单纯控制胎头娩出速度助产法与常规阴道保护助产法的临床比较

目的探究单纯控制胎头娩出速度助产法与常规阴道保护助产法的临床效果。方法随机选取本院2016年1~12月收治的行阴道分娩的产妇128例,按照随机数字表法分为观察组与对照组,每组64例,对照组产妇采取常规阴道助产法进行助产,观察组产妇采取单纯控制胎头娩出速度助产法进行助产,比较两种助产法在临床上的效果。结果观察组会阴裂伤发生率为18.75%,明显低于对照组的40.63%;其中,观察组Ⅱ度裂伤3例(4.69%),显著低于对照组的15例(23.44%),组间差异有统计学的意义(P0.01)。两组产妇第二产程时长经比较差异无统计学意义(P0.05);而产后出血量和住院时间两个指标相比,观察组均显著优于对照组,组间比较差异具有统计学的意义(均P0.05)。观察组满意度为96.88%显著高于对照组的85.94%,差异有统计学意义(P0.05)。结论与传统的会阴保护法进行比较,通过控制胎头的娩出速度法助产能够显著地降低会阴裂伤发生几率,降低裂伤的程度,使住院时间缩短,对第二产程无影响,安全可靠,可以作为产妇经阴道自然分娩的重要助产手段。     

循证助产评估(母婴评估)表在产妇分娩中的应用效果研究

目的探讨循证助产评估(母婴评估)表在产妇分娩中的应用效果。方法选取2017年12月至2018年8月在本院拟经阴道分娩的产妇200例为研究对象,随机将其等分为观察组和对照组,观察组按照循证助产评估(母婴评估)表采用控制胎头娩出速度法接生;对照组采用传统托肛法接生;比较两组产妇会阴侧切率、会阴裂伤率、第二产程时间、产后出血量、新生儿轻度窒息率。结果观察组产妇会阴裂伤率、会阴侧切率低于对照组(P 0. 05),产后出血量少于对照组(P 0. 05);两组产妇第二产程时间以及新生儿轻度窒息率比较差异无统计学意义(P0. 05)。结论根据循证助产评估(母婴评估)表,采用控制胎头娩出速度法助产技术,能够减少产妇分娩创伤,促进自然分娩,提高助产质量,使助产技术向无创接生迈进,具有较高的临床应用与推广价值。     

改良产后出血预测评分联合护理干预在阴道分娩产后出血中的应用

目的探讨改良产后出血预测评分联合护理干预对阴道分娩产后出血的影响。方法选择本院进行阴道分娩的280例产妇作为研究对象,采用随机数字表对其分组,分为研究组与对照组各140例。对照组仅采取常规护理干预措施;研究组通过改良产后出血预测评分评估产妇的综合信息,并对中高危产妇实施针对性护理干预。观察比较2组会阴裂伤情况、产后出血率、产后出血量、住院时间。结果研究组会阴裂伤发生率25.00%,低于对照组42.86%;研究组会阴侧切率4.29%,低于对照组10.71%;研究组产后出血率为0,低于对照组4.29%;研究组产后出血量(322.52±102.52)mL,低于对照组(478.52±105.65)mL;研究组住院时间(3.32±0.84)d,低于对照组(4.32±0.85)d。结论改良产后出血预测评分联合针对性护理干预可以有效减少阴道分娩产妇的产后出血量与会阴裂伤情况,缩短住院时间,进一步保障了分娩质量,适于临床应用与推广。     

控制胎头娩出及无保护会阴接生的临床效果分析

目的探讨控制胎头娩出及无保护会阴接生的临床效果。方法选择阴道分娩产妇30例纳入研究组,采用控制胎头娩出及无保护会阴接生;另选资料匹配的30例为对照组,采用传统的保护会阴接生法。对比观察两组的第二产程时间、会阴裂伤发生情况、其他并发症发生情况以及新生儿出生体重。结果两组在第二产程时间上无统计学差异,在会阴裂伤发生率比较中,研究组会阴完整比率显著高于对照组,会阴I度裂伤和II度裂伤比率均显著低于对照组(P0.05)。两组羊水污染比率、新生儿体重、新生儿轻度窒息发生率比较,无统计学差异(P0.05)。结论控制胎头娩出及无保护会阴接生助产技术非常实用,可减少会阴裂伤,值得临床推广应用。     

控制胎头娩出速度联合新会阴保护模式对初产妇会阴保护效果的影响

目的:探讨控制胎头娩出速度联合新会阴保护模式对初产妇会阴保护效果的影响。方法:选择2018年3月至2019年1月阴道分娩初产妇96例进行研究,根据助产方式不同分组,对照组48例采用常规助产方式,观察组48例在对照组基础上加控制胎头娩出速度联合新会阴保护模式,对两组会阴保护效果进行观察。结果:两组第一产程、第二产程时间无明显差异(P>0.05),观察组产后出血量较对照组低(P<0.05);观察组产妇会阴撕裂程度、会阴侧切率、会阴水肿发生率与对照组比较有明显差异(P<0.05)。结论:控制胎头娩出速度联合新会阴保护模式不会影响产程时间,可最大程度降低会阴撕裂程度,减少水肿、侧切的发生。     

无创助产技术的应用效果

目的观察无创助产技术在降低会阴侧切率、会阴水肿发生率及缩短住院时间中的效果。方法将200例产妇按随机数字表分为观察组和对照组各100例,对照组采用传统接生法接生,观察组采用无创助产技术接生,分别记录两组产妇产后2h出血量、会阴水肿发生率、会阴裂伤情况、会阴侧切率、婴儿体质量、平均住院时间,进行对比分析。结果观察组会阴水肿发生率、会阴侧切率、平均住院时间低于对照组,比较差异有统计学意义(P0.05)。会阴裂伤情况观察组高于对照组,但以Ⅰ度裂伤为主,两组比较差异有统计学意义(P0.05)。两组产妇产后2h出血量、婴儿体质量情况比较差异无统计学意义(P0.05)。结论无创助产技术可降低产妇会阴水肿发生率和会阴侧切率,减少产道损伤,缩短平均住院时间。     

骨盆摇摆配合气囊仿生助产在头位难产中的应用探讨

目的:探究骨盆摇摆配合气囊仿生助产在头位难产中的应用价值。方法:采用随机数字表法将2017年10月～2019年1月我院收治的头位难产孕妇92例分为对照组和研究组各46例。对照组采用常规舒适体位配合徒手旋转胎头分娩,研究组采用骨盆摇摆配合气囊仿生助产,对比两组产程时间、会阴裂伤、会阴切开、宫颈裂伤、产后并发症、胎儿窘迫和新生儿窒息发生情况。结果:研究组第一、第二产程以及总产程时长短于对照组,差异有统计学意义(P0.05);两组第三产程时长比较,差异无统计学意义(P0.05);研究组会阴裂伤、会阴切开、产后并发症、胎儿窘迫和新生儿窒息发生率低于对照组,差异有统计学意义(P0.05);两组宫颈裂伤率对比,差异无统计意义(P0.05)。结论:骨盆摇摆配合气囊仿生助产在头位难产中的应用价值较高,有助于缩短产程时间,降低产妇会阴裂伤、会阴切开率以及产后并发症发生率,降低胎儿窘迫和新生儿窒息发生率。     

无保护会阴接生技术与控制胎头娩出在自然分娩初产妇中的应用

目的:探讨无保护会阴接生技术与控制胎头娩出在自然分娩初产妇中的应用方法及效果。方法:将150例自然分娩初产妇按分娩方式分为观察组和对照组各75例,对照组产妇采用传统托肛保护会阴方式,观察组产妇采用无保护会阴接生技术与控制胎头娩出方案,比较两组临床情况。结果:两组产妇会阴侧切率及会阴裂伤情况比较差异有统计学意义(P 0. 05);观察组新生儿Apgar评分高于对照组(P 0. 05),两组窒息发生率比较差异无统计学意义(P 0. 05);两组第二产程时间比较差异无统计学意义(P 0. 05),观察组产后并发症发生率低于对照组(P 0. 05)。结论:无保护会阴接生技术与控制胎头娩出的应用可以明显降低自然分娩初产妇会阴侧切率,减少会阴裂伤,提高自然分娩的安全性。     

探究气囊仿生助产配合无保护会阴接生在初产妇阴道分娩中的应用效果

目的 探讨气囊仿生助产配合无保护会阴接生应用于初产妇阴道分娩中的效果,分析其对产妇会阴的影响,为临床提供参考。方法 选取2019年4月至2021年3月于东方市人民医院行阴道分娩的60例初产妇为研究对象,按照随机数字表法分为参照组和研究组,各30例。参照组产妇实施常规助产法,研究组产妇实施气囊仿生助产配合无保护会阴接生技术。比较两组产妇会阴裂伤情况、会阴侧切率、产程、新生儿评分量表（Apgar）评分及产后2 h出血量。结果 研究组产妇会阴裂伤情况优于参照组（P<0.05）;研究组产妇会阴侧切率低于参照组（P<0.05）;研究组产妇第一、第二及第三产程时间均少于参照组（P<0.05）;研究组新生儿评分量表（Apgar）评分高于参照组,产妇产后2 h出血量低于参照组（P<0.05）。结论 在初产妇阴道分娩中联合应用气囊仿生助产与无保护会阴接生,可在一定程度上保护会阴,缩短产妇产程,促使新生儿顺利娩出,临床应用价值高。     

三种不同助产技术对产妇性功能的影响

目的探讨三种不同助产技术对产妇性功能的影响,为确定损伤最小的助产技术提供依据。方法将产科阴道分娩产妇242例随机分为会阴侧切组(行会阴切开术,手掌合并用大鱼际肌贴在会阴体部保护会阴)95例,传统助产技术组(无侧切,手掌合并用大鱼际肌贴在会阴体部保护会阴)86例和无创助产技术组(单手控制胎头娩出速度,不扶持会阴体)61例。比较三组的盆底肌力受损情况及性功能障碍发生率。结果无创助产组产后性功能障碍发生率显著低于会阴侧切组和传统助产组(P0.01)。结论无创助产技术有利于减轻产妇性功能障碍,提高产妇生活质量。     

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.