孕期体重管理影响因素及对分娩结局的影响

目的 探讨孕期体重管理影响因素及对分娩结局的影响.方法 选择2019年1月至2020年4月在绍兴市柯桥区妇幼保健院建档的孕妇192例为研究对象,根据孕期体重管理效果分为孕期体重增长适宜组134例(适宜组),与孕期体重管理欠佳组58例(欠佳组,均为增长过度).统计孕妇一般资料,调查孕期体重管理知识、态度、行为.单因素及多...     

Domestic abuse on women in China before, during, and after pregnancy

Background Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. Methods A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1,2001 and February 28, 2002. Results The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period (before, during, or after pregnancy) was 12.6%. The prevalence of abuse during the approximate 9 months of pregnancy (4.3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9. 1%) and after delivery (8.3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the panner, socioeconomic level, alcohol consumption, and smoking. Conclusions It is necessary to do in-depth training and to raise awareness of panner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses.     

Beta adrenoceptor blockade and responses of serum lipids to a meal and to exercise

During a randomised placebo controlled trial of the effects of nadolol in hypertensive patients serum lipid profiles were obtained while the patients were fasting and during and after a meal and an exercise test. Treatment with nadolol was associated with a significant reduction in high density lipoprotein cholesterol at all time points. Serum triglyceride concentrations during treatment with nadolol were higher in the fasting state, though not significantly so, increased further postprandially, and were significantly higher during and after exercise. The changes in high density lipoprotein cholesterol and triglyceride concentrations during beta adrenoceptor blockade may be secondary to a reduction in lipoprotein lipase activity.     

Sulphonylureas in the management of type 2 diabetes during the fasting month of Ramadan

Although a majority of Muslim patients with type 2 diabetes fast during the month of Ramadan, there are no accepted guidelines for its management during this period. The few studies on this subject suggest that there are important alterations in energy intake and physical activity, and that most patients change their pattern of drug intake. This is associated with a greater risk of hypoglycaemia and ketoacidosis. The usual pattern of eating during Ramadan, and its influence on the normal diurnal variation of blood sugar with a regular non-fasting diabetic diet, suggests that anti-diabetic agents for use during this period need to be selected according to their pharmacokinetic and tablet formulation characteristics. The sulphonylureas are first line drugs in type 2 diabetes and used by a majority of patients. A comparison of the pharmacokinetics, efficacy, and safety characteristics of these agents suggests that a long-acting once daily formulation of gliclazide such as gliclazide modified release, taken in the evening, may be the sulphonylurea of choice during Ramadan.     

Serial estimation of serum angiotensin converting enzyme activity during and after pregnancy in a woman with sarcoidosis

Serum angiotensin converting enzyme activities were estimated during pregnancy and the puerperium in a woman with sarcoidosis and a series of normal women. In the patient with sarcoidosis angiotensin converting enzyme activity was raised during pregnancy, particularly at 21 weeks' gestation, yet she remained well with no symptoms to suggest relapse of sarcoidosis. Serum angiotensin converting enzyme activity may not be of value in monitoring sarcoidosis activity during pregnancy.     

基于钟基因Clock和Bmal1调控探究辰时针刺自发性高血压大鼠的降压机制

目的 以自发性高血压大鼠（spontaneous hypertensive rat，SHR）为观察对象，探究针刺降压的钟基因调控作用。方法 将24只SHR随机分为针刺组和模型组，12只Wistar-Kyoto（WKY）大鼠作为正常组。针刺组选择辰时针刺SHR双侧曲池、足三里穴，模型组和正常组仅接受与针刺组同等强度的捆绑操作。4周后，各组分别在辰、酉时随机抽取6只大鼠，测量鼠尾收缩压（systolic blood pressure, SBP）和舒张压（diastolic blood pressure, DBP），然后检测血清5-羟色胺（5-hydroxytryptamine，5-HT）、褪黑素（melatonin, MT）的含量以及心脏生物钟基因Clock和Bmal1的表达水平。结果 分组因素对SBP、DBP、血清MT含量、Clock表达结果的RQ值、Bmal1表达结果的RQ值的主效应均有统计学意义（P＜0.05），时辰因素对各指标的主效应和两者的交互作用均无统计学意义（P＞0.05）。模型组辰、酉两个时辰的SBP和DBP均高于正常组（P<0.05），针刺组辰时的SBP和DBP及酉时的SBP均低于模型组（P<0.05）。模型组辰时MT含量较正常组降低，5-HT含量较正常组升高（P<0.05），针刺组辰时MT含量较模型组升高，5-HT含量较模型组降低（P<0.05）；针刺组酉时的MT含量较模型组升高（P<0.05）。针刺组辰时心脏Clock基因表达水平和酉时心脏Bmal1基因表达水平较模型组升高（P＜0．05）。结论 辰时针刺可以降低SHR的“双峰”血压，其作用机制可能与提高血清MT含量，减少5-HT含量以及提高心脏Clock和Bmal1基因的表达水平有关。     

全身麻醉患者术中知晓情况分析

目的明确应用目前全身麻醉方法行择期手术术中知晓的发生率,对可能引起术中知晓的原因进行分析。并对术中知晓病例的术后情况进行统计分析。方法随访接受全身麻醉的择期手术患者2025例,以准确回述记忆确定术中知晓。对存在术中知晓的患者记录知晓时的感知觉、心理反应,并于术后2周追踪有无后遗症状发生。采用多元Logistic回归分析对可能与术中知晓有关的因素进行分析。结果共28例（1．4％）患者存在术中知晓。女性（OR=2．836;95％ CI 1．181～6．810）,应用喉罩进行气道管理（OR=19．609;95％CI3．894～98．740）,麻醉维持过程中一段时间或全程未应用挥发性麻醉剂（OR=3．084;95％CI1．246～7．629）,术中血压波动（OR=10．430;95％CI3．918～27．763）的患者易发生术中知晓,应用术前药（OR=0．326;95％C10．110～0．965）有助于使发生术中知晓的危险性下降。而患者的年龄、体重、ASA分级、麻醉时间、术中是否复合应用阻滞麻醉、术中是否复合应用阿片类镇痛药对术中知晓的发生并没有显著影响。28例术中知晓患者中,23／28（82％）术中存在听觉;7／28（25％）术中存在不同程度的疼痛;10／28（36％）术中有恐惧和焦虑感;6／28（21％）术后出现不同程度的后遗症。结论术中知晓可在多种择期手术中散发。女性,应用喉罩进行气道管理,麻醉维持过程中一段时间未用或全程未用挥发性麻醉剂,术中出现血压波动,是全身麻醉患者术中知晓的可能危险因素,术前药物的应用对预防术中知晓有益。术中知晓的患者术后可能发生不同程度的后遗症。     

哮喘患者支气管诱导痰液中炎性细胞的分析研究

目的研究哮喘患者急性发作期及缓解期痰液中炎性细胞的变化。方法留取哮喘患者发作期和缓解期支气管诱导痰液,检测其细胞成分并与对照组相比较。结果哮喘患者急性发作期诱导痰液的中性粒细胞数较其缓解期和对照组均明显增高,嗜酸性粒细胞数与哮喘急性发作期和缓解期均较对照组明显增高,巨噬细胞数与哮喘各期均较对照组明显降低。结论哮喘病是一种慢性气道炎症性疾病,在不同发病时期气道内的炎性细胞变化不同。     

Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum: a case-control study

Background  Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum.

Methods  We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A (during pregnancy) or group B (during postpartum). The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages.

Results  Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms (P=0.022) and cerebral infarction (P=0.014) occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses (P=1.000), with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension. Delayed diagnosis was associated with a poorer prognosis.

Conclusions  Cerebral venous thrombosis manifests different clinical characteristics during pregnancy and postpartum, though both have a good prognosis. Early diagnosis and prompt anticoagulation therapy are essential.

     

缩肛状态下肛提肌应变率用于评价压力性尿失禁患者盆底肌收缩功能的价值

目的 研究缩肛状态下肛提肌应变率评价压力性尿失禁患者盆底肌收缩功能中的价值,从而为临床提供可量化的客观指标.方法 选取77例压力性尿失禁患者作为研究对象,根据Oxford肌力分级标准分为肌力障碍组27例和非肌力障碍组50例;选择30例其他普通妇科疾病且无盆底肌功能障碍患者作为健康对照组.比较3组缩肛状态下的肛提肌应变率;分析缩肛状态下肛提肌应变率与Oxford肌力分级的相关性;并通过绘制受试者工作特征曲线来探索缩肛状态下肛提肌应变率诊断盆底肌收缩功能障碍的最佳临界值.结果 肌力障碍组缩肛状态下肛提肌应变率低于其他两组(P<0.05).Oxford肌力分级与缩肛状态下肛提肌应变率呈正相关(r=0.815,P<0.05).缩肛状态下肛提肌应变率诊断盆底肌收缩功能障碍最佳临界值为10.07%,曲线下面积为0.888(P<0.05),其灵敏度、特异度、阳性预测值及阴性预测值分别为91.8%、78.6%、80.8%、86.3%.结论 缩肛状态下肛提肌应变率对压力性尿失禁患者盆底肌收缩功能障碍的诊断具有一定价值,但仍需进一步研究以证实其对其他类型疾病患者盆底肌功能的诊断效能.     

Pump models assessed by transesophageal echocardiography during cardiopulmonar y resuscitation

目的　对院内心脏骤停患者于心肺复苏期间行经食管超声心动图检查 ,以进一步探讨心肺复苏时的血液动力学机制。方法　对 6例院内心脏骤停患者依照进一步心血管生命支持指南行心肺复苏术。于心肺复苏 15min内 ,在喉镜指引下 ,插入多平面食管超声探头 ,采用二维及脉冲波多普勒超声心动图技术 ,观察整个心肺复苏过程中二尖瓣、三尖瓣和主动脉瓣的运动状况 ,左室内径、胸主动脉内径的变化和二尖瓣、主动脉瓣的血流频谱。结果　所有的 6例病人 ,胸按压时 ,二尖瓣和三尖瓣关闭 ,同时主动脉瓣开放 ,前向血流自心室进入体循环和肺循环 ;发生在胸按压时的主动脉瓣峰值前向血流速度为 5 8 8± 11 6cm/s。而在按压放松时 ,主动脉瓣关闭伴房室瓣迅速开放 ,出现心室充盈 ,二尖瓣峰值前向血流速度为 6 0 6± 2 0 0cm/s。有 5例病人在按压期出现二尖瓣反流 ,提示存在着室至房的压力阶差。所有的 6例病人于胸按压时出现左室内径减小和胸主动脉内径增加 ,表明直接的心室受压是前向血流产生的机制。结论　上述资料支持心泵理论是人类心肺复苏时产生前向血流的主导性机制。     

慢性肺源性心脏病急性加重期三重酸碱失衡28例临床分析

目的：探讨慢性肺源性心脏病（肺心病）急性加重期三重酸碱失衡血气和电解质变化，分析原因并制定防治措施。方法：250例慢性肺心病患者合并三重酸碱失衡者28例，对28例患者的血气和电解质指标，包括pH值、动脉血二氧化碳分压（PaCO2）、碳酸氢根离子（HCO3^-）、钠离子（Na^＋）、氯离子（Cl^-）浓度进行测定，并与32例血气分析结果正常者进行比较，观察各项指标变化情况。结果：28例三重酸碱失衡患者中，20例为呼酸型三重酸碱失衡，与血气正常者相比，pH、Cl^-浓度降低，PaCO2、HCO3^-浓度升高。8例呼碱型三重酸碱失衡，与血气正常者相比，PaCO2及HCO3^-、Cl^-浓度降低，pH升高。结论：慢性肺心病急性加重期者常发生三重酸碱失衡，以呼酸型三重酸碱失衡为主。三重酸碱失衡的纠正是临床治疗成功与否的关键性因素之一。     

Progesterone administration and progressive sleep apneas

Nine adult patients with obstructive sleep apnea syndrome were administered medroxyprogesterone acetate, 60 to 120 mg/day, and the effect of medroxyprogesterone on clinical symptoms and obstructive apneas during sleep was assessed. Four patients responded with resolution of daytime sleepiness, disappearance of pedal edema, and a decrease in the number of obstructive apneas during sleep. Cessation of therapy led to a return of daytime sleepiness in three and an increase in obstructive apneas in all four subjects. Two responders experienced side effects of alopecia or decreased libido. Before medroxyprogesterone therapy, responders were distinguished from nonresponders only by the presence of a significantly lower resting arterial oxygen tension during wakefulness. We characterize a subgroup of patients who benefit from medroxyprogesterone therapy by reducing obstructive apneas during sleep.     

心泵或胸泵,心肺复苏时经食管超声心动图的观察

目的　对院内心脏骤停患者于心肺复苏期间行经食管超声心动图检查,以进一步探讨心肺复苏时的血液动力学机制.方法　对6例院内心脏骤停患者依照进一步心血管生命支持指南行心肺复苏术.于心肺复苏15 min内,在喉镜指引下,插入多平面食管超声探头,采用二维及脉冲波多普勒超声心动图技术,观察整个心肺复苏过程中二尖瓣、三尖瓣和主动脉瓣的运动状况,左室内径、胸主动脉内径的变化和二尖瓣、主动脉瓣的血流频谱.结果　所有的6例病人,胸按压时,二尖瓣和三尖瓣关闭,同时主动脉瓣开放,前向血流自心室进入体循环和肺循环；发生在胸按压时的主动脉瓣峰值前向血流速度为58.8±11.6?cm/s.而在按压放松时,主动脉瓣关闭伴房室瓣迅速开放,出现心室充盈,二尖瓣峰值前向血流速度为60.6±20.0?cm/s.有5例病人在按压期出现二尖瓣反流,提示存在着室至房的压力阶差.所有的6例病人于胸按压时出现左室内径减小和胸主动脉内径增加,表明直接的心室受压是前向血流产生的机制.结论　上述资料支持心泵理论是人类心肺复苏时产生前向血流的主导性机制.     

The effects of physical exercise on plasma levels of relaxin,NTproANP, and NTproBNP in patients with ischemic heart disease

The insulin-like and vasodilatatory polypeptide relaxin (RLX), formerly known as a pregnancy hormone, has gained interest as a potential humoral mediator in human heart failure. Controversy exists about the relation between plasma levels of RLX and the severity of heart failure. The present study was designed to determine the course of RLX, atrial, and brain natriuretic peptide (NT-proANP and NT-proBNP) during physical exercise in patients with ischemic heart disease (IHD) and to relate hormone levels to peak cardiac power output (CPO) as a measure of cardiopulmonary function with prognostic relevance. 40 patients with IHD were studied during right-heart-catheterization at rest and during supine bicycle ergometry. RLX, NTproBNP, and NTproANP were determined before, during exercise, and after recovery. NT-proANP and NT-proBNP levels increased during maximal charge, and recovery while RLX levels decreased. Cardiac power output at maximal charge correlated inversely with NTproANP and NTproBNP but positively with RLX. Patients with high degree heart failure (CPO < 1.96 W) had higher NTproANP and NTproB-NP and lower RLX levels than patients with low degree heart failure. While confirming the role of NTproANP and NTproBNP as markers for the severity of heart failure, the present data do not support the concept that plasma levels of RLX are related to the severity of myocardial dysfunction and that systemic RLX acts as a compensatory vasodilatatory response hormone in ischemic heart disease.     

Evaluating medical school graduates of a reduced course program: a preliminary report

The performance of 32 medical school graduates who had pursued a reduced course load ("extended program") for one or more years during medical school was examined during the first postgraduate year (PGY-1) of training. Those with academic problems as undergraduates performed at only a slightly lower than average level, while those who had extended their curricula to pursue personal or extracurricular interests tended to perform at a better than average level in the PGY-1 residency. Graduates with significant emotional disorders in medical school who pursued a reduced course load had a high (35 percent) dropout rate during the residency that occurred despite expert psychiatric care and substantial support during medical school and the residency. The authors suggest that extended programs may be useful for students seeking personal enrichment and for some with academic problems but that they do not seem particularly helpful to students with major emotional disturbances.     

孕期体质量增值、血脂水平与孕妇妊娠期高血压靶器官损害及妊娠结局的关联性分析

目的探讨孕期体质量增值、血脂水平与孕妇妊娠期高血压靶器官损害及妊娠结局的关联性。方法选取85例妊娠期高血压孕妇作为研究组,随机选取同期60名正常孕妇作为对照组。统计比较2组一般资料,探讨妊娠期高血压发病的危险因素,比较研究组不同靶器官损害情况病人的孕期体质量增值、血脂水平,并分析孕期体质量增值、血脂水平与靶器官损害的关联性,随访至妊娠结束,统计研究组妊娠结局,比较妊娠结局良好与妊娠结局不良病人的孕期体质量增值、血脂水平,探究孕期体质量增值、血脂水平评估靶器官损害情况及预测妊娠结局不良的效能。结果研究组孕前体质量指数（BMI）、孕期体质量增值、高血压病家族史及三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均高于对照组（P<0.01）,高密度脂蛋白胆固醇（HDL-C）水平低于对照组（P<0.05）;妊娠期高血压发生的影响因素包括孕前BMI、孕期体质量增值、高血压病家族史及TG、TC、HDL-C、LDL-C水平（P<0.05~P<0.01）;孕期体质量增值、TG、TC、LDL-C水平与靶器官损害呈正相关关系（P<0.01）,HDL-C水平与靶器官损害呈负相关关系（P<0.05）;孕期体质量增值、TG、TC、HDL-C、LDL-C水平联合评估靶器官损害情况的曲线下面积（AUC）为0.879,大于各指标单一评估,最佳评估敏感度、特异度分别为73.82%、92.40%;妊娠结局不良病人的孕期体质量增值、TG、TC、LDL-C水平高于妊娠结局良好病人,HDL-C水平低于妊娠结局良好患者病人（P<0.05）;孕期体质量增值、TG、TC、HDL-C、LDL-C水平联合预测妊娠结局不良的AUC为0.932,大于各指标单一预测,最佳预测敏感度、特异度分别为88.89%、88.06%。结论孕期体质量增值、血脂水平与孕妇妊娠期高血压发病及靶器官损害密切相关,且能辅助临床评估靶器官损害情况、预测不良妊娠结局发生风险。     

Appendectomies during physicians' boycott. Analysis of surgical care.

The 1975 San Francisco physicians' boycott caused major changes in patterns of providing surgical care, but there was no appreciable change in the number of appendectomies performed during the boycott month when compared with a six-month baseline period. The ratio of normal to inflamed appendices removed was no different during the boycott than it was during the control period, and no differences were noted in the percentage of cases perforating in the boycott month when compared with the control period. In addition, patients seeking care for appendicitis during the boycott month did not experience delays. The lack of change in the standard direct and indirect indicators used to monitor quality of care suggests no major lapses in appendicitis care occurred in San Francisco during the boycott.     

地西泮终止大鼠晚期癫痫持续状态的效果观察

目的观察大鼠癫痫持续状态(SE)4h以后时间窗时,地西泮终止其发作的疗效。方法SD雄性大鼠,随机分为3组:对照组、持续棘波发放期(3期,1h)给药组和晚期周期性痫性波发放期(5期,PED,4h)给药组。采用氯化锂-匹罗卡品化学药物诱发大鼠SE,行为学观察和脑电图(EEG)记录持续到SE开始后5h。结果3组中SE1、2期的时长没有统计学差异,但地西泮能明显缩短SE3、4期的时长。即使在SE5期,给予地西泮后绝大多数SE大鼠能成功地终止其行为学和EEG上的痫性发作。结论(1)地西泮终止SE4h以后发作的效果比早期更为容易,提示癫痫持续的时间越长越不容易终止发作的结论在SE早期适用,可能并不适用于SE晚期;(2)在大鼠SE模型,海马与皮质EEG一样,也显现出5个特异性波形期。     

宫腔镜手术的麻醉及电解质、血糖等监测对预防TURS的临床意义

目的：探讨宫腔镜手术的麻醉方法,了解电解质、血糖等在宫腔镜手术中的变化。方法：80例行寓腔镜手术的患者,随机分为GA组(静脉吸入复合全身麻醉组．n=36)和EA(硬膜外麻醉组．n=44)。所有的病人均于术前、术中、术后检测电解质(Na^ 、K^ 、Cl^-)、血糖和血气(HCO3^-、PaCO2、pH、Hb、Hct),同时记录下所用灌流液多少及手术时间。结果：两组术中血糖、术后血糖均较术前显著上升,术后血糖较术中血糖有所上升。电解质中以血钠变化明显,术中、术后较术前显著下降。组间比较无显著差异。两组灌流液量无明显差异。结论：宫腔镜手术中,静脉吸入复合全麻和硬膜外麻醉均可安全使用。电解质、血糖等监测是不可缺少的手段之一。