老年血流感染患者病原菌分布及耐药性分析

目的对老年患者血流感染(BSI)病原菌分布及耐药情况进行分析,为临床合理用药提供依据。方法收集2016—2018年上海建工医院≥65岁住院患者血培养标本1 346例,分析病原菌分布及耐药情况。结果共分离病原菌112株(8.3%),其中革兰阴性菌占60.71%,以肠杆菌科细菌(52.7%)为主,检出率居前2位的是大肠埃希菌(32.14%)和肺炎克雷伯菌(12.5%);肠杆菌科细菌中,碳青霉烯类耐药菌检出率为17.3%,产超广谱β-内酰胺酶耐药菌占35.6%。革兰阳性菌占39.29%,以葡萄球菌属为主,包括凝固酶阴性葡萄球菌(10.7%)及金黄色葡萄球菌(8.9%);凝固酶阴性葡萄球菌中,耐甲氧西林凝固酶阴性葡萄球菌及甲氧西林敏感凝固酶阴性葡萄球菌分别占83.3%及16.7%;金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌及甲氧西林敏感金黄色葡萄球菌各占50.0%。3年阳性菌株检出数无显著变化。革兰阴性菌中,肠杆菌科细菌对阿米卡星、哌拉西林-他唑巴坦、亚胺培南及头孢替坦的耐药率为16.9%～20.4%,对氨苄西林、头孢唑啉的耐药率分别为94.2%、97.6%;非发酵菌对阿米卡星、哌拉西林-他唑巴坦的耐药率分别为16.7%、20.0%,对氨苄西林、头孢唑啉、头孢替坦的耐药率均为100%。革兰阳性菌中,葡萄球菌属细菌对万古霉素、替加环素、奎奴普丁-达福普丁及利奈唑胺均不耐药,对利福平的耐药率仅为4.8%,对红霉素、青霉素的耐药率分别为72.7%、88.9%;肠球菌属细菌对万古霉素、替加环素及利奈唑胺均敏感,但对红霉素的耐药率达93.3%。结论上海建工医院老年患者BSI病原菌以革兰阴性菌为主,大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌是最常见的病原菌,不同病原菌对抗菌药物表现出不同的耐药性,临床应注意合理用药。     

襄阳市中医医院血流感染病原菌的分布与耐药性分析

目的了解医院血流感染病原菌的分布和耐药状况,为临床治疗血流感染提供依据。方法收集襄阳市中医医院2014年1—12月门诊及住院血流感染患者血培养分离的病原菌及药敏试验资料进行回顾性分析。结果血培养共分离病原菌637株,其中以革兰阳性球菌为主,占55.4%;革兰阴性杆菌占44.1%;真菌占0.5%。病原菌检出率排在首位的是凝固酶阴性葡萄球菌,占34.9%;其次为大肠埃希菌,占14.4%;肺炎克雷伯菌,占9.9%;肠球菌属,占9.9%;金黄色葡萄球菌(金葡菌),占8.3%;鲍曼不动杆菌,占7.4%等。血培养葡萄球菌属细菌对青霉素高度耐药,对红霉素、克林霉素耐药率相对较高,对利福平的耐药率相对较低,尚未发现耐万古霉素、替考拉宁、利奈唑胺的菌株。肠球菌属中屎肠球菌的耐药率明显高于粪肠球菌。甲氧西林耐药金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为47.2%和59.0%。大肠埃希菌和肺炎克雷伯菌对第一、二代头孢菌素耐药率较高,对阿米卡星耐药率较低。产超广谱β内酰胺酶大肠埃希菌和肺炎克雷伯菌检出率分别为50.0%和36.5%。血流感染中鲍曼不动杆菌对亚胺培南的耐药率为51.1%,对米诺环素耐药率为29.7%;铜绿假单胞菌检出比例相对较小,对哌拉西林耐药率较高,对其他抗菌药物耐药率相对较低。结论血培养以革兰阳性球菌为主。应加强对医院血培养病原菌进行耐药监测,掌握其耐药特点,合理使用抗菌药物,防止耐药菌的传播。     

儿童血培养病原菌分布及耐药性分析

目的 回顾性分析该院2010年1月至2011年12月儿童血培养病原菌分布和耐药性特点,为该院儿童血流感染抗菌药物使用提供依据.方法 血培养采用BACTEC自动化血培养仪,菌株鉴定使用VITEK-32细菌鉴定系统或API鉴定系统.结果 2 134例血培养标本中共分离210株细菌,其中革兰阳性菌株157株(占74.76%),革兰阴性菌株53株(占25.24%).耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌56.12%,耐甲氧西林凝固酶阴性葡萄球菌占凝固酶阴性葡萄球菌79.07%,未检出耐万古霉素、替考拉宁革兰阳性球菌;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶分别占55.56%、46.15%,未检出耐碳青霉烯革兰阴性细菌.结论 该院儿童血培养主要病原菌为革兰阳性菌,且耐药株比例较高,重视抗菌药物的合理使用刻不容缓.     

2 527株临床分离病原菌的耐药性分析

目的 分析粤北人民医院临床分离病原菌对常用抗菌药的耐药性,为临床合理使用抗菌药物提供依据。方法 采用K-B法或MIC法对2013年2 527株临床分离株进行药敏试验。以CLSI 2012为判断标准,应用WHONET5.4和SPSS19.0软件进行数据分析,综合分析医院的耐药情况。结果 金黄色葡萄球菌中耐甲氧西林菌株占30.9%,耐甲氧西林凝固酶阴性葡萄球菌的检出率为76.2%,未检出万古霉素、利奈唑胺耐药菌株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌,屎肠球菌中未检出糖肽类和利奈唑胺耐药菌株,但是粪肠球菌中检出1株利奈唑胺耐药菌株,检出2株替考拉宁耐药菌株。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,大肠埃希菌、肺炎克雷伯菌中产ESBLs株分别为43.9%和37.5%,检出5株对多黏菌素B耐药的铜绿假单胞菌,多重耐药鲍曼不动杆菌占了63.7%。结论 临床病原菌耐药性较严重,应加强监测,临床应依据药敏结果合理的应用抗生素。     

2013年上海市青浦地区革兰阳性菌耐药性监测

目的了解2013年上海市青浦地区革兰阳性菌细菌耐药性监测结果,为临床合理使用抗菌药物提供依据。方法采用自动化仪器对青浦地区2所医院临床分离的革兰阳性菌进行药敏试验,采用CLSI 2014年版标准判断结果。结果 315株革兰阳性菌中,肠球菌属细菌、金黄色葡萄球菌(金葡萄)和凝固酶阴性葡萄球菌分别占40.3%(127/315)、36.5%(115/315)、20.3%(64/315)。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为48.7%和82.8%。甲氧西林耐药株对临床常用抗菌药物的耐药率均高于甲氧西林敏感株。葡萄球菌属和链球菌属细菌中未发现万古霉素和利奈唑胺耐药株。发现1株万古霉素耐药屎肠球菌和2株粪肠球菌。结论细菌耐药性仍对临床构成严重威胁,应引起临床严重关注。     

2019-2020年昆明某医院细菌耐药性监测

目的 分析云南圣约翰医院2019-2020年临床分离常见病原菌的分布及对常用抗菌药物的耐药情况.方法 收集2019-2020年住院患者送检标本的分离菌株,分析其菌群种类及耐药性变化趋势.结果 该院共分离非重复菌株2047株,其中革兰阳性菌309株,占15.1％;革兰阴性菌1738株,占84.9％.金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为41.8％和19.1％,未检出对万古霉素、利奈唑胺和替考拉宁耐药的葡萄球菌.肠球菌属以粪肠球菌、铅黄肠球菌和屎肠球菌为主,粪肠球菌对磺胺类和高浓度庆大霉素的耐药率高于屎肠球菌,未检出对万古霉素、替考拉宁和利奈唑胺耐药的菌株.肠杆菌科中,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌检出率分别为51.2％和13.7％;耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的检出率分别为6.6％、42.5％、56.5％和66.0％.肠杆菌科细菌对碳青霉烯类抗菌药物仍较为敏感,但肺炎克雷伯菌对亚胺培南和美罗培南的耐药率较高,分别为42.5％和46.1％;铜绿假单胞菌和鲍曼不动杆菌对上述两种药物的耐药率分别为56.5％和44.9％、66.0％和70.2％.结论 该院临床分离菌仍以革兰阴性菌为主,细菌耐药形势不容乐观,临床应重视药敏试验监测情况,合理选用抗菌药物,尤其要加强碳青霉烯类抗菌药物的合理使用.     

血培养常见病原菌分布和耐药性分析

目的 了解血培养常见病原菌的分布和耐药情况.方法 在5054份血培养标本中收集非重复分离株674株,其中革兰阳性菌63.2%,革兰阴性菌34.9%,真菌1.9%.以CLSI推荐的纸片扩散法测定其抗菌药物敏感性,用WHONET 5.4软件分析结果.结果 5054例血培养中,分离非重复株674,阳性率为13.3%.主要病原菌有凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌、肠球菌、链球菌、肺炎克雷伯菌等.其中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占凝固酶阴性葡萄球菌的83%,耐甲氧西林金黄色葡萄球菌（MRSA）占金黄色葡萄球菌的61.2%,未发现耐万古霉素的葡萄球菌,大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）的菌株分别为63.8%和35.5%,分离出13株真菌.高耐氨基甙类肠球菌（HLGR）检出率为58.1%,分离到耐万古霉素的肠球菌.结论 血培养中病原菌复杂多样,耐药率高,及时监测血培养中病原菌的耐药性对于指导临床合理用药、防止滥用抗生素、减少耐药菌株的产生是很有必要的.     

2012年度某院患者无菌体液耐药性监测的调查

目的 了解2012年度该院患者无菌体液的细菌分布和对抗菌药物的耐药性.方法 对临床送检的无菌体液标本按常规进行病原菌分离,采用Vitek2-Compact系统和ATB Express系统进行鉴定,测定抗菌药物的最低抑菌浓度（MIC）值,采用纸片扩散法（K-B）进行微生物敏感性试验.应用WHONET 5.6软件进行数据分析.结果 分离菌株556株,革兰阴性菌316株（57%）,革兰阳性菌226株（40%）.常见细菌分别为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、粪肠球菌、屎肠球菌、鲍曼不动杆菌、铜绿假单胞菌.大肠埃希菌、肺炎克雷伯菌的检出率分别为53.3%和21.1%;检出9株金黄色葡萄球菌,其中,耐甲氧西林金黄色葡萄球菌（66%）;耐甲氧西林凝固酶阴性葡萄球菌（74%）.未发现对万古霉素和利奈唑胺耐药的葡萄球菌.未发现对万古霉素耐药的肠球菌属细菌.大肠埃希菌、肺炎克雷伯菌对碳青酶烯类耐药的检出率分别为3.8%和3.8%.结论 及时监测病原菌的菌群种类、分布和耐药变迁以指导临床合理、规范地使用抗菌药物.     

2009～2011年本院临床标本病原菌分布及耐药性分析

目的 分析2009～2011年该院临床常见的病原菌的分布及耐药情况,指导临床科学合理用药.方法 收集2009～2011年该院临床送检标本,进行病原菌鉴定和药敏试验.结果 共分离到3 121株病原菌,其中2009年864株,2010年987株,2011年1 270株,常见病原菌在该院检出的总数及比例无明显差异.革兰阴性杆菌检出率明显高于革兰阳性球菌,约占60%～70%,真菌占18%.该院常见革兰阴性杆菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,对碳青霉烯类药物亚胺培南、美罗培南及复方制剂哌拉西林/他唑巴坦的敏感性较高,但对β-内酰胺类药物耐药率均超过50%.常见革兰阳性球菌为葡萄球菌、肠球菌和肺炎链球菌,其中葡萄球菌中,耐甲氧西林黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为54%、82%.革兰阳性球菌均对利奈唑胺和万古霉素敏感性均很高,但对青霉素几乎均耐药.结论 耐药性有升高趋势,应加强医院感染病原菌的监测,合理使用抗菌药物,切断耐药菌传播途径,降低院内感染发生率.     

2013-2019年无菌体液病原菌分布及耐药性分析

目的 了解本院2013年3月至2019年3月临床分离的脑脊液及其他无菌体液病原菌的分布及耐药情况。方法 收集和统计2013年3至2019年3月脑脊液及其他无菌体液标本分离的病原菌分布及耐药性特点,运用WHONET5.6软件进行菌株分布及药敏结果分析。结果 共分离病原菌1 450株,革兰阳性菌806株(55.6%);革兰阴性菌556株(38.3%);真菌88株(6.1%)。常见病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、粪肠球菌。无菌体液标本中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为35.8%和75.4%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。肠球菌属中屎肠球菌对除四环素外的大多数抗菌药物耐药率明显高于粪肠球菌。产超广谱内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为60.6%和65.9%,除肺炎克雷伯菌对亚胺培南耐药率大于10.0%,其他肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感。多重耐药鲍曼不动杆菌和铜绿假单胞菌检出率分别为65.3%和12.7%。结论 应加强常见耐药菌的监测,尤其是耐碳青霉烯类肠杆菌科细菌和多重耐药鲍曼不动杆菌应引起高度关注,根据药敏试验结果合理使用抗菌药物,加强耐药菌感染控制,以减少耐药菌株产生。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.