妊娠合并癫痫16例临床分析

目的探讨妊娠合并癫痫临床处理。方法回顾性分析16例妊娠合并癫痫孕妇服抗癫痫药情况、癫痫发作频率变化及妊娠结局。结果妊娠合并癫痫发生率0.078%,原发性4例,继发性12例。全身性癫痫发作13例（2例癫痫持续状态）,局部癫痫发作3例。孕期发作频率增加者5例,无变化者6例。孕期新发现单次发作5例。孕期未用抗癫痫药物（AEDs）3例,间断用药1例,连续用药7例,均为单一AEDs治疗。顺产4例,剖宫产10例,人工流产2例。新生儿出生无窒息,平均出生体重2852g,无新生儿出生缺陷,无新生儿死亡。母亲亦无产科并发症发生。2例人工流产孕妇癫痫持续状态、吸入性肺炎死亡,1例智力低下孕妇产后卡马西平中毒昏迷,抢救成功。结论妊娠可诱发并使癫痫发作频率增加。孕期用AEDs可控制癫痫发作。应采用单一AEDs治疗,且应按时监测血浆中AED及叶酸水平。     

抗癫痫药物在孕产妇中的应用

目的探讨抗癫痫药物在癫痫孕产妇中应用的相关因素.方法对1985～2000年26例癫痫孕产妇服药方法、分娩方式、新生儿情况进行回顾性分析,并与正常新生儿相比较.结果26例中孕期坚持服药8例,5例整个孕期不发作.未服药18例,16例发作次数较原来频繁,因孕期停药9例全部出现强直性痉挛性发作.新生儿头围小于正常人群,早产3例,宫内发育迟缓1例,畸形1例.结论癫痫孕妇应在疾病控制良好后妊娠,孕期坚持服药,停药或减量易引起癫痫复发.合理选药、单药、低剂量,并配以辅助措施,可获良好的妊娠结局.     

抗癫痫药物在孕产妇中的应用

目的：探讨抗癫痫药物在癫痫孕产妇中应用的相关因素。方法：对1985-2000年26例癫痫孕产妇服药方法、分娩方式、新生儿情况进行回顾性分析，并与正常新生儿相比较。结果：26例中孕期坚持服药8例，5例整个孕期不发作。未服药18例，16例发作次数较原来频繁，因孕期停药9例全部出现强直性痉挛性发作。新生儿头围小于正常人群，早产3例，宫内发育迟缓1例，畸形1例。结论：癫痫孕妇应在疾病控制良好后妊娠，孕期坚持服药，停药或减量易引起癫痫复发。合理选药、单药、低剂量，并配以辅助措施，可获得良好的妊娠结局。     

129例妊娠合并癫痫患者的护理

目的探讨妊娠合并癫痫孕产妇的临床特点及围产期护理方法。方法收集我院2010年1月～2017年12月收治的129例妊娠合并癫痫患者的临床资料,回顾性分析其抗癫痫药物服用情况,发作频率及母婴结局。探讨围产期及产褥期有效的护理措施。结果 129例妊娠合并癫痫患者中,孕期癫痫发作频率增加的31例,发作频率无改变的45例,发作频率减少的21例;妊娠期出现合并症49例,胎儿畸形3例。自然分娩23例,产程中小发作行产钳助产1例,为缩短二产程产钳助产2例。计划性剖宫产82例,因出现产科并发症而实施手术24例(包括前置胎盘、胎儿宫内窘迫、子痫前期)母婴均安全出院。结论通过医生和护士的精心治疗和护理,严密观察病情变化,及时提供优质高效的护理措施和正确的治疗方法,可以减少癫痫的发作,保证母婴安全。     

妊娠合并癫痫患者围生期的护理体会

目的：探讨妊娠合并癫痫患者围生期的护理方法。方法：回顾性分析11例妊娠合并癫痫患者的临床资料。结果：围生期癫痫发作频率增加者7例（53．8％），发作频率减少者2例（15．4％），无变化者4例（30．8％）。结论：妊娠使癫痫发作频率增加并可诱发癫痫发作，癫痫可使围生期并发症增多，因此，认真做好妊娠合并癫痫患者围生期的护理以及严密观察尤为重要，不仅可减少和避免并发症的发生，而且可改善妊娠合并癫痫患者以及新生儿的远期康复效果，应引起我们足够的重视。     

妊娠期用药：第九讲 妊娠合并癫痫的药物治疗

群体中癫痫的发生率约为 0 4 %～ 0 8%。大约85%的癫痫属特发性 ,另外的 1 5%系由代谢病、占位性疾病、感染或外伤所致。因受多种相互联系的因素的影响 ,妊娠合并癫痫的治疗较非孕期更复杂 ,涉及妊娠对癫痫的影响 ,癫痫对妊娠结局的影响以及抗癫痫药的致畸作用问题。妊娠对癫痫发作频率可能产生影响 ,据文献报道 ,其中 5%～ 2 5%癫痫发作频率可增加 ,60 %～85%无改变。患有癫痫的孕妇其婴儿发生早产、低出生体重、低Ａｐｇａｒ评分、缺氧、出血病和先天性畸形的危险增加。目前普遍认为几乎所有抗癫痫药物都能增加胎儿畸形率 ,但畸形是癫痫…     

系统性红斑狼疮患者妊娠时机选择与妊娠结局

目的 探讨系统性红斑狼疮(SLE)患者妊娠时机的选择与妊娠结局的相关性.方法 回顾性分析2005年1月-2011年7月我院收治的33例SLE合并妊娠患者临床资料,根据妊娠时机分为孕前持续缓解期(A组)和活动期(B组),比较两组孕期并发症及母婴结局.结果 A组20例中,孕期发生严重并发症者6例(30.0％),足月终止妊娠10例,早产7例,治疗性引产2例,胎死宫内1例,无孕产妇死亡,无新生儿畸形;B组13例中,孕期发生严重并发症11例(84.6％),早产8例,治疗性引产3例,胎死宫内2例.B组孕期发生严重并发症几率增加,妊娠丢失率及早产率高,早产新生儿体重轻,差异有统计学意义(P＜0.05).结论 SLE患者选择病情持续稳定期计划妊娠,孕期严格监测、合理调整用药、适时终止妊娠是减少SLE患者孕期并发症以及改善母婴结局的关键.     

16例脑卒中后继发癫痫临床分析

目的 探讨脑卒中后继发癫痫的临床特点及发病机制.方法 通过药物和常规治疗脑卒中后继发癫痫16例,观察其临床表现、治疗效果等并进行分析.结果 早期应用抗癫痫物治疗效果良好,3例未按挽律服药间断有部分发作,3例强直一阵挛持续状态中,2例死于脑病及全身衰竭.结论 脑卒中后继发癫痫的发生率与病灶部位有关,皮层病变更易引起癫痫,早期治疗多可缓解,对迟发性癫痫应坚持长期规则服用抗癫痫药.     

左乙拉西坦联合拉莫三嗪治疗妊娠期癫痫的疗效及对妊娠结局的影响

目的 分析左乙拉西坦联合拉莫三嗪治疗妊娠期癫痫的疗效和对妊娠结局的影响.方法 选择2017年1月至2021年2月在南京医科大学附属苏州市立医院门诊及住院治疗的76例妊娠期癫痫患者为研究对象,其中左乙拉西坦单药治疗组20例、拉莫三嗪单药治疗组22例、左乙拉西坦联合拉莫三嗪治疗组34例,对3组妊娠期癫痫患者的癫痫发作频率、妊娠相关并发症及不良妊娠结局进行对比.结果 治疗期间,左乙拉西坦联合拉莫三嗪治疗组妊娠期癫痫无发作、发作频率无变化、发作频率增加、发作频率减少的患者比例分别为82.3％(28/34)、2.9％(1/34)、5.8％(2/34)、8.8％(3/34),左乙拉西坦单药治疗组分别为45.0％(9/20)、25.0％(5/20)、15.0％(3/20)、15.0％(3/20),拉莫三嗪单药治疗组分别为45.5％(10/22)、13.6％(3/22)、18.2％(4/22)、22.7％(5/22),3组间差异有统计学意义(P<0.05).3组患者妊娠相关并发症及不良妊娠结局的发生率差异均无统计学意义(P均>0.05).结论 左乙拉西坦联合拉莫三嗪治疗控制妊娠期癫痫发作的效果优于单药治疗,在降低妊娠期癫痫发作频率的同时不增加妊娠相关并发症和不良妊娠结局的发生风险.     

氯硝西泮治疗慢性癫痫的有效性和安全性分析

【目的】探讨氯硝西泮治疗慢性癫痫患者的有效性和安全性。【方法】对119例癫痫患者进行回顾性分析。治疗组54例,服用常规抗癫痫药物联合氯硝西泮。对照组65例服用常规抗癫痫药物,包括卡马西平、丙戊酸、奥卡西平、拉莫i秦、妥泰、左乙拉西坦、苯妥英钠等。有效性评价指标为发作控制率,安全性评价指标为不良事件的发生率。【结果】（1）疗效分析：治疗组：常规抗癫痫药物联合氯硝西泮开始有效,2-4个月后疗效下降,发作控制率50％以上;对照组：48例（52．30％）患者认为服用一种抗癫痫或联合用药后有效,且疗效维持。服药6个月后两组比较结果显示,氯硝西泮组疗效低于对照组（P=0．02）。（2）安全性分析：①治疗不良反应：治疗组：该药服用6个月或以上,不良反应发生率为98％,最常见不良反应依次为嗜睡占51．85％,健忘占48．15％,注意力不集中占37．04％,头晕或眩晕占37．04％,头痛占37．04％等,明显高于对照组（P〈0．05）。②撤药不良反应：治疗组撤药后发作加重、癫痫持续状态、焦虑、失眠、紧张等。90％的患者曾存在不规范服药,包括间断服药,或突然撤停,或自行增减剂量。【结论】氯硝西泮对癫痫疗效维持时间短,副作用发生率高,选药时应严格掌握适应症。     

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.