28例子痫患者的护理体会

子痫是在先兆子痫的基础上进而出现抽搐发作,或伴昏迷,称为子痫。子痫多发生于妊娠晚期或临产前;少数发生于分娩过程中;个别发生在产后24h内。子痫也是世界范围内构成孕产妇生命威胁的严重妊娠并发症，治疗不及时甚至可造成胎儿及孕产妇的死亡。我院自2007-2009年共收治子痫患者28例，经过积极的治疗与精心的护理后均取得较满意的治疗效果，现报道如下。

研究重度子痫前期分娩时机及方式与围产儿预后的关系

目的：研究重度子痫前期病人分娩方式与时机对围产儿预后的影响。方法：取我院收治的150例重度子痫前期患者为研究对象，回顾性分析其临床资料，其中90例为剖宫产，60例为阴道引产；围产儿中54例为低于34孕周分娩，96例分娩期为34～37孕周之间。结果：与阴道引产组相比，剖宫产组围产儿死亡率、新生儿窒息率和缺氧缺血性脑病发生率更低，组间差异显著（P＜0．05）；34孕周前终止妊娠的围产儿与34～37孕周间终止妊娠的围产儿相比，其新生儿缺氧缺血性脑病（HIE）、生长发育迟缓、死亡率以及新生儿窒息率更高，组间差异显著（P＜0．05）。结论：对于重度子痫前期病人而言，剖宫产是一种有效的终止妊娠方法，对围产儿预后较为有利；而适当延长孕周则有利于围产儿死亡率降低，使围产儿预后得到有效改善。

子痫前期重度早发型及晚发型临床结局探讨

目的:探讨子痫前期重度早发型与晚发型的临床结局及临床界定。方法:分析119例子痫前期重度患者的临床资料,119例按发病孕周不同分为3组:A组:发病孕周小于32周;B组:发病孕周32～34周;C组:发病孕期大于34周。统计3组发病孕期、分娩孕周、住院时间,比较孕产妇并发症及围产儿结局。结果:(1)3组平均孕产妇年龄、孕次、产次,入院时收缩压及舒张压比较,无显著性差异(P>0.05);组组之间行统计学比较,发病孕周与妊娠终止孕周、治疗时间、妊娠合并症及新生儿结局,成正相关性。(2)2种界定方案分组统计比较孕龄长短、新生儿、母亲合并症及感染等状况,34周为界定早发型子痫前期重度,新生儿预后明显好于32周发病孕周的患者。结论:(1)发病越早,妊娠终止孕周越早,并进行治疗所需时间越长,妊娠合并症及新生儿窒息和新生儿病死率越高。(2)将32周做为界定值更能反映早发型子痫前期重度的围产儿结局及不良预后程度,并明确显示早发型与晚发型子痫前期的围产儿结局不同。

Right heart modified myocardial performance index and ductus venosus spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes

Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.

Preeclampsia: Definitions, screening tools and diagnostic criteria in the supersonic era

Preeclampsia is still a major risk factor for maternal-fetal health. Therefore, early identifcation of pregnant women at risk for preeclampsia is a big priority in ob-stetrics in order to decrease the mortality and morbidity associated with this disease. On the basis of well known and new pathophysiological mechanisms of preeclamp-sia, different biochemical and ultrasonographic param-eters have been investigated in the literature, without fnding an ideal marker for early screening. In this brief review, we present the best studied ultrasonographic markers and the most recent genetic factors and prom-ising emerging biomarkers of preeclampsia, to date. We hope that in the future the combination of these tests will allow us to predict which women are at risk of preeclampsia.

Preeclampsia-What is to blame?The placenta,maternal cardiovascular system or both?

Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy.PE also results in fetal morbidity due to prematurity and fetal growth restriction.The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental,immunological and genetic factors.The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia,hypoxia and thus oxidative stress.The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone.Herein we critically evaluate the clinical(risk factors,placental blood flow and biomarkers)and pathological(genetic,molecular,histological)correlates for PE.Furthermore,we discuss the role played by the(dysfunctional)maternal cardiovascular system in the aetiology of PE.We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early-and late-onset PE and highlight some of the key differences between these two distinct disease entities.

Association between gamete source, exposure and preeclampsia: A review of literature

Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis ofpreeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.

Microarray analysis of genes differentially expressed in placentas of pregnancy-induced hypertension patients

Objective: To uncover new clue for the research of the etiology of pregnancy-induced hypertension (PIH) by testing the gene expression difference between preeclamptic placentas and normal ones. Methods: mRNA level of 4 PIH placentas were examined using 4000 feature cDNA microarray in comparison with the pooled control consisting of total RNA from 4 cases of PIH placentas after the control cDNA and experimental cDNA were labeled by cy3 and cy5 respectively. Results: Fifty-eight to 131 genes were found down or up-regulated in 4 runs of hybridization. Among the differentially expressed genes, 22 genes, including genes encoding secreted protein ADRP, CYR61, EPI and HIF2, had the concordance in at least 2 cases were up-regulated or down-regulated. Conclusion: cDNA microarray is a high throughput and time-saving method to monitor the altered gene expression and the result could provide interesting clue and strategy for the etiological research of PIH.

Alteration and potential role of soluble fms-like tyrosine kinase receptor 1 in preeclampsia

Objective:To investigate the alteration of serum soluble fms-like tyrosine kinase receptor 1 (sFlt-1), the possible cause in preeclampsia, the relationship between altered sFlt-1 and the development of pregnancy. Methods: Semi-quantitative RT-PCR was carried out to detect the level of sFlt-1 mRNA in placental tissue of 10 preeclampsia (study group) and 10 normotensive pregnancies (control group); ELISA was used to detect the serum level of sFlt-1 in peripheral venous blood and uterine venous blood in control group (n=35) and study group (n=35), and furthermore to detect the volume of peripheral venous blood sFlt-1 in early, middle and later pregnancies. Results: sFlt-1 mRNA of placental tissue was significantly higher in preeclampsia than that in normal pregnancy. The serum level of sFlt-1 of peripheral vein in preeclampsia was higher than that in normal pregnancy ([ 5639.6±3190.5] pg/ml vs[ 2194.4±635.8 ] pg/ml, P<0.01) , so did the serum sFlt-1 of uterine vein in preeclampsia and control group ([7673.3±2295.8] pg/ml vs[ 3056.6±784.6] pg/ml, P<0.01), indicating that the volume of sFlt-1 of uterine vein blood was significantly higher than that of peripheral venous blood (P<0.01). The serum level of sFlt-1 in early, middle and later pregnancy were (31.7±19.6) pg/ml (n=10), (994.0±302.1) pg/ml (n=10), (2194.4±635.8) pg/ml (n=35), respectively, showing that the level of sFlt-1 in peripheral venous blood increasingly elevated with the development of pregnancy (P<0.01). Conclusion: Preeclampsia is associated with increased level of sFlt-1 which might be largely from placenta during pregnancy.

Contribution of placental leptin to the serum levels in preeclampsia and the effect of hypoxia on synthesis of placental leptin

Objective: To investigate the contribution of placental leptin to the serum levels in preeclampsia and the effect of hypoxia on synthesis of placental leptin. Methods: Fifteen preeclamptic women and 20 normotensive pregnant women were recruited in present study. Leptin concentrations in peripheral venous blood samples and uterine venous blood samples were measured by radioimmunoassay. Eight cases of normal human term placental villi were cultured either in normaxia （21%O2） or in hypoxia （2%O2） followed by determining leptin in the culture medium by radioimmunoassay. Results: Leptin concentrations were significantly higher in preeclamptic women than in normotensive pregnant women, both in the peripheral vein （[23.29±12.87] μg/L vs [13.87±5.57] μg/L, P<0.01） and uterine vein （[16.44±8.62] μg/L vs [11.21±4.20] μg/L, P<0.05）. Leptin concentrations were significantly higher in the peripheral vein than in uterine vein, both in the preeclamptic （P<0.01） and in normotensive pregnant women （P<0.01）. Concentrations of leptin in the culture medium were significantly increased in hypoxia than in normoxia （P<0.05）. Conclusion: The pathogenesis of preeclampsia may be associated with an increase of maternal serum leptin and placenta leptin, and hypoxia in placenta may be an important factor that results in preeclamptic placenta to produce more leptin. Placenta is not the principal source of the serum leptin in the preeclamptic women or normotensive pregnant women.

Cloning and sequencing genes related to preeclampsia

Objectives: To clone genes specifically expressed in the placenta of patients with preeclampsia. and to explain the mechanism in the etiopathology of preeclampsia. Methods: The placentae of preeclamptic and normotensive subjects with pregnancy were used as models, and the eDNA Library was constructed and 20 differentially expressed fragments were cloned after a new version of PCR-based subtractive hybridization. The false positive clones were identified by reverse dot blot analysis. With one of the obtained gene taken as the probe, the placentas of 10 normal pregnant women and 10 preeclamptic patients were studied by using dot hybridization methods. Results: Six false positive clones were identified by reverse dot blot, and the rest 14 clones were identified as preeclampsia-related genes. These clones were sequenced, and analyzed with BLAST analysis system. Eleven of 14 clones were genes already known, among which one belongs to necdin family; the rest 3 were identified as novel genes. These 3 genes were acknowledged by GenBank, with the accession numbers AF2322 16, AF2322 17, AF233648. The results of dot hybridization using necdin gene as probe were as follows: (1) There was this mRNA in the placental tissues of normal pregnancy as well as in that of preeclampsia. (2) The intensity of transcription of this mRNA in the placental tissues of preeclampsia increased significantly compared with that of the normal pregnancy (P＜0.05). Conclusions: This study for the first time reported this group of genes, especially necdin-expressing gene, which are related to the etiopathology of preeclampsia. In addition, the overtranscription of necdin gene has been found in preeclampsia. it is helpful in further studies of the etiology of preeclampsia.

Impact of Omega-3 Nutritional Protocol on the Occurrence of Preeclampsia among High Risk Pregnant Women

Purpose： to examine the impact of omega-3 nutritional protocol for risky pregnant women on the occurrence of preeclampsia. Topic： Supplementation with omega-3 has been proposed to reduce the risk of preeclampsia, but the effects of this intervention are still uncertain. Method： A RCT （randomized controlled trial） had been conducted on 400 pregnant women between 12 and 16 weeks of gestation. Women were assigned randomly to either the control group or the study group. Achievements： Of the 400 women enrolled, 195 were randomly assigned to the study group and 205 to the control group. There was a significant difference between the study and the control groups in relation to the incidence ofpreeclampsia （0.5% and 5.5% respectively, P 〈 0.05）.

Regulating Neuronal Hyper-Excitability and Hyper-Synchrony in Epileptic Patients by Using PUFA, Calcium and ATP Buffering

Epilepsy is a severe neurological disorder clinically identified by hyper-excitability and/or hyper-synchrony in the cortex and other subcortical regions of the brain. To regulate such excitability and synchrony, Hodgkin and Huxley model has been deployed with either PUFA or calcium buffering coupled with ATP modulate neurotransmitter release. We formulate and analyze a system of differential equations that describe the effects of PUFA, ATP, and calcium buffering in regulating neuronal hyper-excitability and hyper-synchrony in epileptic patients. We observed that PUFA had diverse effects on the gating variables. Specifically, there was a significant reduction in the inhibitory potency of PUFA on the m-gates which may cause a direct inhibition of the voltage-gated Na＋ channels and thus reduce neuronal excitability in epileptic patients. Also, the activation of the potassium channels by PUFA directly limited the neuronal hyper-excitability, while a small change in voltage potential coupled with PUFA restraint activated the voltage dependent ion channels which aided in lowering epileptic excitability in patients. In addition, higher ATP buffer levels in the presence of PUFA caused a significant hyperpolarization which may decrease neuronal excitability while lower ATP level initiated neuron depolarization. These results clearly suggest that PUFA coupled with calcium and ATP buffering could be used to modulate neuronal excitability excessive synchrony in epileptic patients.

Anterior dislocation of shoulder in eclampsia： a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia. This is an unusual mechanism of injury, but similar to other un- controlled muscular contractions caused by electroconvul- sive therapy, etc. To the best of our knowledge only one such case has been reported in the English literature. Closed reduction under general anaesthesia was successfully achieved. High suspicion in patients complaining of pain over shoulder joint is necessary for early diagnosis of this condition.