新产程标准下剖宫产后阴道试产239例妊娠结局

目的 探讨新产程标准下剖宫产术后再次妊娠阴道分娩(VBAC)孕妇的妊娠结局。方法 对照组108例VBAC产妇采用Friedman产程标准;观察组为239例VBAC产妇,采用新产程标准。回顾并分析两组产妇相关临床资料,比较两组分娩情况、产程时间、产时干预措施、分娩并发症和新生儿结局差异。结果 观察组自然分娩率73.2%,妊娠中转剖宫产24.3%;对照组自然分娩率61.1%,妊娠中转剖宫产37.0%,两组比较差异有统计学意义(P＜0.05)。与对照组比较观察组妊娠活跃期时间明显缩短(P＜0.001),第一、第二产程时间明显延长(P＜0.001)。观察组缩宫素使用、人工破膜、地西泮使用均显著低于对照组(P＜0.05)。两组在产后并发症及新生儿不良结局方面比较差异无统计学意义(P＞0.05)。结论 新产程标准放宽了第一、第二产程,使VBAC产妇充分试产,降低了剖宫产率,减少产程中医疗干预,且并未影响围产结局。     

新产程标准管理下第二产程时长对产妇和新生儿结局的影响观察

目的探讨在新产程标准管理下,产妇以及新生儿结局受到第二产程时长的综合性影响。方法结合新产程标准管理以及产妇第二产程时长的相关情况,将2017年2月～2018年10月在新产程标准管理下在我院进行生产200例初产妇划分为实验组(A组产程时长:2～2.5h,B组产程时长:2.5～3h,C组产程时长:3h以上)与对照组(产程时长:低于2h)。对上述产妇以及新生儿的结局进行记录与对比分析。结果对照组中未见剖宫产患者,而实验组患者中的剖宫产率为7.3%,差异有统计学意义(P <0.05)。实验组B、C两组的不良反应总发生率均显著高于对照组和实验组A组,差异有统计学意义(P <0.05)。C组新生儿不良结局发生率与对照组比较差异有统计学意义(P <0.05)。结论在新产程标准管理的前提条件下,第二产程时间越短,则对分娩方式以及母婴结局的影响相对越小。当产程在2.5～3h的区间内时,产妇所受的影响得以提高。而随着产程时间的进一步增加,则新生儿受到的影响开始逐渐提高。     

导乐陪伴对母婴结局的临床研究

目的 评价分析导乐陪伴对母婴结局的影响。方法 采用前瞻性研究的方法,选取2018年6月～2019年8月惠州市妇幼保健计划生育服务中心产科收治的自然足月妊娠的初产妇200例,按随机数字表法分为研究组和对照组,其中研究组100例,进入产程后即给予导乐陪伴分娩,对照组100例,采取仅有家属陪伴的常规分娩,比较两组产妇产程时间、分娩方式、出血量及不同时间新生儿Apgar评分差异。结果 研究组第一产程、第二产程及总产程时间均低于对照组,差异有统计学意义(P 0.05),两组产妇第三产程时间比较差异无统计学意义(P 0.05)。研究组剖宫产例数及产后出血量均低于对照组,差异有统计学意义(P 0.05),两组产妇产钳助产、会阴侧切例数比较差异无统计学意义(P 0.05)。研究组1min及5min Apgar评分均高于对照组,差异有统计学意义(P 0.05)。结论 导乐陪伴分娩是一种优质的分娩模式,可缩短产妇产程时间,提高自然分娩率并确保母婴安全,可在临床上予以推广实施。     

无痛分娩下新产程时限管理对母儿结局的临床观察

目的探究无痛分娩下新产程时限管理对母儿结局的临床价值。方法按照随机数字表法将我院2015年6月～2016年6月期间收治的阴道试产单胎足月初产妇108例分为传统组与实验组两组,每组产妇均占54例。传统组产妇采用传统Friedman产程标准,实验组产妇则使用新产程时限管理标准。对比两组产妇的分娩方式(自然分娩、产钳助产、中转剖宫产、会阴侧切)、产程时间、医疗干预情况,并观察两组的产后并发症以及新生儿结局情况。结果两组产妇的分娩方式比较发现存在较大差异,实验组产妇的自然分娩率为81.48%,高于传统组;中转剖宫产率为7.41%,低于传统组,差异有统计学意义(P 0.05);两组产妇的产钳助产率、会阴侧切率比较差异无统计学意义(P 0.05);两组产妇的第一产程和总产程时间存在较大差异,实验组第一产程时间为(605.36±115.34)min、总产程时间为(670.81±130.50)min,均较传统组更长,差异有统计学意义(P 0.05);两组产妇的第二产程以及第三产程时间比较差异无统计学意义(P 0.05);两组产妇的医疗干预情况对比存在较大差异,实验组总医疗干预率为27.78%,明显低于传统组,差异有统计学意义(P 0.05);实验组产后出血率、产后尿潴留率、巨大儿以及新生儿窒息率均较传统组高,差异无统计学意义(P 0.05)。结论产妇在无痛分娩下,采用新产程时限管理产程干预后,尽管第二产程时间延长,但放宽潜伏期的时限,产妇有足够试产时间。有利于降低剖宫产率,改善母儿结局。     

新产程标准中活跃期拐点对初产妇与经产妇的影响

目的 观察新产程标准中活跃期拐点对初产妇与经产妇的影响。方法 我院2018年5月～2019年5月收治的124例产妇为本研究对象,按照产妇分娩过程中是否应用新产程标准中活跃期拐点将产妇分为对照组(62例,未应用新产程标准中活跃期拐点)与实验组(62例,应用新产程标准中活跃期拐点),比较两组产妇分娩结局。结果 实验组产妇剖宫产率(3.23%)、不良分娩结局发生率(6.46%)均低于对照组,差异有统计学意义(P 0.05)。实验组54例产妇奶量充足例数明显多于对照组48例,差异有统计学意义(P 0.05)。实验组产妇产后宫底高度均低于对照组,差异有统计学意义(P 0.05)。结论 初产妇与经产妇应用新产程标准中活跃期拐点可提升分娩安全性,有利于产妇泌乳。     

新产程标准第二产程时长对母婴结局的探讨

目的:分析研究新产程标准第二产程时长对母婴结局的探讨。方法:抽取某院200例初产妇当做研究对象,按照新产程标准,第二产程超过2h的114例患者设为研究组(A组),第二产程不到2h者86例患者设为对照组(B组),研究组依据第二产程时长差异又能够分为甲、乙、丙组,比较4组母儿最终结局。结果:研究组剖宫产率显著高于对照组(P0.05);甲组不良结局发生率高于对照组(P0.05),而乙组以及丙组不良结局发生率显著高于对照组(P0.05);甲组、乙组里面的新生儿不良结局出现率都高于对照组(P0.05),丙组里面新生儿不良结局出现率显著高于对照组(P0.05)。结论:新产程标准下,第二产程时长处于2~2.5h范围内会对分娩方式产生影响,处于2.5~3h范围内会对分娩方式以及产妇结局造成影响,超过3h会对分娩方式以及母儿结局造成影响。     

间苯三酚加速产程的效果及对妊娠结局的影响观察

目的探讨间苯三酚加速产程的效果及对妊娠结局的影响。方法选取2016年10月～2018年5月于我院分娩的80例足月胎膜早破2h未临产产妇为主要研究对象,随机将其分为两组,每组40例。对照组给予缩宫素,观察组给予缩宫素+间苯三酚,对两组的产程时间、妊娠结局及新生儿出生情况进行对比分析。结果 (1)在第一产程时间、第二产程时间、总产程时间上,观察组明显短于对照组,差异有统计学意义(P 0.05);两组在第三产程时间的对比上,差异无统计学意义(P 0.05)。(2)在分娩方式上,观察组产妇的阴道分娩率明显高于对照组;观察组的剖宫产率明显低于对照组,两组对比,差异有统计学意义(P 0.05)。(3)两组产妇的产后24h出血量对比,差异无统计学意义(P 0.05),两组新生儿Apgar评分、胎儿窘迫发生率比较,差异无统计学意义(P 0.05)。结论应用缩宫素+间苯三酚可缩短产程时间,提高阴道分娩成功率,且产妇产后的出血量少,不会影响新生儿的身体质量,值得在产科临床上进一步推广和应用。     

硬膜外镇痛给药的背景模式改变对妊娠结局的影响

目的:探讨硬膜外镇痛给药的背景模式改变对妊娠结局的影响。方法:以2015年1月～2017年12月期间于某院进行分娩的285例正常产妇作为此次研究对象,按照入院先后顺序将其分为对照组(2015年1月～2016年5月)与研究组(2016年6月～2017年12月),对照组给予0.1%盐酸罗哌卡因和0.5μg/ml舒芬太尼混合液10ml+硬膜外导管接自控镇痛泵进行镇痛,研究组在对照组的镇痛基础上加入背景输入式改变,对比两组镇痛效果及对妊娠结局的影响。结果:两组镇痛前VAS评分与镇痛持续时间对比差异均无统计学意义(P0.05),研究组在宫口开6cm、10cm时VAS评分明显低于对照组,差异对比有意义(P0.05);两组各产程时间以及留置尿管时间对比均无统计学意义(P0.05);研究组导尿次数明显低于对照组,差异对比有意义(P0.05);两组新生儿Apgar评分≤7分、呼吸评分以及胎儿窘迫现象差异对比均无统计学意义(P0.05)。结论:采用硬膜外镇痛联合背景输入给药形式不仅能够达到更强的止痛效果,持续时间更长,并且不会对产妇的最终分娩方式以及新生儿结局产生影响,相对安全。     

妊娠期高血压孕妇产程行胎心监护的必要性及异常图形与妊娠结局的相关性

目的 探究妊娠期高血压孕妇产程胎心监护的必要性,并研究胎心监护中异常图形与妊娠结局的相关性.方法 选取本院在2014年1月至2015年6月期间定期孕检的400例妊娠高血压孕妇,所有孕妇均为单胎初妊娠.根据有无胎心监护分为胎心监护组(n=212)和无胎心监护组(n=188),对比分析两组孕妇妊娠结局.另从行胎心监护的212例患者中根据NICHD和ACOG所制定的胎心监护三级分类系统将患者分为Ⅰ类图形的对照组以及Ⅱ、Ⅲ类图形的研究组,其中对照组90例,研究组122例,对比分析两组患者妊娠结局.结果 胎心监护组孕产妇发生产后出血、脐带异常、过期妊娠、胎膜早破、羊水过少、羊水过多及产褥感染等妊娠及分娩并发症概率均低于无胎心监护组,差异均有统计学意义(均P＜ 0.05);胎心监护组顺产率高于无胎心监护组;胎心监护组剖宫产率、死胎率、新生儿窒息、新生儿窘迫及新生儿NICU均低于无胎心监护组,差异均有统计学意义(均P＜0.05);两组妊娠产妇产钳助产率比较差异无统计学意义(P＞0.05);图像异常的研究组患者顺产率和产钳助产率均明显低于图像正常的对照组,差异均有统计学意义(均P＜ 0.05);研究组的剖宫产率、死胎率、新生儿窒息、新生儿窘迫及新生儿NICU均明显高于对照组,差异均有统计学意义(均P＜0.05).结论 妊娠高血压孕妇产程行胎心监护有利于生产过程的监护与预防,尤其是通过异常图形的判读有利于改善妊娠结局,对提高新生儿和产妇的存活率具有重要意义.     

剖宫产术后再次妊娠孕妇采用阴道分娩方式的可行性及对母婴结局的影响

目的探讨剖宫产术后再次妊娠孕妇采用阴道分娩方式的可行性及对母婴结局的影响。方法选取2016年1月～2018年9月在我院分娩的无剖宫产史50例孕妇作为对照组,择同期在我院分娩的剖宫产术后再次妊娠50例孕妇作为研究组,比较两组产程时间、出血量、住院时间、新生儿体质量、新生儿1min、5min时Apgar评分、新生儿神经行为功能评分、产妇产后并发症发生率、新生儿并发症发生率。结果两组产程时间、出血量、住院时间、新生儿体质量、新生儿1min、5min时Apgar评分、新生儿神经行为功能评分、产妇产后并发症发生率、新生儿并发症发生率比较,差异无统计学意义(P 0.05)。结论剖宫产术后再次妊娠孕妇采用阴道分娩方式是切实可行的,对母婴结局无明显影响,可降低再次剖宫产率。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.