临产孕妇凝血指标的检测与分析

目的通过对产前凝血功能的检测与分析,探讨正常妊娠临产孕妇组与有不良妊娠史（包括死胎、脊拄裂、脑积水、唇腭裂、肾积水等）临产孕妇组凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、凝血酶时间（TT）、纤雏蛋白原（FIB）四项指标变化情况,为防止孕妇在分娩过程中出现产后大出血或血栓的形成提供科学的依据。方法采用Sysmex-50凝血分析仪对448例临产孕妇与50例健康非妊娠妇女为对照组的结果进行比较分析。结果正常妊娠史组与有不良妊娠史组临产孕妇的PT、TT明显低于对照组,有显著性差异（P〈0．01）;而FIB明显高于对照组,有显著性差异（P〈0．01）;册与对照组比较无明显差异（P〉0．05）。结论临产孕妇血液呈高凝状态,有利于产后快速有效的止血,临产前及时检测凝血四项指标对预防产科异常出血及并发症（如：DXC）有着极其重要的意义。     

凝血四项指标在孕妇正常分娩前后的变化及临床意义

目的了解孕妇正常分娩前后的凝血功能情况。方法采用日本SysmexCA一6000全自动血凝分析仪对我院产科148例孕妇正常分娩前后和30例正常非妊娠妇女进行凝血酶原时间（PT）／国际标准化比值（PT—INR）、活化部分凝血酶原时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB）自动检测。结果孕妇正常分娩前凝血四项与健康对照组比较差异有统计学意义（P〈0．01）,PT／PT—INR、APTT、TT明显短于对照组,FIB明显高于健康对照组,正常分娩后凝血四项与健康对照组差异无统计学意义（P〉0．05）。结论孕妇正常分娩前血液处于高凝状态,分娩72h后恢复。在分娩前后联合检测凝血四项指标并动态观察,能较全面、完整地反映孕产妇凝血功能情况,对预防和治疗产妇产后出血以及评估预后具有重要的临床意义。     

凝血四项指标检测在剖宫产产后出血中的预测价值

目的探讨凝血四项指标检测在剖宫产产后出血中的预测价值。方法选取收治的226例剖宫产产后出血产妇,根据产后出血量不同,将出血量500ml的109例产妇作为对照组、≥500ml的117例产妇作为观察组。结果所有产妇均于剖宫产前48h及剖宫产24h后经肘静脉抽取静脉血测定凝血四项指标,对比两组产妇产前及产后凝血四项指标异常率、凝血四项指标水平,以明确凝血四项指标在产后出血中的预测价值。观察组产前及产后凝血四项指标异常率均较对照组高,差异有统计学意义(P0.05);产前与产后,观察组PT、TT及APTT水平均较对照组高,FIB水平较对照组低,差异有统计学意义(P0.05);对照组产前、产后PT、TT、APTT及FIB水平对比,差异无统计学意义(P0.05);观察组产后PT、APTT水平较产前高,FIB水平较产前低,差异有统计学意义(P0.05);观察组产后TT水平与产前相比,差异无统计学意义(P0.05)。结论剖宫产产后出血的发生与凝血四项指标异常密切相关,产前积极检测凝血四项指标可有效预测产后出血,为降低产后出血发生率提供可靠依据。     

产妇分娩前后凝血和纤溶指标监测的意义

目的 探讨产妇分娩前后凝血与纤溶指标监测的意义。方法 产后出血组(出血量大于或等于500mL)212例和正常分娩组235例,检测产前及产后72h血浆凝血酶原时间(PT)、国际标准化比值(PT-INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(DD)、血小板(PLT)和血红蛋白(HB),健康体检女性85例作为健康组。结果 产前比较:正常分娩组PT/PT-INR、APTT、TT、PLT、HB低于健康组,FIB、DD高于健康组;产后出血组PT/PT-INR、APTT、TT、DD高于正常分娩组,FIB、PLT低于正常分娩组。产后比较:正常分娩组PT/PT-INR、APTT、TT、DD与健康组比较差异无统计学意义(P>0.05),但FIB高于健康组;产后出血组PT/PT-INR、APTT、TT、DD高于正常分娩组,FIB、PLT、HB低于正常分娩组。结论 产前及产后动态监测各项凝血与纤溶指标变化对预防产后出血、血栓形成具有重要意义。     

孕妇正常分娩前后凝血指标的变化及临床意义

目的了解孕妇正常分娩前后的凝血功能情况。方法对2008年1—10月我院产科146例孕妇正常分娩前后和40例正常非妊娠妇女进行凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB）的检测。结果孕妇正常分娩前凝血四项与健康对照组比较有显著性差异（P〈0．01）,而分娩后各指标与正常对照组差异无统计学意义（P〉0．05）。结论孕妇正常分娩前血液处于高凝状态,分娩后72h恢复正常,动态观察凝血四项指标可以较全面的了解孕产妇凝血功能,对监测和预防孕产妇产后出血及预后评估具有重要的临床意义。     

375例妊娠晚期孕妇凝血4项测定的临床价值

目的探讨检测妊娠晚期孕妇血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）的临床应用价值。方法对375例晚期孕妇组（实验组）与133例健康非妊娠妇女组（对照组）的凝血4项指标进行比较分析。结果晚期孕妇组PT、APTT、TT较对照组明显缩短（P〈0．01）、FIB明显增多（P〈0．01）。结论妊娠晚期孕妇处于高凝状态,及时监测凝血4项指标对预测、治疗产妇异常出血有临床应用价值。     

不同妊娠时期检查APTT、PT、TT、FIB对孕妇产后出血的预测价值

目的探讨不同妊娠时期检查活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)对孕妇产后出血的预测价值。方法选取收治的65例孕妇作为观察组,观察不同妊娠时期各项凝血指标,包括妊娠早期(妊娠短于12周)、妊娠中期(妊娠13~28周)、妊娠晚期(妊娠29周以上)和产后,并选取60例健康体检的育龄非妊娠妇女作为对照组,检测所有研究对象APTT、PT、TT、FIB值,并进行分析。结果观察组不同妊娠时期孕妇APTT水平均显著高于健康组(P<0.05),妊娠中期、晚期、产后PT、TT值均高于对照组,妊娠中期、晚期FIB值均高于对照组(P<0.05),产后大量出血孕妇APTT、PT、TT值均显著高于少量出血者(P<0.05),FIB值显著低于少量出血者(P<0.05),单因素和多因素Logistic分析显示,APTT、PT、FIB是预测产后出血的独立因素。结论在产前对孕产进行APTT、PT、TT、FIB检测,可有效预测产后出血情况,及时发现凝血异常,减少产后大出血的发生。     

D-二聚体和凝血四项检测在临产期孕妇中的应用价值分析

目的 探讨D-二聚体(D-D)和凝血四项(FIB、PT、TT、APTT)检测在临产期孕妇中的应用价值。方法 回顾性分析收治的36例临产期孕妇为研究组,并选取同期36例健康非孕妇为对照组,比较两组血浆D-D、凝血四项指标水平;同时,根据临产期孕妇产后出血情况分为产后出血组、产后未出血组,比较两组产前、产后血浆D-D、凝血四项指标水平。结果 研究组血浆D-D、FIB水平较对照组高,PT、TT及APTT较对照组短(P<0.05)。产后出血组产后血浆D-D水平高于产前,FIB水平低于产前,PT、APTT长于产前(P<0.05);产后出血组产后血浆D-D水平高于产后未出血组,FIB水平低于产后未出血组,PT、APTT长于产后未出血组(P<0.05)。结论 对临产期孕妇进行D-D、凝血四项监测可及时发现其凝血功能变化,有助于预估产后出血等不良结局的发生。     

大庆地区妊娠妇女凝血检测结果分析

目的检测孕期5～10周早期妊娠妇女和孕足月（37～42周1妊娠妇女凝血的指标,并对结果进行分析。方法分别选择孕足月及预行人工流产或药物流产孕妇各300例,采用磁珠凝固法检测凝血酶原时间（PT）、部分活化凝血酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）,并与225名正常健康妇女比较。结果早孕组与孕足月组PT、APTT、TT、FIB都发生不同程度的改变;早孕组与对照组差异不明显;孕足月组与对照组比较,PT、APTT有差异（P〈O．05）,TT差异不明显,FIB差异有显著性（P〈0．01）早孕组与孕足月组比较,PT、APTT、FIB有差异（p〈0．05）,TT差异不明显（P〉0．05）。结论妊娠妇女凝血系统发生改变,检测凝血指标有利于预防血栓形成、降低DIC发生率,具有一定指导作用。     

孕妇产前凝血功能检测的临床意义及结果分析

目的探讨孕妇产前凝血功能检测在妊娠高血压综合征（下称妊高征）发病中的作用。方法采用SysmexCA-50自动凝血分析仪对67例轻、中、重度妊高征患者，35例健康妊娠妇女和35例健康非妊娠妇女产前凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fbg）检测结果进行分析。结果妊高征患者PT、APTT缩短，Fbg含量升高，与健康非妊娠妇女、妊娠妇女相比，P〈0．05；中、重度妊高征患者的上述指标与轻度妊高征患者相比，P％0．05；健康妊娠妇女与健康妇女相比，差异无统计学意义（P〉0．05）。结论产前凝血功能检测不仅对产妇和医务人员自身有益，而且避免了孕妇产前及产后意外的发生，确保了母子生命安全，有效地降底了孕产妇死亡率，其凝血指标对妊高征患者的病情有较好的辅肋诊断价值．     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

皮肤麻风病6例临床病理观察及误诊分析

目的 探讨皮肤麻风病的临床病理特征,讨论需要鉴别诊断的疾病并吸取误诊教训.方法 收集皮肤麻风病6例,回顾性分析其临床资料、HE、免疫组化、抗酸染色及病理诊断结果 .结果 6例中除3例因临床及病理特征典型首次活检即被确诊外,其余3例初始均被误诊.1例误诊为皮肤假性淋巴瘤和皮肤非霍奇金淋巴瘤, 1例误为皮肤纤维组织细胞瘤,1例误为炎性肉芽肿伴化脓性炎和皮肤脂膜炎样T细胞淋巴瘤,后经多家医院会诊并加做抗酸染色方确诊.结论 麻风病现已较为少见,非典型病例较易误为肿瘤或其他炎性疾病.