早发型重度子痫前期期待治疗及母婴预后分析

目的探讨早发型重度子痫前期(EOSP)期待治疗及母婴预后。方法选择早发型重度子痫前期孕妇69例,根据发病时孕周将患者分为Ⅰ组(孕周<31+6周)45例与Ⅱ组(≥孕32周)24例,对比两组孕妇并发症发生情况、胎儿围生期情况,以及期待治疗时间、终止妊娠时间及分娩方式等。结果Ⅰ组孕妇发病时孕周、终止妊娠孕周及期待治疗时间均明显短于Ⅱ组(P<0.05)。两组孕妇胎盘早剥、HELLP综合征、弥散性血管内凝血(DIC)、视网膜病变、产后出血、肝肾损害、低蛋白血症发生率比较,差异均无统计学意义(P>0.05),但Ⅰ组孕妇总并发症发生率明显高于Ⅱ组(P<0.05)。两组围产儿出生时体重比较,差异无统计学意义(P>0.05);Ⅰ组胎儿宫内生长受限(FGR)、新生儿窒息、胎死宫内、新生儿死亡及围产儿死亡发生率均明显高于Ⅱ组(P<0.05)。结论与晚发型重度子痫前期孕妇相比,EOSP孕妇期待治疗时间更短,总并发症发生率更高,围产儿预后更差。短期的保守治疗可有效地延长孕周,在适当的时候采取合适的方式终止妊娠有助于改善母婴结局。     

早发型与晚发型重度子痫前期对围生儿结局的影响

目的了解重度子痫前期不同孕周对围生儿结局的影响。方法回顾性分析88例重度子痫前期患者的临床资料,按照34孕周为界分为早发型重度子痫前期组(A组)、晚发型重度子痫前期组(B组)。对其一般资料、分娩孕周、早产、胎儿生长受限发生率、新生儿窒息发生率、围生儿死亡发生率、新生儿体重等进行比较。结果①两组患者一般资料中,分娩孕周、早产发生率、规律产检率差异有统计学意义(P<0.05),其余差异均无统计学意义(P>0.05)。②围生儿结局中,各项差异均有统计学意义(P<0.05),存活新生儿中,新生儿体重比较差异也具有统计学意义(P<0.05)。结论重度子痫前期患者的发病孕周直接影响围产结局,且早发型重度子痫前期孕妇早产儿、低体重儿、围生儿死亡的发生率明显增加,相关新生儿疾病(如新生儿窒息等)的发病率也明显增加。     

早发型重度子痫前期的期待治疗临床观察

目的探讨早发型重度子痫前期期待治疗对母儿结局的影响及其期待治疗效果。方法对52例早发型重度子痫前期病例进行回顾性分析,按发病孕龄分为3组:即A组9例(孕周<28 W),B组15例(28 W≤孕周<32 W),C组28例(32 W≤孕周<34 W)。结果早发型重度子痫前期发病孕周越早,患者并发症的发生率越高,但3组患者并发症发生率无统计学意义(P>0.05);3组间新生儿窒息率和围产儿死亡率均有统计学意义(P<0.05);B组期待治疗时间均明显长于其他两组(P<0.05)。结论早发型重度子痫前期新生儿窒息和围生儿死亡率随发病孕周延长而降低,适当期限内的保守治疗有助于改善母儿结局。     

早发型重度子痫前期期待治疗的临床研究

目的分析早发型重度子痫前期期待治疗时限及妊娠结局。方法选择无严重并发症早发型重度子痫前期病人66例,以其终止妊娠前孕周分为3组,A组发病孕周<28周(10例),B组发病孕周为28~31+6周(24例),C组发病孕周32~33+6周(32例)。分析3组孕期治疗时限、孕妇并发症、胎儿及围生儿结局。结果 3组孕妇并发症发生率随着孕周的延长有升高的趋势,但差异无显著性(P>0.05)。胎儿窘迫、胎死宫内、新生儿窒息及新生儿死亡的发生率随孕周增长而下降,差异有显著性(P=0.000~0.006)。B组的期待治疗时间明显较A、C组长(F=7.572,q=7.587、6.457,P<0.05),而A组和C组比较差异无显著性(P>0.05)。3组剖宫产率比较差异无显著性(P>0.05)。结论早发型重度子痫前期非手术治疗可行,但在治疗中应严密监测,权衡利弊,适时终止妊娠,剖宫产仍是终止重度子痫前期的主要治疗方法。     

孕30周至34周重度子痫前期53例

目的探讨孕30~34周重度子痫前期积极治疗和期待治疗对母儿结局的影响。方法2001年5月至2005年10月收治孕30~34周重度子痫前期53例,分为积极治疗组(27例)和期待治疗组(26例),比较2组母儿的结局。结果积极治疗组重要器官损害累计平均数、胎儿死亡发生率和小于胎龄儿发生率明显低于期待治疗组(P<0.05),2组围产儿死亡率无显著差异(P>0.05)。结论对孕30~34周重度子痫前期应给予积极治疗。     

超声心动图监测孕中晚期胎儿心室Tei指数变化及其与子痫前期的关系

目的 超声心动图监测孕中晚期胎儿心室Tei指数变化情况,探讨其与子痫前期的关系。 方法 选择2012年12月-2015年12月金华市中心医院产科重度子痫前期孕妇70例作为A组,轻度子痫前期孕妇70例作为B组,同期正常孕妇220例作为C组。对所有孕妇进行超声心动图检查,观察正常孕妇不同孕周胎儿心室Tei指数,各组孕妇新生儿出生情况、心室功能指标、心室Tei指数,子痫前期孕妇胎儿右心室Tei指数和胎儿出生情况的相关性。 结果 在正常孕妇中,各孕周右心室的Tei指数高于左心室的Tei指数,但两者之间比较差异没有统计学意义(P>0.05)。A组新生儿出生体重、出生孕周均小于B组和C组(P<0.05),A组新生儿出生1 min和5min Apgar评分均小于B组和C组(P<0.05)。A组左心室射血分数和右心室射血分数低于C组(P<0.05);A组和B组左心室等容时间和右心室等容时间高于C组(P<0.05)。A组左心室Tei指数和右心室Tei指数高于B组和C组(P<0.05);B组左心室Tei指数和右心室Tei指数高于C组(P<0.05)。子痫前期新生儿的右心室Tei指数和胎儿的出生体重、出生孕周、1 min Apgar评分、5 min Apgar评分均呈负相关(P<0.05)。 结论 心室Tei指数能够评价胎儿心脏功能,子痫前期胎儿心功能有一定程度的损害,影响胎儿的预后,Tei指数检测对预测子痫前期胎儿预后有一定价值。      

早发型重度子痫前期的临床特点及妊娠结局分析

目的研究早发型重度子痫前期的临床特点,并研究其对妊娠结局的影响。方法选取我院134例重度子痫前期患者为研究对象,根据孕周分为早发组(<34周)与晚发组(≥34周),均为67例,对两组临床资料进行回顾性分析,同时对围产儿并发症发生的高危因素进行探讨。结果两组发病孕周、入院时孕周、延长孕周比较有显著差异(P<0.05);早发组新生儿Apgar评分<3、3~7分人数均超晚发组,新生儿体重(1194.61±435.64)g、(2348.81±790.30)g,早发组显著较低(P<0.05),早发组各并发症发生率均显著高于晚发组(P<0.05)。结论早发型重度子痫前期患者发病较早,并发症多,影响孕产妇与胎儿健康的因素众多,必须采取严密的监控措施,必要时应及时终止妊娠。     

早发型子痫前期临床分析

目的探讨早发型子痫前期的临床特点及母儿结局。方法对103例不同孕周的早发型子痫前期患者进行回顾性分析。根据发病孕周数分为<28周组、28～周组、32～38周组,比较3组间孕妇一般情况、并发症发生情况及围生儿结局情况间的差异。结果 3组孕妇一般情况(孕产次、年龄、血压情况)比较差异无统计学意义(P>0.05);3组间患者并发症发生率差异有统计学意义(χ2=6.60,P<0.05)。新生儿窒息发生率3组间比较差异有统计学意义(χ2=8.64、11.31、7.32,P<0.05),并随孕周延长而下降。结论早发型重度子痫前期患者发病孕周越小,母体并发症发生率越高,新生儿患病率及死亡率越高。     

哈族与汉族婴幼儿缺铁性贫血对照观察

目的:了解4个月～3岁哈族与汉族婴幼儿缺铁性贫血发生情况,对比分析影响因素,探讨干预及治疗措施。方法:对儿科门诊就诊及住院哈族、汉族婴幼儿做血常规检测。结果:4个月～3岁哈族与汉族患儿在发病因素上:哈族与汉族孕妇贫血发生情况比较差异具有明显统计学意义(P<0.05),在男、女性别比较差异无统计学意义(P>0.05);在单纯喂养上,两者比较差异具有明显统计学意义(P<0.05),而人工喂养及混合喂养上差异无统计学意义(P>0.05),在与其他疾病是否有关系方面两者比较差异具有明显统计学意义(P<0.05);在发病严重程度上,哈族与汉族患儿缺铁性贫血比较差异具有明显统计学意义(P<0.05);治疗结果上,给予铁剂治疗后差异无统计学意义(P>0.05)。结论:4个月～3岁哈族患儿母亲孕期贫血,居住在农村,哈族患儿饮食单一是导致哈族患儿缺铁性贫血的重要因素,发病率比汉族患儿缺铁性贫血高,发病轻,中及重上均比汉族患儿贫血严重,注重哈族婴幼儿缺铁性贫血保健知识宣传,从育龄产妇做起,合理饮食,及时给哈族婴幼儿添加辅食,定期查血红蛋白,早期干预是降低哈族患儿缺铁性贫血的有效手段。     

早发型重度子痫前期孕妇分娩结局分析

目的:分析不同孕周发病的早发型重度子痫前期孕妇分娩结局。方法:早发型重度子痫前期孕妇86例,根据发病孕周分成A组(孕周<28周)、B组(28周≤孕周<32周)、C组(32周≤孕周<34周)。所有患者均通过期待性治疗延长孕周,依据病情及胎儿情况选择合适的终止妊娠方式(剖宫产、阴道分娩以及羊膜腔内引产),对比三组的延长孕周时间、新生儿窒息率、围产儿死亡率及剖宫产率。结果:三组平均期待治疗时间无明显差异(P>0.05);三组新生儿窒息率、围产儿死亡率有明显差异,随着孕周延长而下降(P<0.05);剖宫率随着孕周延长增加,三组有明显差异(P<0.05)。结论:早发型重度子痫前期孕妇妊娠结局与发病时孕周有着密切关系,发生时间越早结局越差,通过适当的期待治疗并延长孕周对改善母儿结局有着较好的效果,剖宫产明显降低母儿并发症发生。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.