孕前体质量指数及孕期体质量增加与妊娠期糖尿病的相关性

目的:分析孕前体质量指数(BMI)及孕期体质量增加与妊娠期糖尿病(GDM)的相关性。方法:选取2016年6月~2017年6月于我院行常规产检的100例孕妇为研究对象,根据孕前BMI水平将其分为低体重组12例、正常体重组45例、超体重组28例、肥胖组15例,并根据孕期体质量增幅分为≤12.5 kg、12.5 kg两个组段。分析孕前BMI、孕期体质量增加与GDM发病情况的关系。结果:低体重组、正常体重组、超体重组及肥胖组GDM发生率分别为8.33%、22.22%、53.57%、80.00%,GDM发生率随BMI的增加而升高,P0.05;空腹血糖、餐后1 h血糖及餐后2 h血糖与BMI相关系数r分别为0.131 1、0.266 9、0.226 4,P0.05;除低体重组外,在同等BMI范围内,孕期体质量增幅12.5 kg孕妇的GDM检出率显著高于孕期体重增幅≤12.5 kg的孕妇,P0.05;孕前BMI、孕期体质量增加与GDM的发生呈正相关,相关系数r分别为0.151 1、0.160 7,P0.05。结论:孕前BMI、孕期体质量增加与GDM的发生呈正相关,孕前超重及孕期体质量增加过多均可增加GDM发生率。     

妊娠糖尿病患者血脂水平及其与体质量变化的关系

【目的】探讨妊娠糖尿病（GDM ）患者妊娠期血脂水平及其与孕期体质量变化的关系。【方法】选择159例妊娠24～28周孕妇,根据口服葡萄糖糖耐量试验（OGTT）结果,将其分为GDM 组（n＝70）及健康孕妇组（n＝89）;记录孕前、孕期体质量,测量身高,计算孕前及孕期体质量指数（BMI）、孕期增重;测定血浆总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL‐C）、低密度脂蛋白胆固醇（LDL‐C）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）等水平;比较两组间血脂水平、体质量变化的差异及相关性。【结果】GDM 组 TC、LDL‐c显著低于健康孕妇组（均 P ＜0．05）,HDL‐C显著高于健康孕妇组（ P ＜0．05）,健康孕妇组TG水平高于GDM 组,但无显著性差异（ P＞0．05）;但健康孕妇中,TC与体质量增加（ r ＝0．249,P＝0．017）、孕期BMI（ r＝0．224,P＝0．033）及BMI增加（ r ＝0．259,P＝0．013）相关;GDM 组中,TC与BMI（ P ＝0．241,P ＝0．041）相关。【结论】GDM患者存在血脂代谢紊乱,但孕期营养摄入及体质量增加过多可能对血脂的影响更大。     

生活行为干预对妊娠糖尿病患者血糖及妊娠结局的影响

正妊娠糖尿病(gestational diabetes mellitus,GDM)是指在妊娠后首次发现的糖尿病或糖耐量异常[1]。GDM患者发展成糖尿病的概率是血糖正常孕妇的7倍[2]。GDM涉及多种因素,包括种族、家族遗传史、年龄等不可控制因素,以及活方式、饮食习惯、体力活动、BMI等可控制因素[3]。其中孕期膳食结构不合理、能量过剩、缺乏运动等不良生活方式导致的胰岛素抵抗和胰岛素     

妊娠期糖尿病营养相关危险因素病例对照研究

目的:探讨妊娠期糖尿病（GDM）营养相关危险因素,为孕期合理膳食及健康管理提供依据。 目的　探讨妊娠糖尿病（gestational diabetes mellitus,GDM）营养相关危险因素,为孕期合理膳食及健康管理提供依据。方法　纳入2014年12月至2015年5月就诊于北京协和医院产科且在孕24~28周完成糖耐量筛查的25~45岁孕妇。采取多阶段连续等比例抽样,确诊GDM新发病例150例为病例组,同期就诊非GDM 150例为对照组。利用食物频率问卷对其一般情况及膳食状况进行调查。采用Logistic回归筛选GDM营养相关危险因素。结果　单因素分析显示,2型糖尿病家族史、孕前体重指数（body mass index, BMI）、GDM史、水果摄入量、精制谷物所占比例、每日肉类摄入量、高脂食品摄入频率、每日食盐摄入量、每日烹调油摄入量、每日坚果摄入量、在外就餐频率、含糖饮料摄入及体力活动状况与GDM之间相关性具有统计学意义（P＜0.05）。多因素Logistic回归分析显示,孕前BMI (OR=1.628, 95% CI: 1.079~2.456)、2型糖尿病家族史 (OR=1.761, 95% CI: 1.001~3.096)、GDM史(OR=7.855, 95% CI: 1.982~31.125)、水果摄入量(OR=1.457, 95% CI: 1.148~1.849)、精制谷物(OR=1.350, 95% CI:1.008~1.808)、高脂食品(OR=1.398, 95% CI: 1.066~1.833)及缺乏体力活动(OR=1.257, 95% CI: 1.111~1.422)与GDM具有相关性(P＜0.05)。结论　孕前BMI异常、2型糖尿病家族史、GDM史、水果摄入过量、主食过于精制、经常摄入高脂食品及缺乏体力活动可增加GDM发病风险。     

孕妇体质量、降钙素原与孕期血糖的相关性研究

【目的】探讨孕妇体质量、降钙素原（PCT）与孕期血糖的相关性。【方法】375例孕妇按体质量指数（BMI）分为正常组238例、超重组105例和肥胖组32例;按PCT浓度分为低浓度组360例、中浓度组88例和高浓度组18例,对三组孕妇进行血糖检测并比较分析。【结果】空腹血糖（FPG）异常、PCT异常、葡萄糖耐量试验（OGTT）异常和妊娠期糖尿病（GDM）的发生率均随孕妇体重升高、PCT浓度升高呈增加趋势,不同组间比较差异均有高度显著性（均P＜0．01）;孕前 BMI与 PCT呈正相关（r＝0．66,P＜0．01）。【结论】孕妇体重、PCT与孕期血糖密切相关,孕妇体重与PCT呈明显正相关。     

妊娠期糖尿病葡萄糖耐量试验与妊娠结局及孕前BMI的关系

目的探讨血糖控制满意的妊娠期糖尿病(GDM)孕妇,葡萄糖耐量试验(OGTT)结果与妊娠结局及孕前体质量指数(BMI)的关系。方法选取2013年1月至2016年6月确诊的GDM孕妇120例作为研究组,血糖均控制满意。其中OGTT 3个时点血糖(空腹血糖,服用葡萄糖后1h、2h血糖)任何1个时点异常者为Ⅰ组,共46例;OGTT任意2个时点血糖异常者为Ⅱ组,共44例;OGTT 3个时点血糖均异常者为Ⅲ组,共30例。选取同期健康孕妇120例为对照组。对各组BMI、妊娠期高血压率、剖宫产率、新生儿低血糖率、巨大儿率及入住新生儿病房情况进行分析。结果研究组孕前BMI[(21.88±2.91)kg/m~2]、剖宫产率(45.0%)、巨大儿率(19.2%)、入住新生儿病房率(18.3%)与对照组[(21.21±1.96)kg/m~2、30.0%、5.0%、8.3%]比较,差异有统计学意义(P0.05)。Ⅲ组BMI显著高于Ⅰ组和Ⅱ组,差异有统计学意义(P0.05),且Ⅲ组妊娠期高血压率和入住新生儿病房率均高于Ⅰ组,差异有统计学意义(P0.05)。结论 GDM孕妇其孕前BMI较健康孕妇高,妊娠结局较健康孕妇组差。孕前BMI越高,OGTT血糖异常时点数目越多,GDM孕妇妊娠结局越差。临床上应对该类患者提高警惕,需注意和预防妊娠不良结局的发生,以改善母婴结局。     

妊娠期糖尿病患者发病的影响因素探讨

目的探讨引发妊娠期糖尿病(GDM)发病的危险因素,为临床的预防和治疗提供参考。方法采用病例对照研究方法,选取2012年1月至2014年12月海南省保亭黎族苗族自治县人民医院收治的GDM患者98例作为观察组,另选同期健康体检孕妇98例作为对照组,采用单因素和多因素非条件Logistic回归分析筛选引发GDM的危险因素。结果单因素结果显示,年龄大于或等于35岁、孕前体质量指数(BMI)、糖尿病家族史、三酰甘油水平、孕期体质量增长、不良孕产史、空腹血糖水平、空腹胰岛素水平、胰岛素抵抗指数为GDM相关危险因素(P0.05);而与总胆固醇水平、高密度脂蛋白水平、低密度脂蛋白水平差异无统计学意义(P0.05);多因素非条件Logistic回归分析结果显示,年龄大于或等于35岁、孕前BMI、糖尿病家族史、三酰甘油水平、空腹血糖、空腹胰岛素是引发GDM的独立危险因素(P0.05)。结论年龄、糖尿病家族史等因素在GDM发生和发展中具有重要作用,因此孕妇要密切注意引发GDM的相关危险因素和适时监测血糖,加强早孕期GDM筛查和防治,减少和阻止GDM发生。     

产后护理干预对妊娠期糖尿病妇女的影响

[目的]研究产后护理干预对妊娠期糖尿病(GDM)产妇的影响。[方法]将进行分娩的80例GDM产妇按随机数字表法分为观察组和对照组各40例,观察组由研究人员进行糖尿病教育、膳食指导、制订个性化运动方案、电话随访、家庭随访辅助指导等产后护理管理干预,对照组实施一般常规护理,比较两组产妇护理前、产后3d、42d及12周体重指数(BMI)、空腹血糖、糖化血红蛋白(HbA1c)以及疾病认知程度等指标。[结果]护理后3d、42d、12周观察组BMI、空腹血糖及HbA1c水平均显著低于对照组(P均0.05);护理后观察组GDM定义以及临床表现、妊娠期糖代谢特点、GDM诊断、GDM正确处理等疾病认知情况答题正确率显著高于对照组(P均0.05)。[结论]合理的产后护理干预能有效降低GDM产妇产后BMI、空腹血糖以及HbA1c水平,同时提高产妇对疾病认知程度。     

健康行为干预对妊娠期糖尿病高危孕妇早期筛查指标的影响

目的研究早期健康行为干预对妊娠期糖尿病(GDM)高危孕妇GDM发病率和早期筛查指标的影响。方法采用随机数字表法将74例符合入组标准且同意参加试验的GDM高危孕妇分为对照组和干预组,对照组35例,干预组39例。对比两组孕妇孕中期体质量增加值、血浆脂联素(PA)、空腹血糖(FBG)、血清25-羟基维生素D[25-(OH)D]水平和GDM发生率。结果干预组孕妇孕中期体质量增加值、PA、FBG和血清25-(OH)D水平等早期筛查指标均较对照组明显改善,组间差异均具有统计学意义(P0.05);干预组GDM检出率低于对照组,组间比较差异具有统计学意义(P0.05)。结论早期健康行为优化可以降低GDM高危孕妇GDM检出率,可能与有效控制孕期体质量过度增加和提升PA、血清维生素D水平密切相关。     

助产士主导的群组孕期母婴健康教育在妊娠期糖尿病孕妇中的应用

目的：探讨助产士主导的群组孕期母婴健康教育在妊娠期糖尿病(GDM)孕妇中的应用效果。方法：将2019年9月1日～2020年9月30日收治的174例GDM孕妇随机分为观察组和对照组各87例,对照组实施常规护理和健康教育,观察组实施助产士主导的群组孕期母婴健康教育。比较两组血糖水平控制情况、分娩结局、疾病认知水平、自我效能[采用糖尿病管理自我效能感量表(C-DMSES)]、自我管理能力[采用糖尿病自我管理行为量表(SDSCA)]。结果：干预后,两组空腹血糖、餐后2 h血糖及糖化血红蛋白水平均低于干预前(P<0.05),且观察组低于对照组(P<0.05);观察组自然分娩率高于对照组(P<0.05),不良妊娠结局发生率低于对照组(P<0.01,P<0.05);干预后,两组疾病健康知识调查问卷、C-DMSES、SDSCA评分均高于干预前(P<0.05),且观察组高于对照组(P<0.05)。结论：将助产士主导的群组孕期母婴健康教育模式应用于GDM患者的护理干预中,可通过提升孕妇对疾病的认知水平、自我效能和自我管理能力达到提升血糖管理效果的目的,有助于孕妇自...     

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.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.