胎儿先天性心脏病与孕妇年龄关系的探讨

目的探讨胎儿先天性心脏病与孕妇妊娠年龄的关系。方法回顾性分析11 215例孕妇(均为单胎)的产前超声检查和产后随访结果,按照孕妇妊娠年龄分成4组,即A组≤23岁,B组24~29岁,C组30~34岁,D组≥35岁,分别统计各组胎儿先天性心脏病的类型和发病率,计算并比较4组胎儿先天性心脏病的总体发病率。结果 11 215例受检胎儿中,共检出先天性心脏病胎儿106例,其中101例由产前超声检出,5例由产后超声心动图检出,产前超声检出率95.3%,先天性心脏病总发病率0.94%。A、B、C、D组胎儿先天性心脏病发病率分别为1.10%、0.88%、0.81%、1.32%,各组总体发病率比较差异无统计学意义。其中室间隔缺损发病率最高,单纯性室间隔缺损24例,合并其他心内畸形10例;其次为肺动脉狭窄14例,合并心内畸形10例(其中法洛四联症9例)。结论不同妊娠年龄孕妇的胎儿先天性心脏病发病率无差别,各年龄段孕妇定期的产前超声检查必不可少。     

辅助生育技术胎儿心脏形态及功能改变研究

目的本研究通过对辅助生育技术(ART)受孕胎儿与自然受孕胎儿的心脏形态、功能进行对比,探究ART受孕胎儿是否存在心脏形态及功能改变。方法于我院行胎儿超声心动图检查的孕龄与孕周匹配的ART孕妇与自然受孕孕妇各35例,记录两组病例心脏形态及心脏功能指标。结果 ART组胎儿表现出了心血管系统重塑,包括左、右房面积增大,左、右室呈球形并球形指数减低,左室游离壁、室间隔、右室游离壁厚度增加,主动脉、肺动脉增宽,左室FS减低,左室Tei指数增加,二尖瓣、三尖瓣瓣环位移减低,二尖瓣、三尖瓣E峰减速时间降低。结论 ART在胎儿期就已经表现出心脏形态及功能的改变,在早期发现这一改变,能够给临床的早期干预提供重要依据。     

产前超声心动图诊断胎儿房室间隔缺损分型及合并畸形

目的 探讨胎儿超声心动图在诊断房室间隔缺损(AVSD)的常见类型、合并畸形中的作用及其要点。方法 选择胎儿超声心动图检查确诊的先天性心脏病312胎,其中AVSD 19胎,采用超声心动图对胎儿进行全面、系统、多切面扫查。结果 19胎AVSD中,完全型15胎,过渡型2胎,部分型2胎;其中13胎合并其他心脏畸形(6胎合并永存动脉干)。19胎全部引产,病理解剖证实12胎。结论 胎儿AVSD合并其他心脏畸形的发生率较高;分型以完全型AVSD最多;合并畸形中永存动脉干常见。     

妊娠合并心脏病孕妇外周血中miR-27a和GATA6水平与妊娠结局关系

摘要：目的?探讨外周血中miR-27a和GATA结合蛋白6(GATA6)的表达水平与妊娠合并心脏病孕妇妊娠结局关系。方法?回顾性分析2017年5月至2019年7月西安医学院第二附属医院妇产科收治的不良妊娠结局妊娠合并心脏病孕妇81例作为病例组，另取同期就诊的妊娠合并心脏病妊娠结局良好者81例为对照组，收集孕妇治疗前血清，实时定量PCR(RT-qPCR)检测孕妇血清miR-27a的表达水平；western blot检测GATA6蛋白的表达水平；ELISA法检测血清心肌肌钙蛋白I(cTnI)的表达水平；放射免疫法检测血清pro-BNP的表达水平；采用Pearson法分析血清miR-27a、GATA6蛋白与血清cTnI、pro-BNP水平的相关性；采用Logistic回归模型分析影响妊娠合并心脏病孕妇不良妊娠结局的危险因素。ROC曲线分析miR-27a、GATA6、cTnI、pro-BNP对妊娠合并心脏病的诊断价值。结果?与对照组比较，病例组心功能分级Ⅰ+Ⅱ级比例、GATA6?mRNA水平均显著降低，而Ⅲ+Ⅳ级比例、血清miR-27a、cTnI、pro-BNP水平均显著增加(P均<0.05)。此外，与心功能分级Ⅰ+Ⅱ级比较，Ⅲ+Ⅳ级患者血清miR-27a、cTnI、pro-BNP表达水平均显著升高，GATA6?mRNA水平显著降低(P均<0.001)；妊娠合并心脏病孕妇血清miR-27a与GATA6?mRNA水平呈负相关(r=-0.499，P<0.05)，而与血清cTnI、pro-BNP水平均呈正相关(r分别为0.512、0.497，P<0.05)，此外，GATA6?mRNA与cTnI、pro-BNP水平均呈负相关(r分别为-0.531、-0.524，P<0.05)。Logistic回归分析结果发现，心功能分级升高、血清miR-27a、cTnI、pro-BNP水平升高、GATA6水平降低是影响妊娠合并心脏病孕妇不良妊娠结局的危险因素(P<0.05)。结论?血清miR-27a水平增加及GATA6蛋白水平降低可能与妊娠合并心脏病孕妇心肌损伤有关，是影响不良妊娠结局的危险因素。     

先天性心脏病合并心外畸形的产前超声诊断

目的探讨超声检查在胎儿先天性心脏病合并心外畸形诊断中的价值。方法收集我院同时行产前系统超声和胎儿心脏超声检查,且超声诊断均有异常的单胎妊娠病例136例,分析胎儿先天性心脏病合并心外畸形的类型及临床预后。结果 136例先天性心脏病合并心外畸形的病例中,81例(59.6%)合并一种心外畸形,33例(24.3%)合并两种心外畸形,15例(11.0%)合并三种心外畸形,7例(5.1%)合并四种心外畸形。复合型先天性心脏病合并心外畸形占53.7%。最常见的独立发生的先天性心脏病为室间隔缺损,占33.8%。其中,8例同时行染色体检查,2例染色体异常,均为18-三体综合征。对所有病例追踪随访,116例行引产术;20例继续妊娠,其中3例产前超声诊断的室间隔肌部小缺损出生后检查为正常;1例产前误诊房间隔缺损;3例产前超声诊断的肾积水出生后复查正常;13例出生后复查超声与产前超声诊断一致,其中7例行手术治疗。结论超声检查能有效筛查胎儿先天性心脏病及其合并的心外系统畸形,为优生优育提供价值。     

多切面图像分析在胎儿超声心动图产前诊断结构性心脏病的应用价值

目的:探讨多切面图像分析在胎儿超声心动图产前诊断结构性心脏病的应用价值。方法:回顾性选取2017年3月至2022年12月期间于屏南县总医院收治的76例经产前常规超声检查或外院诊断为疑似结构性心脏病胎儿的孕妇临床病例资料,所有孕妇均进行产前胎儿超声心动图检查,对胎儿心脏进行多切面截取观察,收集相关图像进行分析,判断结构性心脏病类型(包括先天性心脏病、膜瓣性心脏病、心肌病、心脏肿瘤),并将分析结果与孕妇最终分娩或引产后检查结果进行对比,其中死胎经组织学检查确诊,活胎经体格检查、血氧饱和度测定及超声心动图检查确诊,计算结构性心脏病符合率,同时进行一致性分析,评估其产前筛查诊断价值。结果:所有孕妇最终分娩或引产后确诊结果为结构性心脏病胚胎有65例(85.53%),其中先天性心脏病21例(32.31%%)、瓣膜性心脏病19例(29.23%)、心肌病15例(23.08%)、心脏肿瘤10例(15.38%);与胎儿超声心动图下多切面图像分析结果比较,各类型结构性心脏病符合率范围80.00%-94.74%,整体符合率达90.77%,以最终确诊结果为金标准,经Kappa一致性分析,灵敏度为90.77%,特...     

妊娠合并心脏病孕妇心功能情况及不良妊娠结局影响因素分析

目的 探讨妊娠合并心脏病孕妇心功能情况及不良妊娠结局影响因素,为临床提供理论参考。方法 选取自2017年1月至2022年6月收治的257例妊娠合并心脏病孕妇作为研究对象,统计孕妇的心脏病类型和心功能情况,比较心功能1～2级和3～4级孕妇的妊娠结局,分析孕妇不良妊娠结局的影响因素。结果 257例妊娠合并心脏病孕妇中,先天性心脏病占40.1%(103/257),瓣膜性心脏病占35.8%(92/257),功能性心脏病占17.5%(45/257),其他类型占6.6%(17/257)。心功能分级1级占56.8%(146/257),心功能分级2级占26.5%(68/257),心功能分级3级占13.6%(35/257),心功能分级4级占3.1%(8/257)。心功能分级1～2级孕妇早产、产后出血及胎儿出生缺陷比例明显低于心功能分级3～4级,差异有统计学意义（P<0.05）。Logistic多因素回归分析显示,孕次、心功能分级、心脏病类型、高血压是妊娠合并心脏病的独立危险因素（P<0.05）。结论 妊娠合并心脏病孕妇的心功能以1～2级为主,心功能分级低的孕妇不良妊娠结局发生率相对较低。孕次...     

产前超声检查对胎儿先天性心脏病的诊断价值探讨

研究分析产前超声检查对胎儿先天性心脏病的诊断价值。选择2012年3月~2015年3月在我院进行检查的孕妇668例作为研究对象,采用超声对所有孕妇进行检查,运用五组基本切面扫查法确诊先天性心脏病,分析检查结果。11例产前确诊为先天性心脏病,其中,4例孕妇引产,7例正常分娩,且经分娩、引产证实确诊为先天性心脏病,检出率为100.00%;在所有孕妇中,3例先天性心脏病胎儿未检出,2例室间隔缺损,1例房间隔缺损,超声产前诊断敏感性为78.57%(11/14);11例产前确诊为先天性心脏病的胎儿中,1例左心发育不良综合征,1例法洛四联症,1例大血管转位,5例室间隔缺损,1例完全性心内膜塾缺损,2例卵圆孔直径增大;四腔心切面确诊率比三血管切面、右室流出道切面、左室流出道切面高(χ2=4.21、4.18、4.24),有统计学意义(P0.05)。产前超声检查在胎儿先天性心脏病的诊断中发挥着重要作用,临床上应予以重视。     

超声心动图诊断及随访胎儿单纯室间隔缺损

目的 探讨超声心动图在胎儿单纯室间隔缺损(VSD)的产前诊断及随访中的应用价值。方法 纳入产前超声心动图诊断为VSD的胎儿35胎,分析胎儿超声心动图特征,对其进行宫内及出生后超声随访,观察缺损大小及闭合情况。结果 误诊2胎;非高危胎儿26胎、高危胎儿7胎;肌部缺损18胎(18/33,54.55%)、膜周缺损13胎(13/33,39.39%)、干下缺损1胎(1/33,3.03%)、隔瓣下缺损1胎(1/33,3.03%);失访1胎,宫内缺损闭合2胎,出生后3年内缺损闭合21例,未闭合9例。非高危胎儿缺损闭合率高于高危胎儿(P<0.05),肌部缺损闭合率明显高于膜周及其他部位缺损(P均<0.05),缺损直径≤3.0 mm者缺损闭合率明显高于缺损3.1~5.0 mm和>5.0 mm者(P均<0.05)。结论 超声心动图在胎儿单纯VSD的产前诊断、随访观察及治疗方案的选择等方面具有重要临床价值。     

彩色多普勒超声对胎儿心脏病的诊断研究

目的 探讨彩色多普勒超声对胎儿心脏病的产前诊断价值。方法 随机对6000例孕妇进行胎儿超声心动图检查。结果 产前检出30例胎儿心脏病，16例经引产尸体解剖证实，产后彩超检查证实14例。声像图显示四腔心不对称者占30．0％（9／30），有室间隔缺损者占73．3％（22／30）。结论 常规胎儿心动图检查对产前检出胎儿心脏病具有重要的临床价值；四腔心不对称和室间隔缺损是胎儿心脏病最主要的声像图表现。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。