剖宫产瘢痕妊娠的MRI影像学表现与诊断价值

目的探讨剖宫产瘢痕妊娠的MRI影像学表现和诊断价值。方法收集我院2017年1月～2019年4月期间经手术病理证实为剖宫产瘢痕妊娠的患者27例,回顾性分析其MRI图像特征:其中15例行MRI增强扫描,12例行MRI平扫。观察剖宫产瘢痕妊娠的MRI表现、诊断准确率。结果26例表现为子宫前壁峡部瘢痕处囊性或囊实性妊娠囊。瘢痕处肌层明显变薄。20例妊娠囊表现为囊性T1WI低T2WI高信号;6例表现囊实性,囊性信号内混杂T1WI稍低T2WI较高信号。15例增强扫描均见强化。1例未能确诊。结论剖宫产瘢痕妊娠的MRI影像学表现具有特征性,对其诊断和治疗具有重要价值。     

右美托咪定对剖宫产围手术期血流动力学及术后神经功能障碍的影响

【摘要】 目的 分析右美托咪定对剖宫产围手术期血流动力学及术后神经功能障碍的影响。方法 选取本院收治的72例择期硬膜外麻醉剖宫产患者进行研究,分为研究组与对照组,每组各36例。回顾性分析两组的临床资料,比较两组手术中的血流动力学指标及感觉阻滞情况,同时评估两组麻醉后的Ramsay镇静评分和术中牵拉反应程度,观察记录两组不同时间点（入手术室前记为T0,手术开始即刻记为T1,硬膜外注药完毕后10min记为T2,手术结束即刻记为T3）,MMSE评分及术后不良反应的发生情况。结果 研究组T1、T2、T3 HR、DBP、SBP水平均低于T0,差异无统计学意义（P＞005）;对照组T1、T2、T3 HR、DBP、SBP水平均高于T0（P＜005）;研究组T1、T2、T3 HR、DBP、SBP水平均低于对照组（P＜005）。与对照组比较,研究组麻醉起效时间、达峰效应时间缩短,麻醉平面持续时间均延长（P＜005）。术后第1天,研究组MMSE评分高于对照组（P＜005）;术后第3天,研究组MMSE评分高于对照组（P＜005）。研究组心动过缓、呼吸抑制、寒战及恶心呕吐的发生率低于对照组（P＜005）,两组低血压的发生率比较差异无统计学意义（P＞005）。结论 剖宫产围术期应用右美托咪定可缩短硬膜外麻醉的起效时间,延长感觉阻滞时间,有效增强剖宫产术中镇痛、镇静效果,能保持产妇血流动力学的稳定,减少术后不良反应发生率,且不会影响术后认知功能,同时右美托咪啶毒副作用小,安全性较高。     

口服米索前列醇联合宫腔吸引管在剖宫产术后无痛人流的应用

分析口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流的临床效果及机制。120例患者随机分为对照组(n=60)和观察组(n=60)。对照组患者接受宫腔吸引管处理,观察组患者口服米索前列醇(0.6 mg)后接受宫腔吸引管。结果显示观察组患者的手术时间和苏醒时间明显缩短(P<0.05),术中出血量和异丙酚用量明显减少(P<0.05);观察组患者的宫颈扩张效果总有效率明显升高(P<0.05)而不良反应发生率明显降低(P<0.05);两组患者治疗后血清中白细胞介素1β(IL-1β)和IL-2水平明显升高,且对照组患者的上述白细胞介素水平升高更显著(P<0.05)而雌激素促黄体生成素(Luteotropic hormone,LH)、促卵泡激素(Follicle stimulating horman,FSH)和雌二醇(Estradiol,E2)水平无明显变化(P>0.05)。实验表明口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流临床效果明显,且不引起白细胞介素和雌激素水平的剧烈变化。     

脐动脉血气pH值对剖宫产新生儿住院期间并发症的预测价值

目的:分析脐动脉血气pH值对剖宫产新生儿住院期间并发症的预测价值。方法:本研究为回顾性队列研究,选择2017年1月1日至6月30日在北京大学第一医院剖宫产娩出并完成脐动脉血气分析的新生儿为研究对象,主要观察终点是新生儿住院期间并发症发生率。按照新生儿是否发生住院期间并发症将研究对象分为两组,比较两组间脐动脉血气pH值。收集母婴围产期的资料和新生儿住院期间并发症的资料,采用ROC曲线分析脐动脉血气pH对新生儿住院期间并发症的预测价值。结果:共纳入872例新生儿(择期541例、急诊331例),新生儿住院期间并发症的总体发生率为14.1%,其中发生率最高的3项分别为感染、吸入性肺炎及心肌损伤。无并发症组pH值平均为7.31,有并发症组pH值平均为7.29,组间比较差异有统计学意义(P<0.001)。本研究中pH≤7.20的总体比例为3.1%(27/872),其中无并发症组pH值≤7.20的比例为1.6%(12/749),有并发症组pH值≤7.20的比例为12.2%(15/123),组间比较差异有统计学意义(P<0.001)。多因素Logistic回归分析显示,早产(OR=8.224, 95%CI: 4.910~13.777, P<0.001)、妊娠期高血压(OR=1.886, 95%CI: 1.004~3.546, P=0.049)、宫内生长受限(OR=4.429, 95%CI: 1.280~15.330, P=0.019)、急诊剖宫产(OR=2.711, 95%CI: 1.682~4.369, P<0.001)、脐动脉血气pH值≤7.20(OR=7.420, 95%CI: 2.951~18.655, P<0.001)及5分钟Apgar评分小于10分(OR=11.849, 95%CI: 3.977~35.128, P<0.001)是新生儿发生住院期间并发症的危险因素。脐动脉血气pH值预测全部新生儿、择期新生儿及急诊新生儿住院并发症的ROC曲线下面积分别为0.570(95%CI: 0.508~0.633, P=0.012)、0.559(95%CI: 0.465~0.652, P=0.189)及0.617(95%CI: 0.538~0.697, P=0.002)。结论:脐动脉血气pH值≤7.2与剖宫产新生儿住院并发症发生率增加有相关性,但是ROC分析显示其预测价值较低。     

基于组织连续切片后三维重建技术的研究进展

]三维重建技术对于人体内部微观结构的展现细致详尽,为基础科学和临床科研提供了全面的解剖资料。本文综述了组织包埋、切片、染色及计算机辅助人体组织连续切片后进行的组织结构三维重建,展现了组织连续切片三维重建技术中各步骤不同方法的优势与不足,为相关研究提供借鉴。     

Analgesic effects of intrathecal tramadol in patients undergoing caesarean section: a randomised,double-blind study

BackgroundIntrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery. The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section.MethodsEighty full-term parturients scheduled for elective caesarean section were randomly divided into two groups. In the fentanyl group, patients received intrathecal 0.5% bupivacaine 10 mg with fentanyl 10 μg; in the tramadol group, patients were given the same dose of bupivacaine with tramadol 10 mg. Sensory and motor block characteristics, duration of postoperative analgesia, maternal side effects, and neonatal outcome were compared.ResultsOne patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis. Median [interquartile range] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [240–360] min and 260 [233–300] min respectively (P = 0.02). The incidence of shivering was lower in patients who received tramadol (5%) than those who had fentanyl (32%) (P = 0.003). Apgar scores, umbilical cord acid–base measurement and neurologic and adaptive capacity scores were comparable between the two groups.ConclusionCompared to intrathecal fentanyl 10 μg, tramadol 10 mg, as an adjunct to bupivacaine for subarachnoid block for caesarean section, showed a longer duration of analgesia with a reduced incidence of shivering.     

子宫腔填塞纱条治疗前置胎盘剖宫产术中大出血21例分析

目的　总结 2 1例子宫腔填塞纱条治疗前置胎盘剖宫产术中大出血的临床经验。方法　对 1990年 5月— 2 0 0 1年12月在我院用子宫腔填塞纱条治疗前置胎盘剖宫产术中大出血 2 1例进行分析。结果　 2 1例前置胎盘剖宫产术中大出血用纱条填塞子宫腔后均获成功止血 ,2 0～ 30h后经阴道顺利取出 ,未发生阴道大出血 ,产后 4 2d随访 18例 ,子宫复旧良好。结论　子宫腔填塞纱条是治疗前置胎盘剖宫产术中大出血的有效方法。     

Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section

Background. During spinal anaesthesia for Caesarean section,the optimal phenylephrine regimen and the optimal blood pressure(BP) to which it should be titrated are undetermined. The idealregimen would balance efficacy for maintaining uteroplacentalperfusion pressure against potential for uteroplacental vasoconstriction,both of which may affect fetal acid–base status. We comparedphenylephrine infusion regimens based on three different BPthresholds. Methods. After intrathecal injection, we infused phenylephrine100 µg min^–1 for 2 min. Then, until delivery,we infused phenylephrine whenever systolic BP (SBP), measuredevery 1 min, was below a randomly assigned percentage of baseline:100% (Group 100, n=25), 90% (Group 90, n=25) or 80% (Group 80,n=24). We compared umbilical blood gases, Apgar scores and maternalhaemodynamics and symptoms. Results. Patients in Group 100 had fewer episodes [median 0(range 0–8)] of hypotension (SBP <80% baseline) comparedwith Group 80 [5 (0–18)] and Group 90 [2 (0–7)](P<0.001 in each instance). Total dose of phenylephrine wasgreater in Group 100 [median 1520 µg (interquartile range1250–2130 µg)] compared with Group 90 [1070 (890–1360)µg] and Group 80 [790 (590–950) µg]. Umbilicalarterial pH was greater in Group 100 [mean 7.32 (95% confidenceinterval 7.31–7.34)] than in Group 80 [7.30 (7.28–7.31)](P=0.034). No patient had umbilical arterial pH <7.2. InGroup 100, 1/24 (4%) patients had nausea or vomiting comparedwith 4/25 (16%) in Group 90 and 10/25 (40%) in Group 80 (P=0.006). Conclusions. For optimal management, phenylephrine should betitrated to maintain maternal BP at near-baseline values. Br J Anaesth 2004; 92: 469–74     

中原油田巨大儿发生的相关因素分析

目的　通过十年间巨大儿的状况变化 ,分析巨大儿发生的相关因素。方法　回顾性分析我院十年间 12 2 3例巨大儿病例。结果　十年间新生儿体重逐年增高 ,巨大儿发生率亦逐年增加 ,由 1991年的 2 95 %增至 2 0 0 0年的13 73%且超巨大儿发生率亦有逐年增长趋势。巨大儿中孕妇肥胖者占 82 6 % ,巨大儿中男性占 6 0 30 % ,明显高于非巨大儿中男性比率 4 9 4 5 % (P <0 0 1)。巨大儿剖宫产占同期剖宫产比率逐年增加。巨大儿中 ,过期妊娠占2 0 2 8% ,妊娠期糖尿病占 19 91%。巨大儿新生儿病率 12 98% ,显著高于非巨大儿 1 2 6 % (P <0 0 1)。巨大儿产妇产后出血量平均为 (32 0± 15 0 )ml,较同期孕妇产后出血明显增多 (P <0 0 5 )。结论　中原油田巨大儿发生率逐年增加 ,占同期剖宫产率逐年增加。     

Ostomy and pregnancy

Pregnancy in a woman with ostomy poses significant concern in its management. A search for literature addressing this problem revealed minimal information. Questionnaires on this subject were sent to all of the members of the American Society of Colon and Rectal Surgeons, and the replies received from them were analyzed by the computer. Attempts were made to answer questions regarding stoma complications, recurrence of disease during pregnancy, type of childbirth (vaginal or cesarean), special needs during pregnancy, and any recurring problems with subsequent pregnancies. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.