硝苯地平联合拉贝洛尔治疗对子痫前期患者脐动脉S/D值、胎儿血流动力学的影响#br#

Objective?To analyze the effects of nifedipine combined with labetalol in the treatment of preeclampsia (PE). Methods?110 patients with PE in Ma'anshan Maternal and Child Health Hospital were selected, and randomly divided into control group (54 cases, treated with magnesium sulfate and nifedipine) and observation group (56 cases, treated with labetalol based on the treatment of control group). Clinical effects and fetal hemodynamic parameters were compared between the two groups. Maternal and neonatal outcomes, and adverse reactions were recorded. Results?The total response rate in observation group was higher than that in the control group (P<0.05). After treatment, the 24-hour mean systolic blood pressure, 24-hour mean diastolic blood pressure, 24-hour mean arterial pressure, umbilical artery S/D value, arterial pulsatility index (PI) and arterial blood flow resistance index (RI) of observation group were lower than those of the control group (P<0.05). The incidences of adverse pregnancy outcomes and neonatal outcomes in observation group were lower than those in the control group, and 5 min Apgar score was higher (P<0.05). The incidence rates of adverse reactions were similar in the two groups (P>0.05). Conclusion?Nifedipine combined with labetalol in the treatment of PE can significantly improve the hemodynamic indexes of umbilical artery, which is beneficial to ensure good maternal and infant outcomes.     

硝苯地平联合拉贝洛尔治疗对子痫前期患者脐动脉S/D值、胎儿血流动力学的影响CSCD

目的 分析硝苯地平联合拉贝洛尔治疗子痫前期(PE)的疗效。方法 选取安徽省马鞍山市妇幼保健院PE患者110例,随机分为对照组(54例,予以硫酸镁及硝苯地平)、观察组(56例,在对照组基础上予以拉贝洛尔),比较两组临床疗效、治疗前后胎儿血流动力学相关参数,记录母婴结局、不良反应。结果 观察组治疗总有效率高于对照组(P <0.05);治疗后观察组24 h平均收缩压、平均舒张压、平均动脉压及脐动脉S/D值、动脉搏动指数(PI)、动脉血流阻力指数(RI)均低于对照组(P <0.05);观察组妊娠结局、新生儿结局不良发生率低于对照组,而出生后5 min Apgar评分高于对照组(均P <0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论 硝苯地平联合拉贝洛尔治疗PE可明显改善脐动脉血流动力学指标,有利于确保获得良好母婴结局。     

催产素激惹试验中胎儿脐动脉血流变化及其临床意义

目的　研究催产素激惹试验 (oxytocin challenge test,OCT)在脐动脉血流异常的高危妊娠中应用价值 ,及 OCT试验中同时行脐动脉血流检测的临床意义。　方法　对 170例脐动脉血管阻力增加但仍有舒张期前进血流的患者及 178例脐动脉血流正常的患者行 OCT试验 ,同时于 OCT试验中子宫收缩时和收缩间歇进行脐动脉血流检测。对于 OCT中子宫收缩时脐动脉血管阻力增加>0 .5的阳性 OCT患者于当日行剖宫产终止妊娠 ,余者试行阴道分娩。　结果　在脐动脉血流异常组和正常组 ,阳性 OCT发生率分别为 4 5 .3%和 10 .1% ,差异有显著性 (P<0 .0 0 1) ,伴子宫收缩时脐动脉血流增高 >0 .5的阳性 OCT发生率分别为 37.4 %和 6 .7% ,差异有显著性 (P<0 .0 0 1) ;对于 19例 OCT中没有脐动脉血流增高的阳性 OCT者 ,15例成功阴道分娩。在阴性 OCT组共有 30例患者在分娩过程中因胎儿宫内窘迫进行了手术产 (ODFD) ,其中 2 4例患者 OCT中子宫收缩时脐动脉血管阻力增加 >0 .5。对于不良围产期结果患者 ,78.6 %～ 81.8%发生于 ODFD患者。　结论　 OCT结合脐动脉血流检测对弥补 OCT假阳性和假阴性不足、筛选潜在宫内缺氧的脐动脉血流异常高危儿和改善围产期预后有重要临床价值。     

胎儿单脐动脉临床评估及预后

目的:了解单脐动脉胎儿的转归,围生结局及处理方式。方法:回顾我院近4年170例单脐动脉胎儿的临床资料(经超声、MRI、羊水或脐血染色体检查、引产胎儿尸体解剖结果等),随访出生后婴儿情况并进行临床评估及分析。结果:单脐动脉合并其他结构畸形的发生率为49.3%,合并一种畸形的发生率为15.9%,合并多种畸形发生率为33.3%;单脐动脉胎儿合并染色体异常发生率为18.4%;行MRI检查37例,与超声结果相符29例,8例与超声结果有差异,与超声符合率为78.4%。结论:超声检查易早期诊断单脐动脉,单脐动脉具有胎儿畸形的高风险性。单脐动脉合并其他结构畸形者建议行胎儿染色体检查。超声、染色体检查诊断未发现合并畸形的胎儿出生后仍有异常可能。单脐动脉不是剖宫产指征。     

胎盘成熟度超声分级与脐血流及围生儿结局的关系

目的探讨胎盘成熟度超声分级与脐血流改变及围生儿结局的关系。方法选择35～42周正常单胎妊娠孕妇253例,在分娩前1周内进行B超胎盘成熟度分级检查,其中101例孕妇同时进行了多普勒脐血流检查。根据Grannum胎盘成熟度分级,分为胎盘Ⅱ级组和Ⅲ级组,比较两组间脐动脉血流多普勒参数和新生儿预后指标。结果两组间的脐血流参数虽都在正常范围,但Ⅲ级胎盘组S/D值较Ⅱ级胎盘组明显升高(P<0.05);两组间羊水量、新生儿Apgar评分、新生儿体重差异无显著性,但胎盘Ⅲ级组羊水胎粪污染发生率、胎心监护异常及新生儿转科显著增加(P<0.05)。结论胎盘成熟的形态学改变可影响脐血流和胎儿的预后。     

胎盘和脐带肿物彩色多普勒超声诊断价值

目的:探讨胎盘和脐带肿物彩色多普勒超声的诊断价值.方法:分析产前彩色多普勒超声诊断为胎盘和脐带肿物20例患者的声像特点,并与产后病理检查比较.结果:超声诊断胎盘绒毛膜血管瘤7例,胎盘和脐带囊肿12例,脐静脉瘤l例.产后病理证实19例,超声误诊1例,超声诊断正确率为95％.结论:彩色多普勒超声是产前诊断胎儿附属结构肿物的有效和首选方法.     

Gross Abnormalities of the Umbilical Cord: Related Placental Histology and Clinical Significance

ObjectiveTo evaluate umbilical cord abnormalities predisposing to mechanical cord compression and determine their relationship to adverse clinical outcomes and stasis-associated histologic changes in the placenta.MethodsPlacental slides of 224 singleton pregnancies with gross cord abnormality (true knots, long cords, nuchal/body cords, abnormal cord insertion, hypercoiled cords, narrow cords with diminished Wharton's jelly), delivered on or after 28 weeks gestational age, and 317 gestational age-matched controls, were reviewed and specifically evaluated for the following histologic changes: (1) fetal vascular ectasia, (2) fetal vascular thrombosis, (3) and fetal thrombotic vasculopathy/avascular villi. These changes were analyzed in relation to both clinical information and findings at gross pathologic examination.ResultsGross cord abnormalities were associated with stillbirth, intrauterine growth restriction, non-reassuring fetal tracing, meconium-stained amniotic fluid, and increased rate of emergency Cesarean section. At microscopic evaluation, cases with gross cord abnormalities showed a statistically significant association with both ectasia and thrombosis in the fetal vasculature, as well as changes of fetal thrombotic vasculopathy in the terminal villi. When considering individual gross cord abnormalities, long cord and nuchal cord had the highest rates of thrombosis-related histopathology. Finally, cases with both abnormal cords and histologic thrombosis had significantly higher rates of adverse outcomes, including IUGR and stillbirth.ConclusionGross cord abnormalities predispose the fetus to stasis-induced vascular ectasia and thrombosis, thus leading to vascular obstruction and adverse neonatal outcome, including IUGR and stillbirth. We recommend a thorough histopathologic evaluation of all placentas with gross cord abnormalities predisposing to cord compression.     

Comparison of Diagnostic Efficacy of Umbilical Artery and Middle Cerebral Artery Waveform with Color Doppler Study for Detection of Intrauterine Growth Restriction

Background and Objectives

Intrauterine growth restriction is associated with increased perinatal mortality and morbidity, possibly extending also in adult life, as compared to fetuses and newborns presenting characteristics of normal growth. The present study had been planned to measure the pulsatility index (PI) and resistive index of the middle cerebral artery with pulsatility and resistive index of the umbilical artery in predicting fetal growth restriction.

Materials and Methods

A total of 60 pregnant women with a clinical history and grayscale-screened patients were taken for Doppler analysis, and a final comparison of accuracy of Doppler indices was done with perinatal outcome.

Statistical Analysis

The statistical analysis was done using the Statistical Package for Social Sciences version 15.0 statistical analysis software. The values were represented in number (%) and mean ± SD.

Observation and Results

The umbilical artery PI had maximum sensitivity at the third visit (32–37 weeks) and maximum specificity also at the third visit (32–37 weeks). The umbilical artery resistive index had maximum sensitivity at the second visit (28–32 weeks) and maximum specificity at the third visit (32–37 weeks). The MCA PI had an overall diagnostic accuracy of 52.8 %.

Conclusion

The PI of the umbilical artery was more sensitive than the PI of the middle cerebral artery. Umbilical artery PI has the maximum overall diagnostic accuracy of 75 %.     

胎儿心律失常的临床意义及预后的研究

目的 总结胎儿心律失常原因，进一步探讨其临床意义及对胎儿预后的影响。方法 采用回顾性分析方法，对26例胎儿心律失常孕妇的情况、胎儿心律失常的临床表现、诊断方法及长期随诊结果进行总结。结果 胎儿心律失常的发生率为0．2％。26例胎儿心律失常中，3例为胎儿心动过速(11．5％)，4例为胎儿心动过缓(15．4％)，19例为不规则胎儿心律(73．1％)；胎儿心律失常平均诊断孕周为35托周(15～41^ 1周)。26例中22例为产前胎心听诊时发现胎儿心律失常；1例为妊娠15周超声检查时发现胎儿心律失常；3例胎心监测发现胎儿心律失常。17例产前进行了胎儿超声心动检查，心脏结构未见异常，其中6例胎儿超声心动检查提示胎儿房性早搏，占35．3％，余未见异常。产后新生儿均存活，随诊24例(92．3％)，16例新生儿进行了超声心动检查，其中2例诊断为先天性心脏病，均为房间膈缺损。先天性心脏病新生儿在心律失常胎儿中发生率为7．7％。结论 大多数心律失常的胎儿预后是好的，心脏畸形的发生率很低。对于持续性心率慢的胎儿，需注意心脏结构异常的存在；对于心律失常胎儿的处理采用期待疗法，根据产科指征决定终止妊娠的方式。     

新生儿脐动脉血乳酸及血气分析检测的临床意义

目的　探讨新生儿脐动脉血乳酸及血气测定的意义。　方法　新生儿出生后第一次呼吸前即抽取脐动脉血测血气及乳酸值。　结果　共检测 6 2例新生儿 ,p H=7.2 2± 0 .0 7,剩余碱 =(- 5 .4± 2 .7) m Eq/L,乳酸 =(4 .4± 1.7) mm ol/L。脐动脉血乳酸与 p H呈明显负相关 (r=- 0 .86 ,P<0 .0 1) ,剩余碱与乳酸呈明显正相关 (r=0 .85 ,P<0 .0 1) ,胎心监护中晚期减速及持续减速对胎儿的酸碱状况影响明显 ,早期减速对新生儿出生时的 p H影响不大 ,但早期减速新生儿脐动脉血乳酸较无减速者明显增加。有阴道操作组和无阴道操作组 p H分别为 7.18± 0 .0 7和 7.2 4± 0 .0 6 ,两组比较差异有显著性 (P<0 .0 1) ,两组乳酸值差异无显著性。　结论　脐动脉血乳酸测定和 p H同样有临床意义 ,且标本采集较简单 ,有临床实用价值