剖宫产术后再次妊娠阴道分娩的临床分析

目的：探讨剖宫产术后再次妊娠阴道分娩（VBAC）患者的试产成功率、产程及母婴并发症。方法：选取2012年1至2013年3月在我院行阴道分娩的剖宫产术后再次妊娠的153例产妇为研究组,同期选取行阴道分娩的200例孕足月初产妇为对照组。分析两组的阴道试产成功率、产程、母婴并发症。结果：研究组153例,试产成功130例（84.97%）;对照组200例,试产成功183例（91.50%）。两组的阴道试产成功率、第一产程、第二产程及总产程、新生儿窒息率、巨大儿发生率均无显著差异（P〉0.05）;而第三产程时间、手取胎盘率、会阴侧切率及产后出血率均显著高于对照组（P〈0.05）。结论：对有1次子宫下段横切口剖宫产史的孕妇,应给予充分的阴道试产机会,同时应积极处理第三产程,预防产后出血。     

盐酸多奈哌齐与苯磺酸氨氯地平联用对其在人体药代动力学的影响

正多奈哌齐为新一代中枢乙酰胆碱酯酶抑制剂,能够增加大脑乙酰胆碱含量,因其半衰期长、不良反应较小,是目前治疗早、中期阿尔茨海默病(AD)的有效药物;苯磺酸氨氯地平     

丙戊酸镁对慢性应激抑郁小鼠行为及脑脂质过氧化的影响

Objective To explore the effects of magnesium valprote on behaviors and lipid peroxidation of brain in chronic stress depression mice.Methods 40 male mice were randomly divided into normal control group,model group, amitriptyline control group and magnesium valprote group, and.10 mice each group.Except normal control group,other groups were separated one mouse in each box and exposed to 21 days chronic unpredictable stressors, and the mice of normal control group were fed in a box and stress-free.During the stress, the mice of amitriptyline control group were applied amitriptyline(0.2 mg/10g) by intragastric every day,magnesium valprote group were given intragastrically magnesium valprote (0.8 mg/10g), and the mice of model and normal control group were administrated with normal sodium of the same volume by the same method.On 7th, 14th,21st day, all mice weight were weighed and weight gain was calculated.The ethology examination was performed by using jigglecage connected with Biology Function Experiment System and experiment of sucrose solution consumption after the chronic stress.At the end of experiment, all mice were killed, and then their brains were removed and made into brain homogenate.The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and the content of malondialdehyde(MDA) in brain homogenate were analyzed by spectrophotometry.Results Compared with model group, magnesium valprote group were increased on locomotor activity number(97.50 ± 20.54,302.30± 39.04, t = 31.1432, P ＜ 0.01 ), sucrose solution consumption ( ( 15.30 ± 3.60 ) ml, ( 23.70 ± 4.45 ) ml, t =9.8446, P＜0.01) ,body weight gain(( 10.56 ± 1.53)g,( 12.63 ±2.12)g, t=5.3113, P=0.007) ,the activity of SOD( t =3.8428, P=0.004) ,and GSH-Px( t= 3.4143, P=0.007), but decreased on irritation number( t =17.1370, P ＜ 0.01 ) and the content of MDA( t= 11.0778, P = 0.002).Conclusion Magnesium valprote can ameliorate behavior impairment of chronic stress-induced depression mice, and the observed antidepressant-like effects may be related to inhibition lipid peroxidation of mice brain.     

G-CSF对高脂喂养兔不同动脉段内皮的影响

目的 通过高脂喂养兔制造动脉粥样硬化动物模型,研究G-CSF对不同动脉段内皮形态和功能变化的影响及相互关系.方法 30只新西兰成年雄兔随机分4组,分为对照组6只,高脂喂养组、普通及高脂喂养+G-CSF组各8只,分别测定血脂及血清NO浓度,各取胸主动脉、颈总动脉、股动脉,采用病理分析及扫描电镜观察内皮形态的不同变化,同时用RT-PCR方法测定eNOS、ET-1基因的表达了解不同动脉段的内皮功能变化.结果 高脂喂养后兔血脂、NO浓度明显升高,病理发现动脉内膜增厚,以大动脉最著,小动脉最次,扫描电镜下内皮细胞的凋亡、变形亦然.ET-1基因表达相对定量次序为胸主动脉>颈总动脉>股动脉,eNOS基因反之.应用G-CSF后大动脉内皮功能及形态受到明显影响,但小型动脉变化不大.结论 高脂喂养兔能成功制造动脉粥样硬化模型,成模后动脉内皮功能显著受损,其中以大型动脉显著,同时内皮形态出现相应变化.应用G-CSF对全身动脉系统有影响,且动脉越小,影响越小,说明粥样硬化动脉内皮形态与功能改变之间存在必然联系,对G-CSF的反应也不同.     

丙戊酸镁对慢性应激抑郁小鼠行为及脑脂质过氧化的影响

Objective To explore the effects of magnesium valprote on behaviors and lipid peroxidation of brain in chronic stress depression mice.Methods 40 male mice were randomly divided into normal control group,model group, amitriptyline control group and magnesium valprote group, and.10 mice each group.Except normal control group,other groups were separated one mouse in each box and exposed to 21 days chronic unpredictable stressors, and the mice of normal control group were fed in a box and stress-free.During the stress, the mice of amitriptyline control group were applied amitriptyline(0.2 mg/10g) by intragastric every day,magnesium valprote group were given intragastrically magnesium valprote (0.8 mg/10g), and the mice of model and normal control group were administrated with normal sodium of the same volume by the same method.On 7th, 14th,21st day, all mice weight were weighed and weight gain was calculated.The ethology examination was performed by using jigglecage connected with Biology Function Experiment System and experiment of sucrose solution consumption after the chronic stress.At the end of experiment, all mice were killed, and then their brains were removed and made into brain homogenate.The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and the content of malondialdehyde(MDA) in brain homogenate were analyzed by spectrophotometry.Results Compared with model group, magnesium valprote group were increased on locomotor activity number(97.50 ± 20.54,302.30± 39.04, t = 31.1432, P ＜ 0.01 ), sucrose solution consumption ( ( 15.30 ± 3.60 ) ml, ( 23.70 ± 4.45 ) ml, t =9.8446, P＜0.01) ,body weight gain(( 10.56 ± 1.53)g,( 12.63 ±2.12)g, t=5.3113, P=0.007) ,the activity of SOD( t =3.8428, P=0.004) ,and GSH-Px( t= 3.4143, P=0.007), but decreased on irritation number( t =17.1370, P ＜ 0.01 ) and the content of MDA( t= 11.0778, P = 0.002).Conclusion Magnesium valprote can ameliorate behavior impairment of chronic stress-induced depression mice, and the observed antidepressant-like effects may be related to inhibition lipid peroxidation of mice brain.     

三七促进家兔慢性硬膜下血肿吸收的实验研究

目的 观察三七对实验性慢性硬膜下血肿(CSDH)的促吸收效应.方法 硬膜下少量多次注血法制备家兔CSDH模型,观察三七对血肿体积的影响；HE染色观察血肿外膜病理组织学特征；透射电镜和硝酸镧示踪法观察血肿外膜血管超微结构及通透性.结果 三七组血肿液完全吸收或仅少量残余,与模型组相比差异有统计学意义(P＜0.01)；三七组血肿外膜炎性反应较模型组轻而纤维组织增生相对成熟；模型组毛细血管结构功能缺损,而三七组血管内皮及基膜完整连续,血管周围组织中镧颗粒沉积少.结论 三七能加快CSDH血肿吸收速度,此效应可能与其减轻血肿外膜炎性反应、降低外膜新生血管通透性有关.     

89例老年住院病人甲状腺异常分析

目的　探讨因各种急性或慢性疾病就诊的老年病人的甲状腺形态、功能状况。方法　 89例因非甲状腺疾病就诊的住院病人 ,均于入院当日晨起时抽空腹静脉血检测T3 、T4、FT3 、FT4、TSH、rT3 。其中 3 9例行甲状腺B超检查。结果　筛查出临床甲状腺功能减退症 (甲减 )患者 4人 (4 49% ) ,亚临床甲减 5人 (5 61% ) ,另有TSH >4 0mU/L 9人(13 75 % ) ,其中TSH >5 0mU/L 3人 (3 92 % )。 3 3人有T3 /FT3 不同程度降低 ,其中甲状腺功能正常性病变综合征 (SES ,低T3 /低T4综合征 ) 11例 (12 3 % ) ,低T3 、T4综合征 4例。结论　在老年住院病人中 ,甲状腺功能减退是一种发病率高又极其容易被漏诊的疾病 ,同时SES ,T3 /FT3 的降低程度及FT3 的升高程度与疾病的严重程度及预后有关系。     

体元模型动态三维重建超声显像定量测定右心功能

目的　建立多平面经食管体元模型动态三维重建超声显像测定右心功能的方法 ,评价肺动脉高压对右心室形态和功能的影响。方法　将 34例各种原因引起的肺动脉高压患者 ,按疾病对右心室产生的负荷性质分为以容量和压力负荷过重为主两组 ,分别测定其右室容积和游离壁质量 ,并计算射血分数 ;15例正常人为对照组。结果　三维重建后可动态地、多角度地观察右心室的形态和收缩、舒张活动。与正常人比较 ,肺动脉高压患者的右室较为饱满 ,心尖部和流出道的活动程度低于正常人。定量分析发现 ,肺动脉高压患者的右室腔和游离壁各指标均大于正常人 ,差异有显著意义 (P <0 .0 5 )。压力负荷过重组的右室游离壁质量明显高于容量负荷过重组 ,差异有显著意义 (P <0 .0 5 )。而右室容积和射血分数在这两组之间差异无显著意义 (P >0 .0 5 )。结论　多平面经食管超声体元模型动态三维重建能用于临床评价肺动脉高压患者右室腔容积、游离壁质量和右室射血分数指标 ,为临床评价右心功能、估计疾病的严重程度、治疗效果和患者的预后提供定量依据。     

循证病例讨论:丧失手术时机的Ⅲ期非小细胞肺癌治疗

肺癌是起源于支气管表面上皮或粘液腺体的上皮细胞癌，非小细胞肺癌占肺癌总数的75％～80％。临床上许多非小细胞肺癌患就诊时已处于Ⅲb期，丧失了手术时机。放疗、化疗或两联合，均被用于治疗丧失手术时机的Ⅲ期非小细胞肺癌，放化疗方案也不尽相同。系统评价和随机对照试验为我们选择和运用最佳治疗方案提供了有力证据。