克族原发性高血压患者76例及与哈萨克族原发性高血压患者同居住区的哈萨克族非高血压人群83例为研究对象。根据体质量指数(≥25kg/m2为肥胖)分为高血压伴肥胖组40例、高血压无肥胖组36例、肥胖对照组40例、无肥胖对照组43例。取清晨空腹静脉血,测定血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸及血糖。结果:纳入研究对象159例,均进入结果分析。①高血压伴肥胖组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、尿酸较高血压无肥胖组及无肥胖对照组显著升高[总胆固醇分别为(5.24±0.87),(4.76±1.06),(4.24±0.55)mmol/L,三酰甘油分别为(1.72±0.42),(1.31±0.50),(1.18±0.28)mmol/L,低密度脂蛋白胆固醇分别为(3.01±0.71),(2.70±0.74),(2.32±0.37)mmol/L,尿酸分别为(268.55±74.22),(220.06±59.51),(200.63±55.30)μmol/L,P<0.05或P<0.01]。②高血压伴肥胖组血糖较无肥胖对照组也显著升高[分别为(5.67±0.58),(5.39±0.57)mmol/L,P<0.05]。③高血压伴肥胖组血脂、血糖、血尿酸与肥胖对照组相比差异无显著性意义(P>0.05)。④高血压无肥胖组总胆固醇、低密度脂蛋白胆固醇与无肥胖对照组比较显著升高(P<0.01)。⑤肥胖对照组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、尿酸与无肥胖对照组比较也显著升高[总胆固醇分别为(5.13±1.04),(4.24±0.55)mmol/L,三酰甘油分别为(1.60±0.68),(1.18±0.28)mmol/L,低密度脂蛋白胆固醇分别为(3.12±0.90),(2.32±0.37)mmol/L,尿酸分别为(242.15±77.69),(200.63±55.30)μmol/L,P<0.01]。结论:哈萨克族原发性高血压伴肥胖患者存在血脂、血糖及血尿酸水平升高等代谢紊乱的倾向。     

2型糖尿病家系糖耐量正常的一级亲属瘦素水平分析

目的 探讨2型糖尿病(T2DM)患者糖耐量正常的一级亲属血瘦素(leptin)水平及其体重指数、腰臀围比值、血糖、血脂、血压、血胰岛素等的变化.方法 选择T2DM患者一级亲属中口服糖耐量试验、血脂、血压正常者为观察组(46例),以43名性别、年龄与之相匹配的无糖尿病家族史的正常人为对照组.比较2组leptin、体重指数、腰臀围比值、血糖、血脂、血胰岛素等的变化.结果 观察组体重指数[(22.38±1.95)kg/m2]、腰臀围比值(0.87±0.07)、收缩压[(125±14)mm Hg]比对照组[(21.03±2.67)kg/m2、0.78±0.05、(115±12)mm Hg]显著增高(P均<0.05).leptin[(11.04±4.70)g/L]显著高于对照组[(7.25±3.86)g/L](P<0.001),血糖、血胰岛素、甘油三酯、胆固醇、低密度脂蛋白胆固醇水平均高于对照组(P均<0.05),高密度脂蛋白胆固醇低于对照组(P<0.05).结论 T2DM患者一级亲属在口服糖耐量试验,血脂、血压正常时,leptin、血糖、血胰岛素、血脂、血压、体重指数、腰臀围比值已明显高于无糖尿病家族史的正常人,呈胰岛素抵抗趋势,Leptin增高与此趋势有关.     

糖尿病动脉粥样硬化中抗栓联合降血脂治疗作用

目的探讨糖尿病动脉粥样硬化中抗栓联合降血脂的治疗作用。方法选取2019年1月到2020年1月玉环市人民医院诊治的92例糖尿病动脉粥样硬化患者,按照随机数字表法纳入A组(n=46)与B组(n=46),分别予以抗栓治疗与抗栓联合降血脂治疗,对比两组患者的血糖水平(空腹血糖、餐后2 h血糖、糖化血红蛋白)、血脂水平(血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)、斑块指标(颈动脉内-中膜厚度、斑块厚度、斑块评分)、糖尿病并发症(脑血管病、眼底病变、周围神经病变、糖尿病肾病)。结果 B组治疗后的空腹血糖、餐后2 h血糖、糖化血红蛋白[(7.0±1.2)mmol/L、(8.7±2.1)mmol/L、4.9%±1.4%]均低于A组[(8.6±3.3)mmol/L、(13.0±2.3)mmol/L、6.0%±2.1%),P值均0.05;B组治疗后的总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平[(4.22±0.60)mmol/L、(1.15±0.24)mmol/L、(1.68±0.32)mmol/L、(2.25±0.43)mmol/L]均优于A组[(5.75±0.83)mmol/L、(2.68±0.32)mmol/L、(1.25±0.35)mmol/L、(3.88±0.96)mmol/L],P值均0.05;B组治疗后的颈动脉内-中膜厚度、斑块厚度、斑块评分[(1.14±0.22)mm、(1.87±0.10)mm、(0.60±0.12)分]均小于A组[(1.51±0.30)mm、(2.11±0.15)mm、(0.85±0.44)分],P值均0.05;B组的糖尿病并发症发生率(4.3%)低于A组(17.4%),P0.05。结论糖尿病动脉粥样硬化中抗栓联合降血脂的治疗作用显著,可改善血糖、血脂水平及斑块指标,且可降低糖尿病并发症发生率。     

2型糖尿病患者血清胆红素与血脂、脂蛋白关系的研究

目的探讨2型糖尿病患者血清胆红素与脂蛋白之间的相关性。方法选择2型糖尿病患者50例(试验组)和健康体检者50例(对照组),收集受试者临床资料,比较两组胆红素、血糖、血脂和脂蛋白水平差异,Pearson相关法分析胆红素与血脂以及脂蛋白的相关性。结果试验组血清胆红素、高密度脂蛋白胆固醇、载脂蛋白A1分别为(8.0±2.3)μmol/L、(1.08±0.32)mmol/L、(1.33±0.21)g/L,均低于对照组;体质量指数、血糖、糖化血红蛋白、甘油三酯分别为(29.5±4.4)kg/m~2、(8.5±2.1)mmol/L、(9.0±1.6)%、(1.88±1.16)mmol/L,高于对照组,差异有统计学意义(P<0.05)。2型糖尿病患者血清胆红素水平与总胆固醇、高密度脂蛋白胆固醇、甘油三酯、载脂蛋白B以及载脂蛋白E存在相关性(r值分别为-0.409、0.301、-0.511、-0.318以及-0.498,均P<0.05)。结论 2型糖尿病患者血清胆红素与血脂以及脂蛋白代谢密切相关,可能是2型糖尿病脂质代谢紊乱的独立危险因素。     

联合血脂、血糖、肝功能及血尿酸检测在诊断老年脂肪肝患者中的价值

目的探究血脂、血糖、肝功能联合血尿酸检测在诊断老年脂肪肝患者中的应用价值。方法 2016年4-11月该院收治的62例老年脂肪肝患者作为研究组,另选取62例同期体检健康者作为对照组。抽取所有研究对象4mL空腹静脉血,速率法检测总胆汁酸(TBA)、γ-谷氨酸转肽酶(GGT)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平;己糖激酶法检测极低密度脂蛋白胆固醇(VLDL-C)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、甘油三酯(TG)等血脂指标水平;过氧化物酶比色法测定糖化血红蛋白(HbA1c)、空腹血糖(FBG)水平;以深圳迈瑞公司生产的迈瑞BS-400型全自动生化分析仪检测血尿酸水平。对比血脂、血糖、肝功能、血尿酸单独检测与联合检测诊断脂肪肝的性能。结果研究组TBA、GGT、AST、ALT、TBIL水平高于对照组,差异有统计学意义(P0.05);研究组VLDL-C、LDL-C、TC、TG水平高于对照组,HDL-C水平低于对照组,差异有统计学意义(P0.05);研究组HbA1c、FBG水平高于对照组,差异有统计学意义(P0.05);研究组血尿酸水平[(447.12±91.03)μmol/L]高于对照组[(353.41±70.32)μmol/L],差异有统计学意义(P0.05);血脂、血糖、肝功能、血尿酸单独检测对脂肪肝诊断的灵敏度(80.65%、79.03%、82.26%、77.42%)、准确度(90.32%、88.71%、90.32%、88.71%)低于联合检测(95.16%、96.77%),差异有统计学意义(P0.05)。结论脂肪肝患者存在血脂、血糖、肝功能及血尿酸水平异常现象,联合上述指标对脂肪肝进行诊断可提高灵敏度与准确度,为干预方案的制订提供指导依据,值得推广。     

糖尿病、高血压患者血尿酸水平变化与血糖、血脂的关系

目的 :探讨糖尿病 ,高血压患者血尿酸水平变化与血糖、血脂的关系。方法 :总结了 4 2例 2型糖尿病患者 (A组 )和 4 3例 2型糖尿病合并高血压患者 (B组 )及 4 3例高血压病患者 (C组 )的血尿酸水平与血糖、血脂的关系。结果 :(1)A组的血尿酸为 (2 90 .85± 96 .0 0 )umol/L ,B组的血尿酸为 (340 .87± 81.92 )umol/L ,C组的血尿酸为(374 .35± 70 .0 4 )umol/L ,3组间比较差别均有显著性意义 (P <0 .0 5 )。 (2 )A组的血糖与尿酸呈负相关 (P <0 .0 1) ,差别有非常显著性意义。 (3)B组及C组尿酸与收缩压呈正相关 (P <0 .0 1) ,差别均有非常显著性意义。在B组尿酸与甘油三酯呈正相关 (P <0 .0 1)。结论 :①高血压是致高尿酸血症的独立危险因素。②高尿酸血症本身可能不是长期糖尿病患者动脉硬化的高危因素     

2型糖尿病患者大血管并发症与血脂血糖关系的临床观察

目的　探讨 2型糖尿病患者血脂、血糖水平与大血管并发症的关系。方法　采用免疫透射比浊法及酶法 ,分别测定空腹血糖 (FBS)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白 (HDL C)、低密度脂蛋白(LDL C)、载脂蛋白A1(apoA1)及载脂蛋白B(apoB)水平。结果　有大血管并发症组FBS、TC、LDL C、apoB水平及糖尿病病程与对照组比较有显著升高 (P <0 .0 5 )。结论　 2型糖尿病大血管并发症的发生与血脂代谢异常有关     

缓发性自身免疫性糖尿病的临床特征

目的探讨成人缓发性自身免疫性糖尿病(LADA)临床特征及与2型糖尿病患者的差异。方法对40例缓发性自身免疫性糖尿病、30例1型糖尿病、128例2型糖尿病及100例健康对照者进行身高、体重、血糖、糖化血红蛋白、胰岛素、C肽、血脂、血尿酸等水平检测。结果LADA患者体重指数、糖化血红蛋白、空腹血糖、C肽、餐后血糖、刺激后C肽、胰高血糖素、总胆固醇、高密度胆固醇、低密度胆固醇、甘油三酯及血尿酸水平分别为(21.73±3.96)kg/m2、(8.72±1.92)%、(16.87±6.70)mmol/L、(23.79±8.77)mmol/L、(0.50±0.30)nmol/L、(0.90±0.50)nmol/L、(84.12±7.31)pg/dl、(4.79±0.98)mmol/L、(1.08±0.53)mmol/L、(3.37±1.03)mmol/L、(1.89±1.03)mmol/L及(269.48±76.11)μmol/L,多数指标介于T1DM与T2DM水平之间。结论在表型方面LADA患者明显有别于T2DM患者。     

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.