早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床研究

目的 探讨早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床效果及其对生化指标的影响。方法 将2012年1月至2016年12月遵化市人民医院收治的194例妊娠合并甲状腺功能减退症病人按随机数字表法分为研究组(97例)和对照组(97例),对照组病人给予早期综合干预治疗,研究组病人给予早期综合干预联合左甲状腺素钠治疗。观察两组病人治疗后分娩结局(妊娠终止、自然分娩、阴道助产、剖宫产)、母婴结局(产后出血、宫缩乏力、胎儿窘迫及新生儿窒息)以及预后效果,同时检测治疗前后相关生化指标游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺刺激激素(TSH)、人绒毛膜促性腺激素(hCG)和脂联素(ADPN)]和社会支持评定量表(SSRS)评分变化。结果 联合治疗后研究组病人妊娠终止率(5.15%比22.68%)、剖宫产率(6.19%比26.80%)、产后出血率(10.31%比35.05%)、宫缩乏力率(9.28%比36.08%)、胎儿窘迫率(11.34%比34.02%)及新生儿窒息率(10.31%比31.96%)低于治疗后的对照组(χ² 值依次=12.43、14.97、16.93、19.87、14.23、13.64,均P<0.001),自然分娩率68(70.10%)、总有效率93(95.88%)高于治疗后的对照组30(30.93%)、71(73.20%)](均P<0.05),而治疗后两组病人阴道助产率比较差异无统计学意义 (P>0.05)；治疗后两组病人生化指标(FT3、FT4、hCG和ADPN)和SSRS评分高于治疗前,而TSH低于治疗前(P<0.05)；与治疗后对照组相比,治疗后研究组病人生化指标(FT3、FT4、hCG和ADPN)和SSRS评分升高,而TSH降低(P<0.05)。结论 早期综合干预联合左甲状腺素钠可有效改善妊娠合并甲状腺功能减退症病人分娩结局、母婴结局、生化指标以及预后。

Clinical study of early comprehensive intervention combined with levothyroxine sodium in the treatment of hypothyroidism in pregnancy

Objective To compare the stability of injectable pedicle screw with different volumes and distributions of polymethylmethacrylate (PMMA) in severely osteoporotic (OP) synthetic bone and analyze the relationship between screw stability and volume and distribution of PMMA. Methods Severely OP synthetic bone were randomly divided into group A, B, C, D with different kinds of screws, and then blocks in each group were randomly divided into subgroups 0, 1, 2, 3 with different volumes of PMMA. A pilot hole was prepared in advance using the same method in all samples. Pedicle screws of type A-C were directly inserted into vertebrae in groups A-C respectively, and then different volumes of PMMA (0, 2.0, 2.5, 3.0 mL) were injected through screw into blocks in subgroups 0, 1, 2, 3 respectively. The pilot hole was filled with different volumes of PMMA (0, 2.0, 2.5, 3.0 mL) followed by insertion of screw in groups D0, D1, D2 and D3 respectively. X-ray examination was performed to evaluate the distribution of PMMA, and axial pull-out test was performed to measure the maximum axial pullout strength (F_max). Results X-ray examination revealed PMMA surrounding the anterior 1/3 part of screw in groups A1-A3, surrounding the middle 1/3 part of screw in groups B1-B3 and groups C1-C3, and surrounding the full length of screw evenly in groups D1-D3. Two factors like volume and distribution of PMMA showed significant influence on F_max(P<0.05), and there was no significantly correlated influence between volume and distribution of PMMA (P>0.05). Among groups with the same screw, there were no significant differences in F_max between groups with injection of 2.0 mL and 2.5 mL PMMA and between groups with injection of 2.5 mL and 3.0 mL PMMA (P>0.05). F_max in groups with injection of 3.0 mL PMMA was significantly higher than that in groups with injection of 2.0 mL PMMA (P<0.05). F_max in group A1 was significantly lower than that in group D1 (P<0.05), and there were no significant differences between other two groups with the same volume of PMMA (P>0.05). Conclusion PMMA can significantly enhance the stability of different injectable pedicle screws in severely OP synthetic bone, and the volume and distribution of PMMA significantly influence the screw stability. Injection of 3.0 mL PMMA through injectable screw with 180°-four lateral holes in group A or injectable screw with 180°-six lateral holes in group B is considered the preferred choice in severely OP synthetic bone.