小儿预激综合征并发房室折返性心动过速药物复律效果回顾分析

目的探讨小儿预激综合征的临床特点及并发房室折返性心动过速的药物复律效果。方法回顾性分析山东省临沂市人民医院1997-01～2006-01住院并确诊为预激综合征患儿22例的临床资料。结果小儿预激综合征并发房室折返性心动过速，90．9％（20例）是顺传型，仅9．1％（2例）是逆传型，顺传型单用普罗帕酮转复率仅占56．3％（9／16），去乙酰毛花苷转复率可达到100％（10／10）。结论预激综合征并发房室折返性心动过速，若心电图为顺传型且用普罗帕酮无效时，则选用去乙酰毛花苷，若为逆传型，则可以选用普罗帕酮或胺碘酮。     

新生儿三尖瓣下移畸形合并B型预激综合征1例

本文报道1例新生儿三尖瓣下移畸形合并B型预激综合征。患儿胎龄39周娩出, 生后2 d诊断三尖瓣下移畸形合并B型心室预激, 经内科治疗后好转出院。追溯产前超声检查, 胎龄20周胎儿超声心动图未提示异常, 但38周因胎心率过快行M型超声检查诊断室上性心动过速。三尖瓣下移畸形的心脏解剖结构异常不仅导致血流动力学的改变, 而且会引起快速性心律失常。因此对于产前心脏超声检查到室上性心动过速或者出生后心电图检查到B型预激综合征的患儿, 应当在心脏超声检查中仔细扫查三尖瓣, 以免漏诊。     

不同类型胎儿心律失常的临床近远期预后分析

目的:对胎儿心律失常孕妇进行随访,分析其近远期预后,为临床工作提供参考。方法:回顾性分析2004年4月至2010年12月于中国医科大学附属盛京医院进行胎儿心脏超声检查诊断为胎儿心律失常的541例孕妇的临床资料,并进行追踪随访。结果:①541例胎儿心律失常孕妇中,胎儿期前收缩303例(56.01%);快速胎儿心律失常196例(36.23%),其中窦性心动过速92例,室上性心动过速101例,心房扑动3例;胎儿心动过缓42例(7.76%),其中房室传导阻滞8例,窦性心动过缓34例。②共随访391例,失访150例,随访时间1～5年。其中合并胎儿心脏结构异常18例(3.33%),随访15例,有14例终止妊娠放弃胎儿;未合并胎儿心脏结构异常孕妇中有3例因出现胎儿水肿、心力衰竭终止妊娠;不愿承担风险自愿选择终止妊娠10例,分别为室上性心动过速1例,心房扑动2例,房室传导阻滞4例,严重窦性心动过缓3例。产前给予药物治疗共10例,8例有效,2例无效出现胎儿水肿终止妊娠。③共计364例患者继续妊娠,其中期前收缩的胎儿211例,后随访仅1例转归异常;快速胎儿心律失常中窦性心动过速65例和室上性心动过速67例均无转归异常;胎儿心动过缓21例,仅1例于新生儿期死亡。转归正常的患儿生长发育情况等同于正常同龄儿,预后良好。结论:胎儿心律失常类型多样,预后不同,应根据具体类型决定个体化治疗和临床处理方案。发生胎儿心力衰竭、水肿和合并有心脏畸形时,提示预后不良,需要积极进行临床干预,必要时终止妊娠放弃胎儿。胎儿期前收缩临床上最常见,其和胎儿窦性心动过速、室上性心动过速的预后较好。     

小儿阵发性室上性心动过速36例临床复律方法回顾性分析

目的总结小儿阵发性室上性心动过速临床复律方法。方法回顾性分析36例阵发性室上性心动过速患儿的复律方法,包括刺激迷走神经法复律,药物复律（维拉帕米、三磷酸腺苷、普罗帕酮、胺碘酮、洋地黄）和食管心房调搏复律。结果复律成功率分别是刺激迷走神经19.4%（6/31）、维拉帕米84.6%（11/13）、三磷酸腺苷71.4%（5/7）、普罗帕酮77.8%（7/9）、胺碘酮66.7%（2/3）、毛花苷丙40.0%（2/5）、食管心房调搏术100.0%（3/3）。结论阵发性室上性心动过速发作后首选刺激迷走神经,无效者改用药物复律,或食管心房调搏术及电复律,对伴有血流动力学障碍和心功能不全患儿应该首选电复律;年幼患儿可以用药物防治,随年龄增长,部分患儿可能不再发作;对频发的年长患儿和发作时伴有血流动力学障碍和心功能不全患儿应行射频消融术。     

妊娠合并心脏病的手术干预治疗

目的:探讨妊娠合并心脏病患者的手术干预措施及临床效果.方法:回顾性分析我院2000年1月至2007年12月需行心脏手术干预性治疗的34例妊娠合并心脏病患者的临床资料.结果:34例患者中17例因重度二尖瓣狭窄行经皮球囊扩张术(PBMV),术后二尖瓣瓣膜面积明显大于术前(P<0.01);在体外循环下行开胸手术者9例,其中7例因机械瓣膜血栓形成行瓣膜再置换术,1例为左房黏液瘤行切除术,另1例因华氏窦破裂行修补;5例因室上性心律失常行射频消融术,3例因Ⅲ度房室传导阻滞安装起搏器.22例患者的心功能Ⅲ～Ⅳ级,经手术后均改善为Ⅰ～Ⅱ级.治疗后34例孕产妇均存活,胎儿存活23例(67.6%),随访未发现异常.结论:对于妊娠合并心脏病需行手术干预者,应根据不同类型的心脏病及心功能状况,由多科室经验丰富的专家共同协作,制定个体化治疗方案,以期达到最佳治疗效果.     

超声新指标和脑利钠肽评估小儿室间隔缺损 合并肺动脉高压右室功能损害价值分析

目的    探讨组织多普勒（TDI）、二维斑点追踪技术（STI）和血清脑利钠肽（BNP）评估室间隔缺损（VSD）合并不同程度肺动脉高压（PH）患儿右心室功能的价值。方法    2008年6月至2010年6月在苏州大学附属儿童医院住院的VSD合并PH患儿68例,根据三尖瓣反流压差测得肺动脉压力程度分为轻度组（23例）、中度组（21例）、重度组（24例）。同时选择24名健康体检者作为正常对照组。采用GE VIVID7仪器测量右室长轴整体收缩期应变（GLS）和应变率（GLSR）,三尖瓣环脉冲组织多普勒图测量三尖瓣环收缩期峰值速度（Sa）、等容收缩加速度（IVA）、Tei指数,用M型超声测量三尖瓣环收缩期位移（TAPSE）。采用ELIASA法测血清脑钠钛（BNP）浓度。结果    （1） IVA和TAPSE随着PAH升高而降低,而Tei指数随着PAH增加而增大,3个指标除正常对照组和轻度组间差异无统计学意义外（P > 0.05）,其他各组间差异均有统计学意义（P < 0.05）。Sa在中、重度组间差异无统计学意义（P > 0.05）,在正常对照、轻度组间差异无统计学意义（P > 0.05）,其余组间有统计学意义（P < 0.05）。（2）右室GLS、GLSR随着PAH升高而减小,GLS在4组间两两比较差异有统计学意义（P < 0.05）;GLSR中度和重度组与正常对照组和轻度组差异有统计学意义（P < 0.05）,中重度间及正常对照组和轻度间差异无统计学意义（P>0.05）。（3）血清BNP浓度在VSD组中随着PAH程度的加重而升高,在4组间两两比较差异有统计学意义（P < 0.05）。（4）BNP与Tei指数及心功能分级相关性最好。结论    TDI和STI各个参数均能反映VSD合并PH患儿右心室功能,其中BNP和Tei指数与心功能相关性最好,而BNP和GLS可以反映轻度PAH时右室功能受损。     

心脏手术后妊娠分娩217例临床分析

目的:探讨心脏病患者孕前行心脏手术对妊娠结局的影响。方法:回顾性分析1993年1月至2010年9月上海交通大学医学院附属仁济医院妇产科收治的行心脏手术后妊娠及分娩的217例患者的临床资料,并与同期住院心脏疾病谱相同的孕前未行心脏手术的217例患者进行比较。结果:(1)手术组患者中先天性心脏病171例(78.80%),风湿性心脏病35例(16.13%),心律失常11例(5.07%)。(2)手术组患者中行先天性心房间隔缺损修补术60例(27.65%),室间隔缺损修补术47例(21.66%),动脉导管结扎/封堵术22例(10.14%),法洛氏四(三/五)联症矫治术25例(11.52%);风心二尖瓣换瓣/球囊扩张/成形/分离术28例(12.90%),二尖瓣、主动脉瓣联合换瓣术6例(2.76%);心脏起搏器术6例(2.76%),射频消融术5例(2.30%)等。(3)手术组患者孕期心功能Ⅰ～Ⅱ级209例(96.31%),心功能Ⅲ～Ⅳ级8例(3.69%),对照组患者孕期心功能Ⅰ～Ⅱ级183例(84.33%),心功能Ⅲ～Ⅳ级34例(15.67%)。手术组患者的孕前心功能分级与对照组比较无统计学意义(P=0.088),但孕期心功能Ⅰ～Ⅱ级者多于对照组,Ⅲ～Ⅳ级者明显减少,差异有统计学意义(P=0.000)。(4)手术组与对照组孕期发生急性心功能衰竭分别为4例(1.84%)、18例(8.29%),严重心律失常分别为1例(0.46%)、8例(3.69%);足月产儿分别为189例(87.10%)、147例(67.74%),早产儿分别为24例(11.06%)、57例(26.27%),小于胎龄儿分别为16例(12.44%)、42例(19.35%),新生儿窒息分别为3例(1.38%)、15例(6.91%),治疗性流产分别为2例(0.92%)、12例(5.53%),两组差异均有统计学意义(P<0.05)。(5)手术组中无孕产妇及围产儿死亡,对照组中孕产妇死亡2例(0.92%),围产儿死亡2例(0.92%)。结论:妊娠前心脏手术可改善患者孕期的心功能,约96%的患者心脏手术后心功能为Ⅰ～Ⅱ级,能顺利妊娠及分娩,且妊娠结局良好。     

Bénéfices et risques de l’accouchement dans l’eau : une revue systématique

ContextWater birth is under debate among professionals. For the proponents of this approach, immersion in water during labour and birth may increase maternal relaxation, reduce analgesia requirements and promote a model of obstetric care more focused on the needs of mothers, particularly the empowerment of women to realize their full potential. In contrast, major critics cite a risk of inhalation of water for the newborn and a risk of infection for the mother and the newborn.ObjectiveThis review tracks the state of scientific knowledge about water birth in order to determine if it can be generalized in hospitals.MethodA systematic review of the literature was conducted in PubMed, Embase and Cochrane Database. The period covered is from January 1989 to May 2013. The level of evidence of the studies was assessed with the analysis guide of the Haute Autorité de santé.ResultsThe level of evidence of the studies identified goes from moderate to low, particularly as regard to studies analysing the expulsion phase.ConclusionIt is possible to recommend immersion in water during the labour phase. No recommendation can be made as regard to the foetal expulsion phase.     

The role of inflammation in preterm birth—focus on periodontitis

It is universally accepted that acute inflammation is responsible for a substantial fraction of preterm births, particularly early cases. Much of this inflammation is caused by intrauterine infection. There is also evidence that infection and perhaps inflammation remote from the genitourinary tract can trigger preterm labour. Several studies have suggested that periodontitis during pregnancy increases the risk of preterm birth. Periodontitis may cause preterm birth by causing low-grade bacteraemia, which lodges in the decidua, chorion and amnion or by releasing endotoxin into the maternal circulation, which triggers intrauterine inflammation and preterm birth. Alternatively, it may release cytokines and other inflammatory products, which then trigger preterm labour. It is also conceivable that periodontitis might serve as a marker for other unhealthy behaviours, or immune hyperresponsiveness and that hyperresponsiveness to low-grade intrauterine infection itself might cause preterm birth. Currently, there are few data available to distinguish these possibilities. Such distinctions are important since they have clear implications for whether treatment of periodontitis might reduce the incidence of preterm birth. Several clinical trials of treatment of periodontitis are continuing, but until their results are known there is currently little evidence that treatment of periodontitis during pregnancy reduces the incidence of preterm birth.     

Progesterone and Preterm: Seventy Years of“Déjà Vu” or “Still To Be Seen”?

Abstract: Progestogens for the prevention of preterm birth have a long history. In 2003, two widely publicized double‐blind trials, one of daily vaginal progesterone suppositories and the other of weekly intramuscular injections of 17alpha‐hydroxyprogesterone, claimed that the treatments effectively reduce the incidence of preterm birth in women at risk of spontaneous preterm labor. Critical analysis of the reports provides no convincing evidence that either one of these treatments is worth pursuing outside the context of controlled research to determine, first, whether and, second, how the treatments might work.     

Quelle utilisation de la progestérone pour prévenir la prématurité ?

Widely prescribed in the years 1970–1980 to prolong gestation, progesterone has regained interest after the publication of randomized trials since 10 years. In women at increased risk of preterm birth with a history of preterm delivery or late miscarriage, the use of progesterone, especially intramuscularly may reduce the incidence of spontaneous preterm birth. In contrast, in cases of preterm labor or twin pregnancies, progesterone efficacy to reduce preterm birth has not been demonstrated. In women with asymptomatic midtrimester sonographic short cervix, randomized studies show conflicting results and new studies are necessary before its widespread utilisation.     

鄂州市中心医院近2年新生儿出生缺陷监测报告

目的：探讨新生儿出生缺陷发病趋势,发现其发病的高危影响因素。方法：回顾分析在我院产科出生的近两年发病例数,有效的减少新生儿出生缺陷发生率。结果：鄂州市中心医院近两年出生的4094例新生儿中有25例出生缺陷患儿,出生缺陷的病种有多指,马蹄内翻足,先天性脑积水,外耳畸形,腹裂,尿道下裂,大脑发育异常,脑静脉瘤,血管瘤,面部黑痣,腰骶部突出物,腹腔积液等。结论：新生儿出生缺陷多与基因突变、遗传因素、孕妇生活的外在环境因素有关,做好新生儿出生缺陷的三级预防工作可明显降低新生儿出生缺陷率。     

Alveolar fluid clearance in developing lungs and its role in neonatal transition.

Successful resuscitation of a fetus and a smooth transition to air breathing is a complex process that requires the orchestration of numerous events. The ability of the newborn to establish adequate ventilation and oxygenation is critically dependent on alveolar expansion and clearing of lung fluid. This transition is aided by changes, including a decrease in lung fluid production, that occur in the immediate period prior to birth. In neonates who face difficulty in establishing air exchange after birth, failure of adequate clearance of lung fluid is an important factor. Such infants are likely to benefit from efforts directed at increasing lung epithelial sodium reabsorption, which in turn will drive water out of the alveolar spaces. We are beginning to understand how these physiologic events occur and some of the factors that can speed up the process. Therapeutic modalities aimed at rescuing infants whose lungs continue to stay flooded are likely to reduce pulmonary morbidity and improve outcome.     

Women's experience of waterbirth

Five birthing centres were approached for permission to administer a questionnaire, giving a sample of 189 mothers who had experienced waterbirth. Mothers who had Apgars lower than 7 at 1 were excluded from the sample for ethical reasons. The results showed that waterbirth is a consumer-led trend, mainly pursued by educated middle class women. Better antenatal preparation is needed to reduce the need for other forms of analgesia when women are in water. Most women desired waterbirth as they thought it was a natural drug-free method and would be a less painful birth. They also wanted a gentle delivery for the baby and thought waterbirth seemed the right medium for this. They felt more in control of their environment in water, and particularly liked the relaxing calming quality of the water, the physical support it gave them and being able to hold their babies immediately after birth. Women's responses to the survey suggested that mothers perceived waterbirth as therapeutic. They demonstrated a strong desire for water in labour. There were no significant behaviour differences between water-born babies and non water-born babies.     

围孕期出生缺陷的预防

出生缺陷目前已成为影响人口素质和群体健康水平的公共卫生问题,是引起新生儿残疾、疾病甚至死亡的主要原因之一,严重影响了社会文明和人口素质的发展。开展围孕期保健可降低出生缺陷发生率。     

Sonographic assessment of cervical length and the risk of preterm birth

Sonographic assessment of cervical length is useful in evaluating the risk of preterm birth. Ultrasound is more accurate than digital exam and can be used in conjunction with fetal fibronectin (fFN) testing. Documentation of a long cervical length can reduce unnecessary treatments and hospitalizations in women who are unlikely to give birth preterm. Short cervical length can promote prompt intervention. Recognition of normal sonographic anatomy and proper measurement of the cervical canal are required.     

Does Bathing Newborns Remove Potentially Harmful Pathogens from the Skin?

Background: Newborn infants are routinely bathed after birth partly to reduce the possibility of transmitting potential pathogens to others. The extent to which a mild soap reduces the quantity and type of microbes found on the skin through normal colonization has not been reported. The objective of the study was to compare colonization rates between infants bathed in soap and water and infants bathed in plain water. Method: One hundred and forty infants were randomly assigned to one group bathed in a mild pH neutral soap and water or to another group bathed in water alone. Microbiology swabs were taken on three occasions (before the first bath, 1 hour after the bath, and 24 hours after birth) from two sites (anterior fontanelle and umbilical area). Results: No difference occurred between groups on type or quantity of organisms found at each time period. Skin colonization is a function of time, and the quantity of organisms identified increased over time (Friedman A ²= 111.379, df = 5, p < 0.001). Conclusions: Bathing with mild soap as opposed to bathing in water alone has minimal effect on skin bacterial colonization. Skin colonization increased over time. The findings did not support the efficacy of bathing with soap and water to reduce skin colonization of bacterial pathogens. Although the incidence of potential pathogens colonizing the skin during the first day of life is low and unlikely to pose a risk to healthy newborns, health care professionals may wish to wear gloves until the infant has been bathed.