联合镇痛分娩的临床观察

目的 评价氧化亚氮吸人联合次髎穴、子宫穴注射利多卡因与单独治疗方法分娩镇痛的效果及对母儿的影响.方法 将400例产妇随机均分为四组,每组100例,产程活跃期给药实施分娩镇痛.观察组予50％氧化亚氮吸入,联合次髎穴、子宫穴注射利多卡因;对照组1给予50％氧化亚氮加50％氧气的混和气体吸入;对照组2给予次髎穴、子宫穴注射利多卡因;对照组3按产科常规分娩,不采取任何镇痛措施.分别观察镇痛效果、产程时间、分娩方式、新生儿情况、出血量情况.结果 观察组与3个对照组的镇痛效果(x2 =48.513)、产程时间(F =782.88、1120.81、1104.57)、分娩方式(x2=85.715),出血量(F=422.66)比较,差异均有统计学意义(均P＜0.05).结论 联合镇痛可明显减轻分娩时的痛苦,缩短产程,增加经阴道分娩率,减少剖宫产率,减少出血量,比使用单一镇痛方法有效.     

妊娠期糖尿病危险因素分析及对妊娠结局的影响

目的研究妊娠期糖尿病危险因素并分析其及对妊娠结局的影响。方法该院2013年1月—2018年12月根据有无妊娠期糖尿病分为100例妊娠期糖尿病组(GDM组)和100例无妊娠期糖尿病组(n-GDM组),比较两组研究对象一般临床资料、早期空腹血糖、孕早期糖化血红蛋白、孕早期甘油三脂和妊娠结局的差异,采用Logistics回归分析妊娠期糖尿病危险因素。结果 GDM组和n-GDM组孕产妇在年龄、既往代谢疾病史、孕次和产次中的差异无统计学意义,在孕前BMI、孕期体重增加量、孕早期空腹血糖、孕早期糖化血红蛋白和孕早期甘油三酯中的差异有统计学意义(P0.05)。Logistics回归分析发现孕前BMI、孕期体重增加量、孕早期空腹血糖、孕早期糖化血红蛋白和孕早期甘油三酯为妊娠期糖尿病的危险因素(P0.05)。GDM组妊娠期糖尿病孕产妇产后出血、羊水异常、胎膜早破及早产发生率均显著高于n-GDM组正常孕产妇,差异有统计学意义(P0.05)。结论产前HbA1c水平对妊娠期糖尿病孕产妇妊娠结局具有重要影响,与围产期并发症密切相关,临床上应积极干预。     

胰岛素治疗妊娠糖尿病起始剂量与妊娠结局的相关性分析

目的探讨与分析胰岛素治疗妊娠糖尿病的起始剂量与妊娠结局的相关性。方法2015年5月—2018年12月选择诊治的106例妊娠糖尿病孕妇,根据随机数字表法分为低剂量组与高剂量组各53例。高剂量组:给予胰岛素1日多次给药治疗,门冬胰岛素注射液初始剂量0.5 U/(kg·d),低剂量组给予胰岛素泵持续治疗,门冬胰岛素注射液起始剂量0.2 U/(kg·d),两组疗程均为4周,记录两组妊娠结局。结果低剂量组的胰岛素用量显著低于高剂量组(P<0.05),两组血糖达标时间对比差异无统计学意义(P>0.05)。两组治疗后的FPG与2 hPG值都显著低于治疗前(P<0.05)。所有孕妇都顺利完成分娩,低剂量组的羊水过多、早产、妊娠期高血压、低血糖等并发症发生率为3.8%,显著低于高剂量组的24.5%(P<0.05)。低剂量组的新生儿高胆红素血症、新生儿低血糖、新生儿窒息、巨大儿等并发症发生率为3.8%,显著低于高剂量组的26.4%(P<0.05)。结论基于初始低剂量的胰岛素泵注射方式在妊娠糖尿病孕妇中的应用能减少胰岛素的应用剂量,能达到同样的降糖效果,改善孕妇与新生儿的预后。     

Expression of Toil-like Receptor 4 in Neonatal Cord Blood Mononuclear Cells in Patients with Preeclampsia

The expression of Toll-like receptor 4 (TLR4) in neonatal cord blood mononuclear cells (MNCs) and serum TNF-α were investigated in order to explore the roles of TLR4 in the pathogenesis ofpreeclampsia. The study enrolled 27 patients suffering from preeclampsia (experimental group)and 21 normal pregnancy patients (control group). After MNCs were separated, the expression of TLR4 mRNA and protein was detected by using real-time quantitative PCR and Western blotting respectively, and the expression of TNF-α by using ELISA. The results showed the TLR4 mRNA level in cord blood MNCs (2-△CT: 0.07±0.17), TLR4 protein expression level (absorbance ratio:0.81%±0.15%) and TNF-a level (9.5±1.73 pg/mL) were all increased in experimental group as compared with control group with the differences being statistically significant (P＜0.05). There was a positive correlation between the expression of TLR4 mRNA and TNF-α in both experimental group and control group (r=0.54 and 0.53, respectively, P＜0.05). It was concluded that TLR4 expression in the experimental group of cord blood MNCs was increased and there was a positive correlation between the expression of TLR4 mRNA and TNF-α in both groups. TLR4-mediated release of inflammatory cytokines may be one of the important reasons leading to preeclampsia.     

Expression of Toll-like receptor 4 in neonatal cord blood mononuclear cells in patients with preeclampsia

The expression of Toll-like receptor 4 (TLR4) in neonatal cord blood mononuclear cells (MNCs) and serum TNF-α were investigated in order to explore the roles of TLR4 in the pathogenesis of preeclampsia.The study enrolled 27 patients suffering from preeclampsia (experimental group) and 21 normal pregnancy patients (control group).After MNCs were separated, the expression of TLR4 mRNA and protein was detected by using real-time quantitative PCR and Western blotting respectively, and the expression of TNF-α by using ELISA.The results showed the TLR4 mRNA level in cord blood MNCs (2-CT:0.07±0.17), TLR4 protein expression level (absorbance ratio:0.81%±0.15%) and TNF-α level (9.5±1.73 pg/mL) were all increased in experimental group as compared with control group with the differences being statistically significant (P<0.05).There was a positive correlation between the expression of TLR4 mRNA and TNF-α in both experimental group and control group (r=0.54 and 0.53, respectively, P<0.05).It was concluded that TLR4 expression in the experimental group of cord blood MNCs was increased and there was a positive correlation between the expression of TLR4 mRNA and TNF-α in both groups.TLR4-mediated release of inflammatory cytokines may be one of the important reasons leading to preeclampsia.     

413例胎儿脐血染色体异常相关因素的临床分析

目的评价超声引导下脐血管穿刺术在产前诊断中的应用,探讨胎儿染色体异常的临床高危因素,提高脐血管穿刺对胎儿异常染色体核型的检出率。方法选取在我院超声引导下经腹脐血管穿刺并行染色体检查的孕妇413例,进行染色体核型分析,比较不同产前诊断指征组的异常染色体检出率及相关因素分析。结果穿刺成功率100%,胎儿脐血管穿刺的主要并发症为穿刺点出血41例,占9.92%;胎心心动过缓8例,占1.93%;胎儿丢失1例,占2.42‰。共检出异常染色体核型62例,检出率15.01%。发现同时合并两种以上指征者与胎儿染色体异常存在相关性(r=0.526,P=0.005)。结论脐血染色体核型分析能够为临床上诊断胎儿染色体异常提供可靠依据,但需要把握好手术指征及加强施术者的技术熟练程度。同时合并两种以上指征者很有必要进行产前诊断。     

孕中期超声检测子宫动脉血流用于预测早发型子痫前期的价值

目的 探讨孕中期超声监测子宫动脉血流动力学变化在早发型子痫前期临床诊治中的应用价值.方法 应用彩色多普勒测量妊娠妇女在孕20～23＋6周及孕24～28周的子宫动脉血流PI（搏动指数）、RI（阻力指数）、S/D（收缩期峰值流速/舒张末期流速）,追踪随访孕妇中晚期妊娠过程及分娩情况,比较早发型子痫前期组和正常妊娠对照组子宫动脉血流参数的差异.结果 根据妊娠结局,获取早发型子痫前期组21例,正常对照组40例,早发型子痫前期组妊娠20 ～ 23＋6周及妊娠24～28周子宫动脉PI、RI、S/D均高于正常对照组,两者比较差异有统计学意义（P＜0.05）.结论 早发型子痫前期子宫动脉血流动力学较正常妊娠妇女有较大不同,孕中期子宫动脉血流参数可作为一项辅助指标协助临床医生筛查出早发型子痫前期的高危人群.     

妊娠期糖尿病筛查及相关因素分析

目的妊娠期糖尿病对母儿危害较大,我国糖尿病的发生率为1％-5％,近年有明显增高的趋势。早期诊断及治疗母儿预后很重要。因此,笔者通过回顾分析探讨妊娠期糖尿病的发生情况,以及妊娠期糖尿病相关高危因素与无高危因素者葡萄糖耐量试验异常的关系。方法对24—28周孕妇口服50g葡萄糖行糖筛查,血糖≥7．8mmol／L者行葡萄糖耐量（OGTF）试验以明确诊断。结果妊娠期糖尿病（GDM）发生率1．26％。妊娠期糖耐量异常（GTGT）发生率2．95％,妊娠期糖尿病相关高危因素中的不良孕产史,DM家族史、孕前肥胖或孕期体重增长过快者与无高危因素者的葡萄糖耐量试验异常之间差异有统计学意义（P〈0．01）。结论对妊娠期所有孕妇行糖筛查可以减少妊娠期糖尿病的漏诊,妊娠期糖耐量减低也应积极治疗,伴有高危因素的孕妇应重点监测。