妊娠剧吐与微量元素的关系

目的：通过测定妊娠剧吐孕妇头发中微量元素的含量,与同期正常孕妇做对照,以探讨微量元素与妊娠剧吐的关系,为临床诊断、治疗、预防提供科学的依据。方法：选择妊娠剧吐孕妇200例及同期正常孕妇200例,分别检测其发中微量元素锌、铜、硒、锰的含量,结果进行统计学分析。结果：研究组孕妇发中锌和锰的含量显著低于对照组。结论：微量元素锌和锰的缺乏与妊娠剧吐的发生有一定的关系。     

舒适护理在妊娠剧吐患者中的应用分析

目的探讨舒适护理在妊娠剧吐患者中的应用,以便为临床上提供有价值的参考。方法选取在2006~2010年间入我院分娩的78例妊娠妇女,年龄在19~34岁,将78例产妇随机分为两组,观察组40例,对照组38例,观察组对妊娠期妇女采用舒适护理,对照组对妊娠期妇女则采用常规护理。对两组妊娠期妇女的恢复情况进行跟踪观察,并记录所得数据。结果经过对分妊娠期妇女进行一系列的护理,两组妊娠期妇女的生命体征都较为稳定。观察组剧吐率、紧张导致难产率、新生儿窒息率明显低于对照组(P<0.05)。顺利生产明显高于对照组(P<0.05)。结论对分娩期的妊娠期妇女实行舒适护理的效果较为显著,可以有效减少妊娠期妇女的剧吐想象,稳定妊娠期妇女的各项生命体征,保证其顺利分娩,值得在临床推广应用。     

综合干预在妊娠剧吐孕妇中应用的效果评价

目的探讨综合干预对妊娠剧吐孕妇的应用效果。方法按随机数字表法将100例妊娠剧吐孕妇随机分为观察组和对照组各50例,对照组给予补充能量,纠正水、电解质、酸碱平衡失调等常规疗法,实施临床常规护理和健康教育。观察组在此基础上进行综合干预,包括中药治疗、认知干预、行为干预及家庭干预。比较两组孕妇的临床护理效果及其对护理工作的满意度。结果观察组孕妇的临床护理效果及其对护理工作的满意度明显高于对照组,差异有统计学意义（P〈0．01）。结论对妊娠剧吐孕妇实施综合干预可提高临床护理效果及其对护理工作的满意度,改善生活质量,促进疾病康复,值得在临床推广应用。     

妊娠20周前甲状腺功能变化分析

目的：探讨妊娠20周前甲状腺功能参考范围及甲状腺功能异常患病率。方法选取行产检的健康单胎初产妇1706例及同期健康检查的非妊娠女性为研究对象,测定其甲状腺功能,分析甲状腺功能变化特点。结果促甲状腺激素（ TSH）中位数值最低、最高分别为孕8周、孕19^＋6周,分别为0．90 mU／L、2．74 mU／L;游离甲状腺素（ FT4）中位数值最低、最高分别为孕9周、孕19^＋6周,分别为11．34 pmol／L、8．75 pmol／L;TSH随妊娠时间的延长,逐渐增加,而FT4逐渐降低。与非妊娠女性相比,孕8～12^＋6周孕妇TSH中位数下降28．48％,34例孕妇FSH低于非妊娠期参考范围,占5．54％。 FT4较非妊娠女性中位数增加7．98％,39例孕妇FT4高于非妊娠期参考范围,占6．35％。以第2．5百分数和第97．5百分位为甲状腺功能正常参考范围,非妊娠女性、孕8～12^＋6周、孕13～16^＋6周、孕17～19^＋6周TSH 参考范围分别为0．16～5．90 mU／L、0．03～3．66 mU／L、0．06～3．75 mU／L、0．32～4．32 mU／L, FT4分别为6．70～14．04 pmol／L、7．99～18．67 pmol／L、6．19～16．23 pmol／L、6．43～13．50 pmol／L。在1706例妊娠20周前孕妇中,41例存在甲状腺功能异常,总患病率为2．40％,其中1例甲亢、1例甲减、33例亚临床甲减、6例低T4血症,最常见的为亚临床甲减。甲状腺过氧化物酶自身抗体（TPOAb）阳性率为18．70％。结论 TSH于妊娠8～12^＋6周逐渐下降,后逐渐升高;而FT4于妊娠8～12^＋6周逐渐升高,后逐渐降低;甲状腺功能异常中以亚临床甲减最为常见,建议妊娠早期常规行甲状腺功能检查。     

Raised serum human chorionic gonadotrophin concentrations in hyperemesis gravidarum.

Serum human chorionic gonadotrophin (HCG) concentrations were determined by radioimmunoassay with an antiserum specific to HCG beta-subunit in 42 patients with hyperemesis gravidarum and 115 women with normal pregnancies. Mean concentrations (+/- SE of mean) were higher in the women with hyperemesis gravidarum at 7-8 weeks (40.8 +/- 5.2 IU/ml v 22.1 +/- 1.4 IU/ml; P less than 0.001), 9-11 weeks (38.1 +/- 2.3 IU/ml v 27.1 +/- 2.1 IU/ml; P less than 0.0025), and 12-14 weeks of gestation (35.9 +/- 4.2 IU/ml v 25.1 +/- 1.7 IU/ml; P less than 0.005), but there was no difference between the two groups at 15-20 weeks of gestation. In the hyperemesis gravidarum group primigravid women had a higher (P less than 0.005) mean HCG concentration (41.8 +/- 4.0 IU/ml) than multigravid women (32.2 +/- 2.3 IU/ml). The results suggest a causal relation between a high serum HCG concentration and hyperemesis gravidarum.     

静脉营养用于妊娠剧吐的疗效观察

目的探讨静脉营养用于妊娠剧吐的有效治疗方法。方法 73例妊娠剧吐患者分为对照组35例与治疗组38例,分别采用单用静脉补液方法和常规静脉补充营养液方法。结果在治疗结束后3d,治疗组的患者体重表现出逐渐恢复的效果,同时饮食转向正常,从治愈率和总有效率的比较看,相对于对照组,治疗组显示出了差异具备显著性(均P<0.05),患者均顺利度过妊娠前3个月,没有终止妊娠的患者;对16例患者进行随访,都顺利分娩。结论针对妊娠剧吐的而患者给予静脉营养,其疗效显著。     

Inter- and intrasubject variability of gastric emptying in healthy volunteers measured by scintigraphy and paracetamol absorption.

1. Inter- and intrasubject variability in the gastric emptying of semisolids and liquids was measured by scintigraphic emptying of radionuclide-labelled semisolid and from paracetamol absorption in ten healthy volunteers of both sexes. 2. The intrasubject variability was not statistically significant for any of scintigraphic or paracetamol absorption parameters. 3. The intersubject variation was significant for all scintigraphic and paracetamol absorption parameters. 4. In women, the gastric emptying rate of semisolid decreased linearly during the menstrual cycle. 5. The lag period and paracetamol absorption parameters were unrelated to the day of the menstrual cycle day. 6. There was no statistically significant relationship between scintigraphic and paracetamol absorption parameters.     

Hyperemesis gravidarum: pathogenesis and the use of antiemetic agents

INTRODUCTION: Nausea and vomiting in pregnancy remains the most common cause of hospitalization in the first half of pregnancy. Although the exact cause is largely unknown, an interaction of genetic, biological and psychological factors is plausible. An endocrine trigger for hyperemesis has been linked with both ovarian and placental hormones, but this association requires further clarification. The use of type-3 serotonin receptor antagonists is increasing but as yet there are no convincing data to demonstrate their superiority over the other antiemetics. AREAS COVERED: A computerized search was conducted using PubMed, Embase, Cinahl, Lilacs, ISI Web of Science, the Cochrane Central Register of Controlled Trials (all from inception or 1960 to October 2010), and Research Registries of ongoing trials. The key words used were nausea, vomiting, emesis, hyperemesis gravidarum, morning sickness, pregnancy, pregnancy complications, treatment, efficacy, effectiveness, antiemetics, safety and teratogenesis. EXPERT OPINION: The precise mechanism underlying hyperemesis gravidarum remains unclear, but appears to be multifactorial. As yet there is no evidence that any antiemetic class is superior to another with respect to effectiveness.     

Does intravenous ondansetron affect gastric emptying of a solid meal,gastric electrical activity or blood hormone levels in healthy volunteers?

BACKGROUND: In previous studies, tropisetron has been shown to accelerate gastric emptying of a solid meal. However, it is uncertain whether other specific 5-hydroxytryptamine-3 receptor antagonists, such as ondansetron, also have a gastroprokinetic effect in humans. AIM: To evaluate the effect of ondansetron on gastric half-emptying time (T1/2) of a solid meal, gastric myoelectrical activity and hormone levels in 14 healthy volunteers. METHODS: In a placebo-controlled, randomized, crossover study, we investigated the effects of ondansetron (8 mg intravenously) on the gastric emptying of solids (by scintigraphy), gastric myoelectrical activity (by electrogastrography) and the post-prandial release of cholecystokinin, gastrin, human pancreatic polypeptide, gastric inhibitory polypeptide, vasoactive intestinal polypeptide, motilin, substance P and galanin. RESULTS: The average T1/2 values were 86 min and 85.5 min without lag time (P=0.082) and 92 min and 93 min with lag time (P=0.158) for the placebo and ondansetron treatments, respectively. The average T1/2 of female volunteers was significantly longer than that of male volunteers. The dominant gastric electrical frequency and hormone plasma concentrations were not altered by ondansetron. CONCLUSIONS: Ondansetron did not affect the gastric emptying of solids, the dominant gastric electrical frequency or the plasma concentrations of the analysed gastrointestinal peptides.     

Investigation of the influence of pregnancy on the role of nitric oxide in gastric emptying and non-adrenergic non-cholinergic relaxation in the rat

The influence of pregnancy on the role of nitric oxide (NO) in gastric emptying and in non-adrenergic non-cholinergic (NANC) relaxation was studied in rats. The gastric emptying of a non-nutrient liquid solution and of polysterene beads was studied in non-pregnant (NP), 6 to 7 days pregnant (P7) and 18 to 20 days pregnant (P20) rats. Longitudinal muscle strips of the gastric fundus and circular muscle strips of the pylorus were isolated from NP and P20 rats and NANC relaxations were induced by electrical field stimulation. The gastric emptying of the liquid meal was significantly increased in P20 rats as compared to NP and P7 rats. In NP rats, N^G-nitro-L-arginine methyl ester (L-NAME) dose-dependently (50–150 mg/kg ip) reduced the gastric liquid emptying; the inhibitory effect of 100 mg/kg L-NAME ip was prevented by 400 mg/kg ip L-arginine and was mimicked by 100 mg/kg N^G-monomethyl-L-arginine (L-NMMA). The percentage inhibition of the liquid emptying by L-NAME did not differ between the 3 groups, except for the dose of 150 mg/kg ip where it was significantly lower in P20 rats. The gastric emptying of beads was 54% in NP, 36% in P7 and 69% in P20 rats but these values were not significantly different illustrating the great variability. The inhibitory effect of L-NAME (25 and 100 mg/kg ip) on the emptying of beads did not differ between the 3 groups. As evaluated in NP rats, the inhibitory effect of L-NAME on the gastric emptying of the beads was not prevented by L-arginine nor mimicked by L–NMMA. Electrical field stimulation in NANC conditions induced frequency-dependent relaxations in the fundus strips and relaxations followed by rebound contractions in the pyloric strips. These electrically induced NANC relaxations and their reduction by 3×10^–4 M L-NAME were not different between NP and P20 rats. It can be concluded that no evidence for a regulatory role of NO in the gastric emptying of the beads was found, and that the nitrergic contribution to the gastric emptying of liquids and to the fundic and pyloric NANC relaxations was not influenced by pregnancy in rats. Received: 29 December 1997 / Accepted: 25 February 1998     

Timing and magnitude of changes in basal energy expenditure during pregnancy in Indian women

Basal energy expenditure (BEE) was determined in 291 pregnant women, age 20-35 years, using Benedict Roth Metabolism Apparatus. A control study was undertaken in 38 non pregnant women during both follicular and luteal phases of menstrual cycle respectively. The mean +/- SD of BEE were found to be 34.04 +/- 3.05, 35.85 +/- 2.60 and 39.69 +/- 2.75 Kcal/m2/hr during first, second and third trimesters of pregnancy respectively. BEE was progressively and significantly increased (P < 0.01). However, increase in BEE during first trimester of pregnancy compared to that of luteal phase of menstrual cycle was insignificant. The results indicate that Indian pregnant women should maintain energy requirements by increasing caloric intake throughout the gestation.     

Effect of the motilin agonist KC 11458 on gastric emptying in diabetic gastroparesis

BACKGROUND: KC 11458, a motilin agonist without antibiotic properties, accelerates gastric emptying in animals and healthy humans. AIM: To evaluate the acute effects of KC 11458 on gastric emptying in diabetic gastroparesis. METHODS: Twenty-nine patients (6 type 1 and 23 type 2) with gastroparesis underwent assessments of: (i) gastric emptying of a solid/liquid meal using scintigraphy, (ii) glycaemic control (blood glucose at 0, 30, 60, 90 and 120 min during the gastric emptying measurement) and (iii) upper gastrointestinal and 'meal-related' symptoms (questionnaire), at baseline and after treatment with KC 11458 in a dose of 8 mg t.d.s., or placebo for 8 days. RESULTS: KC 11458 had no statistically significant or clinically relevant effect on gastric emptying of either the solid intragastric retention at 100 min (T100) (P = 0.87) or liquid 50% emptying time (T50) (P = 0.17) components of the meal. KC 11458 slightly worsened (P = 0.04) upper gastrointestinal symptoms when compared with placebo. The magnitude of the change in solid gastric emptying correlated with the change in the blood glucose concentration (r = 0.49; P < 0.05). CONCLUSIONS: KC 11458, in a dose of 8 mg t.d.s. for 8 days, does not accelerate gastric emptying in patients with diabetic gastroparesis. The absence of efficacy may relate to an effect of hyperglycaemia.     

妊娠剧吐60例临床观察

目的 探讨妊娠剧吐的临床治疗.方法 回顾性分析2002年5月2011年8月收治的60例妊娠剧吐病历资料,观察系统治疗的临床效果.结果 60例患者,治愈57例,占95%;有效减轻症状者2例,占3.33%;无效1例,占1.67%.总有效率为98.33%.结论 积极的营养支持和补液治疗,可以治愈妊娠剧吐,能有效防止孕妇发生重度电解质紊乱、酸碱失衡、Wernicke 脑病甚至死亡.     

碘缺乏病高危地区城镇维吾尔族孕妇甲状腺功能与 子女脑发育情况调查分析

目的 评估碘缺乏病高危地区新疆阿克苏城镇采取持续补碘措施后孕妇甲状腺功能和子女脑发育状 况。方法 非孕育龄妇女（非孕组） 35 例和孕妇组 165 例, 其中 5 例孕妇因脱落未测促甲状腺激素（TSH）与甲状腺 激素（TH）; 孕妇组 160 例分为早、 中、 晚期组 3 个亚组, 分别对应为孕 0～13 周、 孕 14～27 周和孕 28～40 周。采集 2 组清晨一次性随意尿样和静脉血样, 使用过硫酸铵消化砷-铈催化分光光度法测定其尿碘浓度, 免疫化学发光法测 定其 TSH、 游离四碘甲状腺原氨酸（FT4）、 游离三碘甲状腺原氨酸（FT3）、 总甲状腺素（TT4）、 总三碘甲状腺原氨酸 （TT3） 水平。2 年后追踪入组孕妇所育子女, 使用格赛尔发展诊断量表 （Gesell） 测量其神经认知发育水平。结果 孕 妇总体尿碘中位数为 196.7（122.9, 269.2）μg/L; 孕妇总体尿碘水平≤150 μg/L 及＞150 μg/L 以上者分别为 52 例 （32.5%） 和 108 例 （67.5%）。孕妇组与非孕组比较, 孕早期 FT3水平降低, TT4、 TT3水平升高; 中期和晚期 FT4、 FT3水平 均降低, 而 TT4、 TT3水平均升高（P＜0.05）。孕早期 FT3水平高于孕中期和孕晚期（P＜0.05）, 3 组间其他指标差异均 无统计学意义。孕妇组甲状腺异常发生率为 8.75%（14/160）。其中, 亚临床甲减占 5.63%（9/160）; 甲状腺球蛋白抗 体 （Tg-Ab） 阳性 （Tg-Ab+） 占 3.13% （5/160）, 亚临床甲减与 Tg-Ab+无重叠病例; 无甲状腺功能减退、 甲状腺功能亢进 和低 T4血症病例。追踪观察的 80 例维吾尔族孕妇子女中, 语言商得分偏低, Gesell 诊断异常率为 3.75%（3/80）, 可 疑 12.50% （10/80）, 正常 83.75% （67/80）。结论 家庭合格碘盐食用率达标多年后, 维吾尔族城镇孕妇碘营养状况适 宜, 甲状腺功能正常, 结果可用于后续研究。     

Influence of intrapyloric botulinum toxin injection on gastric emptying and meal-related symptoms in gastroparesis patients

BACKGROUND: Recent observations in limited numbers of patients suggest a potential benefit of intrapyloric injection of botulinum toxin in the treatment of gastroparesis. AIM: To characterize the effect of botulinum toxin on solid and liquid gastric emptying and on meal-related symptoms. METHODS: In 20 gastroparesis patients (17 women, mean age 37 +/- 3 years, three diabetic and 17 idiopathic), gastric emptying for solids and liquids was measured before and one month after intrapyloric botulinum toxin 4 x 25 units. Before the meal and at 15-min intervals up to 240 min postprandially, the patient graded the intensity of six gastroparesis symptoms, and a meal-related severity score was obtained by adding all intensities. Data (mean +/- S.E.M.) were compared using paired Student's t-test. RESULTS: Treatment with botulinum toxin significantly enhanced solid (t(1/2) 132 +/- 16 vs. 204 +/- 35 min, P < 0.05) but not liquid (92 +/- 10 vs. 104 +/- 11 min, N.S.) emptying. This was accompanied by a significant decrease in cumulative meal-related symptom score (73.5 +/- 16.3 vs. 103 +/- 17.1 baseline, P = 0.01) as well as individual severity scores for postprandial fullness, bloating, nausea and belching (all P < 0.001, two-way anova). CONCLUSIONS: Botulinum toxin improves solid but not liquid gastric emptying in gastroparesis, and this is accompanied by significant improvement of several meal-related symptoms.     

功能性消化不良病人胃排空功能改变的危险因素

目的 :研究功能性消化不良病人胃排空功能的异常与症状之间的关系及西沙比利疗效。方法 :对 36例功能性消化不良病人 4种症状进行分级 ,并行胃排空检查 ,分别与健康人对照组 12例比较 ,并与西沙比利 5mg ,po ,tid治疗后自身对照比较。结果 :半排时间固体实验组治疗前为 5 9min±s 10min ,健康人对照组为 5 0min± 11min(P <0 .0 5 ) ,治疗后为 4 9min± 9min(P <0 .0 5 ) ;液体半排时间分别为 13min± 4min ,15min± 6min (P >0 .0 5 ) ,治疗后为 13min± 3min与治疗前比较P >0 .0 5。腹胀、腹痛、恶心、呕吐与固体胃排空延迟的回归系数分别为 0 .381,0 .5 43,0 .178,0 .4 63。结论 :功能性消化不良病人固体胃排空延迟 ,且可被西沙比利纠正 ,腹胀、腹痛、呕吐是固体胃排空延迟的危险因素     

妊娠剧吐病人舒适度的影响因素及护理对策

目的调查了解影响妊娠剧吐病人舒适度的相关因素,提出个性化的舒适护理措施,促进疾病康复。方法采用自行设计的调查问卷对100例妊娠剧吐病人进行调查,并对结果进行分析。结果发放调查问卷100份,回收100份,有效回收率为100％。频繁恶心呕吐、静脉穿刺疼痛、静脉补钾所致的疼痛等因素严重影响病人的舒适度。结论针对妊娠剧吐病人不舒适的原因,实施个性化的舒适护理措施,增强服务质量和水平,树立“以人为本”的服务理念,促使病人尽快达到最舒适的状态。     

苏叶黄连汤直肠滴入治疗重症妊娠剧吐32例

目的 探讨苏叶黄连汤直肠滴入治疗重症妊娠剧吐的临床疗效。方法 纳入2019年3月至2021年4月在南阳市中心医院产科住院治疗确诊为重症妊娠剧吐病人共64例,按随机数字表法分为治疗组和对照组,各32例。对照组按照妊娠剧吐临床处理专家共识给予治疗,治疗组在西医治疗基础上配合苏叶黄连汤直肠滴入,比较两组在改善症状、尿酮体转阴时间、复发率方面的差异。结果 治疗后5 d和治疗后10 d,两组恶心呕吐妊娠专用量化表评分（PUQE）均明显降低（P<0.05）;治疗组在治疗后5 d和治疗后10 d PUQE评分分别为（11.91±1.51）分、（7.97±1.47）分,均低于对照组（13.05±2.13）分、（11.13±2.20）分（均P<0.05）。治疗组尿酮体转阴时间显著短于对照组[（2.39±0.80）d比（2.81±0.83）d,P<0.05];随访至孕28周观察两组病人的复发情况,两组病人在治疗后复发率方面比较差异无统计学意义（P>0.05）。结论 苏叶黄连汤直肠滴入联合西药治疗重症妊娠剧吐疗效显著,能有效改善重症妊娠剧吐病人的症状、缩短尿酮体转阴时间。     

以甲状腺功能亢进为首发表现的葡萄胎1例

葡萄胎（HM）是一种异常的人类妊娠,可将其分为完全性葡萄胎（CHM）和部分性葡萄胎（PHM）。其主要临床表现为停经后阴道不规则流血、子宫异常增大、妊娠呕吐、腹痛、卵巢黄素化囊肿及甲状腺功能亢进征象等,其中甲状腺功能亢进临床表现少见。我们报道1例以间断性怕热、多汗、心悸、消瘦为主要临床表现的育龄期女性患者,常规抗甲状腺药物治疗无效,后经阴道B超、血HCG检查诊为CHM。清宫术后患者临床症状好转,甲状腺功能完全恢复正常,从而证实甲状腺功能亢进继发于CHM。因此,临床医生对于育龄期女性甲状腺功能亢进患者,在排除甲状腺性、垂体性以及医源性因素后,应注意葡萄胎及其他妊娠滋养细胞疾病等妇科情况及疾病。