前置胎盘临床高危因素分析及其与妊娠结局的相关性研究

目的探讨前置胎盘的临床高危因素及其对母婴的影响,为其预防提供理论依据。方法选取2010年9月—2013年6月期间住院的单胎前置胎盘孕产妇(112例)为研究组,同期住院的健康、单胎、非前置胎盘孕产妇(177例)为对照组,回顾性分析前置胎盘临床常见病因及其对母婴的影响。结果研究组中年龄≥35岁者43例,占38.4%,无业30例,占26.8%,工人32例,占28.6%,分娩史≥3次者29例,占25.9%,人工流产史≥3次者48例,占42.9%,剖宫产史者22例,占19.6%,盆腔炎史者39例,占34.8%,均高于对照组;经统计学分析比较,两组患者年龄、人工流产史、剖宫产史、分娩史、盆腔炎史差异有统计学意义(均P0.05),Logistic回归分析显示,高龄、多次人工流产史、剖宫产史及分娩史暴露率相对较高,是前置胎盘的常见病因;两组产妇妊娠结局比较,研究组剖宫产、胎盘粘连、胎盘植入、产后出血、产褥期感染、早产、低出生体重儿、新生儿窒息发生率明显高于对照组,差异均有统计学意义(均P0.05)。结论年龄、人工流产史、剖宫产史、分娩史是前置胎盘的高危因素,严重威胁母婴生命,应做好生殖卫生、实行计划生育、减少人工流产次数、降低剖宫产率等防治措施。     

围生期生殖道感染病原菌构成及耐药分析

目的 了解2008-2010年产科病房孕产妇围生期生殖道感染病原菌的构成特点及其耐药性变化,为临床合理使用抗菌药物提供依据,并为加强控制医院感染的发生提供实验室诊断.方法 对产科病房2008-2010年生殖道标本所分离出的病原菌及其耐药性进行回顾性调查分析.结果 送检标本共2047份,检出病原菌88株,检出率4.3％;前4位病原菌依次为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、无乳链球菌,分别占28.4％、26.2％、10.2％、6.8％;金黄色葡萄球菌、革兰阴性杆菌和链球菌属对常用抗菌药物耐药较为严重,且呈多药耐药性,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为21.7％,革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)检出率为17.4％.结论 进行病原学监测,了解病原菌构成及其耐药趋势,对合理选择抗菌药物、降低围生期生殖道细菌感染发生率、减少耐药菌株产生和控制医院感染暴发和流行均有重要价值.     

Design and analysis of trials with a partially nested design and a binary outcome measure

Where treatments are administered to groups of patients or delivered by therapists, outcomes for patients in the same group or treated by the same therapist may be more similar, leading to clustering. Trials of such treatments should take account of this effect. Where such a treatment is compared with an un‐clustered treatment, the trial has a partially nested design. This paper compares statistical methods for this design where the outcome is binary. Investigation of consistency reveals that a random coefficient model with a random effect for group or therapist is not consistent with other methods for a null treatment effect, and so this model is not recommended for this design. Small sample performance of a cluster‐adjusted test of proportions, a summary measures test and logistic generalised estimating equations and random intercept models are investigated through simulation. The expected treatment effect is biased for the logistic models. Empirical test size of two‐sided tests is raised only slightly, but there are substantial biases for one‐sided tests. Three formulae are proposed for calculating sample size and power based on (i) the difference of proportions, (ii) the log‐odds ratio or (iii) the arc‐sine transformation of proportions. Calculated power from these formulae is compared with empirical power from a simulations study. Logistic models appeared to perform better than those based on proportions with the likelihood ratio test performing best in the range of scenarios considered. For these analyses, the log‐odds ratio method of calculation of power gave an approximate lower limit for empirical power. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.     

Development and Validation of Global Leadership Initiative on Malnutrition for Prognostic Prediction in Patients Who Underwent Cardiac Surgery

The Global Leadership Initiative on Malnutrition (GLIM) has achieved a consensus for the diagnosis of malnutrition in recent years. This study aims to determine the prognostic effect of the GLIM after cardiac surgery. A total of 603 patients in the training cohort and 258 patients in the validation cohort were enrolled in this study. Perioperative characteristics and follow-up data were collected. A nomogram based on independent prognostic predictors was developed for survival prediction. In total, 114 (18.9%) and 48 (18.6%) patients were defined as being malnourished according to the GLIM criteria in the two cohorts, respectively. Multivariate regression analysis showed that GLIM-defined malnutrition was an independent risk factor of total complication (OR 1.661, 95% CI: 1.063–2.594) and overall survival (HR 2.339, 95% CI: 1.504–3.637). The c-index was 0.72 (95% CI: 0.66–0.79) and AUC were 0.800, 0.798, and 0.780 for 1-, 2-, and 3-year survival prediction, respectively. The calibration curves of the nomogram fit well. In conclusion, GLIM criteria can efficiently identify malnutrition and has a prognostic effect on clinical outcomes after cardiac surgery. GLIM-based nomogram has favorable performance in survival prediction.     

腹腔镜术后联合GnRH-α对子宫内膜异位症合并不孕患者妊娠结局及婚姻质量的影响

目的 分析腹腔镜术后联合促性腺激素释放激素(GnRH)对子宫内膜异位症合并不孕患者妊娠结局及婚姻质量的影响.方法 选取青岛市市立医院自2014年6月至2015年6月收治的110例子宫内膜异位症合并不孕患者,采取随机数字表法分为对照组与观察组,每组各55例,对照组仅给予单纯腹腔镜治疗,观察组给予腹腔镜联合GnRH-α治疗,对比两组患者术后试孕12个月自然妊娠率、流产率、异位妊娠率、早产率、足月产率等妊娠结局,同时对比两组患者术后随访12个月期间的婚姻质量.结果 观察组与对照组相比,术后试孕12个月累计妊娠率及足月产率高,流产率、异位妊娠率及早产率低,差异均具有统计学意义(x2值分别为7.89、9.98、6.76、6.41、6.76,均P＜0.05).与治疗前相比,两组治疗后的过分理想化、婚姻满意度、夫妻交流、性格相容性、解决冲突、经济安排、业余活动、子女和婚姻、与亲友关系、角色平等性、信仰一致性及性生活评分均明显升高,但观察组比对照组改善更加显著,均具有统计学意义(f值为6.45～7.66,均P＜0.05).结论 腹腔镜术后联合GnRH-α治疗子宫内膜异位症合并不孕患者的疗效明显优于单独使用腹腔镜者,可获得更高的妊娠率,改善妊娠结局,提高婚姻质量.     

流动人口中妊娠期交界性糖耐量异常对胎儿体重及妊娠结局的影响

目的分析交界性糖耐量异常对妊娠结局和新生儿体重的影响。方法以前瞻性队列研究的方法,将2008年7月至2009年10月符合纳入标准的孕妇分为BGGI病例组（n=371）和正常对照组（n=368）,随访并=记录其妊娠结局和新生儿体重情况。结果两组对象间年龄、月收入、分娩孕周和体重增加值等指标差异均无统计学意义（p〉0．05）,病例组新生儿出生体重、巨大儿以及大于孕龄儿发生率,与对照组差异均具有显著统计学意义（P〈O．01）。结论交界性糖耐量异常可使胎儿体重过大发生率增加,但其对于其他不良妊娠结局的影响尚无法明确。对交界性糖耐量孕妇可能有必要进行孕期干预。     

含有缺失机制的多元纵向数据分析

目的本文旨在对含有不可忽略缺失机制的多元纵向数据建立一个适当的统计模型。方法对纵向数据建立含有潜在变量的线性混合模型;由于潜在变量在本文中代表治疗效果,而且随着时间变化在不断改进,所以本文用一阶的马氏链来反应潜在变量之间的这种联系;引入logistic回归模型来描述数据的缺失机制。最后利用EM算法对参数进行估计,并且给出了数据的模拟结果。结果从模拟的结果可以看出,参数的96%置信区间包含了待估计参数的真值。结论本文所提出的方法对于估计类似数据的参数具有一定的有效性,相对于传统方法,适用性更广泛,且大大简化了计算的工作量。     

侧卧位分娩对产程及母婴结局的影响

目的 比较侧卧位分娩与传统仰卧位分娩对产程以及母婴结局的影响.方法 选择2015年8月至2016年6月在西安交通大学医学院第一附属医院妇产科产房无合并症的足月初产妇200例为研究对象,其中100例侧卧位分娩为研究组,100例传统仰卧位分娩为对照组,比较两组产妇的第二产程时限、会阴损伤、新生儿窒息及产后出血等母儿结局.结果 研究组产妇第二产程显著短于对照组(t=-3.10,P<0.05).研究组胎儿窘迫、新生儿窒息发生率显著低于对照组(χ2值分别为6.37、5.10,均P<0.05),而两组新生儿锁骨骨折、新生儿臂丛神经损伤发生率无显著性差异(χ2值分别为2.75、1.01,均P>0.05).研究组的产妇会阴完整率明显优于对照组(χ2=7.29,P<0.01),且产后出血发生率显著低于对照组(χ2=4.35,P<0.05).结论 侧卧位分娩能够预防胎儿窘迫,减少新生儿窒息,减少产妇的会阴撕裂伤,降低产妇会阴侧切率,有利于产后恢复,还能够预防产后出血的发生,值得临床推广.