妊娠期甲状腺功能异常的筛查及诊断研究进展

妊娠期甲状腺疾病包括妊娠合并甲亢,妊娠合并甲减及产后甲状腺炎,其发病率分别为0．1％-0．2％,1％。2％,1．9％-16．7％。母体甲状腺功能异常会对母婴产生多种并发症及不良结局如流产、早产、死胎、子痫前期和胎盘早剥等。因此对妊娠期妇女行甲状腺功能筛查,早发现、早治疗极为重要。本文对近年有关妊娠期妇女甲状腺功能异常的筛查及诊断的研究综述如下。     

妊娠合并恶性肿瘤

1病例介绍 例1：30岁,因左乳包块伴疼痛不适2个月入院。2个月前,患者无意发现左乳房包块伴触痛,行“左乳切开引流并活检”,病检结果：左乳浸润性导管癌伴局部坏死灶。遂入重庆医科大学附属第一医院内分泌乳腺外科。入院诊断：左乳癌,31“周妊娠G2P0。     

妇科术后舒芬太尼硬膜外镇痛与静脉镇痛比较

目的 比较舒芬太尼复合罗哌卡因用于硬膜外镇痛与相同浓度的舒芬太尼用于静脉镇痛的疗效.方法 将40例在腰硬膜外联合麻醉下行子宫切除或子宫肌瘤挖除的患者,随机均分为硬膜外镇痛组(Ⅰ组)和静脉镇痛组(Ⅱ组).观察两组患者术后4、8、12、24 h镇痛效果,采用疼痛视觉模拟(VSA)评分评价运动恢复、恶心呕吐、皮肤瘙痒、嗜睡、镇静、呼吸抑制等.结果 Ⅰ 组各时间点VAS评分低于Ⅱ组,且恶心呕吐等不良反应发生率低,尤其是4、8、24 h,患者满意度高.两组在运动恢复、头晕、皮肤瘙痒、嗜睡、镇静、呼吸抑制等方面差异无统计学意义.结论 0.1%罗哌卡因+1 μg/ml舒芬太尼+0.04 mg/L昂丹司琼在妇科术后镇痛效果好,安全可靠,患者满意度高,值得临床推广.     

非那雄胺治疗经尿道前列腺切除术后肉眼血尿的效果

目的探讨非那雄胺对经尿道前列腺切除（TURP）术后肉眼血尿的治疗效果。方法将TURP术后发生肉眼血尿的68例患者按入院顺序分为治疗组（39例）和观察组（29例）。治疗组除进行常规处理外,予服用非那雄胺5mg/次,1次/d,连续服用3个月。对照组仅常规对症处理。两组患者均通过门诊随访6个月,观察复发情况。结果在6个月的随访期内,治疗组肉眼血尿复发率明显低于对照组（〈0.01）,复发的肉眼血尿分级也明显低于对照组（〈0.01）。结论非那雄胺可有效减少TURP术后肉眼血尿的发生。     

低位脐带结扎法及二次断脐临床效果研究

目的探讨低位脐带结扎法对二次断脐效果的影响。方法正常足月剖宫产儿300例随机分为组1（实验组）和组2（对照组）,组1距脐轮0.1 cm处低位结扎脐带,组2采用常规结扎脐带,两组均于生后24小时二次断脐。观察两组二次断脐前脐带的干燥度及二次断脐后脐部出血、脐炎的发生率及脐部愈合时间。结果组1 24小时脐带干燥率（90.67%）明显高于对照组（78%）,二次断脐后出血率低,脐炎发生率低,脐部愈合快,与组2比较,差异有统计学意义（P〈0.05）。结论低位脐带结扎法有助于脐带快速干燥,减少了脐带出血和脐炎等并发症的发生,促进脐带残端的愈合,值得临床推广运用。     

妊娠期细颗粒物的暴露对胎儿影响的研究进展

近年来,已有大量临床研究、流行病学调查资料、动物研究结果等表明妊娠期孕妇细颗粒物（PM2.5）的暴露导致了死胎、流产、胎儿生长受限、低体质量儿、早产等不良妊娠结局,其具体致病机制目前尚不清楚。现有的研究表明,PM2.5导致的死胎、流产、先天畸形可能与其遗传毒性损伤作用有关,胎儿生长受限与PM2.5造成的胎盘功能障碍密切相关,而PM2.5所致的胎膜结构改变是未足月胎膜早破及早产的一个重要原因。以国内外发表的大量流行病学调查资料为基础,对妊娠期母体PM2.5的暴露对胎儿生长发育的影响进行综述。     

Expression and significance of interleukin-18.12 and tumor necrosis factor-α in intrahepatic cholestasis of pregnancy

Objective To investigate the effect of Interleukin(IL)-18,IL-12 and tumor necrosis factor-α(TNF-α)in hepatic injury in intrahepatic cholestasis of pregnancy(ICP).Methods Sixty-two cases of ICP patients(ICP group),30 cases of normal pregnant women(control group)and 30 cases of hepatitis B(HBV) women (hepatitis group) were recruited. Serum IL-18, IL-12 and TNF-α were examined by ELISA. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were examined by automatic biochemical analysis instrument. Results ( 1 ) In hepatitis group, serum concentrations of IL-18,IL-12 and TNF-α were (256±51 ) ng/L, ( 122±96) ng/L and (207±3) ng/L; serum levels of ALT and AST were(363±174) U/L and (359 ±237) U/L, respectively. In ICP group, serum concentrations of IL18, IL-12 and TNF-α were (72±32) ng/L, (42 ±28) ng/L and (48±14) ng/L; serum levels of ALT and AST were (201 ±128) U/L and ( 132±87) U/L, respectively. While in control group, serum concentrations of IL-18, IL-12 and TNF-α were (43 ± 13) ng/L, ( 10±3) ng/L and (33±9) ng/L; serum levels of ALT and AST were (13 ~ 4) U/L and (15 ± 3) U/L, respectively. Serum IL-18, IL-12, TNF-α, ALT and AST levels in hepatitis group were significantly higher than those in ICP group and control group ( P ＜0. 05 ).Serum IL-18, IL-12, TNF-α, ALT and AST levels in ICP group were significantly higher than those in control group(P ＜ 0. 05 ). (2) In severe ICP subgroup, serum concentrations of IL-18, IL-12 and TNF-α were (81 ±32) ng/L, (50 ±25) ng/L and(50 ± 14) ng/L; serum levels of ALT and AST were (269 ± 111 ) U/L and (181±73) U/L In mild ICP subgroup, serum concentrations of IL-18, IL-12 and TNF-α were (48 ±18 ) ng/L, (17 ± 4 ) ng/L and (40 ± 10 ) ng/L; serum levels of ALT and AST were (87±46) U/L and (50 ±21 ) U/L, respectively. Serum IL-18, IL-12, TNF-α, ALT and AST levels in severe ICP subgroup were significantly higher than those in mild ICP subgroup and control group (P ＜ 0. 05). And serum ALT and AST levels in mild ICP subgroup were significantly higher than those in control group(P ＜0. 05). (3) There were 16 cases with preterm birth (50%, 16/32 ) and 10 cases with meconium-stained amniotic fluid( 31%, 10/32 ) in severe ICP subgroup, significantly higher than those in mild ICP subgroup ( P＜ 0. 05 ), which contained 2 preterm births ( 7%, 2/30) and 1 meconium-stained amniotic fluid (3%, 1/30). While in control group, the numbers were 1(3%, 1/30)and 1(3%, 1/30),respectively. As for the cases of neonates whose 1 minute Apgar score were not more than 7, there were 2 cases, 1 case and 1 case in severe ICP subgroup, mild ICP subgroup and control group, respectively,which showed no significant difference(P＞ 0. 05). Conclusion Serum IL-18, IL-12 and TNF-α may be involved in the process of hepatic injury of ICP.