妊娠合并肺动脉高压伴心力衰竭患者的围生结局

目的 探讨妊娠合并肺动脉高压伴心衰患者的围生结局.方法 收集2000年1月至2010年12月温州医学院附属第二医院产科、心内科收治的妊娠合并肺动脉高压患者54例,其中伴心衰患者34例,分析其终止妊娠的时机、方式及围生结局,并比较肺动脉高压伴心衰患者和无心衰患者的妊娠结局.结果 (1)54例妊娠合并肺动脉高压患者中,心衰发生率为62.96%(34/54),轻度、中度和重度肺动脉高压心衰发生率分别为27.78%(5/18),73.33%(11/15),85.71%(18/21),三组比较差异具有统计学意义(P<0.05);(2)妊娠合并肺动脉高压伴心衰患者中并发症发生率为47.06%(16/34),孕产妇病死率为17.64%(6/34),医源性胎儿丢失率为29.41%(10/34),早产发生率52.94%(18/34),新生儿窒息35.29%(12/34),围生儿死亡23.53%(8/34).(3)妊娠合并肺动脉高压伴心衰患者以剖宫产分娩为主91.18%(31/34).(4)妊娠合并肺动脉高压伴心衰患者医源性引产、早产,孕产妇并发症,孕产妇死亡,新生儿窒息和胎儿、新生儿死亡发生率明显高于无心衰组,差异有统计学意义(P<0.05).结论 随着肺动脉压力的升高,孕妇心衰发生率随之增加;心衰是影响妊娠合并肺动脉高压患者围生预后的最主要因素;剖宫产终止妊娠是比较安全的分娩方式.

Abstract：

Objective To discuss the effect of the occurrence of congestive heart failure on the outcome of pregnant women with pulmonary hypertension. Methods Fifty-four pregnant patients complicated with pulmonary hypertension were admitted from January 2000 through December 2010. Among them, 34 had comorbidity of congestive heart failure. The timing and mode of pregnancy termination, and perinatal outcomes were studied, and comparison was made between those with and without heart failure. Results ① Of all 54 pregnant women with pulmonary hypertension, 34 had congestive heart failure. The incidences of congestive heart failure in patients with mild, moderate and severe degree of pulmonary hypertension were 27.78% (5/18), 73.33% (11/15) and 85.71% (18/21), respectively (P<0.05).②The rate of maternal complications was 47.06% (16/34) and maternal mortality was 17.65% (6/34) in the patients with combined pulmonary hypertension and heart failure. The rate of iatrogenic fetal loss was 29.41% ( 10/34) , preterm labor 52.94% (18/34), neonatal asphyxia 35.29% (12/34) and neonatal mortality 23.53% (8/34) in case of patients with pulmonary hypertension complicated with congestive heart failure. ③The rate of Cesarean section was 91. 18% (31/34) in the patients with combined pulmonary hypertension and heart failure. ④ The rates of iatrogenic induction, premature delivery, maternal complications and mortality, neonatal asphyxia and fetal or neonatal fatality were significantly higher in women with combined pulmonary hypertension and heart failure than those with simple pulmonary hypertension ( P < 0. 05). Conclusions The risk of heart failure increases with the severity of pulmonary hypertension. The occurrence of heart failure is the most important factor affecting the outcome of patients in pregnancy already complicated with pulmonary hypertension , and Cesarean section is the safer mode of termination of pregnancy in this cohort of women.     

侧方加压充填技术和氯仿软化牙胶尖充填技术根尖封闭能力的比较

目的 比较侧方加压充填技术与氯仿软化牙胶尖充填技术的根尖封闭能力。方法 选取40个下颌单根管前磨牙作为研究对象，A组20个采用侧方加压技术进行充填，B组20个采用氯仿软化牙胶尖充填。采用染色法比较根尖封闭能力。结果 A组与B组的根尖封闭能力无显著性差异。结论 氯仿软化牙胶尖不能提高根尖封闭能力。     

加强国际合作,促进新药开发

加强国际交流与合作,是促进医药科学技术和新药研发的重要途径之一.药物研究所自改革开放以来,重视和积极开展对外科技合作,取得了一些可喜的成果,积累了一些宝贵经验.本文结合本单位在对外科技合作中的一些体会,与大家共同探讨如何通过加强国际合作,来促进我们自己的新药研究与开发.     

超声对下肢淋巴水肿的诊断价值

目的:探讨彩色多普勒超声对下肢水肿性疾病的诊断价值.方法:运用超声诊断仪对水肿部位进行连续性扫察.结果:下肢水肿性疾病在彩色超声中具有特异性声像图表现,可明确诊断下肢淋巴性水肿.结论:超声在下肢淋巴水肿中具有重要意义.可作为临床进行本病诊断的重要手段.     

手助腹腔镜与开腹巨脾切除术的临床对比研究

目的对比手助腹腔镜与开腹手术治疗巨脾症的临床疗效。方法 2006年8月～2011年6月,将40例巨脾按患者意愿分成2组各20例,分别进行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)和传统开腹脾切除术(open splenectomy,OS),比较两组的手术时间、术中出血量、术后肛门排气时间、术后并发症发生率及术后住院时间等。结果 20例HALS组手术均获得成功,无中转开腹。与OS组相比,HALS组手术时间长[(110.9±37.2)min vs.(80.2±20.7)min,t=3.225,P=0.003],术中出血量少[(205.2±70.7)ml vs.(390.7±175.1)ml,t=-4.393,P=0.000],术后肛门排气早[(1.8±0.6)d vs.(2.4±0.9)d,t=-2.481,P=0.018],术后住院时间短[(8.9±1.2)d vs.(10.9±1.8)d,t=-4.134,P=0.000],术后并发症发生率差异无显著性[0(0例)vs.5.0%(1例),P=1.000]。结论 相比开腹手术,手助腹腔镜巨脾切除术具有切口美观、创伤小、恢复快的优点,是一种安全可行的治疗巨脾症的手术方式。     

Isolation of CIq in Human Serum with Anti-human CIq McAb Affinity Column Chromatography

This paper is to report a procedure for the isolation of Clq in humanserum with anti-human C1q McAb affinity column chromatography.Thisprocedure is simple and rapid,Which can be performed within 24 to 48 hours.The yield of Clq can reach 7-10 mg per 100 ml serum.The preparation isimmunoglobulin free as proved by double diffusion and immunoelectrophoresisassay and exhibits typical C1q subunit structure on SDS-PAGE.After biologicalactivity evaluation with red blood cell agglutination and latex agglutinationassay,this C1q preparation was found to be satisfactory in its activity.The anti-human C1q McAb sepharose 4B column can be used repeatedly.Itcan be stored in 4℃ for approximately a year without losing any of its absorptionactivity.     

前房煤质异物存留七年一例

患者庞××,男,35岁,内蒙大杨树煤矿井下采煤工人,于1984年7月18日入院,住院号3606。主诉:右眼视力障碍,眼内有煤质异物,病史:于7年前在井下采煤时,煤块崩入右眼内,当时经当地医院检查,于9点钟角膜边缘处有穿通伤,并于5时处前     

股方肌骨瓣转位移植治疗股骨颈骨折

自1997年以来,笔者应用带蒂股方肌骨移植加内固定治疗股骨颈骨折、青壮年股骨颈骨折、移位型股骨颈骨折及陈旧性股骨颈骨折28例,经8个月至5年随访,疗效满意。报道如下。1资料与方法1.1本组28例,男19例,女9例;年龄24～68岁,平均44.8岁。新鲜骨折25例,陈旧骨折股骨头无坏死3例。致伤原因:平地滑倒7例,高处坠落8例,交通事故13例。骨折类型:颈中型16例,头颈型9例,头下型3例。Garden分型:GardenⅡ3例;Ⅲ型20例;Ⅳ型5例。1.2治疗方法:术前先作骨牵引,床边摄片证实骨折牵开后手术,牵引时间2～7天。在硬膜外麻醉下行髋关节后侧入路,切取股方肌骨瓣…     

关于超声诊断仪器的一些情况

超声医学是以现代超声技术为手段而发展起来的一门应用科学。由于超声诊断方法具有无损伤的特点,特别是对软组织鉴别充分显示其特长,所以受到人们的普遍重视,得到不断发展。可以预计,随着现代科学技术的发展,尤其是电子计算机的普及,超声技术应用在人类生理信息计测和临床诊断中的前途是极为广阔的。同时,临床诊断医学的研究和提高,又为超声诊断仪器开拓新的     

SIEMENS数字直线加速器的安全系统

安全系统在放射治疗中起到保障患者和设备安全的重要作用。该文分析了西门子数字式直线加速器3种安全系统的原理和构成,并实例介绍了它在日常中的应用。