腹膜外子宫下段剖宫产术在临产后剖宫产中的应用

目的 探讨腹膜外子宫下段剖宫产术在临产后剖宫产中应用的特点.方法 80例临产后需要剖宫产的孕妇,随机分为观察组和对照组,每组40例,观察组行腹膜外子宫下段剖宫产术,对照组行腹膜内子宫下段剖宫产术,对比分析两组从切皮到取出胎儿的时间、总手术时间、术中出血量、术中膀胱及输尿管损伤、新生儿评分、新生儿体质量及产后恢复情况.结果 从切皮到取出胎儿的手术时间、总手术时间、产妇下床活动时间、肛门排气时间两组比较差异有统计学意义(P＜0.05).术中出血量、术中损伤情况、产后病率、新生儿评分、新生儿体质量两组比较差异均无统计学意义(P＞0.05).结论 孕足月孕妇临产后剖宫产采用腹膜外子宫下段剖宫产术手术时间短,术后恢复快,值得推广.     

子宫背带式缝合术治疗在剖宫产术中对产后出血的疗效评价

目的:探讨子宫背带式缝合术治疗在剖宫产术中对产后出血的疗效。方法:将60例行剖宫产手术的产妇按照抽签方法随机地均分为对照组与观察组,对照组采用双侧子宫动脉上行支结扎及宫腔填塞纱条进行治疗,观察组采用子宫背带式缝合术治疗。比较两组手术时间、产后出血、产褥病率、切除子宫率及不良反应发生率。结果:观察组手术时间、产后出血、产褥病率及切除子宫率均显著小于对照组差异有统计学意义(P<0.05);对照组不良反应发生率为30.00%,观察组为10.00%,两组差异具有统计学意义(P<0.05)。结论:子宫背带式缝合术治疗在剖宫产术中对产后出血的疗效显著,应在临床上进行推广。     

新式剖宫产术132例分析

目的:探讨新式剖宫产术的临床价值。方法:随机抽取同期228例足月妊娠,具有手术指征的孕妇分为新式剖宫产术组和传统剖宫产术组,新式剖宫产术132例为新式组,传统剖宫产术96例为对照组,对两组手术时间、出血量、术后排气时间、术后疼痛、术后病率、切口愈合、切口感染、新生儿Apgar评分及体重等情况进行对比观察。结果:新式组比对照组手术时间缩短,平均缩短(30~40)min;术后排气时间平均缩短(6~8)小时;术中出血少,平均减少200mL,有显著差别性(P<0.01);术后病率低,术后24小时疼痛轻于对照组,有显著差别性(P<0.05);新生儿Apgar评分及体重比较无差别(P>0.05)。结论:新式剖宫产术具有手术时间短、术中出血少、术后疼痛轻、术后病率低、切口愈合美观等优点,值得临床推广。     

改良式B-lynch缝合术在剖宫产产后出血中的应用

目的探讨改良式B-lynch缝合术在治疗剖宫产产后出血的可行性。方法回顾性分析明光市人民医2009年1月-2012年8月3741例剖宫产,将宫缩乏力性产后出血的病例分为两组,研究组40例施行改良式B-lynch缝合术治疗,对照组40例采用传统方法治疗,计算两组手术时间、产后出血量、产褥病率,并观察术后及随访情况。结果产妇手术时间:研究组(55±10)min,对照组(67±15)min,两组比较差异有显著性。产后出血量:研究组(650±165)ml,对照组(905±182)ml,两组比较差异有统计学意义。产褥病率:研究组7.5%,对照组25%,两组比较差异有显著性。两组均无严重并发症。结论改良式B-lynch缝合术操作简单、安全、止血效果确切,是治疗剖宫产产后出血行之有效的止血的方法。     

传统剖宫产与新式剖宫产术后再次剖宫产289例临床分析

目的 分析不同剖宫产手术方式对再次剖宫产的影响,了解瘢痕子宫再次剖宫产手术的风险,以提高手术的安全性.方法 网顾性分析289例再次剖宫产患者.其中对照组157例,前次手术为传统的腹部纵切口子宫下段剖宫产术,研究组132例,前次手术为新式剖宫产术.比较两组患者一般情况,包括:前次剖宫产间隔时间、年龄、孕周、新生儿体重等方面;术中情况,包括:开腹时间、总手术时间、术中出血量、粘连状况;术后情况,包括:术后排气时间、产褥病率、切口感染、产后出血.结果 两组间一般情况各项比较.差异均无统计学意义.术中情况比较,研究组手术开腹时间、总手术时间、无粘连例数和重度粘连例数均明显低于对照组,前者分别为(8.33±2.65)min、(43.79±3.65)min、57例、15例,后者分别为(11.25±4.03)min、(51.95±4.55)min、47例、48例,差异有统计学意义(P<0.05).术后情况比较,术后排气时间差异有统计学意义(P<0.01).结论 新式剖宫产再次手术因粘连发生率低、手术时间短、术后恢复快,有利于降低再次剖宫产的手术难度和并发症的发生,值得在临床加以推广.     

剖宫产术中子宫肌瘤剥除术临床分析

目的:探讨剖宫产术中子宫肌瘤剥除术的安全性和可行性。方法:回顾性分析剖宫产术中子宫肌瘤剥除术患者的临床资料,观察其手术时间、术中出血、产后出血、术后病率、住院时间等情况,并与同期单纯剖宫产进行比较分析。观察组及对照组各81例。结果:观察组手术时间较对照组延长(P<0.05),但两组术中出血量、产后出血量、术后患病率、住院天数比较无显著性差异(P>0.05)。结论:做好术前准备,剖宫产术中子宫肌瘤剥除术是安全可行的。     

瘢痕子宫二次妊娠剖宫产术后并发症发生情况分

目的分析瘢痕子宫二次妊娠剖宫产术后并发症发生情况。方法以瘢痕子宫二次妊娠剖宫产患者作为观察组,以无瘢痕子宫的二次妊娠剖宫产患者作为对照组,观察两者的差异。结果观察组患者术中出血量(350.54±12.52)mL、分娩时间(57.60±3.58)min、手术时间(7.96±2.65)min、产后出血率28.57%、子宫破裂率9.52%、胎盘植入率11.90%、盆腔粘连率19.05%。对照组患者术中出血量(204.58±11.04)mL、分娩时间(32.18±1.77)min、手术时间(15.13±1.30)min、产后出血率4.76%、子宫破裂率为0、胎盘植入率为0、盆腔粘连率2.38%。两组数据相比,差异显著(P0.05)。结论瘢痕子宫二次妊娠剖宫产患者,分娩时间长,术中出血量大。产后出血、子宫破裂、胎盘植入及盆腔粘连等并发症发生率高。     

新式子宫压缩缝合术联合安列克在剖宫产术子宫大出血中的应用

目的探讨新式子宫压缩缝合术联合安列克对剖宫产术中子宫出血的治疗作用。方法将2011年5月至2012年5月在我院剖宫产术中发生大出血的孕妇40例随机分为研究组和对照组各20例。研究组术中实施新式子宫压缩缝合术,同时深部肌注安列克250μg,对照组只术中肌注安列克250μg。观察两组术中及术后24h出血量、产后出血率、子宫收缩所用时间、术后重复肌注安列克的例数、新生儿窒息率及产褥病率。结果研究组术中及术后24h出血量、产后出血率、重复使用安列克的例数、子宫收缩所用时间均少于对照组,差异有统计学意义(P<0.05);新生儿窒息率及产褥病率差异无统计学意义(P>0.05)。结论新式子宫压缩缝合术联合安列克能有效治疗剖宫产术中、术后的产后出血,也不增加新生儿窒息率及产褥病率。     

两种介入治疗方法预防前置胎盘产后出血临床疗效分析

目的:探讨两种介入方法在预防前置胎盘产后出血的临床价值。方法:将56例前置胎盘孕妇随机分为对照组与观察组各28例,观察组行动脉球囊封堵术,对照组行子宫动脉栓塞术,比较两组患者手术时间、术中出血量、24h出血量、子宫切除率、产褥病率、新生儿窒息率以及不良反应发生情况。结果:两组患者在手术时间、术中出血量、术后24h出血量、子宫切除率、产褥病率、新生儿窒息率方面比较差异无统计学意义。对照组与观察组不良反应发生率分别为21.4%(6/28)、3.6%(1/28),两组比较差异有统计学意义。结论:动脉球囊封堵术与动脉栓塞术均具有预防前置胎盘孕妇产后出血的作用,动脉球囊封堵术安全性相对较好。     

剖宫产术后再次妊娠分娩方式的选择

目的:探讨剖宫产术后再次妊娠分娩方式的选择。方法:剖宫产术后再次妊娠晚期分娩孕妇614例为观察组,分4组:A组为剖宫产术后阴道分娩组;B组为具备阴道试产条件但选择重复剖宫产分娩组;C组为第二次剖宫产分娩组(包括B组);D组为第三次及四次剖宫产分娩组。选择无剖宫产史晚期分娩孕妇376例为对照组,分为2组:阴道分娩组(E组)和首次剖宫产组(F组)。将A组与B组,A组与E组,C、D组与F组配对比较,对母婴并发症、手术时间及住院时间等进行回顾性分析。结果:A组产后出血量和住院时间均明显少于B组(P<0.01),2组产褥病率及新生儿窒息率差异均无统计学意义(P>0.05);A组与E组产后出血量、产褥病率、住院时间、新生儿窒息率及阴道助产率差异均无统计学意义(P>0.05),A组会阴切开率较E组明显升高(P<0.01);C组、D组与F组产后出血量、产褥病率、住院时间及新生儿窒息率差异均无统计学意义(P>0.05),F组手术时间和盆腹腔粘连率均明显少于C组(P<0.01),C组和F组手术时间和盆腹腔粘连率亦显著小于D组(P<0.01)。结论:剖宫产术后再次妊娠,经过严格评估、筛选,对符合阴道分娩条件的孕妇实施阴道试产是安全的,与再次剖宫产相比可明显缩短住院时间,减少母婴并发症。     

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.