右美托咪定与丙泊酚用于子痫前期产妇剖宫产手术术中镇静的比较

目的 比较右美托咪定与丙泊酚用于子痫前期患者剖宫产手术术中镇静的有效性和安全性。方法 腰硬联合麻醉下行择期剖宫产手术的子痫前期患者90例,随机均分为右美托咪定组、丙泊酚组及对照组,各组按预定方法分别给予药物。记录患者入室时(T₀)、CSEA给药前(T₁)、切皮时(T₂)、清理腹腔时(T₃)及手术结束时(T₄)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(oxygen saturation,SpO₂)、警觉-镇静(observer’s assessment of alertness/sedation,OAA/S)评分,记录新生儿Apgar评分及各组不良反应发生情况。结果 MAP、HR及OAA/S T_1-4右美托咪定组及丙泊酚组均低于对照组,MAP T_1-4,HR T₁、T₃及T₄及OAA/S T₄右美托咪定组低于丙泊酚组(P<0.05)。新生儿Apgar 评分,3组组间比较差异无统计学意义。恶心呕吐、牵拉痛及寒战发生率右美托咪定组及丙泊酚组均低于对照组(P<0.05);低血压及心动过缓发生率右美托咪定组及丙泊酚组略高于对照组,呼吸抑制及躁动发生率右美托咪定组低于丙泊酚组,但差异均无统计学意义。结论 右美托咪定和丙泊酚均可安全有效地应用于子痫前期患者剖宫产术中镇静,比较而言,右美托咪定镇静后可唤醒,血流动力学更平稳,呼吸抑制等不良反应更少。     

胶体液预负荷和晶体液共负荷在预防腰麻剖宫产术中低血压效应的临床疗效对比

目的 比较胶体液预负荷和晶体液共负荷在预防腰麻剖宫产术中低血压效应的临床疗效.方法 选取腰麻剖宫产术的产妇150例,随机分为胶体液预负荷和晶体液共负荷两组.胶体液预负荷组在腰麻前15 min内注射500 mL羟乙基淀粉200/0.5氯化钠注射液;晶体液共负荷组在鞘内注射麻醉时,同时注射1 000 mL乳酸钠林格注射液进行共负荷,当产妇有低血压症状时,注射麻黄碱;记录产妇低血压症状发生概率,麻黄碱使用量,以及术中恶心呕吐情况;新生儿通过Apgars评分,脐静脉血气来分析.结果 胶体液预负荷组和晶体液共负荷组在低血压概率分别为46.7％和45.3％,没有显著性(P＞0.05);麻黄碱使用量和产妇术中恶心呕吐情况,新生儿Apgars评分和脐静脉血气指数没有显著性(P＞0.05).结论 在腰麻剖宫产术中,使用500 mL胶体液预负荷和1 000mL晶体液共负荷在预防低血压症状的临床效果相似,二者都只能降低低血压效应发生率,而不能彻底预防血压效应,应该联合其他血管加压药物才能彻底预防腰麻剖宫产术中低血压效应.     

Maternal medical compromise during pregnancy and pregnancy outcomes

Objective: To examine the outcomes of pregnancy and newborn following an event of maternal medical compromise during pregnancy.

Methods: A retrospective study was performed on all patients hospitalized following an event of medical compromise during pregnancy. Medical compromise was divided to acute or chronic bleeding, major or complicated operations, and admission to intensive care unit (ICU). Data collected included maternal, fetal, neonatal and child’s follow-up.

Results: The study included 51 pregnant patients and 58 fetuses. The study group had increased risk of preterm deliveries (35.0 versus 6.5%, p?p?p?=?0.002). Patients with acute bleeding had higher rates of cesarean sections, preterm deliveries, admissions to neonatal ICU and neonatal mortality. Two cases of fetal abnormalities included brain abnormalities and pericardial effusion. Three terminations of pregnancies were performed: two in patients in ICU due to severe maternal medical condition and one in the fetus with brain abnormalities.

Conclusions: Maternal medical compromise during pregnancy increases the risk for preterm deliveries, cesarean delivery and low Apgar scores. Acute bleeding was the main cause of medical compromised and with the higher rates of adverse outcomes.     

Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study

Objective: To estimate the association between gestational diabetes mellitus (GDM) and adverse pregnancy and neonatal outcomes in Denmark.

Methods: A population-based cohort study including all singleton pregnancies in Denmark from 2004 to 2010 (n?=?403?092). Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases 10th Revision.

Results: The final study population consisted of 398?623 women. Of these, 9014 (2.3%) had GDM. Data were adjusted for maternal age, parity, smoking, gestational age, birth weight, BMI, gender of the fetus and calendar year. The risk of preeclampsia, caesarean section (both planned and emergency) and shoulder dystocia was increased in women with GDM. In the unadjusted analysis, the risk of thrombosis was increased by a factor 2 in the GDM patients, but in the adjusted analysis this association disappeared. Post-partum hemorrhage was similar in the two groups. The GDM women had an increased risk of giving birth to a macrosomic neonate although the unadjusted analysis did not show any difference between the two groups. Low Apgar score was increased in the GDM, but this association disappeared in the adjusted analysis. Stillbirth was comparable in the two groups.

Conclusions: Women with GDM still have increased incidence of obstetric and neonatal complications, which could imply that treatment of women with GDM should be tightened.     

Does dystocia during labor pose a risk factor for another non-progressive labor during the subsequent delivery?

Objective: To establish whether failure to progress during labor poses a risk factor for another non-progressive labor (NPL) during the subsequent delivery.

Methods: A retrospective cohort study including singleton pregnancies that failed to progress during the previous labor and resulted in a cesarean section (CS) was conducted. Parturients were classified into three groups for both previous and subsequent labors: CS due to NPL stage I, stage II and an elective CS as a comparison group.

Results: Of 202?462 deliveries, 10?654 women met the inclusion criteria: 3068 women were operated due to NPL stage I and 1218 due to NPL stage II. The comparison group included 6368 women. Using a multivariable logistic regression models, NPL stage I during the previous delivery was found as an independent risk factor for another NPL stage I in the subsequent labor (adjusted odds ratio [OR]?=?2.9; 95% confidence interval [CI]?=?2.4–3.7; p?p?=?0.033; adjusted OR?=?5.3; 95% CI?=?3.7–7.5; p?Conclusion: A previous CS due to a NPL is an independent risk factor for another NPL in the subsequent pregnancy and for recurrent cesarean delivery.     

Clusters of proliferating endothelial cells and smooth muscle cells in rabbit carotid arteries

Schwarz and Benditt found clustering of replicating cells in aortic endothelium in 1976 and discussed how homeostasis of the arterial wall is maintained through this nonrandom distribution of replicating cells. However, it is still unclear how cells of vascular walls turnover. In order to address this issue, we evaluated distribution of the cells in mitotic cycle, labeled by Ki67‐immunostaining, in serial histological sections of twelve carotid arteries of six adult male Japanese rabbits. As a result, a total of 1713 Ki67‐positive endothelial cells (ECs) and 1247 Ki67‐positive smooth muscle cells (SMCs) were identified. The Ki67‐positivity rate in ECs and SMCs were about 0.048% and 0.0027%, respectively. Many of the Ki67‐positive cells clustered in two (EC, 37%; SMC, 33%), three to four (EC, 8%; SMC, 28%), and five to eight cells (EC, 5%; SMC, 10%). Clusters having more than eight cells were not found. Thus, it can be speculated that the cell division of proliferating ECs and SMCs occur four times at most. These novel findings offer great insights for better understanding of the mechanism that underlies cell number regulation of the blood vessel.     

围手术期剖宫产妇女心理状况及心理干预效果

目的:探讨围手术期剖宫产妇女心理状况及心理干预的效果.方法:选取2013年3月～2014年3月柳州市妇幼保健院收治的剖宫产妇女122例,随机分为对照组和观察组,每组各61例,对照组采取常规护理,观察组在常规护理基础上实施心理保健护理.比较两组女性的护理满意度、焦虑自评量表(SAS)评分与疼痛评分(VAS)情况.结果:观察组49例产妇对护理满意,10例产妇对护理较满意,2例产妇对护理不满意,总满意度为96.7％.对照组42例产妇对护理满意,12例产妇对护理较满意,7例产妇对护理不满意,总满意度为88.5％.观察组护理满意度优于对照组,两组比较,差异有统计学意义(P＜0.05).实施护理干预前,两组患者VAS评分与SAS评分比较,差异无统计学意义(P＞0.05).实施护理干预后,观察组的VAS评分与SAS评分改善情况明显优于对照组,两组比较,差异有统计学意义(P＜0.05).结论:对围手术期剖宫产妇女实施心理护理干预,有利于降低妇女的焦虑感,缓解其疼痛,提高护理满意度,值得临床推广应用.     

Can Caesarean section improve child and maternal health? The case of breech babies

This paper examines the health effects of Caesarean section (CS) for children and their mothers. We use exogenous variation in the probability of CS in a fuzzy regression discontinuity design. Using administrative Danish data, we exploit an information shock for obstetricians that sharply altered CS rates for breech babies. We find that CS decreases the child's probability of having a low APGAR score and the number of family doctor visits in the first year of life. We find no significant effects for severe neonatal morbidity or hospitalizations. While mothers are hospitalized longer after birth, we find no effects of CS for maternal post-birth complications or infections. Although the change in mode of delivery for the marginal breech babies increases direct costs, the health benefits show that CS is the safest option for these children.     

护理干预对减少无指征剖宫产率的影响

目的：观察护理干预减少无指征剖宫产率的效果。方法选择我院2010年—2013年6月入院的孕足月产妇200例,年龄23岁~41岁,平均年龄28.6岁。孕周37+4周~41+3周,平均39+2周。随机分为2组各100例,其中A组为常规护理组,包括常规宣教,护理评估,执行医嘱,监测胎心胎动等;B组为护理干预组,在常规护理基础上加强产程观察与监测,注重导乐分娩,减少分娩疼痛等。比较2组在剖宫产数,难产数,产后出血,产褥病率等方面的差异。结果护理干预组在剖宫产数,难产数,产后出血,产褥病率等方面均显著优于常规护理组（P<0.05）。结论通过护理干预,可以减少无指征剖宫产,有利于产妇和胎儿,具有重要的现实意义。     

异硫氰酸荧光素染色在真菌性角膜炎中的应用

目的：寻找真菌性角膜炎组织切片快速、准确、方便操作的特殊染色方式。

方法：采用经真菌培养均为阳性的真菌性角膜炎患者的角膜标本38例,常规固定脱水透明浸蜡,进行4μm石蜡切片,脱蜡至水,选用异硫氰酸荧光素(FITC)荧光法和过碘酸雪夫氏染色法(PAS)进行染色对比。

结果：异硫氰酸荧光素法检测阳性率为97.4%(37/38),过碘酸雪夫氏染色法检测阳性率为86.8%(33/38)。结果比较有统计学差异(P<0.001)。

结论：异硫氰酸荧光素法镜检真菌性角膜炎优于过碘酸雪夫氏染色法镜检。