子宫腺肌病(AM)是临床常见的妇科疾病,严重影响女性的健康及生活质量,保留子宫的治疗在控制痛经和(或)月经过多症状时有时疗效欠佳,是世界性难题.近年来,AM的发病率在年轻女性中呈上升趋势,根治性子宫切除术不适用于年轻女性或强烈希望保留子宫的女性,高强度聚焦超声(HIFU)治疗作为一种新兴的无创治疗技术,在AM治疗方面已卓有成效,但各中心报道的HIFU治疗有效率波动较大,如何选择最佳适应症以求达到更好的疗效,仍是目前需解决的问题.本文拟从AM的不同分型及不同磁共振成像特征与HIFU治疗疗效的相关性进行综述,为临床决策提供思路.

目的:分析急诊重症监护室(EICU)不同年龄段呼吸重症病人机械通气治疗后的相关因素,为EICU不同年龄段呼吸重症病人机械通气治疗方案制定提供依据.方法:选取148例EICU呼吸重症病人作为研究对象,根据病人年龄进行分组,比较各组病人机械通气时间、一次性撤机成功率和死亡率.结果:随着病人年龄增长,插管时间整体呈递减趋势,50～59岁组和≥90岁组插管时间相对较短(P<0.05).各组内不同性别病人插管时间差异均无统计学意义(P>0.05).<39岁组病人一次性拔管成功率最低(50.0％),死亡率最高(35.7％);40～49岁组和60～69岁组病人一次性拔管成功率较高,分别为83.3％和83.9％;40～49岁组和50～59岁组的拔管死亡率较低,分别为8.3％和9.5％,但各组一次性拔管成功率和死亡率差异均无统计学意义(P>0.05).结论:40～59岁为机械通气应用时的最佳年龄段,39岁以下病人机械通气拔管风险较大.为EICU不同年龄段呼吸重症病人机械通气治疗方案的制定和临床护理提供了参考.

目的:探讨聚焦超声消融术(FUAS)联合宫腔镜子宫内膜部分切除术(TCRE)在子宫腺肌病(AM)治疗中的临床应用价值.方法:选取医院收治的142例AM患者,根据FUAS后是否行TCRE分为观察组(71例)和对照组(71例).观察组采用FUAS后行TCRE;对照组采用FUAS后直接宫内放置左炔诺孕酮宫内节育系统(曼月乐LNG-IUS).随访持续至治疗后12个月,随访指标为月经出血量,痛经评分和并发症发生率.结果:观察组中65例完成随访,对照组中57例完成随访.两组患者术后3个、6个月和12个月的月经量和痛经评分均明显下降,与术前相比差异有统计学意义(t=6.541,t=1.860,t=3.086;P<0.05).两组患者治疗后3个月、6个月和12个月的月经出血量、痛经评分比较,差异无统计学意义.对照组患者术后不规则少量阴道流血率为30.9％,观察组为67.2％.对照组的平均阴道出血时间为89.7 d,观察组为4.6 d,两组术后平均阴道流血时间相比,差异有统计学意义(t=3.875,P<0.05).结论:FUAS结合TCRE可明显改善AM的临床症状,且不良反应更小,是无生育要求患者治疗AM的有效方法.

目的 探讨高强度聚焦超声联合宫腔镜治疗剖宫产瘢痕部位妊娠后的再妊娠结局.方法 随访2015年6月-2018年12月于川北医学院附属医院确诊为CSP,并经高强度聚焦超声消融联合宫腔镜治疗后的病例75例,收集其临床资料、妊娠结局情况,并初步分析不良妊娠结局原因.结果 失访12例,成功随访63例.12例有妊娠意愿的患者中有9例成功妊娠,2例因惧怕复发性CSP而避孕,51例无妊娠意愿的患者中有7例意外妊娠,总妊娠率25.3％ (16/63).16例再次妊娠患者中,4例足月剖宫产分娩4例正常新生儿;3例尚处于妊娠期;1例复发性CSP;1例自然流产;7例无妊娠意愿而意外妊娠的患者均于早孕期终止妊娠.结论 高强度聚焦超声联合宫腔镜可有效治疗CSP,术后再妊娠率高,妊娠结局良好.

Objective To evaluate the feasibility and safety of high-intensity focused ultrasound (HIFU) treatment combined with hysteroscope for the treatment of cesarean scar pregnancy (CSP). Methods Retrospective analysis of 22 cases of CSP diagnosed by vaginal color Doppler ultrasound or MRI at the Affiliated Hospital of North Sichuan Medical College from January to December 2017, all the patients received HIFU ablation, suction curettage under hysteroscopic guidance was performed at 1 ~5 days after HIFU ablation. The change of β-human chorionic gonadotropin (β-hCG) level,intraoperative blood loss in suction curettage and time for normal menstruation recovery were recorded. Results All the 22 patients successfully completed once HIFU treatment, the average treatment time was (41. 2 ± 9. 2) min; the irradiation time was average (409. 0 ± 116. 3) s; the treatment intensity was (595. 0 ± 114. 9) s/h, no serious complications occurred. During hysteroscopic curettage,the average intraoperative blood loss was 10. 0 mL (3~1 200 mL). Two of the patients had more intraoperative hemorrhage, 500 mL and 1 200 mL, respectively. The Foleys urinary catheter was used to stop bleeding and the red blood cell suspension was input. After hysteroscopic surgery (29. 4 ± 13. 7) d hCG decreased to normal, (41. 0 ± 15. 0) d returned to normal menstruation. Conclusion HIFU combined with hysteroscopic treatment of CSP has good safety and effectiveness, but more research is needed to clarify its exact scope of application.

患者女,32岁,因停经68 d,阴道不规律流血就诊,血人绒毛膜促性腺激素(HCG)265 954 mIU/ml,考虑葡萄胎行清宫术,术后血HCG 11 321 mIU/ml,病理结果:部分性葡萄胎.再次行清宫术,术后血HCG 15 094 mIU/L.超声检查:子宫前壁下段见一28 mm×28 mm×24 mm低回声伴不规则液性无回声区,界线欠清;CDFI于周边探及条状血流信号包绕(图1A).

目的 评价高强度聚焦超声(HIFU)联合促性腺激素释放激素激动剂(GnRHa)治疗子宫腺肌症的临床疗效.方法 收集2015年1月至2016年7月在该院确诊的子宫腺肌病患者250例,根据患者病情及意愿选择下列治疗方法之一,共分为5组,A组为单纯GnRHa治疗组,B组为全子宫切除术组,C组为全子宫切除术+GnRHa治疗组,D组为HIFU治疗组,E组为HIFU+GnRHa治疗组;观察各组患者治疗前后内分泌激素(FSH、LH、E2)的变化情况,初步分析对卵巢功能的影响;同时观察患者治疗前后痛经评分、月经量的变化情况、治疗后的复发率及患者自测健康评定量表(SRHMS),进一步分析HIFU联合GnRHa治疗子宫腺肌症的有效性和安全性.结果 D组患者治疗前、后3个月FSH、LH和E2水平无明显变化(P＞0.05);B组治疗后3个月与治疗前比较,FSH和LH水平升高,E2水平下降,差异有统计学意义(P＜0.05);其余各组治疗后3个月的FSH、LH和E2水平较治疗前明显下降(P＜0.05).A、D、E组治疗后3个月患者痛经评分、月经量均少于治疗前,而E组患者的变化幅度均大于其余各组,差异均有统计学意义(P＜0.05);治疗1年后A、D、E组患者SRHMS与治疗后3个月无明显变化(P＞0.05),而存在子宫全切术的B、C组患者治疗的1年SRHMS明显低于治疗后3个月(P＜0.05).结论 HIFU联合GnRHa治疗子宫腺肌症安全有效,对患者治疗后社会活动、人际交流无明显影响,同时对患者卵巢功能影响甚微.

Objective To investigate the effect of high-intensity focused ultrasound on immune function to patients with uterine leiomyomas in the perioperative period.Methods 87 patients with uterine leiomyomas who received treatment, and were diagnosed by clinical symptoms and imageology in the Affiliated Hospital of North Sichuan Medical College from were selected as clinical subjects.They were divided into the following groups according to the patients' treatment choices:HIFU treatment, laparoscopic myomectomy and conventional myomectomy.The venous blood samples were taken from the patients before the operation and 24 hours after.The serum levels of interleukin-2 (IL-2) and IL-10 were quantified by enzyme-linked immunosorbent assay (ELISA).The changes of the detection indexes before and after the operation were compared among the three groups.Results The levels of plasma IL-2 in HIFU group were significantly higher than those in laparoscopic and the conventional myomectomy groups (P＜0.05).The levels of plasma IL-10 in the conventional myomectomy group were significantly higher than those in the HIFU group and the laparoscopic group (P＜0.05).In each group, the level of IL-2 in the HIFU group was higher than before the operation, and the level of IL-2 in laparoscopic and the conventional myomectomy groups were lower than that before the operation, and the differences were statistically significant (P＜0.05).The level of plasma IL-10 in the conventional myomectomy group was higher than before operation (P＜0.05).However, in the HIFU and the laparoscopic myomectomy group, there were no significant differences in the IL-10 level, compared with before operation (P＞0.05).Conclusions HIFU treatment for the uterine fibroids has small trauma to the body, and may enhance the body's cellular immune function in the perioperative period to a certain degree, and it is a safer minimally invasive treatment.

Objective To evaluate the pregnancy outcome of high intensity focused ultrasound (HIFU) ablation of uterine fibroids among women with unintentional pregnancy within one year therapy.Methods A retrospective analysis was conducted of 371 women under the age of 40 years old (23-40 years) who underwent HIFU therapy at affiliated hospital of north sichuan medical college.Results (1) 27 women were unplanned pregnancy within 1 year after the HIFU therapy, the pregnancy rate was 7.3％, 17 of these women had desired pregnancy before undergoing treatment and smooth delivery, without any complications such as uterine rupture;8 women without pregnancy desire underwent induced abortion, 2 women experienced spontaneous abortion. (2) No adhesion occurred after HIFU therapy, which had no effect on Menstrual cycle and sexual life.Conclusions HIFU therapy for uterine fibroids among women who pregnant within 1 year were safe.

Objective To investigate the clinical value of high- intensity focused ultrasound therapy in treatment of cesarean scar pregnancy(CSP).Methods Fifteen cases of CSP were confirmed,and they were accepted the high- intensity focused ultrasound treatment.Contrast -enhancement ultrasound were performed immediately after operation,hysteroscopy electrotomy or curettage guided by ultrasound was performed in the patients with the lesion in the uterine cavity.The operation time,blood flow of the lesion before and after the operation,decline of the serum β-HCG and menstruation recovery were retrospectively analyzed.Results All the patients completed the treatment at one time.The operation time ranged from 15 to 97 min (mean 52.9 min).Contrast-enhanced ultrasound immediately after operation indicated that lesions and their surrounding blood flow was significantly reduced compared with those before operation,and the re-examination showed serum β-HCG was decreased. 7 cases underwent hysteroscopy electrotomy after high-intensity focused ultrasound resection,the intraoperative blood loss was 2~50 ml(mean15 ml),and 1 case underwent curettage under the monitoring of ultrasound,the intraoperative blood loss was 10 ml. All of them were successfully cleared embryonic tissue at one time.The average time for serum β-HCG returned to normal levels was(23.9±6.1)d,the average time for menstruation recovery was(31.4±4.7)d.The rest 7 cases were not accepted curettage,due to lesions in serous layer.The average time for serum β-HCG returned to normal levels was(31.8±7.5)d,he average time for menstruation recovery was(43.9±10.4)d.15 patients were followed up for 3 months,no complications was occurred.Conclusion High-intensity focused ultrasound is a safe,effective and minimally invasive method in the treatment of CSP.

Objective To investigate the effect of UCP2 on cell proliferation, apoptosis, metastasis in cervical squamous carcinoma. Methods Plasmid?mediated downregulation of UCP2 was obtained in cervical cancer cell lines. MTT, flow cytometry and transwell chamber assay were conducted to detect the ability of proliferation, apoptosis and metastasis. Characteristics of UCP2 protein was analyzed by bioinformatics methods. Results (1)UCP2 was verified to be downregulated by qRT?PCR and Western blotting assay.(2)MTT, apoptosis assay and transwell chamber assay showed that the proliferation of SiHa cell was significantly inhibited, and the apoptosis rate was significantly increased, and metastasis was markedly deduced (P < 0.05). (3) Bioinformatic analysis showed that UCP2 was located in mitochondria with several phosphorylation sites, and UCP2 interacted with other proteins to produce biological effects. Conclusion UCP2 may play an important role in the occurrence and development of cervical cancer, and it is expected to be a new target for the early diagnosis and treatment of cervical cancer.

Objective To study the expression level of GRIM-19 in endometrial tissue of the patients with adenomyosis and to investigate its molecular mechanism during disease occurrence and progress process.Methods The ectopic and eutopic endometrial tissues were obtained from 30 patients with adenomyosis.Immunohistochemistry and Western blot were performed to detect the expression of GRIM-19,pSTAT3 and VEGF.The endometrial tissueapoptosis was assayed by TUNEL.Immunohistoehemistry with anti-CD34 antibody was performed to detect angiogenesis in endometrial tissue.GRIM-19 small interfering RNA(siRNA) and recombinant GRIM-19 plasmid were constructed and transfected into Ishikawa cells for detecting the change of downstream signal molecules pSTAT3,STAT3 and VEGF.Results The expression level of GRIM-19 was decreased in the ectopic and eutopic endometrial tissues of patients with adenomyosis compared with control group.Apoptosis in ectopic and eutopic endometrial tissues was reduced;the microvessel density and expression levels of pSTAT3 and VEGF were increased.Transfecting Ishikawa cells and downregulating GRIM-19 expression could significantly activate pSTAT3 and VEGF.Conclusion GRIM-19 promotes the occurrence and development of adenomyosis by inhibiting apoptosis and angiogenesis.

The emergency department, which is highly centralized with critically and acutely ill patients, is also with the highest fluidity of medical personnel, and the key place where complicated patients are taken care. Therefore emergency nurses are supposed to choose pain assessment tools correctly and timely, manage the pain of the patients effectively, and improve the skills of their own in the analgesia. In this review, we summarize the characteristics of the pain (acute abdominal pain) in the emergency surgery patients, the methods on pain assessment, and the application of several kinds of drugs on analgesia in clinical nursing practice.

目的 探讨高强度聚焦超声(HIFU)消融治疗子宫肌瘤时病灶出现不同灰度图像变化的意义.方法 回顾性分析50例行超声消融治疗的单发子宫肌瘤患者的声像图资料,根据治疗时病灶图像灰度变化的不同,分为团状灰度变化组(22例)和整体灰度变化组(28例),术前术后行增强MRI.比较两组肌瘤体积、治疗强度、消融率、MRI非灌注区、治疗时间、治疗剂量及不良反应.结果 团状灰度变化组与整体灰度变化组在肌瘤体积、消融率、消融体积、不良反应及治疗强度等方面比较差异无统计学意义,但团状灰度变化组治疗剂量、治疗时间明显低于整体灰度变化组,差异均有统计学意义(均P＜ 0.05).结论 HIFU治疗子宫肌瘤时实时超声监控图像出现整体灰度变化和团状灰度变化均能达到满意消融效果,但团状灰度变化组的治疗时间、治疗剂量更少.

目的:观察丙泊酚在小儿喉罩置入麻醉诱导中的应用效果.方法:选择2013年3月至2014年10月在本院进行择期手术患儿60例,年龄1～8岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,体重10～ 30 kg.常规禁食禁饮,术前30 min给予盐酸戊乙奎醚(0.01 mg/kg).基础麻醉:咪达唑仑(0.03 mg/kg)和芬太尼(1μg/kg)静脉注射,分别给予丙泊酚2.0 mg/kg(A组,n=30)和3.0 mg/kg(B组,n=30)诱导,诱导前3 min静脉给予利多卡因1 mg/kg.在咽喉反射消失、下颌松弛、睫毛反射消失时用翻转法置入大小合适的喉罩.观察诱导前后血流动力学变化、并发症、喉罩首次置入成功率.结果:丙泊酚诱导后喉罩置入的首次成功率分别为28例(93.3％)和27例(90.0％),差异无统计学意义(P＞0.05).并可以建立安全有效的通气.麻醉后患者血压、心率均正常.结论:静脉注射咪达唑仑、芬太尼、利多卡因基础麻醉后,使用丙泊酚诱导置入喉罩具有较好的效果.

目的:探讨子宫肌瘤合并妊娠产妇行剖宫产术中切除肌瘤的临床意义。方法:52例子宫肌瘤合并妊娠产妇,行剖宫产术同时切除肌瘤,观察术中术后各项指标、术后恢复情况及术后并发症发生情况。结果:手术时间(61.2±13.3)min,术中出血量(266.4±35.4)ml,术中缩宫素使用量(38.5±5.7)U,术后缩宫素使用量(25.1±3.0)U,术后血红蛋白值(96.5±6.9)g/L;术后肛门排气时间(1.1±0.2)d,产褥病率2例(3.8%),恶露干净时间(31.4±2.8)d,术后住院时间(8.2±1.3)d;子宫出血3例(5.8%),切口感染2例(3.8%),切口裂开1例(1.9%),经对症处理后均恢复满意,对产妇术后的恢复无影响。结论:子宫肌瘤合并妊娠剖宫产分娩时,应尽量在行剖宫产术中剔出肌瘤,对产妇的术后恢复无影响。

Objective To explore the clinical effect of Compound Reduced Glutathione Mixture combined with ursodeoxycholic acid(UDCA) in treating intrahepatic cholestasis of pregnancy(ICP).Methods 56 cases of ICP pregnant women were divided into two groups:30 cases in the treatment group and 26 cases in the control group.The treatment group was given 10% glucose injection(GS) 250 mL+Compound Reduced Glutathione Mixture 0.6 g,5% GS 250 mL+adenosylmethionine1.0 g,10% GS 250 mL+potassium magnesium aspartate20 mL+Vit K1 20 mg,10% GS 500 mL+10% potassium chloride10 mL+VitC 3.0 g+ 10% calcium gluconate10 mL,10% GS 250 mL+50% GS 40 mL+10% potassium chloride7 mL,Salvia Miltiorrhiza Injection 250 mL by intravenous drip,once daily and oral UDCA 250 mg,twice daily.The control group took oral UDCA250 mg,twice daily.The two groups all took 10-14 d as a course of treatment.The itchy symptom,changes of blood total bile acid(TBA),alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TB),pregnancy outcome and perinatal infants situation before and after treatment were compared between the two groups.The results were statistically analyzed.Results The pruritus score,TBA,transminases levels after treatment in the two groups were decreased obviously compared with before treatment(P<0.05 or 0.01),but there was no change in TB(P>0.05).The difference values of the pruritus score,TBA,ALT,AST before and after treat ment in the treatment group were higher than those in the control group(P<0.05).The delivery gestational weeks in the treatment was prolonged compared with the control group(P<0.05).Fetal distress and the amniotic fluid pollution degree in the treatment group were better than those in the control group(P<0.01).There was no statistical difference in the Apgar scores(≤7 points) between the two groups(P>0.05).Conclusion The effect of Compound Reduced Glutathione Mixture combined with UDCA in treating ICP is more obvious and safer.

Objective: To investigate the high risk HPV infection(HR-HPV) in the pregnancy patients complicated with uterine cervical intraepithelial neoplasia(CIN).Methods: A total of 150 pregnancy cases complicated with CIN and 50 cases of normal cervix in our hospital form February 2011 to June 2012 were randomly selected.Hybrid capture Ⅱ(HC-Ⅱ) was used to detect the positive infection rate,types and the loading amount of the HR-HPV of all cases at pregnancy and the postpartum.The logistic regression model was used to analyze the correlation between the extent lesions of the CIN patients and the positive rates of HPV and the loading amount.Results: The main type of HPV in the CIN group was HPV-16 and 18,accounting for 81%(162/200).The main type of HPV in the normal healthy pregnant women was HPV-31,33 and 35.The single and multiple HR-HPV infection rates of the CIN group at gestational and postnatal were significantly higher than that in the control group(P<0.01).The HR-HPV loading amount of the CIN group at pregnancy and postpartum were higher than that in the control group(P<0.05).The HR-HPV loading amount of the CINⅡand CINⅠ group at postpartum were significantly lower than that at pregnancy(P<0.05);while the HR-HPV loading amount of the CIN Ⅲ group at postpartum had no significant difference compared with pregnancy cases(P>0.05).The correlation coefficients between the lesions extent and the positive rate and the loading amount of the HR-HPV were 0.871 and 0.901,both of which reached a significant level(P<0.05).Conclusions: The main HPV type of the CIN group is HPV16 and HPV18 and plays an important role in the occurrence and development of cervical carcinoma.There is significant positive correlation between the lesions extent and the positive rate and the loading amount of the HR-HPV.The positive rate and the loading amount of the HR-HPV could be used as an early clinical diagnostic index to diagnose pregnancy complicated with CIN

胎盘植入是胎盘绒毛因子宫蜕膜发育不良,胎盘绒毛穿透底蜕膜侵入子宫基层,为产科严重并发症,常导致产妇严重的产时产后出血、子宫穿孔、继发感染,甚至危及产妇的生命.近年来,随着医学技术的发展,对胎盘植入的保守治疗有了较大的进展.现就药物治疗、手术治疗、介入治疗、宫腔镜电切术等方面来阐述胎盘植入保守性治疗新的进展.