NR2B反义寡核苷酸对大鼠脊髓星形胶质细胞体外分泌TNF-α及释放谷氨酸的影响

目的:观察N-甲基-D-天冬氨酸受体2B亚基(NR2B)反义寡核苷酸对体外培养的大鼠脊髓星形胶质细胞(AST)分泌肿瘤坏死因子(TNF)-α及释放谷氨酸(Glu)的影响。方法:取新生2～3d新生的SD大鼠L4～6脊髓背角AST细胞原代纯化培养,C组:正常对照,除加入与干预组等量的培养液外不加任何药物;脂多糖(LPS)组:在培养液中加入LPS,终浓度为1mg/L,孵育24h;SNR2B组:在培养液中加入经lipofectamine2000处理的NR2B反义寡核苷酸,终浓度为2μmol/L,孵育48h后再加入LPS,终浓度1mg/L,再孵育24h;ANR2B组:在培养液中加入经lipofectamine2000处理的NR2B正义寡核苷酸,终浓度为2μmol/L,孵育72h后再加入LPS,终浓度1mg/L,孵育24h;5000r/min离心15min后取上清液和细胞,分别用于TNF-α、Glu和NR2B mRNA检测。应用酶联免疫吸附法(ELISA)检测上清液中TNF-α的浓度;用高效液相色谱仪测定Glu含量,RT-PCR检测NR2B mRNA的表达。结果:与C组比较,LPS组和ANR2B组释放的TNF-α和Glu显著增加(P<0.01),而SNR2B组无显著变化;与LPS组和ANR2B组相比,SNR2B组释放的TNF-α和Glu减少(P<0.01)。与C组比较,LPS组和ANR2B组AST细胞的NR2B mRNA的表达显著升高(P<0.01),而SNR2B组差异无显著性。结论:NR2B反义寡核苷酸下调脊髓AST细胞NR2B mRNA表达,减少TNF-α和Glu的释放。     

HSP70的表达在不同预处理下星形孢菌素诱导的大鼠神经细胞毒性应激损伤模型中的意义

目的评估不同预处理对抑制星形孢菌素(STS)诱导的神经细胞毒性应激损伤的作用。方法选取SD大鼠乳鼠120只,分为对照组(n=20)、STS模型组(n=20)、姜黄素组(n=20)、槲皮素+STS模型组(n=20)、姜黄素+STS预处理组(n=20)、姜黄素+槲皮素+STS处理组(n=20)6个组。取乳鼠海马神经细胞,利用STS诱导建立神经细胞毒性应激损伤模型。对照组研究期间不作任何特殊处理,STS模型组、槲皮素+STS模型组、姜黄素+STS预处理组、姜黄素+槲皮素+STS处理组、姜黄素组分别加入终浓度为20μmol/L的STS、终浓度为10μmol/L槲皮素+20μmol/L STS、终浓度为20μmol/L的姜黄素和槲皮素、终浓度为10μmol/L的槲皮素+20μmol/L的姜黄素和槲皮素、终浓度为20μmol/L的姜黄素。利用噻唑蓝(MTT)法、乳酸脱氢酶(LDH)释放率和Western Blot法分别测定各组细胞存活率、细胞毒性损伤程度和HSP70表达量。结果姜黄素+STS预处理组、姜黄素组细胞存活率明显高于STS模型组,差异具有统计学意义(P0.01);姜黄素+STS预处理组和姜黄素组神经细胞毒性率明显低于STS模型组,差异有统计学意义(P0.01);姜黄素+STS预处理组HSP70表达量高于STS模型组和姜黄素组,差异有统计学意义(P0.01);姜黄素+STS模型组神经元存活率高于槲皮素+STS预处理组、姜黄素+槲皮素+STS预处理组和STS模型组,差异具有统计学意义(P0.05)。结论姜黄素能增强HSP70的表达并抑制STS诱导的SD乳鼠神经元细胞毒性损伤,而槲皮素通过阻断HSP70表达使姜黄素的抑制作用被抵消。     

不同浓度异丙酚对谷氨酸诱导大鼠脊髓背角星形胶质细胞损伤的影响

目的:观察不同浓度异丙酚对谷氨酸诱导大鼠脊髓背角星形胶质细胞损伤的影响。方法:取新生2～3dWistar大鼠T12～L6脊髓背角星形胶质细胞,原代纯化培养。将细胞随机分为7组(n=9),正常对照组(C组)加入Hanks液;乳剂对照组(L组)加入乳剂0.2mL/L;谷氨酸组(G组)加入谷氨酸至终浓度100μmol/L;异丙酚组(P组)加入异丙酚至终浓度50μmol/L;GP1、GP2、GP3组先加入谷氨酸至终浓度100μmol/L,10min后分别加入异丙酚至终浓度5、25、50μmol/L。培养30min后取各组细胞检测犤Ca2+犦i,再培养24h取各组细胞检测细胞凋亡、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。结果:与C组比较,G组和GP1组细胞凋亡增加(P<0.01),犤Ca2+犦i显著升高(P<0.01),MDA含量增加,SOD活性显著降低(P<0.01),G组与GP1组间比较差异无统计学意义(P>0.05)。与G组比较,GP2组和GP3组凋亡细胞减少(P<0.01),犤Ca2+犦i降低,MDA含量降低,SOD活性增加(其中GP2组P<0.05,GP3组P<0.01)。C组与L组比较各指标差异...     

大鼠海马神经元脂肪酸构成中长链多不饱和脂肪酸的功能及其机制

目的:观察长链多不饱和脂肪酸花生四烯酸(AA)和/或二十二碳六烯酸(DHA)对体外培养新生大鼠海马神经元脂肪酸构成的影响。方法:采用无血清培养液培养新生大鼠海马神经元,实验组分别在对照组的无血清培养液中添加4μmol/LAA,4μmol/LDHA或总浓度为4μmol/L、比例为1:2～16:1的AA和DHA。采用毛细管气相色谱法分析神经元中脂肪酸的构成。结果:培养液中AA和DHA总浓度为4μmol/L、比例为1:2～16:1,海马神经元中AA百分含量、AA/DHA比值与培养液中AA和DHA比例均呈正相关(P均<0.001)。结论:培养液中海马神经元中AA百分含量、AA/DHA比值与培养液中AA和DHA比例均呈正相关。     

一氧化氮供体硝普钠对海马神经元cpp32基因表达的影响

背景:阿尔茨海默病是一种老年神经系统退行性疾病,神经元凋亡被认为是其可能的发病原因之一,体外细胞培养是研究其凋亡机制的常用方法。目的:观察一氧化氮供体硝普钠对体外培养的海马神经元cpp32基因表达的影响。设计:随机对照动物实验。单位:广东医学院生物化学与分子生物学研究所。材料:实验在广东医学院生物化学与分子生物学研究所完成,实验动物为新生(出生24h以内)SD大鼠。方法:取大鼠海马神经元进行原代培养,采用终浓度分别为0,25,50,100,200,400μmol/L的硝普钠处理海马神经元24h,用反转录聚合酶链反应检测mRNA表达变化,Westernblot检测蛋白表达的变化;再用终浓度分别为0,25,50,100,200μmol/L的硝普钠处理海马神经元12h,用CPP32活性检测试剂盒检测CPP32酶活性。主要观察指标:cpp32mRNA表达、CPP32蛋白表达及CPP32酶活性检测。结果:随着硝普钠剂量的增加,cpp32mRNA表达无改变;但CPP32酶原被裂解活化,从硝普钠50μmol/L开始,酶活性显著增加,为对照组的3.02倍,100μmol/L达最大值,为对照组的3.47倍。结论:硝普钠不增加cpp32mRNA的表达,但可诱导CPP32酶原的裂解,使CPP32活化。     

大鼠海马神经元脂肪酸构成中长链多不饱和脂肪酸的功能及其机制

目的：观察长链多不饱和脂肪酸花生四烯酸(AA)和／或二十二碳六烯酸(DHA)对体外培养新生大鼠海马神经元脂肪酸构成的影响。方法：采用无血清培养液培养新生大鼠海马神经元，实验组分别在对照组的无血清培养液中添加4μmol／LAA，4μmol／LDHA或总浓度为4μmol／L、比例为1：2～16：1的AA和DHA。采用毛细管气相色谱法分析神经元中脂肪酸的构成。结果：培养液中AA和DHA总浓度为4μmol／L、比例为1：2～16：1，海马神经元中AA百分含量、AA／DHA比值与培养液中AA和DHA比例均呈正相关(P均&;lt;0．001)。结论：培养液中海马神经元中AA百分含量、AA／DHA比值与培养液中AA和DHA比例均呈正相关。     

二苯乙烯苷对谷氨酸致原代培养大鼠海马神经元损伤的保护作用

目的观察二苯乙烯苷对谷氨酸 (Glu)致原代培养大鼠海马神经元损伤的保护作用。方法原代培养大鼠海马神经元细胞与不同浓度的二苯乙烯苷 (5— 10 0 μmol/L)共同孵育 2 4h ,加入工具药Glu(终浓度为 5 0 0 μmol/L)孵育。四甲基偶氮唑盐(MTT)法测定细胞存活率 ;乳酸脱氢酶 (LDH )漏出率法测定细胞膜损伤 ;使用荧光指示试剂Fluo 3 /AM负载后 ,在激光共聚焦显微镜下观察不同细胞内Ca2 的荧光强度。结果不同浓度的二苯乙烯苷与细胞孵育 2 4h后可明显拮抗Glu介导的神经毒性作用 ,细胞存活率明显增加 ,LDH漏出减少 ,细胞死亡率降低 ,并呈明显剂量依赖关系 ;细胞内的Ca2 荧光强度降低。结论二苯乙烯苷拮抗Glu诱导的神经毒作用的机制可能为选择性抑制大剂量Glu引起的Ca2 浓度异常升高。     

藏红花素对缺氧环境下Wistar大鼠视网膜Müller细胞活性和胶质纤维酸性蛋白表达的影响

目的 观察不同浓度藏红花素对缺氧条件下RMC活性和胶质纤维酸性蛋白(GFAP)表达的影响.方法 改良Reichenbach等方法原代培养Müller细胞,并采用GFAP和Vimentin染色鉴定RMC.RMC培养基中加入终浓度10 μmol/L、50 μmol/L和100 μmol/L藏红花素,于1~7 d计数细胞,于24 h和48 h台盼蓝染色测定细胞活性,对照组RMC培养基中未加入藏红花素.培养液中加入终浓度为200 μmol/L的CoCl2建立化学缺氧模型.实验分4组:缺氧组(H组)、藏红花素处理组(C组)、缺氧+藏红花素处理组(HC组)和正常对照组(NC组),其中C和HC组培养液中加入10 μmol/L藏红花素.处理24 h,台盼蓝染色检测细胞活性,采用Western blot法半定量检测GFAP的表达.结果 含10 μmol/L和50 μmol/L藏红花素的培养液中,细胞生长无抑制;100 μmol/L 藏红花素的培养液中细胞增生受到抑制,培养24 h和48 h RMC活性分别为(68±7)%、(59±9)%,与对照组相比,明显降低(t24h=3.723,P<0.05;t48h=4.103,P<0.05).在缺氧条件下,正常细胞和10 μmol/L 藏红花素的培养液中细胞活性受到明显抑制,藏红花素可减轻缺氧环境对细胞活性的抑制作用.在缺氧条件下,GFAP表达明显升高(t=2.945,P<0.05);藏红花素可部分抑制GFAP高表达(t=3.362,P<0.05).结论 缺氧能诱导体外培养视网膜Müller细胞死亡,适合浓度藏红花素可抑制缺氧诱导的视网膜Müller细胞死亡.     

人参皂苷Rg1对淀粉样β蛋白诱导大鼠海马神经元损伤的保护

目的:观察人参皂苷Rg1对淀粉样β蛋白25～35诱导的海马神经元细胞损伤是否具有保护作用,并分析其作用机制。方法:实验于2004-03/2005-03在广州中医药大学临床药理研究所DME中心完成。①取新生24h清洁级SD大鼠,无菌环境下取出海马组织进行贴壁培养并以B27无血清培养基添加剂抑制非神经元细胞的生长。②海马神经元形态及细胞活力观察:细胞培养7d至分化成熟状态,然后被随机分为3组:人参皂苷Rg1预处理组(分为1,2,4,8,16μmol/L5个浓度组),首先每加入各浓度的Rg1(中国药品生物制品检定所提供,批号:0703-200221)预作用24h后,再加入40μmol/L淀粉样β蛋白25～35共孵育24h;模型组:每孔加入40μmol/L淀粉样β蛋白25～35作用24h;空白组:正常细胞培养用液;每组均为8孔。运用倒置显微镜进行海马神经元形态学观察,四甲基偶氮唑盐比色法法检测细胞活力,即吸光度(A值),该值越高说明细胞活力越强。③检测核因子κB活性:调整细胞悬液密度为2×108L-1,接种于6孔板(内置已用多聚赖氨酸包被的盖玻片),1mL/孔。随机分为5组(3孔/组):正常组,模型组,2,4,8μmol/L人参皂甙Rg1预处理组。细胞培养7d后,2,4,8μmol/L人参皂甙Rg1预处理组加终浓度为2,4,8μmol/L的人参皂甙Rg1预作用24h后,与模型组一起加40μmol/L淀粉样β蛋白,作用24h。激光共聚焦显微镜检测核因子κB在细胞内的激活程度,以图像分析仪计算核区荧光与胞浆区荧光比值,比值越高说明核因子κB活性越高。④计量结果差异比较采用单因素方差分析。结果:①神经元细胞形态:相差显微镜下可见人参皂甙Rg1预处理组细胞损伤相对较模型组轻,但较正常组严重。②海马神经元细胞活力:正常组和2,4μmol/L人参皂甙Rg1预处理组明显高于模型组(P<0.05),以4μmol/L人参皂甙Rg1预处理组最高;1,8,16μmol/L人参皂甙Rg1预处理组虽然也高于模型组,但差异不明显(P>0.05)。③神经元细胞核因子κB活性:正常组和2,4,8μmol/L人参皂甙Rg1预处理组明显高于模型组(P<0.01),以4μmol/L人参皂甙Rg1预处理组最高;4,8μmol/L人参皂甙Rg1预处理组明显高于正常组(P<0.01)。结论:人参皂甙Rg1对淀粉样β蛋白25～35诱导的大鼠海马神经元损伤具有保护作用,尤以4μmol/L人参皂甙Rg1作用效果最明显。核因子κB信号通路可能是人参皂甙Rg1对抗淀粉样β蛋白25～35细胞毒性作用的重要途径之一。     

同型半胱氨酸致脑微血管内皮细胞损伤及丙丁酚拮抗作用的浓度依赖性

目的:观察同型半胱氨酸对大鼠脑微血管内皮细胞的损伤及抗氧化药物丙丁酚的拮抗作用,并观察这种拮抗作用是否有浓度依赖性。方法:实验于2004-04/10在广西壮族自治区人民医院实验中心完成。取Wistar大鼠2只,用酶溶液消化大鼠脑皮质组织制成细胞悬液再进行培养传代。①经过鉴定的大鼠脑微血管内皮细胞分为损伤组和正常对照组,正常对照组加入无血清1640培养液;损伤组分别加入用无血清的培养液配制的浓度为0.1,0.5,1.0,1.5,2.0mmol/L的同型半胱氨酸,两个组孵育2,4,6,8,10h后计算血管内皮细胞损伤的指标乳酸脱氢酶释放率。②另将细胞分为3组,正常对照组换用无血清1640培养液孵育8h;损伤组加入1.0mmol/L同型半胱氨酸孵育8h;干预组分别加入终浓度为10,20,30,40,50μmol/L的丙丁酚各孵育30min后再加入1.0mmol/L同型半胱氨酸孵育8h,然后计算乳酸脱氢酶释放率。③将细胞分为3组:正常对照组RPMI-1640培养基常规培养;损伤组:RPMI-1640培养基+同型半胱氨酸1.0mmol/L进行培养;干预组:RPMI-1640培养基+丙丁酚50μmol/L30min后再加入同型半胱氨酸1.0mmol/L进行培养。一共观察7d,并画出细胞生长曲线。结果:①同型半胱氨酸在浓度1.0mmol/L孵育时间8h时乳酸脱氢酶释放率最高,显著高于对照组[(49.06±1.07)%,(19.6±2.04)%,P<0.01]。②丙丁酚在10,20,30,40,50μmol/L时乳酸脱氢酶释放率为(45.57±1.31)%,(41.17±1.25)%,(37.9±0.69)%,(32.57±2.47)%,(26.26±2.34)%,与损伤组相比差异显著[(49.03±1.12)%,P<0.05],且丙丁酚浓度越高,乳酸脱氢酶释放率越低。③细胞存活数:损伤组低于干预组和对照组(P<0.01),后两组间无差异(P>0.05)。结论:同型半胱氨酸对大鼠脑微血管内皮细胞有毒性损伤作用,丙丁酚10～50μmol/L呈剂量依赖性拮抗作用同型半胱氨酸所致大鼠脑微血管内皮细胞损伤。     

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.