NICU早产儿PICC导管相关血流感染高危因素的Meta分析

目的 通过Meta分析客观地确定NICU早产儿PICC导管相关血流感染的主要高危因素,为预防早产儿PICC导管相关血流感染提供一定的循证证据支持。方法 在线检索CNKI、万方、维普、Cochrane Library、PubMed、EMBASE等数据库,检索年限从各数据库建库起始至2019年1月,有关公开发表的早产儿PICC导管相关血流感染高危因素的文献,由两名研究员独立完成文献筛选、质量评价及资料提取,采用RevMan5.3软件进行Meta分析。结果 经筛选共纳入10篇文献（中文1篇,英文9篇）进行Meta分析。胎龄＜32周(OR=0.26, 95%CI:0.10~0.66),出生体重＜750g(OR=0.53, 95%CI:0.41~0.69),股三角部位置管(OR=1.67, 95%CI:1.31~2.11),置管耗时≥60min(OR=0.61, 95%CI:0.38~0.97),留置管时间≥30天(OR=2.41, 95%CI:1.75~3.31),留置CVC导管数量≥2个(OR=0.21, 95%CI:0.17~0.25)是高危因素。结论 胎龄愈小、出生体重越低、经股三角部位置管、置管耗时和导管留置时间越长、留置多个CVC导管是早产儿PICC置管后发生导管相关血流感染的高危因素,医护人员可采取有效预防措施,降低导管相关血流感染的发生率。     

子宫动脉栓塞术在孕6月余合并中央性前置胎盘引产中的应用一例

患者37岁,G4P2,因停经6个月,反复无痛性少量阴道出血4个月,加重3 d入院.该患者停经2个月后反复出现无痛性少量阴道出血,间隔约40 d 1次,每次持续2～3 d,较平时月经量少,休息后能自止,未就诊.3 d前无明显诱因出现阴道出血500～600 ml,不伴腹痛.入院时,血压130/80 mmHg,中度贫血貌,心肺未闻及异常.宫高、腹围与停经月份符,胎心音140次/min,臀位,宫口未开,无宫缩.辅助检查:血红蛋白(Hb)71 g/L;B超示臀位胎儿,宫颈内口处见胎盘组织回声.     

个体化镇痛时机对硬膜外分娩镇痛效果的影响

目的观察提前预置硬膜外导管,根据产妇需要开始镇痛的个体化镇痛模式对分娩镇痛效果的影响。方法这是一项标签开放的随机对照研究。选择单胎、足月、头位妊娠初产妇,年龄18~35岁,随机分为两组。个体化组产妇在产程开始(出现规律宫缩、宫颈接近消失)行硬膜外穿刺置管,当产妇有镇痛需求且NRS评分≥5分时给予硬膜外镇痛;对照组在宫口开大1 cm时行硬膜外镇痛。主要研究终点是分娩过程最严重疼痛NRS评分及分娩时NRS评分≥7分产妇比例。结果194例产妇完成研究,分娩过程中两组最严重疼痛程度NRS评分[个体化组9(8~10)分vs对照组9(8~10)分,P=0.201]及分娩时NRS评分≥7分产妇比例[个体化组94例(96.9%)vs对照组89例(91.8%),P=0.121]差异均无统计学意义。两组不良事件发生率差异无统计学意义。结论对于单胎、足月、头位且产科评估可试行阴道分娩的产妇,根据产妇需求实施硬膜外分娩镇痛的效果与传统的镇痛时机(宫口开放1 cm)相当。     

Plasma motilin concentration in the second and third trimesters of pregnancy and postpartum

Plasma motilin concentrations were measured in 135 women during the second andthird trimesters of pregnancy and 3～5 d after delivery and the results were compared withthose of 20 healthy nonpregnant women.The mean plasma motilin concentration (323.96±125.10 ng/L) in women during the second trimester of pregnancy was lower than in healthynonpregnant women (366.12±96.23 ng/L) (P<0.05),but that was significantly higher thanin women during the third trimester of pregnancy (121.04±27.00 ng/L) (P<0.01);theplasma motilin concentration in women during 3～5d after delivery (443.05±140.79 ng/L)was significantly higher than that in pregnant women (P<0.01).The results showed thatpregnancy appears to have a profound inhibitory effect on plasma motilin,and this may partlybe responsible for the gastrointestinal hypomotility associated with pregnancy.     

早产儿缺氧缺血性脑病的MRI征像分析

目的:探讨分析早产儿缺氧缺血性脑病的MRI表现及其病理生理。方法:132例临床诊断为新生儿缺氧缺血性脑病的早产儿,常规行T1WI、T2WI、DWI、FLAIR扫描。结果:临床表现均考虑HIE,MRI表现皮层及皮层下出血、深部白质出血、脑室旁出血、脑室内出血、脑室旁软化灶。结论:MRI对早产儿HIE具有特征性表现,对早产儿HIE的早期诊断有重要意义。     

Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia

Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine （Group B）, ropivacaine （Group R） or levobupivacaine （Group L） with sufentanil 0.5 ug/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was 〈30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction （P 〉0.05）. The relative median potency was bupivacaine/ropivacaine： 0.828 （0.602-1.091）, bupivacaine/levobupivacaine： 0.845 （0.617-1.12）, ropivacaine/levobupivacaine： 1.021 （0.774-1.354）, respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of 〉0.1% within each group （P 〈0.05）. Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with s＇ufentanil produce similar analgesia and motor block and safety for labor analgesia. The analgesic efficacy mainly depends on the concentration rather than the type of anesthetics.     

小鼠卵巢玻璃化冻存后异体移植对卵巢衰竭模型鼠卵巢功能的影响

目的研究新鲜与玻璃化冻存幼鼠卵巢异体异位移植对卵巢早衰(POF)小鼠卵巢储备功能的影响。方法以正常小鼠为对照组,使用一次性环磷酰胺150 mg/kg腹腔注射,白消安20 mg/kg皮下注射,建立小鼠卵巢早衰模型,于造模30 d后进行幼鼠新鲜或玻璃化冻存卵巢的肾被膜下移植。通过对移植后30 d各组卵巢组织常规HE染色、血清促卵泡素(FSH)、促黄体生成素(LH)、抑制素B(INHB)、抗苗勒管激素(AMH)变化,观察卵巢玻璃化冻存后异体移植对化学性卵巢功能损伤卵泡储备功能有无挽救作用。结果无论是损伤模型组还是损伤后卵巢移植组,血清FSH、LH浓度明显高于正常对照组(P<0.05),AMH、INHB浓度明显低于正常对照组(P<0.05)。但卵巢移植组与模型对照组比较,各血清激素指标均有所改善,尤其是玻璃化冻存卵巢移植组,血清FSH、LH浓度明显降低(P<0.05),AMH、INHB上升。结论新鲜与玻璃化冻存幼鼠卵巢异体异位移植可以有效改善POF小鼠卵巢功能。     

早产儿甲状腺功能检测及临床意义

目的探讨早产儿血清甲状腺功能检测及临床意义。方法将我院2008年1月～2010年3月收治的早产儿100例分成两组：A组50例,胎龄〈34周;B组50例,胎龄≥34周,对照组为同期出生的正常足月新生儿50例。应用放射免疫法对3组新生儿生后第1、8天血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）水平进行检测。结果三组新生儿T3、T4、TSH水平于生后1～8d呈下降趋势,A、B组T3、T4第1、8天均低于对照组,A组低于B组;生后第1天,A、B组TSH低于对照组,A组高于B组;生后第8天,A组TSH均高于B组和对照组,B组和对照组无明显差异。结论早产儿生后甲状腺功能有暂时性低下,胎龄越小,功能越低,生后应激反应持续时间越长。     

硬膜外阻滞在中期妊娠引产镇痛时机选择的临床观察

目的：比较硬膜外阻滞在中期妊娠引产不同时点开始镇痛的临床效果。方法选取我院60例因计划外妊娠或有胎儿畸形等妊娠合并症要求终止妊娠者,随机分为两组实施硬膜外阻滞,A组为病房常规处理后产妇有疼痛感即开始实施麻醉,B组为病房常规处理后有规律宫缩开始实施麻醉,每组30例;记录镇痛开始前及镇痛后生命体征、各时点孕妇的VAS评分和运动神经阻滞分级、引产时间、出血量及不良反应情况。结果与B组比较,A组在镇痛后各时点VAS评分降低、引产时间延长,差异均有统计学意义（P＜0.05）;两组间孕妇引产期间生命体征平稳,出血量及不良反应差异无统计学意义（P＞0.05）。结论中期妊娠引产无须考虑胎儿因素,早期实施麻醉镇痛干预更为合理,在不增加出血量和不良反应的基础上引产时间略有延长。