终止妊娠时机对妊娠期糖尿病孕妇与围产儿结局的影响研究

目的探讨终止妊娠时机对妊娠期糖尿病(GDM)孕妇与围产儿结局的影响。方法回顾性分析2013年6月—2016年6月在成都市第二人民医院妇产科就诊的179例GDM孕妇的临床资料。根据孕妇终止妊娠时机不同分为早期组67例(终止妊娠时间33~36+6周)、中期组53例(终止妊娠时间37~39+6周)、晚期组59例(终止妊娠时间40~41+6周)。3组孕妇均给予定期门诊产前检查及常规护理,并给予胰岛素治疗、运动干预及饮食干预。比较3组孕妇及胎儿的并发生症发生率(孕妇产后出血、羊水过多、胎膜早破、妊高征及胎儿窒息、巨大儿、低血糖、死亡)。结果 3组孕妇产后出血、羊水过多、胎膜早破、妊高征比较,差异有统计学意义(P0.05);中期组和晚期组孕妇产后出血、羊水过多、胎膜早破、妊高征发生率均低于早期组(P0.05);中期组孕妇产后出血、羊水过多、胎膜早破、妊高征发生率均低于晚期组(P0.05)。3组胎儿窒息、巨大儿、低血糖、死亡发生率比较,差异有统计学意义(P0.05);中期组和晚期组胎儿并发症发生率低于早期组(P0.05);中期组胎儿窒息、巨大儿、低血糖、死亡发生率均低于晚期组(P0.05)。结论选择37~39+6周终止妊娠的效果确切,可明显改善GDM孕妇的妊娠结局,减少母婴并发症的发生。     

妊娠期糖尿病孕妇心率变异性的改变

观察妊娠期糖尿病（GDM）孕妇心率变异性（HRV）的改变。选取GDM孕妇30例作为GDM组,并与同期正常孕妇30例（非GDM组）及非妊娠妇女30例（非孕组）作为比较。前2组于孕32周及产后12周行24 h动态心电图检测;未孕组直接行24h动态心电图检测。结果： GDM组及非GDM组在孕32周时的时域指标及频域指标中的总功率、高频谱功率、低频谱功率均低于非孕组（P〈0.05）,GDM组与非GDM组之间比较无差异（P〉0. 05）;LF/ HF值3组之间两两比较均无差异（P〉0. 05）;GDM组及非GDM组产后12周的各项指标与非孕组之间比较均无差异（P〉0. 05）。结论： GDM对心脏自主神经系统功能影响小。     

妊娠中晚期孕妇心电图的改变情况的临床研究和妊娠合并心脏疾病相关思考

目的研究妊娠中晚期孕妇心电图的改变情况和妊娠合并心脏疾病情况。方法选取2018年5月-2019年5月我院产科收治的56例孕妇作为观察对象,通过妊娠孕早中晚期将孕妇分为对照组和实验组,妊娠早期孕妇28例,妊娠中晚期孕妇28例,两组孕妇均利用24 h动态心电图仪进行心电图监测和检查,分析两组孕妇的心电图改变情况,对妊娠合并心脏疾病的预防和治疗工作进行讨论。结果观察组的妊娠中晚期孕妇发生心律失常、窦性心动过速、窦性心律不齐、窦性心动过缓、PR间期缩短、ST-T改变等情况明显多于对照组的孕早期患者,差异有统计学意义(P<0.05)。结论妊娠中晚期孕妇心电图的改变情况结果显示,妊娠越晚,心脏疾病的发病率越高,这和孕妇的生理变化关系紧密,需要在临床工作中加以重视,做好妊娠合并心脏疾病的预防。     

高龄孕妇妊娠晚期异常心电图与妊娠结局分析

目的分析高龄孕妇妊娠晚期异常心电图情况及与妊娠结局关系。方法对既往来我院进行心电图检查的76例妊娠晚期孕妇进行回顾性分析,其中38例年龄>35岁孕妇记作观察组,另外38例年龄≤35岁孕妇记作对照组,随访两组孕妇最终妊娠结局,分析其与心电图情况关系。结果观察组孕妇异常心电图结果发生率(36.8%)比对照组(13.2%)高,观察组异常心电图孕妇中早产率及低体质量儿发生率也比对照组高(P<0.05)。结论高龄孕妇心电图异常多为心律失常、ST-T段改变,异常心电图孕妇最终胎儿早产及低体质量儿发生率较高,对此应加强高龄孕妇关注,加强对其心电图变化监测,确保母婴安全。     

高龄孕妇妊娠晚期心电图异常情况及其对妊娠结局的影响

目的探讨高龄孕妇妊娠晚期心电图异常的情况对妊娠结局产生的影响。方法选取2018年1月-2019年1月我院收治的120例高龄孕妇妊娠晚期患者作为研究观察对象,通过电脑分组法将患者分为对照组和实验组,每组各60例,对照组为35岁以下的年轻孕妇,实验组为35岁以上的高龄孕妇。孕妇均进行心电图常规检查,统计分析两组妊娠结局,探讨高龄组妊娠晚期异常心电图变化及其对妊娠结局的影响。结果高龄孕妇妊娠晚期心电图异常情况会影响妊娠结局高龄组异常心电图,实验组心电图出现异常的几率比对照组多,孕妇胎儿不稳定的几率比对照组大(P<0.05)。结论因为高龄孕妇的抵抗力,及各个器官的机能都比较弱,所以出出现心电图异常的情况比较多,可能会影响妊娠结局,应该更加关注高龄孕妇,保证孕妇及胎儿的健康。     

子痫前期孕妇动态血压与异常心电图特点分析

目的探讨子痫前期孕妇24 h动态血压的特点、心电图的异常改变以及两者的关系。方法收集子痫前期孕妇95例进行分析,根据病情分重度子痫前期组(A组)46例,轻度子痫前期组(B组)49例,并选取同期年龄、孕次、孕周、体重类似的正常妊娠孕妇45名作为对照组(C组)。所有研究对象均行24 h动态血压监测(ABPM)及常规心电图检查,分析及对比各组孕妇24 h血压及异常心电图改变的特点。结果(1)子痫前期孕妇ABPM各指标均较对照组孕妇明显升高,A组24 h平均收缩压(24h SBP)、24 h平均舒张压(24h DBP)、白天平均收缩压(d SBP)、夜间平均收缩压(n SBP)、夜间平均舒张压(n DBP)、白天平均动脉压(d MAP)、夜间平均动脉压(n MAP)、收缩压负荷(SL)、白天平均心率(d HR)、夜间平均心率(n HR)、24 h平均心率(24h HR)明显高于B组(P0.05)。A及B组夜间血压下降率(MBP)10%,昼夜血压呈"非杓型"改变A组占89%,B组占68%。(2)A组异常心电图发生率明显高于B组及C组(P0.05)。结论子痫前期孕妇昼夜血压节律性多数呈"非杓型",血压水平越高,子痫前期孕妇越容易发生异常心电图。     

超声心动图在GDM孕妇胎儿心脏结构及功能评估中应用分析

目的探讨超声心动图在妊娠期糖尿病(GDM)孕妇胎儿心脏结构及功能评估中应用。方法选择2014年1月—2016年12月在该院接受治疗的妊娠期糖尿病孕妇胎儿患者共32例作为观察组,同时选择同期健康孕妇胎儿32名作为对照组,对两组成员进行心脏结构以及功能指标检测比较。结果两组胎儿在LVDs、LVDd、IVSd指标比较中,差异无统计学意义(P0.05);在RVDs、RVDd、IVSs、LVEF等指标比较中,观察组胎儿数值明显高于对照组,有明显的差异有统计学意义(P0.05)。结论采用妊娠期糖尿病孕妇胎儿的心脏结构以及功能通常会发生一定的改变,采用彩色多普勒超声诊断能够清晰的诊断出其变化。     

门诊产前检查及宣教对妊娠期糖尿病孕妇健康认知及分娩结局的影响

目的分析门诊产前检查及宣教对妊娠期糖尿病孕妇健康认知及分娩结局的影响。方法研究对象为妊娠期糖尿病孕妇,例数3828例,采用抽签分组方式对研究对象3828例进行分组,孕妇收取时间在2017年1—12月,分为观察组一组(1914例)、对照组一组(1914例),分别实施门诊产前检查及宣教和常规宣教,将两组孕妇的分娩结局和健康认知、空腹血糖水平进行对比。结果观察组新生儿窒息率1.04%、胎儿宫内窘迫率1.31%、胎膜早破率2.61%、健康认知掌握评分、空腹血糖与对照组差异有统计学意义(P0.05)。结论通过对妊娠期糖尿病孕妇进行门诊产前检查及宣教后,取得显著效果。     

恶性肿瘤化疗与联合放化疗动态心电图对比分析

目的了解化疗及放化疗期间恶性肿瘤患者出现心慌、心悸等症状时心电图的改变。方法对尚未治疗组（A组）、化疗组（B组）及放化疗组（C组）恶性肿瘤患者在治疗期间出现心慌、心悸等症状时作24h动态心电图（DCG）,对其心率、期前收缩、异位心动过速及ST—T改变等进行对比分析。结果24h最高心率、最低心率、平均心率及24h总心率,B、c组与A组比较具有非常显著性差异（P〈0．01及O．001）。B与C组间平均心率、24h总心率有显著性差异（P〈0．05）,但最高心率、最低心率无显著性差异（P〉0．05）。〉100次／24h房性及室性期前收缩,A与B组间具有显著性差异（P〈0．05）,A与C组间具有非常显著性差异（P〈0．01）。B与C组间房性期前收缩具有显著性差异（P〈0．05）,但室性期前收缩无显著性差异（P〉0．05）。A与B及A与C组间短阵性房性心动过速具有非常显著性差异（P〈0．01）,但B与C组间无显著性差异（P〉0．05）。室性心动过速三组间无显著性差异（P〉0．05）。A与C组间ST—T改变具有非常显著性差异（P〈0．01）,但A与B及B与C间无显著性差异（P〉0．05）。结论化疗、放疗对心脏具有一定毒性作用,联合放化疗可加重二者的毒性作用。动态心电图可作为在化疗、放化疗时,对有症状性肿瘤患者的心脏毒性作用最简捷的监测方法,有利于临床医生及时调整方案。     

胎儿心脏超声对先天性心脏病检测的价值评价

目的评价胎儿心脏超声对先天性心脏病检测的价值。方法选取我院2012年2月~2013年2月收治的孕妇742例作为研究对象,对其进行产前超声系统诊断,对胎儿的心脏四腔心切面、主动脉弓切面、左右室流出道切面以及动脉导管弓切面进行扫描,观察胎儿的心脏功能以及结构形态。结果 742例孕妇经胎儿心脏超声检查后,共检出14例胎儿患有先天性心脏病,其中12例经引产尸解后得以证实,2例正常分娩胎儿经彩色超声心电图检查得到证实。结论在孕妇分娩前,对胎儿实施心脏超声检查,能够有效检测出先天性心脏病胎儿,从而提高优生优育水平。     

Pregnancy: maternal and fetal heart disease

Cardiac disorders complicate less than 1% of all pregnancies. Physiologic changes in pregnancy may mimic heart disease. In order to differentiate these adaptations from pathologic conditions, an in-depth knowledge of cardiovascular physiology is mandatory. A comprehensive history, physical examination, electrocardiogram, chest radiograph, and echocardiogram are sufficient in most cases to confirm the diagnosis. Care of women with cardiac disease begins with preconception counseling. Severe lesions should be taken care of prior to contemplating pregnancy. Management principles for pregnant women are similar to those for the non-pregnant state. A team approach comprised of a maternal fetal medicine specialist, cardiologist, neonatologist, and anesthesiologist is essential to assure optimal outcome for both the mother and the fetus. Although fetal heart disease complicates only a small percentage of pregnancies, congenital heart disease causes more neonatal morbidity and mortality than any other congenital malformation. Unfortunately, screening approaches for fetal heart disease continue to miss a large percentage of cases. This weakness in fetal screening has important clinical implications, because the prenatal detection and diagnosis of congenital heart disease may improve the outcome for many of these fetal patients. In fact, simply the detection of major heart disease prenatally can improve neonatal outcome by avoiding discharge to home of neonates with ductal-dependent congenital heart disease. Fortunately, recent advances in screening techniques, an increased ability to change the prenatal natural history of many forms of fetal heart disease, and an increasing recognition of the importance of a multidisciplinary, team approach to the management of pregnancies complicated with fetal heart disease, together promise to improve the outcome of the fetus with congenital heart disease.     

MIF和iNOS在胎膜早破产妇胎膜组织中的表达及意义

目的探讨巨噬细胞移动抑制因子（MIF）与诱导型一氧化氮合酶（iNOS）在胎膜早破（PROM）发生、发展中的作用。方法研究对象为90例剖宫产的产妇;其中早产胎膜早破（p PROM）30例（p PROM组）,足月胎膜早破（t PROM）30例（t PROM组）,正常足月妊娠30例（正常组）。三组均于剖宫产术中胎盘娩出后于距离胎膜破口〉2 cm处取1 cm×1 cm的胎膜组织制作切片。采用HE染色方法检测绒毛膜羊膜炎（中性粒细胞中、重度浸润）发生情况;采用免疫组化SP法检测MIF、iNOS表达;分析三组及绒毛膜羊膜炎、非绒毛膜羊膜炎产妇MIF、iNOS表达情况。结果三组共检出绒毛膜羊膜炎27例;MIF和iNOS主要表达于羊膜上皮细胞的胞质。p PROM组和t PROM组MIF表达强度明显高于对照组（P〈0.01）;p PROM组iNOS表达强度明显高于对照组（P〈0.01）;绒毛膜羊膜炎产妇胎膜中MIF和iNOS表达强度明显高于非绒毛膜羊膜炎产妇（P〈0.05）。结论 PROM产妇胎膜组织中MIF、iNOS表达上调。MIF、iNOS高表达可促进胎膜早破及绒毛膜羊膜炎的发生。     

脑出血患者植物神经功能昼夜变化规律分析

采用２４小时动态心电图记录３８例脑出血急性期患者及３０例正常人。的心率变异性指标及心律失常昼夜变化。结果：脑出血组ＨＲＶ失去昼夜节律变化，昼夜总心率变异性降低，室性早搏，室上性早搏明显增多；     

宫缩抑制剂在早产治疗中的应用进展

妊娠满28周至不满37周间分娩者为早产。胎儿存活,无胎儿窘迫,胎膜未破,应用宫缩抑制剂抑制宫缩是治疗早产的关键。该文就近年来应用宫缩抑制剂治疗早产的研究进展作简要综述。     

Control of late postoperative ventricular arrhythmias with phenytoin in young patients

Ventricular arrhythmias probably initiate the events leading to sudden death in patients who have recovered uneventfully from surgery for congenital heart disease. It is therefore recommended that antiarrhythmic therapy be given to all patients who have had surgery for congenital heart defects and who have ventricular arrhythmias found in a routine electrocardiogram taken after the immediate postoperative period. The response of ventricular arrhythmias to treatment was studied in six ambulatory patients aged 7 to 27 years (mean 16.5) who had had surgery a mean of 10.7 years before the arrhythmia was recognized. Four patients had unsatisfactory repair of the congenital defect; the two other patients had only a palliative operation. Each patient's electrocardiogram was monitored continually by tape recording. Each received phenytoin, 3.75 mg/kg body weight, every 6 hours for four doses, then 1.9 mg/kg every 6 hours until the serum concentration of phenytoin was 15 to 20 μg/ml. This serum concentration was maintained with the daily administration of 2.5 to 3 mg/kg every 12 hours. In the 24 hours before treatment, two patients had ventricular tachycardia, two had paired premature ventricular complexes and two had 10 or more single premature ventricular complexes/hour. After treatment, all patients had “effective control” (one or less premature ventricular complex/hour for 12 consecutive hours). This control was achieved with phenytoin in five patients, but one patient required the addition of disopyramide (2 mg/kg every 6 hours). All five patients undergoing a treadmill test before treatment had premature ventricular complexes during or after exercise; after treatment, only one had premature ventricular complexes after exercise. The patient who required two drugs was unable to perform a treadmill test. The mean effective serum phenytoin concentration, 15.7 μg/ml (range 8.5 to 20.0), was reached at a mean time of 61.2 hours (range 42 to 80) after the start of phenytoin therapy. Ataxia occurred in two patients with serum phenytoin concentrations of 16 and 20 μg, but not in the other four, three of whom had serum concentrations greater than 20 μg/ml. Echocardiographic, hematopoletic, hepatic and renal function indexes remained constant with treatment.It is concluded that (1) phenytoin suppressed ventricular arrhythmias in six children and young adults after surgery for congenital heart disease; (2) the effective serum concentration of phenytoin was approximately 15 μg/ml, but varied widely; and (3) this concentration was achieved within 48 to 72 hours when an oral loading dose was administered.     

参松养心胶囊对老年频发室性期前收缩患者心率变异性影响的临床观察

目的 观察参松养心胶囊对于老年频发室性期前收缩患者心率变异性(HRV)的影响. 方法 随机选取42例＞ 60岁的频发室性期前收缩(＞1000次/24 h)患者,在常规治疗的基础上,予口服参松养心胶囊,每次4粒,3次/d治疗.比较治疗4周前后患者24 h动态心电图(DCG)、HRV. 结果 治疗后患者R-R总体标准差(SDNN)、每5 min时段平均R-R间期标准差(SDANN)、相邻R-R间期差值的均方根(r MSSD)较治疗前提高(P＜0.05). 结论 经参松养心胶囊治疗后,老年频发室性期前收缩患者的HRV各项指标显著增高,有助于改善患者预后.     

动态心电图与常规心电图对冠心病患者心律失常的诊断价值比较

目的：探讨常规心电图与动态心电图在诊断冠心病心律失常疾病方面的应用价值。方法选取我院心内科收治的冠心病患者60例,均符合冠心病诊断标准,先用常规心电图对所有患者进行检查;然后采用动态心电图系统再次进行检查,24 h监测患者的心率变化。采用计算机分析比较两种诊断方法的检查结果。结果常规心电图检测心律失常阳性34例（56．67％）,低于动态心电图的检出率71．67％（43／60）,差异有统计学意义（P＜0．05）。动态心电图对房性早搏二、三联律,室性早搏二、三联律,房性早搏成对,室性早搏成对和短阵室上速的检出率高于常规心电图,差异有统计学意义（P＜0．05）。结论与常规心电图相比,动态心电图具有明显优势,它可检测出患者任一时间点的冠脉缺血情况、心律失常发作时间和频率,能够更准确、更精细地监测患者心电信号,值得在临床中广泛应用。     

24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children.

Twenty-four hour electrocardiographic recordings were made on 104 randomly selected, healthy 7 to 11-year-old children. Ninety-two were technically adequate and suitable for analysis. The mean highest heart rate measured by direct electrocardiographic analysis over nine beats was 164 +/- 17. The mean lowest heart rates were 49 +/- 6 over three beats', and 56 +/- 6 over nine beats' duration. The maximum duration of heart rates less than 55/minute was 40 minutes. At their lowest heart rates 41 children (45 per cent) had junctional escape rhythms, the maximum duration of which was 25 minutes. Nine children showed PR intervals greater than or equal to 0.20 s and included three with Mobitz type I second degree atrioventricular block. Nineteen (21%) had isolated supraventricular or ventricular premature beats (less than 1/hour). Sixty subjects (65%) had sinus pauses that could not be distinguished on the surface electrocardiogram from those previously described as sinuatrial exit block or sinus arrest. The maximum duration of sinus pause measured over 24 hours on each child was 1.36 +/- 0.23 seconds. Thus apparently healthy children show variations in heart rate and rhythm over 24 hours hitherto considered to be abnormal.     

Heart rate turbulence after atrial premature beats before spontaneous onset of atrial fibrillation

OBJECTIVES: This study was designed to assess the temporal changes in vagal responses to atrial premature beats before spontaneous onset of atrial fibrillation (AF). BACKGROUND: Enhanced vagal activity plays a major role in the onset and perpetuation of experimental AF, but the role of vagal activation in the onset of clinical AF episodes is not so well established. METHODS: We calculated heart rate turbulence after atrial premature impulses occurring 0 to 60 min before the onset of AF ("prior to AF") and compared it with the hourly means of the other hours of the 24-h electrocardiogram recordings ("non-AF hours") in 39 patients with structural heart disease and 29 patients with lone AF. Traditional heart rate variability measurements and approximate entropy (ApEn) were also analyzed. RESULTS: Turbulence onset (TO) was significantly less negative during the 1 h preceding AF than during the non-AF hours (0.71 +/- 1.76 vs. -0.35 +/- 1.46, p < 0.00001). Less negative TO before AF was observed among both the patients with structural heart disease (1.16 +/- 1.73 vs. 0.07 +/- 1.23; p < 0.0001) and those with lone AF (0.17 +/- 1.67 vs. -0.85 +/- 1.56; p < 0.0001). No significant difference was seen in the turbulence slope between the two periods, and none of the traditional frequency and time domain measurements differentiated between the periods; ApEn was significantly lower before AF than during the non-AF hours (p < 0.01). CONCLUSIONS: Altered heart rate dynamics, suggesting transient enhancement of vagal outflow after premature atrial excitation, are temporally related to spontaneous onset of clinical AF.     

Spontaneous uterine rupture with receding of the visible fetal head

A case study of a 32 year old multiparous (para 6) female is presented. Spontaneous labor occurred at 39 weeks gestation. Upon admission her vital signs were normal, and contractions were 3 minutes apart. The fetal heartbeat was normal and the estimated weight was 3.1 kg. The patient's cervix was 80% effaced. After 3 hours of labor, the fetal head was visible at the vulva. Instructions were given to push with uterine contractions. However, the head retracted and was no longer visible. Examination indicated slight vaginal bleeding, increasing pulse rate, and decreasing blood pressure. No fetal heart rate could be detected. Surgery was performed, and 2.5 liters of hemoperitoneum was collected. The uterus had ruptured anteriorly from the fundus to the lower segment and laterally toward the left broad ligament. The male fetus was dead; its weight was 3.25 kg. A hysterectomy was performed. The patient received a blood transfusion of 3 units. 10 days later, the patient was in satisfactory condition and was discharged. The cause of spontaneous uterine rupture in this case study was attributed to grandmultiparity.