晚期妊娠引产应用地诺前列酮栓与宫颈扩张球囊的比较

目的探讨应用地诺前列酮栓与宫颈扩张球囊在晚期妊娠引产中的效果比较,为妊娠晚期需引产的孕妇寻求更安全的方法。方法选取2014年1月至2014年7月收治的晚期妊娠引产的患者360例进行研究,按照临床试验随机的原则将患者分为两组,地诺前列酮栓组与COOK球囊组,每组180例。观察比较两组引产成功率、总产程时间、产后出血量、临产时间、新生儿评分以及分娩时胎心及羊水异常情况等。结果两组孕妇引产成功率、总产程时间差异无统计学意义(P0.05)。球囊组分娩过程出现胎心异常率、出生时羊水性状异常者比率低于地诺前列酮栓组,差异有统计学意义(P0.05);但新生儿体重和新生儿评分比较,差异无统计学意义(P0.05)。球囊组产后出血量少于地诺前列酮栓组(P0.05),但产后缩宫素患者比率、放置时间高于地诺前列酮栓组,差异有统计学意义(P0.05)。结论两组引产成功率相近,但球囊作用较普贝生缓和,安全,并发症少。     

前列腺素E2受体在前列腺素E2诱导H9c2心肌细胞肥大中的作用

目的 评价前列腺素E2受体(EP受体)在前列腺素E2(PCE2)诱导H9c2心肌细胞肥大中的作用.方法 培养H9c2心肌细胞,以4×104个/ml的密度接种于培养瓶(每瓶3ml)、24孔(每孔1 ml)或6孔(每孔2 ml)培养板.采用随机数字表法,将细胞随机分为4组(n=24):空白对照组(C组)不予任何处理,继续培养48 h;PGE2组在细胞培养液中加入PGE2(终浓度1μmol/L);AH6809组(A组)在细胞培养液中加入PGE2(终浓度1μmol/L)和AH6809(EP1及EP2受体拮抗剂,终浓度10μmol/L);GW627368X组(G组)在细胞培养液中加入PGE2(终浓度1μmol/L)和GW627368X(EP4受体拮抗剂,终浓度10 μmol/L).孵育48 h后采用免疫荧光观察心肌细胞形态,Image J医学图像分析系统测量心肌细胞直径,BCA法检测心肌细胞总蛋白含量,RT-PCR法测定胞浆ANP mRNA及BNP mRNA的表达水平.结果 与C组比较,PGE2组、A组和G组心肌细胞总蛋白含量和心肌细胞直径增加,胞浆ANPmRNA及BNPmRNA表达上调(P＜0.05).与PGE2组比较,G组心肌细胞总蛋白含量和心肌细胞直径降低,胞浆ANP mRNA及BNP mRNA表达下调(P＜0.05),A组上述各指标差异无统计学意义(P＞0.05).结论 EP4受体介导了PGE2诱导的心肌细胞肥大效应,而该效应与EP1和EP2受体无关.     

欣普贝生应用于足月胎膜早破引产的临床分析

目的 探讨欣普贝生应用于足月胎膜早破的引产效果. 方法 选择我院70例有引产指征的足月胎膜早破孕妇,完全随机分为2组.研究组35例使用欣普贝生引产,对照组35例以缩宫素引产,比较两组的引产效果以及分娩结局. 结果 研究组12 h内促宫颈成熟有效率100%,高于对照组48.39%;研究组用药至临产时间（6.27±6.13）h,短于对照组（9.65±6.79）h,用药至分娩时间（12.15±7.51）h,也短于对照组（19.34±9.22）h;研究组剖宫产率22.86%,低于对照组45.71%（均P＜0.05）;研究组总产程（6.10±2.60）h,短于对照组（10.97±3.37）h（P＜0.05）;两组产后出血、胎儿窘迫及新生儿窒息的发生率差异均无统计学意义（P＞0.05）. 结论 欣普贝生可安全地用于足月胎膜早破的引产,效果优于缩宫素.     

欣普贝生应用于妊娠晚期引产的临床疗效

目的分析欣普贝生在妊娠晚期引产中的应用及疗效。方法将我院2011年12月～2012年3月收治的80例妊娠晚期引产的患者分为观察组和对照组．观察组采刖欣普贝牛引产,对照组采用缩宫索引产,比较两组患者的引产效果。结果观察组的宫颈成熟评分、引产成功率显著高于对照组,用药到临产时间、剖宫产率显著少于对照组（P〈0．05）。结论欣普贝生有利于促进妊娠晚期患者宫颈成熟,增加引产成功率．值得应用。     

欣普贝生在妊娠延期引产中的临床应用

目的观察欣普贝生联合乳头刺激在妊娠延期引产对母婴影响的临床研究。方法选择100例延期妊娠患者．按照随机数字表随机分为研究组和对照组。对照组予静脉点滴催产素,研究组予阴道放置欣普贝生。比较两组宫颈成熟度、分娩方式、产程时间、产后出血量、不良反应、对母婴的影响等。结果研究组宫颈成熟度、疗效优于对照组,自然分娩率较高,产程时间、产后出血量较对照组少,差异有统计学意义（P〈0．05）。结论在妊娠延期引产过程中应用欣普贝生联合乳头刺激,用药过程中,加强Oream护理和观察能够有效缩短产程,提高分娩质量．降低剖宫产率。     

地诺前列酮栓在足月妊娠促宫颈成熟引产中应用的疗效观察及护理

目的观察地诺前列酮栓用于促宫颈成熟引产的治疗效果及护理要点。方法选取我院妇产科2009年12月至2011年1月收治的92例孕产妇,随机分为观察组和对照组各46例,观察组孕产妇采用地诺前列酮栓引产,对照组用催产素引产。比较2组的应用效果。结果观察组治疗效果显著,宫颈评分用药12h后较用药前明显提高,且与对照组比较,有显著差异;观察组临产时间、总产程及分娩时间等指标明显低于对照组;引产成功率为91．3％,明显高于对照组的引产成功率80．4％。结论地诺前列酮栓适用于足月妊娠促宫颈成熟引产的治疗,且安全、可控,疗效好。     

欣普贝生与催生素用于妊娠足月引产的临床疗效及护理观察

目的 评价欣普贝生与催产素在足月妊娠引产中的效果和安全性。方法 936例妊娠足月产妇随机分为两组,欣普贝生组468例,用欣普贝生放置于阴道后穹窿引产;催产素组468例,静脉滴入小剂量催产素,并做好相应的用药护理及观察。应用统计学分析比较两组产妇的宫颈Bishop评分、临产时间、分娩方式、新生儿评分、产后出血量以及不良反应。结果 应用欣普贝生不同时间段,宫颈Bishop评分明显高于催产素组(P<0.05);欣普贝生组临产时间和产后出血量明显低于催产素组,分娩成功率明显高于催产素组;两组新生儿情况无显著性差异(P>0.05); 欣普贝生组有部分产妇出现不良反应,在停药后症状缓解。结论 欣普贝生应用于足月妊娠引产,效果优于催产素静脉滴入,可安全有效地应用于临床工作中。     

嗜酸粒细胞性支气管炎与咳嗽变异性哮喘患者的气道炎症特征的研究

目的 探究嗜酸粒细胞性支气管炎(EB)和咳嗽变异性哮喘(CVA)患者气道炎症细胞、细胞因子和炎性介质的特征,阐明两者存在不同气道炎性特征的可能机制.方法检测杭州市第一人民医院门诊收治的15例EB患者(EB组)、15例CVA患者(CVA组)、14例支气管哮喘(简称哮喘)患者(哮喘组)和14名健康体检者(健康对照组)诱导痰中嗜酸粒细胞(EOS)百分比;流式细胞仪检测白细胞介素(IL)-5及干扰素(IFN)-γ刺激的EOS表面CD69的表达;实时荧光定量PCR方法检测各组诱导痰上清液中前列腺素E2(PGE2)、白三烯C4(LTC4)、IL-5、IFN-γ mRNA的表达水平;酶联免疫吸附法(ELISA)检测各组诱导痰上清液中PGE2、LTC4、IFN-γ和IL-5蛋白表达水平.结果 EB组、CVA组、哮喘组诱导痰中EOS百分比分别为(15.8±3.2)%、(13.0±2.7)%和(11.6±4.5)%,均明显高于健康对照组的(1.0±0.4)%(均P<0.05).在IL-5和IFN-γ刺激下,EB组诱导痰中EOS表达CD69分别为1.49±0.42和1.51±0.52、CVA组分别为1.37±0.41和1.42±0.32、哮喘组分别为1.42±0.72和1.37±0.46,3组间差异无统计学意义,但较健康对照组(分别为0.42±0.21和0.39±0.12)差异均有统计学意义(均P<0.05).EB组、CVA组、哮喘组诱导痰中IL-5的mRNA及蛋白表达水平明显高于健康对照组(均P<0.05),但3组间差异无统计学意义;各组诱导痰中IFN-γ的mRNA及蛋白表达水平较健康对照组差异均无统计学意义.EB组诱导痰中PGE2浓度为(839±69)ng/L,明显高于CVA组的(33±8)ng/L、哮喘组的(25±6)ng/L和健康对照组的(24±8)ng/L(均P<0.01),后3组差异无统计学意义;EB组PGE2限速酶前列腺素氧化环化酶2(PTGS2)的mRNA水平表达量显著增加,较CVA组、哮喘组及健康对照组差异均有统计学意义(均P<0.01);CVA、EB和哮喘组诱导痰中LTC4浓度明显高于健康对照组(均P<0.05),CVA、EB及哮喘组中LTC4限速酶白三烯C4合成酶(LTC4S)的mRNA表达水平明显高于健康对照组(均P<0.05),EB组LTC4的mRNA及蛋白表达水平与CVA组和哮喘组比较,差异也有统计学意义(均P<0.05).CVA组、哮喘组诱导痰中LTC4/PGE2比值明显高于EB组(t值分别为8.67和13.12,均P<0.05).结论 EB患者诱导痰中PGE2高表达以及CVA组LTC4/PGE2比值较EB组显著增高,这两者可能是EB缺乏气道高反应性的炎症基础.

Abstract：

Objective To explore the characteristics of airway inflammatory cells, cytokines and inflammatory mediators in eosinophilic bronchitis (EB) and cough variant asthma (CVA) patients and to elucidate the underlying mechanism of distinct airway inflammation between EB and CVA. Methods This study included 15 patients with EB (EB group), 15 patients with cough variant asthma (CVA, CVA group), 14 patients with bronchial asthma (asthma group) and 14 healthy controls (healthy group). Percentage of eosinophils (EOS) in sputum induced by hypertonic saline was detected by FACS. The percentage of CD+69 EOS stimulated by interleukin-5 (IL-5) and interferon γ (IFN-γ) was also detected by FACS. The expression of leukotriene C4 synthase (LTC4S) and prostaglandin-endoperoxide synthase-2 (PTGS2) mRNA in sputum was measured by real-time PCR and the concentration of leukotriene C4 (LTC4) and prostaglandin E2(PGE2) in sputum was measured by ELISA. Results The percentage of EOS in induced sputum was 15.8±3.2 (EB group), 13.0±2.7 (CVA group) and 11.6±4.5 (asthma group), respectively, which were significantly higher than 1.0±0.4 in the healthy group. The difference was significant and the t value was 16.31, 15.23 and 14.21 respectively (P<0.05). After stimulated by IL-5 and IFN-γ, the percentage of CD+69 EOS in induced sputum was 1.5±0.4 and 1.5±0.5 (EB group), 1.4±0.4 and 1.4±0.3 (CVA group) and 1.42±0.72 and 1.37±0.46 (asthma group) respectively. There was no statistical significance between these 3 groups, but when compared with 0.4±0.2 and 0.4±0.1 in healthy group, the difference was significant(P<0.05). The expression of IL-5 mRNA and protein in induced sputum of EB group, CVA group and asthma group were higher than the healthy group and the difference was all statistically different (P<0.05), but there was no statistical significance between EB group, CVA group and asthma group. The expression of IFN-γ mRNA and protein in induced sputum of each group was not different when compared with healthy group (P＞0.05). The concentration of PGE2 in induced sputum of EB group was(839±69)ng/L, which was higher than (33±8) ng/L of CVA group, (25±6) ng/L of asthma group and (24±8) ng/L of healthy group (all P<0.01). There was no statistical difference between CVA group, asthma group and healthy group. The expression of PTGS2 in induced sputum of EB group increased significantly; when compared with CVA group, asthma group and healthy group, the difference was significant (all P<0.01). The concentration of LTC4 in induced sputum of EB group, CVA group and asthma group was all higher than the healthy group (all P<0.05). The expression of LTC4S mRNA of EB group, CVA group and asthma group was also higher than the healthy group (all P<0.05). The expression of LTC4S mRNA and LTC4 in the EB group was higher than that in the CVA group and the asthma group (P<0.05). The value of LTC4/PGE2 in the CVA group and the asthma group was higher than that in the EB group (t=8.7 and 13.1, P<0.05). Conclusion These data suggest that the difference in airway function observed in subjects with eosinophilic bronchitis and CVA (or asthma) may be due to the results of differences in PGE2 production and an imbalance between the production of bronchoconstrictor LTC4 and bronchoprotective PGE2 lipid mediators.     

控释地诺前列酮栓用于延期及过期妊娠引产的临床观察

目的:观察控释地诺前列酮(商品名欣普贝生)用于延期妊娠及过期妊娠引产的有效性及安全性。方法:回顾性分析2007—2010年我院98例延期及过期妊娠者,观察组48例,于阴道后穹窿放置控释地诺前列酮引产,对照组50例,静脉滴注催产素引产,应用统计学分析比较两组在给药前和给药后12h的宫颈Bishop评分,引产成功率,宫缩过强,胎儿窘迫,新生儿窒息,产后出血等情况。结果:两组病例在用药后12h宫颈评分比较,观察组明显优于对照组(P<0.01);观察组阴道分娩率高于对照组,剖宫产率低于对照组(P<0.01);两组发生宫缩过强情况,新生儿阿氏评分,产后出血差异无统计学意义(P>0.05)。结论:普贝生用于延期妊娠及过期妊娠引产效果优于催产素引产,并且无降低引产的安全性,是安全有效的引产药物。     

Labor Induction with 50?μg Vaginal Misoprostol: Can We Reduce Induction-Delivery Intervals Safely?

Objective

To compare the efficacy and safety profile of two methods of labor induction i.e., intracervical dinoprostone gel (0.5 mg 8 h) and misoprostol (50 μg 4 h) for induction of labor in women with a poor Bishop’s score.

Design

Observational study.

Study Period

January 1st, 2009 to December 31st, 2010.

Population

A total of 329 women with unfavorable cervices induced at or near term.

Methods

Two cervical ripening agent study arms were used: dinoprostone gel (193 women) and misoprostol (137 women).

Main Outcome Measures

Induction to delivery interval, cesarean section, incidence of meconium stained liquor, FHR pattern, incidence of uterine hyperstimulation, and neonatal outcomes.

Results

The induction to delivery interval was significantly shorter in the misoprostol group as compared to the dinoprostone group (p < 0.001). There was no difference in cesarean section rates between the two groups (dinoprostone gel 43 %; misoprostol 33 %; p = 0.144). The incidence of non-reassuring fetal heart rate pattern, meconium stained liquor, and uterine hyperstimulation were equivalent in both the groups (p = 0.529; 0.733; and 0.321, respectively). The neonatal outcomes in both the groups were comparable in terms of Apgar scores at birth (p = 0.160) and NICU admissions (p = 0.951).

Conclusions

Labor induction in women with unfavorable cervices results in high caesarean section rates. However, the use of misoprostol significantly reduces the induction to delivery interval, without adversely affecting the caesarean section rates and neonatal outcomes. Hence it may become a cost-effective alternative to dinoprostone gel in resource-poor settings like India.