第二产程胎心基线短变异参数预测胎儿窘迫的临床界值的研究

摘要： 目的 探讨胎心宫缩监护(cardiotocography,CTG)计算机分析系统中第二产程胎心基线短变异(short-term variation,STV)参数预测胎儿窘迫的临床界值及其意义。方法 2007年8月至2010年8月对1120例阴道顺产产妇进行产时胎心率监护,计算机分析第二产程CTG图形的STV值,其中450例取脐带血测定其脐动脉血气pH值,结合新生儿出生后1min Apgar评分情况进行分析。 结果 脐动脉血气pH值与其对应的STV值呈正相关（r=0.386,P＜0.01 ）;pH＜7.20组的STV值为（2.47±1.12）ms,明显低于pH7.20～7.25组的STV值（3.82±1.19）ms和pH＞7.25组的STV值（4.56±1.31）ms,差异均有统计学意义（P＜0.01）;1120例产妇中,STV＞4.0ms时,新生儿窒息率为0;STV<2.5ms时,新生儿窒息率增至51.28％。 结论 第二产程CTG中的STV＜2.5ms对预测胎儿窘迫有较高的临床价值,可作为一个较好的临床界值用于预测胎儿窘迫。     

第二产程胎心基线短变异参数预测胎儿窘迫的临床界值

目的 探讨胎心宫缩监护(cardiotocography,CTG)计算机分析系统中第二产程胎心基线短变异(short-term vsriation,STV)参数预测胎儿窘迫的临床界值及其意义.方法 对1 120例阴道顺产产妇进行产时胎心率监护,计算机分析第二产程CTC图形的STV值,其中450例取脐带血测定其脐动脉血气pH值,结合新生儿出生后1 min Apgar评分情况进行分析.结果 脐动脉血气pH值与其对应的STV值呈正相关(r=0.386,P<0.01);pH<7.20组的STV值为(2.47±1.12)ms,明显低于pH 7.20～7.25组[(3.82±1.19)ms]和pH>7.25组的STV值[(4.56±1.31)ms],差异均有统计学意义(P<0.01);1 120例产妇中,STV>4.0 ms时,新生儿窒息率为0;STV<2.5 ms时,新生儿窒息率增至51.28%.结论 第二产程CTG中的STV<2.5ms对预测胎儿窘迫有较高的临床价值,可作为一个较好的临床界值用于预测胎儿窘迫.     

分娩应激反应对255例胎儿脐动脉血酸碱平衡的影响

目的:探讨分娩应激反应对胎儿脐动脉血酸碱平衡的影响。方法:对住院分娩的255例产妇进行全产程连续电子胎心监护(electronicfetalmonitoring,EFM)。按EFM图形分为收缩刺激试验(CST)正常组(171例)、CST可疑组(74例)和CST阳性组(10例)。通过临产前母亲静脉血及新生儿脐动脉血血气分析和新生儿Apgar评分进行比较,了解胎儿宫内缺氧对新生儿的影响。结果:CST正常组、可疑组和阳性组新生儿窒息发生率分别为1.17%、4.05%和50.00%。母亲静脉血pH值分别为7.340±0.04、7.336±0.06和7.334±0.07,新生儿脐动脉血pH值分别为7.239±0.06、7.231±0.67和7.145±0.10。CST阳性组剖宫产率、新生儿窒息率与CST阴性组和CST可疑组比较,差异有极显著性(P<0.001),CST阴性组和CST可疑组比较,剖宫产率、阴道手术产率、新生儿窒息率无显著差异(P>0.05)。结论:分娩应激反应影响胎儿酸碱状态,早期发现和纠正胎儿缺氧,可降低新生儿窒息率。     

腰-硬联合与硬膜外麻醉对剖宫产新生儿的影响

目的观察腰-硬联合(CSEA)和连续硬膜外阻滞(EA)对新生儿的影响。方法选择足月单胎妊娠的健康产妇,预测胎儿大于2500 g的剖宫产手术60例,孕妇随机分CSEA及EA组,两组均在胎儿娩出时抽取脐动脉血进行血气分析,同时观察羊水状况和对新生儿进行Apgar评分,比较两组指标。结果CSEA组及EA组新生儿1min评分分别为(8.9±0.8)分(、8.5±1.1)分,差异无显著意义(P>0.05);胎儿娩出时脐动脉血的pH值,CSEA及EA组分别为7.24±0.06、7.25±0.07,差异无显著意义(P>0.05)。结论CSEA和EA均可以安全地用于剖宫产手术。     

活跃期联合应用胎心监护及脐动脉血流S/D值检测诊断胎儿宫内窘迫的价值

目的:探讨在产程活跃期联合应用胎心监护与脐动脉血流S/D检测能否提高胎儿窘迫的诊断水平,旨在及时准确地发现胎儿宫内缺氧同时减少不必要的干预。方法:156例进入产程活跃期的产妇根据连续胎心电子监护(cardiotocography,CTG)的结果分为晚期减速组(Late deceleration,LD组)及胎心监护正常的对照组。用彩色超声多普勒测定两组胎儿宫缩间歇期与宫缩时的脐动脉收缩期血流速度与舒张期血流速度之比(S/D),产后评定是否存在胎儿窘迫。结果:LD组宫缩间歇期、宫缩时脐动脉血流S/D值异常升高,且与胎儿窘迫有相关性;正常组S/D值与胎儿窘迫无相关性。两种方法联合应用预测胎儿窘迫的敏感性、特异性、阳性预测值、阴性预测值均高于单独使用CTG或脐动脉血流S/D值对胎儿窘迫的诊断水平。结论:活跃期联合应用胎心监护与脐动脉血流S/D值检测可以弥补CTG假阳性率过高的不足,提高胎儿窘迫的诊断水平。     

胎儿窘迫的母,胎血气与酸碱平衡变化

本文报道40例胎儿窘迫的临产妇和胎儿的血气变化。同时以无窘迫的临产妇、胎儿做对照。结果:1、母动脉、胎头、脐动脉、静脉血的pH、PO_2、HCO_2~-、TCO_2、ABE等窘迫组较对照组明显降低(P<0.01),而PCO_2则明显增高(P<0.01);2、母动脉血、胎头血的酸碱失衡类型.窘迫组较对照组混合性酸碱失衡明多显(P<0.01);3、胎头皮血pH<7.20老羊水Ⅲ°混浊占83.33%,Apgar<7分占95.8%,而pH≥7.25者,92.86%无新生儿窒息。     

脐动脉血气分析和 Apgar评分评估新生儿窒息的临床探讨

目的探讨脐动脉血气分析及Apgar评分在评估新生儿窒息中的临床意义。方法选择2012年3月～2013年3月广东省肇庆市第二人民医院分娩的84例新生儿作为研究对象,其中34例窒息新生儿为观察组．50例正常新生儿为对照组。分析两组新生儿出生时Apgar评分及脐动脉血血气分析与脏器损伤的关系,脐动脉血pH值与出生1minApgar评分的关系。结果观察组中,pH值〈7．2者占38．2％,对照组中pH值〈7．2者占16．0％,脐动脉血pH值较低的患儿,Apgar评分也较低,同时窒息的发生率较高,差异均有统计学意义（P〈0．05）。结论评估新生儿窒息不能没有血气分析的结果,脐动脉血气分析比Apgar评分对评估新生儿窒息更具客观性,两者结合,能反映胎儿宫内缺氧缺血程度,为临床正确及时诊断新生儿窒息提供可靠的科学依据。     

脐带血促甲状腺激素水平与出生时酸中毒风险

目的:围生期经历较多胎儿应激状态的新生儿脐带血促甲状腺激素(TSH)水平升高。本研究目的是评价TSH水平升高的新生儿脐带血酸碱状态。研究设计:研究人群为2366例单胎足月产新生儿。根据脐带血TSH水平,将其分为4组,比较4组之间脐带血酸碱度。同时研究脐带血酸碱度与TSH水平之间的关系。结果:TSH最高组(动脉血7.27±0.08vs静脉血7.32±0.07)和TSH次高组(动脉血7.29±0.07vs静脉血7.34±0.06)脐带血pH值显著低于TSH最低组(动脉血7.30±0.06vs静脉血7.35±0.05)。脐带血pH值≤7.20的发生率在4组中从TSH最低组至最高组分别为4.7%、6.8…     

脐动脉血气分析对新生儿窒息诊疗价值分析

目的探讨脐动脉血气分析对新生儿窒息诊治敏感性及特异性。方法选取2014年6月~2016年6月期间,于本院分娩的Apgar评分8分的单胎足月新生儿144例作为研究组,同时期于本院分娩的Apgar评分≥8分的单胎足月新生儿144例为对照组。新生儿分娩后的第一声啼哭前,采集其脐动脉血进行分析,检测其pH、PaO_2、PaCO_2、HCO_3~-及BE值并对比。结果对照组的PaO_2值、pH值和HCO_3~-显著高于研究组,而对照组中脐动脉血的PaCO_2值和BE绝对值显著低于研究组,差异有统计学意义(P0.05);对照组pH值7.20的新生儿显著少于研究组,但pH值7.21~7.25、7.25两种情况下新生儿均显著高于研究组,差异有统计学意义(P0.05);脐动脉血pH值7.20的新生儿HIE发病率显著高于pH值为7.21~7.25及7.25的新生儿,pH值为7.21~7.25的新生儿HIE发病率则显著高于pH值7.25的新生儿,差异有统计学意义(P0.05)。结论脐动脉血气分析对新生儿窒息诊治效果较好,值得临床关注。     

产程中电子胎心监护对胎儿窘迫的诊断价值

目的:探讨持续电子胎心监护(EFM)在分娩过程中的应用价值。方法:选择1 298例单胎足月孕妇作为观察组,在分娩过程中应用中央监护站系统进行持续EFM;同时选取既往产程中未行持续EFM的862例孕妇作为对照组。分别计算2组的羊水粪染率、以胎儿窘迫为指征的剖宫产率及产钳助产率、新生儿窒息率,并检测EFM异常孕妇分娩后新生儿脐动脉血pH值。结果:观察组以胎儿窘迫为指征的剖宫产率为21.4%,高于对照组的15.0%(P0.01);观察组新生儿窒息率及重度窒息率分别为4.5%和1.4%,低于对照组的7.2%和2.7%(P0.01和P0.05)。2组胎儿窘迫诊断率、羊水粪染率、以胎儿窘迫为指征的产钳助产率差异均无统计学意义(P0.05);观察组第二产程胎儿窘迫率10.7%,低于对照组的14.0%(P0.05)。观察组中EFM异常图形病例脐动脉血pH值为7.25±0.26,低于EFM正常图形病例的7.34±0.18(P0.01)。结论:采用中央监护站系统在产程中进行持续EFM,可以早期发现胎儿窘迫,为早期处理和干预提供依据。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.