硬膜外阻滞行剖宫产对产妇及胎儿TXA_2和PGI_2的影响

观察25例硬膜外阻滞行剖宫产的正常产妇及胎儿脐血内TXA_2及PGI_2的变化。发现母体在胎儿娩出及术毕时与麻醉前相比,TXA_2及PGI_2均无统计学的改变(P>0.05),胎儿脐血内含量在母体范围内。表明局麻药利多卡因及丁卡因经硬膜外用药后,对TXA_2和PGI_2的平衡无明显影响,可能是由于硬膜外阻滞有效地抑制手术伤害刺激所致的应激反应。     

冰冻切片、快速石蜡切片在中枢神经系统肿瘤诊断中的应用价值比较

目的：比较冰冻切片与快速石蜡切片诊断中枢神经系统肿瘤的应用价值。方法选取本院2012年6月~2014年6月接收的293例中枢神经系统肿瘤疑似患者为研究对象,所有病例均行冰冻切片与快速石蜡切片病理诊断,将其诊断结果与术后常规石蜡切片病理结果进行对照分析,计算两种检查方法的敏感度、特异度、阳性预测值与阴性预测值,并进行对比。比较三种切片方法操作所需时间。结果术后常规石蜡切片所需时间为(5.07±0.28)d,快速石蜡切片为(6.49±0.67) h,冰冻切片为(6.91±0.54)h,冰冻切片与快速石蜡切片需要时间显著短于术后常规石蜡切片(P<0.05)。术后常规石蜡切片诊断出中枢神经系统肿瘤256例(87.37%);非中枢神经系统肿瘤37例(12.63%)。应用快速石蜡切片对中枢神经系统肿瘤诊断的敏感度、特异度、阳性预测值、阴性预测值、诊断准确率均显著高于冰冻切片(P<0.05)。结论快速石蜡切片能及时发现、诊断中枢神经系统肿瘤,相较于冰冻切片,具有较高的灵敏度、特异度和准确度,值得推广应用。     

帕瑞昔布钠在经产妇剖宫产术后的镇痛作用及安全性分析

目的 观察帕瑞昔布钠在经产妇剖宫产术后减轻子宫收缩痛的作用及其安全性.方法 选取本院2015年2月至2016年2月收治的76例拟行剖宫产的经产妇为观察对象,根据麻醉用药方法分为对照组和观察组各38例.对照组于术后常规应用缩官素和镇痛泵,而观察组加用帕瑞昔布钠镇痛.观察两组患者疼痛程度、24 h出血量和子宫复旧程度.结果 术后2、6、lOh时观察组的VAS评分均明显低于对照组(t=3.076、5.551、4.232、1.043;P=0.023、0.006、0.012、0.144),产妇疼痛程度较轻.而术后24 h,两组疼痛程度比较差异无统计学意义(P＞0.05).对照组产妇24 h出血量及子宫复旧程度与观察组比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠应用于经产妇剖官产有显著的镇痛作用,安全性可靠.     

小剂量去氧肾上腺素、甲氧明、麻黄素和输注羟乙基淀粉对腰硬联合麻醉剖宫产术中低血压的预防

目的比较预注小剂量去氧肾上腺素、甲氧明及麻黄素和输注羟乙基淀粉对腰-硬联合麻醉(CSEA)下产妇心血管系统的影响。方法 120例择期行剖宫产手术的产妇,随机分为4组,入手术室后先开放静脉,输注乳酸钠林格注射液200～300mL,行麻醉穿刺,在蛛网膜下腔注入0.5%布比卡因1.5mL后,产妇转为平卧位时,从静脉分别给予去氧肾上腺素10μg,甲氧明3mg,麻黄素6mg,羟乙基淀粉300mL,所有患者经上述处理后仍出现低血压时,给予麻黄素6～12mg;当心率低于60次/min时,给予阿托品0.5～1.0mg记录腰麻前、腰麻后(预注后)5、10、15min及手术结束后的血压、心率,比较两组间患者低血压、心动过缓的发生率,恶心呕吐的发生情况及麻黄素(不包括预注量)、阿托品用量,两组反应性高血压次数。结果甲氧明组低血压发生率稍高于麻黄素组,但差异无统计学意义(P>0.05)。与麻黄素组比较,甲氧明组心动过缓的发生率稍增多,但差异无统计学意义(P>0.05)。去氧肾上腺素组低血压发生率低于甲氧明组和麻黄素组,羟乙基淀粉组低于甲氧明组和麻黄素组,恶心呕吐发生率比较差异无统计学意义(P>0.05)。麻黄素用量(不包括预注量)差异无统计学意义(P>0.05)。结论去氧肾上腺素10μg,甲氧明3mg,或麻黄素6mg羟乙基淀粉术前输注均能有效地预防CSEA下产妇血压下降,并且对新生儿无不良影响。     

中央性前置胎盘剖宫产保留子宫30例临床分析

目的:探讨中央性前置胎盘剖宫产保留子宫的措施,努力降低产科子宫切除的发生率,提高产科质量。方法:于2003年6月至2007年12月我院产科在子宫血流暂时阻断的条件下应用子宫下段局部环形缝合加子宫动脉下行支结扎治疗中央性前置胎盘剖宫产术中大出血30例。结果:30例患者剖宫产术中能完全止血,全部抢救成功并保留子宫。平均手术时间(60±5)min,术中平均止血时间(15±3)min。结论:该术式,具有止血快,简单易行,安全快速,效果可靠,能保留子宫等优点,是控制中央性前置胎盘剖宫产出血的主要方法。     

预负荷输液联合小剂量腰硬联合麻醉对产妇在剖宫产手术中心血管系统稳定性的影响

目的 研究预负荷输液联合小剂量腰硬联合麻醉是否可降低剖宫产手术中产妇心血管系统并发症的发生率.方法 剖宫产手术病人随机分为4组,每组30人:晶体液预负荷+腰麻组(CR-SA),胶体液预负荷+腰麻组(CO-SA),晶体液预负荷+小剂量腰硬联合麻醉组(CR-CSEA),胶体液预负荷+小剂量腰硬联合麻醉组(CO-CSEA);预负荷输注乳酸钠林格氏液或琥珀酰明胶注射液500 ml;腰麻为:0.5%布比卡因7.5 mg+芬太尼15μg,小剂量腰硬联合麻醉为:0.5%布比卡因5 mg+芬太尼15μg腰麻,5 min后硬膜外给予0.25%布比卡因10 ml;比较各组术中发生低血压、心律失常、恶心、呕吐、寒战的发生率以及麻黄素的用药量差异;比较各组麻醉感觉最高阻滞平面、Bromage评分、腹肌松弛优等率以及新生儿出生后1 min、5min的Apgar评分和出生即刻的脐动脉血气分析值的差异.结果 CO-CSEA组产妇术中低血压发生率为16.7%,显著低于CR-SA组(46.7%),CO-CSEA组与CO-SA组(20.0%)和CR·CSEA组(26.7%)相比,低血压发生率有降低趋势,但无统计学意义;CO-CSEA组产妇术中心律失常发生率为3.3%,显著低于CR-SA组(33.3%)和CO-SA组(23.3%),但与CR.CSEA组(10.0%)比较无统计学意义;CO-CSEA组与CR-SA组相比,产妇术中麻黄素用药量显著减少;CO-CSEA组和CO-SA组恶心、呕吐的发生率显著低于CR-SA组;各组寒战反应发生率都较低,无统计学差异;各组病人麻醉感觉阻滞平面、Bromage评分、腹肌松弛优等率均无统计学差异,新生儿Apgar评分和脐动脉血气分析值也均在正常范围,无统计学差异.结论 预负荷输注胶体液与小剂量腰硬联合麻醉方法联合应用,可有效增强产妇术中心血管系统的稳定性,降低低血压和心律失常的发生率,并可减少术中恶心、呕吐等副作用的发生.     

不同采集地土茯苓中(切面红色、白色)总糖及多糖含量分析与体外抗氧化作用

目的:分析测定26个不同采集地土茯苓中(切面红色、白色)总多糖及多糖的含量并探讨其体外抗氧化活性。方法:采用蒽酮-硫酸比色法,比较分析不同产地及不同切面颜色土茯苓中总糖及多糖含量;同时,以抗坏血酸为阳性对照,通过DPPH自由基(1,1-二苯基-2-苦肼基自由基)清除法来评价该药材中总糖与多糖的抗氧化能力。结果:切面红色土茯苓中总糖的质量分数为1.897 3%~11.680 9%,多糖为0.048 0%~1.863 4%;切面白色土茯苓中总糖的质量分数为7.957 5%~81.681 0%,多糖为0.413 2%~7.963 9%,两者含量差异较大;抗氧化结果表明,总糖及多糖均有清除自由基活性,其IC50依次为抗坏血酸(0.033 4 g·L-1)切面红色多糖(0.176 7 g·L-1)切面白色多糖(0.294 9 g·L-1)切面红色总糖(0.354 8 g·L-1)切面白色总糖(0.769 5 g·L-1)。结论:不同切面颜色及不同产地土茯苓药材中总糖及多糖的含量存在显著性差异,其多糖的含量高低与抗氧化作用的强弱不呈正相关。     

益母草注射液联合缩宫素在剖宫产术中及术后出血中的应用效果观察

目的：探讨益母草注射液联合缩宫素在剖宫产术中及术后出血中的应用效果。方法：将行剖宫产手术的产妇100例随机分为观察组50例行益母草注射液联合缩宫素治疗;对照组50例行缩宫素治疗。观察2组的疗效及产妇术中、术后2小时及术后24小时出血量情况。结果：观察组术中出血量（232.4±27.1） mL,术后2小时（35.5±7.4）mL,术后24小时（31.5±6.3）mL,与对照组比较明显少于对照组对应时间出血量,组间比较差异具有统计学意义（P＜0.01）;观察组治疗后显效19例,总有效率达96%,对照组治疗后显效14例,总有效率74%,2组比较差异具有统计学意义（P＜0.05）。结论：益母草注射液与缩宫素联合应用于剖宫产术中及术后可有效降低子宫收缩乏力导致的产后出血,且效果持久、安全。     

Comparison of chemical compositions and osteoprotective effects of different sections of velvet antler

Ethnopharmacological relevance

Velvet antlers (VA) have been claimed for centuries to have numerous medical benefits including strengthen bones. To investigate and compare the anti-osteoporotic activities from different sections of VA.

Materials and methods

Fresh VA prepared from farmed sika deers (Cervus nippon) was divided into upper (VAU), middle (VAM), and basal (VAB) sections. The chemical constituents and anti-osteoporotic effect of different sections from VA were evaluated using ovariectomized rats.

Results

Levels of water-soluble extracts, diluted alcoholic extract, amino acids, testosterone, insulin-like growth factor (IGF)-1and testosterone plus estradiol significantly differed among the different sections. Levels of these constituents were significantly higher in the upper section than in the basal section. Moreover, levels of testosterone and IGF-1 of the VAM were also significantly higher than those of the VAB. Calcium level increased downward from the tip with statistical significance. The strength of vertebrae increased in all VA-treated groups compared to the control, but only treatment with VAU and VAM increased the strength of the femur and the microarchitecure of the trabecular bone. Alkaline phosphatase levels of VAU- and VAM-treated groups significantly decreased, but osteocalcin did not significantly change. Moreover, VAU and VAM dose-dependently increased proliferation and mineralization of MC3T3-E1 cells.

Conclusion

Our study provides strong evidence for the regional differences in the effectiveness of velvet antler in treating osteoporosis. However, further studies are needed to elucidate the bioactive chemical constituents associated with the anti-osteoporotic effects of velvet antler.     

Maternal mortality in the United States

Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that - essentially - no progress has been made in most US States since 1982. Additionally, the US Centers for Disease Control and Prevention has stated that most cases are probably preventable. Two disheartening issues within this topic include a gross underestimation of the magnitude of maternal mortality - particularly before 1987, but which likely persists to a lesser degree today - and the continued significant racial disparity in maternal mortality. Explanations for the plateau in maternal mortality include the recent trend of delayed childbearing, with the potential accompanying complications associated with older reproductive age (particularly over 35 years) and multiparity. The impressive increase in multifetal pregnancies related to delayed childbearing and assisted reproductive technology also plays a role. Finally, peripartum cardiomyopathy has become an increasingly recognized source of maternal mortality. Pregnancy-related mortality is largely accounted for by thromboembolic disease, hemorrhage, hypertension and its associated complications, and infection. However, since the inclusion of maternal deaths occurring after 42 days post-delivery as pregnancy related, traumatic injuries - including homicides and suicides - are an alarming source of maternal mortality. An especially important contemporary issue to consider within this topic is cesarean delivery "on maternal request", opponents of which cite concerns not only for immediate morbidity and mortality increased over that associated with a vaginal birth, but also for potential morbidity and mortality associated with future pregnancies. One particularly appealing opportunity to reduce maternal mortality is to recognize, examine, and learn from so-called "near-miss" cases.