不同分娩方式与产后压力性尿失禁的关系

目的探讨不同分娩方式与产后压力性尿失禁的关系。方法分析中山市东凤人民医院妇产科2012年2月~2014年10月妇产科分娩的产妇1200例临床资料,依据分娩方式不同进行分组,阴道分娩组600例和剖宫产组600例。观察两组产妇产后排尿状况评分、肌力评分情况、UVJ-M值、尿道旋转角度、压力性尿失禁发生率及尿垫试验阳性情况。结果剖宫产组产妇产后排尿状况评分低于阴道分娩组,肌力评分高于阴道分娩组,差异均有统计学意义(t=27.79、18.91,P<0.05);剖宫产组产妇产后UVJ-M值低于阴道分娩组,尿道旋转角度高于阴道分娩组,,差异均有统计学意义(t=36.31,27.11,P<0.05);剖宫产组产妇产后压力性尿失禁发生率低于阴道分娩组,差异有统计学意义(χ2=13.36,P<0.05);剖宫产组产妇产后尿垫试验阳性率低于阴道分娩组,差异有统计学意义(χ2=13.36,P<0.05)。结论阴道分娩对于盆底神经和肌肉造成损伤,是发生压力性尿失禁的高危因素,应注意盆底组织保护。     

不同分娩方式对产妇盆底支持组织功能所产生的近期影响

目的分析并评价产科相关因素以及采取不同的分娩方式对产妇近期盆底支持组织功能产生的影响。方法将2009年12月至2011年6月期间收治的122例分娩的健康初产妇按分娩方式分为阴道分娩组73例与剖宫产组49例,使用女性尿失禁临床症状调查问卷在产妇分娩后的6～8周进行调查。结果阴道分娩组与剖宫产组在分娩前压力性尿失禁的发生率分别为18%和15%,两组的压力性尿失禁发生率相比,差异无统计学意义(P0.05);阴道分娩组与剖宫产组在分娩后压力性尿失禁的发生率分别为21%和10%,两组分娩后压力性尿失禁的发生率相比差异也无统计学意义(P0.05);妊娠晚期压力性尿失禁是产后压力性尿失禁发生的高危因素。剖宫产组产妇的右侧活力值、功值以及两侧功值的平均值均高于阴道分娩组,两组比较差异有统计学意义(P0.05);剖宫产组产妇的两侧活力值差值低于阴道分娩组,两组比较差异有统计学意义(P0.05);在阴道分娩组产妇中,压力性尿失禁者左侧活力值与峰值均小于无压力性尿失禁者,两组比较差异均有统计学意义(P均0.05);无压力性尿失禁者两侧速度值差值低于压力性尿失禁者,两者比较差异有统计学意义(P0.05)。结论阴道分娩组产妇在分娩后的压力性尿失禁的发生率与剖宫产组产妇的发生率相似;产科的相关因素能够对产妇产后尿失禁的发生率以及产妇盆底肌肉的收缩与舒张能力产生一定的影响。     

分娩方式对孕产妇发生尿失禁的影响分析

目的:探讨分娩方式对孕产妇发生尿失禁的影响分析。方法:选择566例我院进行分娩产后6⁸周进行复查的产妇,按照分娩方式的不同分为阴道分娩组和剖宫产组,对两组产妇的年龄、孕期、尿失禁的发生等多方面进行分析。结果:阴道分娩组产后尿失禁发生率为19.21%,剖宫产组产后尿失禁发生率为4.17%,经统计学比较差异有显著统计学意义(P<0.01)。阴道分娩组孕期出现尿失禁的产妇产后发生尿失禁的发生率高于孕期未出现压力性尿失禁组,第2胎产妇产后尿失禁的发生率高于第一胎产妇,差异有统计学意义(P<0.01)。剖宫产组第2胎产妇出现尿失禁的发生率明显高于第1胎产妇,差异有统计学意义(P<0.01)。两组新生儿体重同产妇发生尿失禁无明显的关联,差异无统计学意义(P>0.05)。结论:临床上对产后尿失禁的影响进行长期的研究,尽量采取前瞻性随机研究与分析,从根本上防治产后尿失禁的发生。     

产科相关因素及分娩方式对压力性尿失禁的影响

目的探讨产科相关因素及不同分娩方式对压力性尿失禁(SUI)的影响。方法选取2014年5月至2016年4月博爱县人民医院114例初产妇,按照分娩方式分为阴道分娩组与剖宫产分娩组,各57例。对比两组产后2个月SUI发生情况,测定膀胱颈活动度(UVJ-M)及尿道旋转角度。结果阴道分娩组产后SUI发生率高于剖宫产分娩组,差异有统计学意义(P<0.05);产后4、8周阴道分娩组UVJ-M与尿道旋转角度大于剖宫产分娩组,差异有统计学意义(P<0.05);阴道分娩、产钳助产、产前SUI、会阴撕裂、子宫脱垂、雌激素治疗均为产后SUI危险因素。结论阴道分娩会提高产后SUI发生风险,阴道分娩、产钳助产等均为产后SUI危险因素。     

IVF术后双胎妊娠不同分娩方式的妊娠结局

目的探讨不同分娩方式对IVF术后双胎妊娠结局的影响。方法回顾性分析厦门大学附属成功医院2015年1月至2020年1月IVF术后双胎妊娠孕产妇的临床资料,根据分娩方式的不同分为阴道分娩组(n=91)和剖宫产组(n=211),比较两组临床资料、妊娠期并发症及母婴结局。结果妊娠期糖尿病的发病率为32.8%;剖宫产组初产妇比例显著高于阴道分娩组(P<0.05),妊娠期高血压疾病的发生率高于阴道分娩组(P<0.05)。两组产后出血发生率比较差异无统计学意义,但剖宫产组产后出血量高于阴道分娩组,差异有统计学意义(P<0.05);阴道分娩组新生儿窒息率高于剖宫产组,差异有统计学意义(P<0.05);两组新生儿出生体质量、转NICU率比较差异无统计学意义,但剖宫产组低体质量儿比例高于阴道分娩组,差异有统计学意义(P<0.05)。结论妊娠期糖尿病是IVF术后双胎妊娠最常见并发症,IVF术后双胎妊娠的初产妇倾向于选择剖宫产终止妊娠,IVF术后双胎妊娠经阴道分娩不会增加产后出血的风险,但要警惕新生儿窒息。     

分娩方式对产后早期尿失禁的影响

目的 研究不同分娩方式对尿失禁发生及其程度影响.方法 随机选择2008年1～10月产后门诊6～8周的产妇84例,按不同分娩方式分为选择性剖宫产组(38例)和阴道顺产组(46例).通过国际尿失禁咨询委员会尿失禁问卷表,对产后6～8周复查的初产妇进行问卷调查,询问产妇产后6～8周尿失禁的发病情况和产后下尿路症状.分析不同分娩方式与产后尿失禁的关系,比较两组产妇压力性尿失禁情况.结果 阴道分娩组发生产后压力性尿失禁的比例明显高于剖宫产组.结论 与阴道分娩相比,剖宫产可以降低产后压力性尿失禁的发生率.     

正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响

目的探讨正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响,以及选择性剖宫产是否对产后压力性尿失禁有预防作用。方法正常阴道分娩组孕妇(16例)和选择性剖宫产组孕妇(15例)于孕38~40周、产后6~8周、产后2年分别进行会阴超声及尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)的变化,及其在两种分娩方式间的差异。无分娩史的非妊娠女性20名为对照组,于排卵期行会阴超声及尿动力检查。结果妊娠晚期的UVJ-M较对照组明显增加(P<0.01),并持续到产后2年。两种方式分娩后6~8周的UVJ-M均较妊娠晚期轻度下降,但差异均无统计学意义(P>0.05);仅选择性剖宫产组的UVJ-M在产后2年较妊娠晚期下降明显(P<0.05)。两种分娩方式相比,UVJ-M在产后6~8周和产后2年的差异均无统计学意义(P>0.05)。结论初产妇在妊娠晚期膀胱颈活动度明显增加,并持续到产后2年,选择性剖宫产对其并无明显的保护作用;妊娠本身可能是产后压力性尿失禁的主要致病因素。     

正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响

目的 探讨正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响,以及选择性剖宫产是否对产后压力性尿失禁有预防作用.方法 正常阴道分娩组孕妇(16例)和选择性剖宫产组孕妇(15例)于孕38 ～ 40周、产后6 ～ 8周、产后2年分别进行会阴超声及尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)的变化,及其在两种分娩方式间的差异.无分娩史的非妊娠女性20名为对照组,于排卵期行会阴超声及尿动力检查.结果 妊娠晚期的UVJ-M较对照组明显增加(P＜0.01),并持续到产后2年.两种方式分娩后6 ～ 8周的UVJ-M均较妊娠晚期轻度下降,但差异均无统计学意义(P＞0.05);仅选择性剖宫产组的UVJ-M在产后2年较妊娠晚期下降明显(P＜0.05).两种分娩方式相比,UVJ-M在产后6 ～ 8周和产后2年的差异均无统计学意义(P＞0.05).结论 初产妇在妊娠晚期膀胱颈活动度明显增加,并持续到产后2年,选择性剖宫产对其并无明显的保护作用;妊娠本身可能是产后压力性尿失禁的主要致病因素.     

不同分娩方式对产后早期压力性尿失禁的影响

目的探讨不同分娩方式对产后早期压力性尿失禁的影响。方法抽取产科分娩的产妇228例,根据不同分娩方式分为选择性剖宫产组（CS,110例）和阴道分娩组（VD,118例）。于产后6-8周进行问卷调查（ICI-Q改良问卷）、超声检测残余尿,比较两组产妇压力性尿失禁的发病率。结果阴道分娩组发生产后尿失禁23例,发生率为11.01%（23/118）;剖宫产组产后压力性尿失禁5例,发生率为4.55%（5/110）,阴道分娩组产后压力性尿失禁发病率明显高于剖宫产组,差异有统计学意义（P〈0.05）。结论选择性剖宫产对于降低产后压力性尿失禁发生率起到一定作用。     

分娩方式、胶原代谢在产后压力性尿失禁发生中的作用

目的探讨不同的分娩方式和胶原蛋白特异性代谢产物吡啶酚与产后压力性尿失禁的相关性。方法选取2011年1月-2012年1月在广州市红十字会医院行产前检查、分娩并分娩后复查的产妇82例作为研究对象,根据不同的分娩方式分为阴道分娩组42例,选择性剖宫产组40例,比较两组产妇产后压力性尿失禁发生情况,并分析其相关因素,使用酶联免疫吸附试验法（ELISA）测定尿吡啶酚的浓度。结果①产后6～8周压力性尿失禁的总发生率为15.9%（13/82）,其中阴道分娩组为26.2%（11/42）,选择性剖宫产组为5.0%（2/40）,阴道分娩组产后6～8周压力性尿失禁发生率高于选择性剖宫产组,差异有统计学意义（P〈0.05）。②孕期发生尿失禁、分娩方式及新生儿体重是产后发生压力性尿失禁的主要影响因素（P〈0.05）。③产后6～8周尿吡啶酚/肌酐值：阴道分娩组为（24.61±2.27）nmol/mmol,选择性剖宫产组为（22.11±3.55）nmol/mmol,阴道分娩组高于选择性剖宫产组,差异有统计学意义（P〈0.05）。结论经阴道分娩的产妇产后压力性尿失禁的发生率及尿吡啶酚的浓度较选择性剖宫产产妇高。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.