86例子痫前期并发症的临床分析

目的分析子痫前期并发症临床特点及对母儿的影响。方法回顾性分析86例有心、肝、肾、脑等妊娠并发症的子痫前期患者的临床资料。36例发病孕周<34周,为早发型子痫前期组;50例发病孕周≥34周,为晚发型子痫前期组。结果子痫前期并发症以肝功能受损发生率最高,早发型组为77.8.%、晚发型组64%;晚发型组心衰发生率高于早发型组(P<0.05);早发型组尿蛋白定性和24 h尿蛋白定量高于晚发型组(P<0.05);早发型组围产儿死亡率、小于胎龄儿发生率和新生儿并发症发生率均高于晚发型组(P<0.05);围产儿死亡的影响因素有发病孕周、分娩孕周、入院时血压和新生儿体质量。结论子痫前期并发症以肝功能受损为主;早发型肾脏受损程度大于晚发型,而晚发型心衰发生率高于早发型;早发型子痫前期围产儿结局更差;重视纠正患者血压,延长孕周,可改善围产儿结局。     

早发型及晚发型子痫前期患者血脂代谢的变化及意义

目的:探讨早发型及晚发型子痫前期患者血脂代谢的变化及意义。方法:回顾性分析子痫前期孕妇89例,其中孕周<34周为早发组,共47例,孕周≥34周为晚发组,共42例。并随机选择同期孕周、年龄相同或相似的正常孕妇53例作为对照组,比较三组患者的血脂代谢变化。结果:三组患者TG指标,差异无统计学意义(P>0.05),早发组TC显著高于对照组及晚发组,差异有统计学意义(P<0.05)。对于HDL-C来说,对照组>晚发组,且差异有统计学意义(P<0.05),晚发组>早发组,差异有统计学意义(P<0.05);对于LDL-C、LDC-C/HDL-C、(TC-HDL-C)/HDL-C来说,早发组>晚发组,且差异有统计学意义(P<0.05),晚发组>正常组,差异有统计学意义(P<0.05)。结论:子痫前期患者血脂代谢可出现异常,应加强对孕妇血脂代谢的检测。     

86例子痫前期并发症的临床分析

目的 分析子痫前期并发症临床特点及对母儿的影响.方法 回顾性分析86例有心、肝、肾、脑等妊娠并发症的子痫前期患者的临床资料.36例发病孕周﹤34周,为早发型子痫前期组;50例发病孕周≥34周,为晚发型子痫前期组.结果 子痫前期并发症以肝功能受损发生率最高,早发型组为77.8.%、晚发型组64%;晚发型组心衰发生率高于早发型组(P＜0.05);早发型组尿蛋白定性和24 h尿蛋白定量高于晚发型组(P＜0.05);早发型组围产儿死亡率、小于胎龄儿发生率和新生儿并发症发生率均高于晚发型组(P＜0.05);围产儿死亡的影响因素有发病孕周、分娩孕周、入院时血压和新生儿体质量.结论 子痫前期并发症以肝功能受损为主;早发型肾脏受损程度大于晚发型,而晚发型心衰发生率高于早发型;早发型子痫前期围产儿结局更差;重视纠正患者血压,延长孕周,可改善围产儿结局.     

早发型重度子痫前期分娩孕周对母儿预后的影响

目的探讨早发型重度子痫前期不同分娩孕周对母儿预后的影响。方法收集2018年5月1日至2019年4月30日在深圳市宝安区妇幼保健院住院治疗并分娩的重度子痫前期患者351例临床资料进行统计分析。按终止妊娠孕周分为≤33~(+6)周分娩,早发型重度子痫前期(早发组)72例,≥34周分娩,晚发型重度子痫前期(晚发组)279例。比较两组的临床特点和母儿预后。结果两组孕妇年龄、产次和舒张压比较,差异均无统计学意义(P0.05)。期待治疗时间两组比较,差异有统计学意义(P0.05)。孕妇并发症包括低蛋白血症、心衰子痫、弥散性血管内凝血(DIC)、肺水肿、HELLP、肾功损害、胎盘早剥、视网膜损害,两组比较,差异均无统计学意义(P0.05)。针对重度子痫前期并发胎儿生长受限(FGR)、新生儿窒息、胎死宫内、新生儿死亡、围产儿死亡情况,早发组患病率明显高于晚发组,差异有统计学意义(P0.05)。结论早发型重度子痫前期患者对围产儿结局的影响明显比晚发型患者严重,因此在权衡终止妊娠的时间和母儿的利弊的时候应慎重选择,尽可能提高早发型重度子痫前期围产儿的存活率和减少围产儿的并发症。     

156例重度子痫前期严重并发症及妊娠结局分析

目的探讨重度子痫前期严重并发症发生情况及妊娠结局。方法回顾分析2010年1月～2011年5月我院产科收治的156例符合重度子痫前期诊断标准的患者,按重度子痫前期发病时间(以34周为界)不同分为:早发型76例、晚发型80例,观察早发型与晚发型重度子痫前期孕妇发生严重并发症发生率及构成比,观察早发型与晚发型重度子痫前期分娩方式及围生儿情况。结果早发型重度子痫前期76例出现严重并发症的发生率73.68%;晚发型重度子痫前期80例出现严重并发症的发生率61.25%;早发型剖宫产67例,阴道分娩9例,剖宫产率88.16%;晚发型剖宫产75例,阴道分娩5例,剖宫产率93.75%;早发型围生儿发生异常63例,发生率82.89%;晚发型围生儿发生异常34例,发生率42.5%。结论重度子痫前期进行严密临床监测,积极期待治疗,适当延长孕周,严格掌握终止妊娠指征,选择适当时机终止妊娠,以达到减少严重并发症发生及改善围生儿结局目的 。     

80例重度子痫前期的临床特点和妊娠结局分析

目的:探讨早发型及晚发型重度子痫前期的临床特点及围产结局。方法:回顾性分析东南大学附属江阴医院产科2010年1月至2012年2月收治的重度子痫前期80例患者的临床资料,将其分为早发型重度子痫前期组(早发型组,妊娠<34周,20例)和晚发型重度子痫前期组(晚发型组,妊娠≥34周,60例)。结果:孕产妇并发症早发型组高于晚发型组,终止妊娠的孕周早于晚发型组,终止妊娠的方式剖宫产率高于晚发型组,差异均具有统计学意义(P<0.05);胎儿窘迫、死胎、胎儿生长受限、新生儿窒息、新生儿死亡等发生率早发型组显著高于晚发型组(P<0.01)。结论:早发型重度子痫前期严重影响母婴预后,适当期限的期待治疗有助于改善母婴结局,剖宫产是终止重度子痫前期的主要方法。     

早发型重度子痫前期患者胎盘组织M-CSF、CRH和HO-2表达的研究

目的：研究早发型重度子痫前期患者胎盘组织中巨噬细胞集落刺激因子(MCSF)、促肾上腺皮质激素释放激素(CRH)、血红素氧化酶-2(HO-2)的表达,探讨它们在早发型重度子痫前期发病机制中的作用。方法整群选择选自2013年9月—2014年8月在郑州大学第三附属医院住院的孕妇73例,年龄22~37岁,孕周32~37周。早发型重度子痫前期患者25例,晚发型重度子痫前期患者23例,正常妊娠对照组25例进行实验对照研究,应用免疫组化方法研究M-CSF、CRH、HO-2的表达情况。结果①三期组孕妇之间年龄、终止妊娠孕周比较,差异均无统计学意义(P﹥0.05)(见表1)。②与正常妊娠组比较,早发型及晚发型重度子痫前期组M-CSF表达水平均明显升高;早发型组M-CSF表达水平明显高于晚发型组。③与正常妊娠组比较,早发型及晚发型组CRH表达水平均明显升高;早发型组CRH表达水平明显高于晚发型组。④与正常妊娠组比较,早发型及晚发型组HO-2表达水平均明显降低;早发型组HO-2表达水平低于晚发型组,差异无统计学意义(P﹥0.05)。结论胎盘中MCSF、CRH的表达增加和HO-2表达降低可能与早发型重度子痫前期的发病有关。     

早发型子痫前期的临床特点及治疗分析

目的探讨早发型重度子痫前期的临床特点及治疗。方法2004年1月至2008年12月收治早发型子痫前期重度患者38例,按1：1比例随机抽取同期晚发型子痫前期患者38例作为晚发型组,进行对比。结果两组间孕妇入院孕周有统计学差异;早发组期待治疗时间明显长于晚发组,差异有统计学意义。早发组产妇并发症明显高于晚发组。早发组围产儿死亡率显著高于晚发组,差异具有显著性。结论对早发型重度子痫前期患者加强护理和监测,采取个体化冶疗,才能在保证母亲安全的同时,尽可能期待、延长孕周,以改善围生儿预后。     

子痫前期重度早发型及晚发型临床结局探讨

目的:探讨子痫前期重度早发型与晚发型的临床结局及临床界定。方法:分析119例子痫前期重度患者的临床资料,119例按发病孕周不同分为3组:A组:发病孕周小于32周;B组:发病孕周32～34周;C组:发病孕期大于34周。统计3组发病孕期、分娩孕周、住院时间,比较孕产妇并发症及围产儿结局。结果:(1)3组平均孕产妇年龄、孕次、产次,入院时收缩压及舒张压比较,无显著性差异(P>0.05);组组之间行统计学比较,发病孕周与妊娠终止孕周、治疗时间、妊娠合并症及新生儿结局,成正相关性。(2)2种界定方案分组统计比较孕龄长短、新生儿、母亲合并症及感染等状况,34周为界定早发型子痫前期重度,新生儿预后明显好于32周发病孕周的患者。结论:(1)发病越早,妊娠终止孕周越早,并进行治疗所需时间越长,妊娠合并症及新生儿窒息和新生儿病死率越高。(2)将32周做为界定值更能反映早发型子痫前期重度的围产儿结局及不良预后程度,并明确显示早发型与晚发型子痫前期的围产儿结局不同。     

早发型重度子痫前期妊娠116例结局分析

目的探讨早发型重度子痫前期的临床转归。方法收集天津市中心妇产科医院2008年1～12月住院分娩116例重度子痫前期孕妇的临床资料,按发病孕周将患者分为两组：55例孕周≤32周为早发型重度子痫前期（earlyonset severe pre-eclampsia,EOSP）组,61例孕周〉32周为晚发型重度子痫前期（late onset severe pre-eclampsia,LOSP）组。主要分析指标：发病孕周、终止妊娠孕周、保守治疗时间、孕妇严重并发症、围产儿死亡、新生儿窒息。结果两组孕妇并发症发生率、新生儿窒息、围产儿死亡情况比较,差异有显著性（P〈0.05）;早发型组保守治疗时间为（4.56±3.01）d,晚发型组为（3.08±2.14）d,两组保守治疗时间比较,差异有显著性（P〈0.05）。结论早发型重度子痫前期发病早、病情重,对母婴危害极大。恰当的围产期管理并适时终止妊娠可改善母婴妊娠结局,剖宫产是早发型重度子痫前期的主要分娩方式。     

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.