人工授精手术中不同黄体支持方法作用的研究

目的 探讨不同黄体支持方法与人工授精的妊娠结局及妊娠周期雌二醇（E2）、孕酮（P）、E2/P动态变化规律,黄体支持中合理的E2/P比值,确定合理的黄体支持方法.方法 对接受供精人工授精促排卵助孕治疗的患者172个治疗周期随机分成3组,分别在排卵后第3天开始接受人绒毛膜促性腺激素（hCG）注射（A组）,hCG＋黄体酮注射（B组）和口服黄体酮胶囊（C组）三种不同黄体支持方法,比较三者的妊娠结局,连续检测妊娠周期早卵泡期、排卵期（hCG日）、孕卵着床期（窗口期）,以及早孕期、孕6、7～8周体内E2、P水平.结果 三种不同黄体支持方法中B组妊娠成功率高于其他两组;排卵用药后各个时期P水平C组最高,A、B两组之间无差异;B组与正常妊娠组E2/P比值及变化趋势最相近.结论 hCG＋黄体酮注射组虽无口服黄体酮胶囊组提高P浓度作用显著,但周期妊娠率最高,而且与妊娠对照组E2/P比值及变化趋势最接近,因此在黄体支持不仅要提高P浓度,尚需维持合适的雌孕激素的比值,提示hCG＋黄体酮注射是三种方案中的最佳支持方法.     

黄体酮对脑外伤后小肠黏膜结构的保护作用及其机制的初步研究

本研究旨在观察黄体酮对TBI后小肠黏膜结构和细胞凋亡的影响,同时观察黄体酮对TBI后肠道炎症因子的调控作用[1].     

阴道黄体酮栓剂黄体支持是否更具优点？

辅助生殖技术（ART）中的控制性超排卵（COH）会影响黄体期的激素水平,导致黄体功能不全,妊娠率下降,流产率增加,影响治疗效果。目前,黄体支持已成为多数ART的常规步骤之一。黄体支持的方案众多,尚无公认的最佳黄体支持药物及给药途径。本研究通过比较黄体酮（P）肌注、安琪坦（Utrogestan,法杏,法国）阴道给药、安琪坦直肠给药三种黄体支持方法对体外受精-胚胎移植（IVF-ET）术后妊娠结局的影响,探讨黄体支持的合理方案。     

术前使用黄体酮对减轻输尿管软镜手术中输尿管损伤的有效研究

目的：研究术前给予黄体酮对输尿管鞘引起的输尿管损伤以及围手术期结局的影响。方法：入选2021年10月至2022年8月北京大兴区医院进行肾及输尿管结石治疗的210例患者,随机数字表法分配在实验组和对照组,实验组在手术前3 d接受20 mg黄体酮肌注,1次/d,对照组则给予安慰剂（0.9%生理盐水2 ml,肌注）。最终实验组92例和对照组86例患者成功放置UAS。比较两组患者输尿管壁损伤率、镇痛药使用率以及其他手术相关指标。结果：对照组26.7%的患者输尿管壁损伤2级或更高,实验组10.9%输尿管壁损伤2级或更高,两组患者输尿管壁损伤率具有统计学差异（P<0.05）。实验组相比对照组镇痛药使用率[16.30(15/86) vs. 30.23(26/92)]显著降低,差异具有统计学意义（P<0.05）。并发症的总体发生率差异没有统计学意义（P>0.05）。结论：术前给予黄体酮治疗可显著减少使用输尿管镜时由于放置输尿管通路鞘而导致的输尿管壁损伤,并减少了术后止痛药的使用。     

辅助生殖过程中不同给药途径进行黄体支持的疗效评价

目的比较辅助生殖技术中黄体酮阴道缓释凝胶与肌肉注射黄体酮两种黄体支持方式对妊娠结局的影响及副反应评价。方法计算机检索PubMed、Medline、CNKI和万方数据库,查找所有比较黄体酮阴道缓释凝胶与肌肉注射黄体酮进行黄体支持的临床随机对照研究(RCT),时间为数据库建立至2017年12月1日。由2人分别按纳入/排除标准检索文献、筛选、质量评价及提取资料,RevMan 5.2进行Meta分析。结果纳入RCT 14个,患者4 386例。妊娠结局对比:两种给药方式进行黄体支持对改善患者的临床妊娠率[RR=0.99,95%CI(0.92,1.07),P=0.86]、改善继续妊娠率[RR=1.06,95%CI(0.94,1.19),P=0.32]、降低异位妊娠率[RR=0.84,95%CI(0.48,1.47),P=0.54]、降低流产率[RR=0.92,95%CI(0.75,1.14),P=0.45]、提高活产率[RR=0.99,95%CI(0.89,1.09),P=0.76]均无统计学差异;副反应发生率:与肌肉注射黄体酮相比,黄体酮阴道缓释凝胶副反应发生率较低[RR=0.23,95%CI(0.05,0.93),P=0.04]。结论黄体酮阴道缓释凝胶与肌肉注射黄体酮在辅助生殖技术行黄体支持均有较好的疗效,但黄体酮阴道缓释凝胶副反应发生率较低,患者满意度较好,可在临床推广使用。     

琥珀消石冲剂配用黄体酮治疗输尿管结石(附20例报告)

目的：观察琥珀消石冲剂配用黄体酮治疗输尿管结石的疗效。方法：设立对照组和实验组,实验组２０例,采用琥珀消石冲剂配用黄体酮治疗直径≤１０ｍｍ的输尿管结石;对照组１８例,只口服琥珀消石冲剂。结果：实验组总排石率高达８５．１％,与对照组总排石率（５３．０％）比较,差异有显著性意义（Ｐ〈０．０５）。结论：琥珀消石冲剂配用黄体酮能明显促进输尿管结石的排出。     

黄体酮治疗输尿管结石60例报告

黄体酮治疗输尿管结石６０例报告解放军第２０５医院泌尿外科（锦州，１２１００１）陈荣山，纵斌，徐获荣，崔飞轮锦州市凌河区医院外科（１２１０００）时学江我们用黄体酮穴位封闭治疗输尿管结石６０例，取得良好疗效。本组男５０例，女１０例。年龄１８～７４岁。均有...     

早发黄体酮升高

早发黄体酮升高是人绒毛膜促性腺激素(hCG)注射日血浆孕酮(P)水平有一定程度的升高.文献报道hCG注射日提前升高的孕酮值从2.54～6.34 nmol/L不等,也有用雌二醇/孕酮比例(E2/P)定义早发黄体酮升高的报道.卵泡发育过程中黄体酮分泌的改变涉及一系列相关酶表达及活性的调节.超排卵周期提前升高的黄体酮有多种可能来源,它对于卵母细胞质量、胚胎发育、子宫内膜改变等的影响尚无定论.本文就早发黄体酮升高的定义、相关酶学变化以及早发黄体酮升高的来源和对妊娠结局的影响作一综述.     

不同浓度黄芪、丹参、黄体酮注射液对精子内Ca2+作用研究

目的 通过精子体外添加黄芪、丹参、黄体酮注射液,研究其对精子内Ca2+浓度的影响.方法 28例标本采自本院门诊,随机分成:空白组,黄芪组,丹参组和黄体酮组,共4组.各组均加入等量的、各浓度试剂,Flu03-AM被动扩散进入细胞后,被酯酶水解放出Flu03,Flu03与钙离子络合,受波长488 nm的激光激发而产生荧光,其荧光值与Ca2+呈正相关,应用流式细胞仪(FCM)及激光共聚焦(LSCM)测定精子内Ca2+浓度.结果 (1)FCM检测黄体酮、黄芪组精子内Ca2+的荧光强度,分别与丹参、空白组比较,差异有统计学意义(P<0.05),表明体外添加黄体酮、黄芪注射液可以使精子内Ca2+浓度增加;(2)黄芪组高、中浓度荧光强度明显增强;黄芪组低浓度荧光强度明显较弱,与高、中浓度组比较,有统计学意义(P<0.05):(3)LSCM测定黄芪组、黄体酮组,与丹参组比较差异有统计学意义(P<0.05);丹参组与空白组比较差异无统计学意义(P>0.05).结论 黄体酮能促进Ca2+内流和细胞内Ca2+浓度增加;高浓度、中浓度黄芪能促进精子内Ca2+水平的增加,与黄体酮作用效果相同;丹参不能引起精子细胞内Ca2+浓度的改变.     

两种不同黄体酮制剂对冻融胚胎移植周期围产期结局的影响

目的初步探讨两种不同的黄体酮制剂对冻融胚胎移植(FET)周期围产期结局的影响。方法采用回顾性队列研究,选取2013年1月至2017年5月在空军军医大学唐都医院妇产科生殖医学中心采用非激素替代周期方案行FET后获得单胎活产的患者共1 803个周期为研究对象,根据黄体支持药物不同分为单纯肌肉注射黄体酮针剂组(黄体酮针组,1 297个周期)和单纯阴道用黄体酮缓释凝胶组(雪诺同组,506个周期),比较两组出生子代37孕周的早产率、平均出生孕周和平均出生体重的差异,通过单因素分析及分层分析探讨子代出生孕周及出生体重的影响因素,通过多元回归分析确定不同黄体酮制剂对子代出生孕周及出生体重的影响。结果雪诺同组与黄体酮针组相比,出生子代37孕周早产率显著降低(5.53%vs.8.64%,P0.05),平均出生孕周有所延长[(38.80±1.46) vs.(38.57±2.41)周,P0.05]。单因素分析及分层分析提示,不同的黄体支持方案、不孕夫妇双方高龄及辅助孵化与出生孕周显著关联(P0.05);顺产分娩方式与出生体重显著关联(P0.05)。多元回归分析结果提示,雪诺同组与黄体酮针组相比,子代出生孕周增加0.16周(P0.05),出生体重增加20.07 g(P0.05)。结论在FET周期中使用阴道用黄体酮缓释凝胶作为黄体支持药物,相对使用肌肉注射黄体酮针剂,能够更积极地降低孕晚期早产的发生风险;且子代出生体重无明显差异。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.