我国分娩镇痛现状和亟待解决的问题

好的产科镇痛管理模式应为：医院可以随时提供完成全身或区域阻滞麻醉的合格人员和设备。分娩镇痛的有效完成是产科与麻醉科通力合作的结果,双方都应该认识到有必要为所有患者提供高品质的服务,共同创建分娩镇痛医疗服务体系。     

白三烯D4对白细胞介素4诱导嗜酸性粒细胞趋化因子-3在支气管上皮细胞表达的影响

目的研究白三烯D4是否参与调节支气管上皮细胞表达嗜酸性粒细胞趋化因子-3(eotaxin-3，Eot-3)，探讨白三烯和支气管上皮细胞在气道变态 反应性炎症中的作用。 方法用白三烯D4预处理支气管上皮细胞1h，然后用白细胞介素-4(IL-4)刺激细胞24h，RT-PCR法检测Eot-3在mRNA水平的表达；ELISA法检测细胞 培养上清液中Eot-3蛋白的表达。 结果未经处理的支气管上皮细胞仅表达微量的Eot-3，用IL-4刺激细胞并培养24h后，在mRAN和蛋白水平的Eot-3表达明显增强，白三烯D4预处理 细胞1h，可以使IL-4的这种诱导作用加强。 结论支气管上皮细胞不仅是一种屏障细胞，也是一种效应细胞，在炎症介质的刺激下能表达Eot-3，参与支气管炎症的产生。白三烯D4通过上调 IL-4诱导Eot-3在上皮细胞的表达可能是其参与支气管哮喘嗜酸性粒细胞炎症的机制之一。     

肺隔离症12例诊断和治疗分析

目的总结12例小儿肺隔离症的诊断和治疗经验。 方法1994-01—2006-08，对温州医学院附属育英儿童医院收治的12例经手术和病理检查证实为肺隔离症的患儿临床资料进行回顾性分析。 结果12例肺隔离症患儿胸部X线均发现肺部异常阴影，7例呈圆形、类圆形或不规则实性块影，5例呈囊性及多囊性阴影改变；术前确诊5例，1例 经主动脉逆行造影证实，4例经螺旋CT三维重建、MRI检查发现胸主动脉与病灶之间有异常血管相通,术前高度怀疑肺隔离症3例，术前有4例误诊 ；8例叶内型肺隔离症患儿行肺叶切除术，4例叶外型肺隔离症行单纯隔离肺切除术。 结论临床医师应提高对肺隔离症的认知和重视程度。为降低肺隔离症误诊率，对可疑的肺隔离症患儿提倡螺旋CT三维重建和胸部MRI检查。     

Tourette综合征的发病危险因素分析

目的探讨Tourette综合征(TS)发病的危险因素。 方法2000 01—2004 12采用病例对照研究的方法，对温州医学院附属一院100例TS患儿及100名对照病例的相关资料进行非条件Logistic回归和主成分分析。 结果非条件Logistic回归多因素分析显示，该病有统计学显著性意义的危险因素是TS家族史、注意缺陷伴多动障碍(ADHD)、过敏性哮喘、母亲孕早期受精神刺激、高热(T>39℃)和极低频磁场暴露，其标准回归系数分别为1.3987、3.6385、1.7657、1.7250、1.8973和1.0677。主成分分析提取了4个主成分，其方差累积贡献率为57.025%。 结论TS的发病与遗传因素和环境因素有关。     

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??Abstract??Objective??To study the characteristics of mutation of TSC1 gene exan 15 in tuberous sclerosis complex. Methods??Totally 21 children with confirmed clinical manifestations of TSC and 38 parents of the children coming from 21 TSC families were included in the study. In total?? we studied 6 familial cases and 15 sporadic cases. The mutation of exon 15 in TSC1 gene was identified by denaturing high performance liquid chromatography ??DHPLC?? and further confirmed by direct sequencing. Results??After being confirmed by DNA direct sequencing?? mutations were identified in 4/21??19%??patients?? in which there were c.1708~1709delAG??p.Arg570GlyfsX17?? and c.1888~1891delAAAG??p.Lys630GlnfsX22?? two small deletion mutations and one c.1460C > G??p.Ser487Cys?? missense mutation. c.1460C > G??p.Ser487Cys?? mutation was reported the second. One family case and three sporadic cases were found. In our study?? the mutation frequency of exon 15 in TSC1 gene was 4/21??19%???? which was higher than other reports. The main clinical characters of the patients with mutation on exon 15 in TSC1 gene were brain and skin impair. We also found that the patients with the same mutation c.1888~1891delAAAG??p.Lys630GlnfsX22?? had different phenotype?? but the patients with different mutations c.1708~1709delAG??p.Arg570GlyfsX17?? and c.1888~1891delAAAG ??p.Lys630GlnfsX22?? nearly had the same phenotype. Conclusion??Totally three TSC1 gene mutations that have never been reported in China are identified.     

应用二维斑点追踪成像技术监测急性淋巴细胞白血病柔红霉素化疗患儿左室扭转功能探讨

探讨应用二维斑点追踪成像技术监测柔红霉素化疗对急性淋巴细胞白血病（急淋）患儿左心室短轴心肌扭转功能的影响,分析心脏功能损伤与柔红霉素不同累积剂量的关系。方法　研究对象为2007年1月至2009年12月深圳市儿童医院诊断的急淋患儿60例,均接受柔红霉素化疗,按治疗程序分为A组（化疗前）、B组（柔红霉素化疗累积剂量达120 mg/m2）和C组（柔红霉素化疗累积剂量达240 mg/m2）。对照组为同期体检正常儿童60名。检测每组常规超声心动图指标左室射血分数（EF）、二尖瓣口舒张期血流比值（E/A）,并应用超声二维斑点追踪成像技术（two-dimensional speckle tracking imaging,2DSI）检测对照组及A、B、C组的左室短轴基底段和心尖段的心肌节段收缩期峰值旋转度,计算左室心肌收缩期峰值扭转角度。结果　心率、EF、二尖瓣口舒张期E/A比值在对照组、A、B、C各组间比较,差别无统计学意义（P > 0.05）。A、B组与对照组比较,基底段和心尖段的峰值旋转角度差异无统计学意义（P > 0.05）;C组与对照组比较心尖段峰值旋转角度,差异无统计学意义（P > 0.05）; C组与对照组、A组、B组比较,基底段峰值旋转角度差异有统计学意义（F＝5.23, P < 0.05）。A、B组与对照组比较,左室扭转角度差异无统计学意义（P > 0.05）,但C组小于对照组、A组、B组,差异有统计学意义（F＝4.51, P < 0.05）。结论　急淋患儿柔红霉素化疗累积剂量达120 mg/m2时未发现心脏扭转功能损伤,当达到240 mg/m2时,心脏扭转功能出现显著损伤,2DSI可无创性定量监测患儿心脏功能的变化,对临床评价柔红霉素的心脏毒性、预防化疗后遗症的发生有重要意义。     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

 含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

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??Effect of laparoscopic surgery CO2 pneumoperitoneum for colorectal cancer on femoral venous hemodynamics WANG Yu*??WANG Yan-ting??JIANG Yan-yan??et al.*Department of General Surgery??Fuzhou General Hospital of Nanjing Military Command??Fuzhou 350025??China Corresponding author:ZOU Zhong-dong,E-mail: fzptwk@21cn.com Abstract Objective To study the effect of the special surgical position and CO2 pneumoperitoneum on femoral venous hemodynamics during laparoscopic surgery for colorectal cancer.Methods Color Doppler ultrasound was adopted to evaluate the diameter??blood velocity and volum of the blood flow in the lower extremity with 30 patients undergoing laparoscopic surgery for colorectal cancer in Fuzhou General Hospital of Nanjing Military Command between August 2007 to June 2008,with different pressure of pneumoperitoneum??6mmHg??8mmHg??10mmHg??12mmHg??and that during the laparoscopic surgery for colorectal cancer with 12mmHgCO2 pneumoperitoneum and head-down tilt position. Results Compared with the stage before the pneumoperitoneum, no change was obserbed with the hemodynamics indexes after the establishment of 6mmHgCO2 pneumoperitoneum??when the pressure of pneumoperitoneum increases to 8mmHg, the femoral vein diameter increases?? the velocity and the amount of blood flow decrease by degrees (P<0.05) with the accrescence of pneumoperitoneum pressure. During the operation, the femoral vein diameter decreased??the velocity and the volum of blood flow increased with the head-down tilt position,but still less than the level before pneumoperitoneum, compared with the stage of prostration after pneumoperitoneum,;At the end of operation without the exhaust of CO2 gas,the femoral vein diameter returned to the level of the prostration after pneumoperitoneum, while the velocity and the volum of blood flow was still higher than that, but significantly lower than that of feet-down tilt position with pneumoperitoneum; At the end of operation with prostration and the exhaust of CO2 gas , the femoral vein diameter decreased,but still thicker than prostration without pneumoperitoneum,and the velocity and the volum of blood flow returned to the level before pneumoperitoneum. Conclusion The CO2 pneumoperitoneum can interfere the recirculation of blood??positive correlated to the pressure,witch will increase the risk of venous thrombosis ,so we should take the lower-grade of pneumoperitoneum pressure as far as possible . Besides, the head-down tilt position is conducive for the blood to recirculate ,which can improve but not fully offset the poor blood returning conducted by CO2 pneumoperitoneum .The vein stasis exists objectively in the perioperation of laparoscopic colorectal cancer operation, which will increase the risk of venous thrombosis ,and taking the active preventive measures is requisite.