超声测定脐血流S/D值对诊断胎儿宫内缺氧的临床价值

目的分析超声测定脐血流收缩期血流速度/舒张期血流速度值(S/D)在诊断胎儿宫内缺氧中的临床价值,为孕期保健提供数据支持。方法选取2014年5月至2018年5月在我院分娩的孕妇80例作为研究对象,所有孕妇均于临产前行超声检查脐血流动力学指标:S/D、、阻力指数(RI)、搏动指数(PI)。按照检测的S/D值及对应的孕周判断脐血S/D值是否正常,将其分为S/D值正常组(41例)和S/D值异常组(39例)。采用胎儿心电监护仪对胎儿胎心率、FQRS波群、FST段、无负荷试验等进行检测,根据上述监测结果综合判断胎儿宫内情况:缺氧、羊水过少、脐带绕颈、生长受限、宫内窘迫等,比较两组患儿上述宫内不良情况发生率。收集两组孕妇分娩方式、母儿妊娠结局并比较组间分娩方式构成及不良妊娠结局率。分析超声测定脐血流S/D值对诊断胎儿宫内情况的临床价值。结果(1)S/D值异常组胎儿宫内缺氧率、羊水过少率、生长受限、宫内窘迫率均高于S/D值正常值胎儿;(2)S/D值正常值孕妇引导分娩成功率明显高于S/D值异常组孕妇,剖宫产率及产钳助产率明显低于S/D值异常组孕妇;(3)两组孕妇母儿妊娠结局不良率明显高于S/D值正常值母儿,差异均有统计学意义(P<0.05)。结论加强孕晚期孕妇超声测定脐血流S/D值,对胎儿宫内缺氧有较高的参考价值,S/D值异常提示胎儿宫内情况不良,应及时增加其他检查方式,明确胎儿宫内情况并及时采取措施,避免对胎儿健康造成不利影响。

血管痉挛性头痛舌下含化硝酸甘油的脑血流改变

目的:探讨血管痉挛性头痛舌下含化硝酸甘油(nitroglycerin,NG)的脑血流改变。方法:通过经颅多普勒超声(transcranial dopple ultrasound,TCD)对40例正常人(Ⅰ组)和90例血管痉挛性头痛患者(Ⅱ组)的颅底动脉血流速度值及频谱形态进行对比分析。结果:含化NG1min时,Ⅱ组血流速度值高于Ⅰ组,2min后才开始减慢,并且出现血流速度最低值的时间早于Ⅰ组。两组血流速度值经t检验比较,差异有统计学意义(P<0.05);两组血流频谱形态均在含化NG1min即发生改变。结论:应用此药物试验可以动态观察脑血管的血流速度值及弹性情况。

血清游离雌三醇和脂联素水平与妊娠糖尿病孕晚期发生胎儿窘迫的相关性研究

目的探讨血清游离雌三醇(free estriol,FE3)和脂联素(adiponectin,ADP)水平与妊娠糖尿病孕晚期胎儿窘迫发生的相关性。方法收集2016年3月~2019年3月期间在陕西省核工业二一五医院妇产科就诊的118例妊娠糖尿病(gestational diabetes mellitus,GDM)患者的临床资料进行回顾性分析,依据孕妇是否发生胎儿宫内窘迫(fetal distres,FD)分为胎儿窘迫组(FD组,22例)和非胎儿窘迫组(NFD组,96例)。血清FE3和ADP水平分别采用电化学发光分析法和酶联免疫吸附法检测;血清葡萄糖水平采用己糖激酶法检测,胎儿脐动脉收缩末期/舒张末期最大血流速度(S/D)采用彩色多普勒超声分析仪检测。选择同期体检正常孕妇56例作为对照组。比较分析以上指标的变化与GDM孕晚期胎儿窘迫发生的相关性。结果在对照组、NFD组和FD组中,血清FE3(ng/ml)和ADP(mg/L)水平分别为18.85±3.77,11.27±2.43,7.09±1.31和13.23±2.91,5.78±1.53,3.92±1.21。在NFD组和FD组中,血清FE3和ADP水平显著低于对照组。在FD组中,两指标的水平显著低于NFD组(F=45.17~63.93,均P=0.000)。在对照组、NFD组和FD组中,血清空腹血糖(mmol/L)、1 h血糖(mmol/L)、2 h血糖(mmol/L)水平及S/D值分别为4.92±0.81,7.37±1.22和8.73±1.91;7.29±2.10,12.73±2.52和13.91±3.32;5.75±1.33,9.62±1.53和10.90±2.03,及2.61±0.15,2.83±0.17和3.17±0.18。在NFD组和FD组中,空腹血糖、1 h血糖、2 h血糖水平及S/D值均显著高于对照组。在FD组中,各指标均显著高于NFD组(F=29.38~51.97,均P=0.000)。相关性分析显示,FD组血清FE3及ADP水平有正相关性(r=0.789,P<0.01)。两指标分别与空腹血糖(r=-0.729,-0.737,均P<0.01),1 h血糖(r=-0.752,-0.761,均P<0.01),2 h血糖(r=-0.772,-0.789,均P<0.01)水平及S/D值(r=-0.697,-0.709,均P<0.01)均有负相关性。在NFD组中,血清FE3及ADP水平有正相关性(r=0.793,P<0.01)。两指标分别与空腹血糖(r=-0.712,-0.723,均P<0.01),1 h血糖(r=-0.738,-0.752,均P<0.01),2 h血糖(r=-0.761,-0.775,均P<0.01)水平及S/D值(r=-0.685,-0.692,均P<0.01)均有负相关性。结论检测血清FE3和ADP水平可以预测GDM孕晚期胎儿窘迫的发生,两指标水平的变化可以评价胎儿窘迫的改善状况。

Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization

AIM:To evaluate the predictive value of preoperative predictors for portal vein thrombosis(PVT)after splenectomy with periesophagogastric devascularization.METHODS:In this prospective study,69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010.The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography.The hepatic congestion index and the ratio of velocity and diameter were calculated before operation.The prothrombin time(PT)and platelet(PLT)levels were measured before and after operation.The patients'spleens were weighed postoperatively.RESULTS:The diameter of portal vein was negatively correlated with the portal vein flow velocity(P<0.05).Thirty-three cases(47.83%)suffered from postoperative PVT.There was no statistically significant difference in the Child-Pugh score,the spleen weights,the PT,or PLT levels between patients with PVT and without PVT.Receiver operating characteristic curves showed four variables(portal vein flow velocity,the ratio of velocity and diameter,hepatic congestion index and diameter of portal vein)could be used as preoperative predictors of postoperative portal vein thrombosis.The respective values of the area under the curve were 0.865,0.893,0.884 and 0.742,and the respective cut-off values(24.45 cm/s,19.4333/s,0.1138 cm/s-1 and 13.5 mm) were of diagnostically efficient,generating sensitivity values of 87.9%,93.9%,87.9%and 81.8%,respectively,specificities of 75%,77.8%,86.1%and 63.9%,respectively.CONCLUSION:The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.