目的 探究缩宫素受体(OTR)和平滑肌动蛋白(SMA)在子宫肌层和瘢痕组织中的表达情况.方法 选择2020年1月至2021年12月在嘉兴市妇幼保健院行剖宫产手术生产的产妇60例,使用缩宫素前,分别取非高龄初产妇及高龄初产妇子宫切口上缘肌层组织、经产妇子宫瘢痕组织样本,均为20例,行常规病理检验,并采用免疫组化法检测OTR和SMA的表达情况.结果 非高龄初产妇子宫肌层组织OTR表达水平高于高龄初产妇子宫肌层组织和经产妇子宫瘢痕组织,差异均有统计学意义(均P＜0.05);高龄初产妇子宫肌层组织OTR表达水平与经产妇子宫瘢痕组织比较,差异无统计学意义(P＞0.05);非高龄初产妇子宫肌层、高龄初产妇子宫肌层的SMA表达水平高于经产妇子宫瘢痕组织,差异均有统计学意义(均P＜0.05).结论 子宫瘢痕和高龄对OTR和SMA表达有影响,高龄导致子宫肌层OTR表达下降,瘢痕导致OTR和SMA表达均下降.

目的 观察右美托咪定复合舒芬太尼用于子痫前期产妇剖宫产术后镇痛的效果.方法 选择2018年1月至2019年7月嘉兴市妇幼保健院拟行择期剖宫产的子痫前期产妇120例,按照随机数字表法分为A组和B组,每组60例.两组均在腰硬联合麻醉下行剖宫产术,术后均采用患者自控镇痛(PCA),镇痛药A组采用右美托咪定1μg/ml复合舒芬太尼1μg/ml,B组采用舒芬太尼1μg/ml.观察并比较两组产妇术后2、4、8、12及24 h产妇疼痛视觉模拟评分(VAS)和Ramsay镇静评分(RSS),术后24 h出血量及低血压、心动过缓、高血压、瘙痒、恶心和呕吐等不良反应发生情况.结果 与B组比较,A组产妇术后4～24 h VAS评分降低、RSS增加、术后24 h出血量减少,高血压和恶心、呕吐的发生率下降,差异均有统计学意义(均P<0.05),但两组产妇低血压、心动过缓、过度镇静和瘙痒发生率比较差异均无统计学意义(均P>0.05).结论 右美托咪定复合舒芬太尼能增强子痫前期产妇剖宫产术后镇痛、镇静效果,减少产后24 h出血量及降低术后高血压、恶心和呕吐的发生率.

目的 为临产妇和产科医生提供一种无创、方便、客观、准确的宫口开大测量装置.方法 通过两个柔性测量指环和位于两个测量指环间的测量尺完成宫口测量,测量方法符合临床常规宫口测量习惯且不受测量时手掌形变及阴道特定生理弯曲角度影响,准确测量宫口开大距离.结果 在产前宫颈变化与产道关系模型中使用宫口测量器测量比徒手测量准确度高,测量结果客观可靠.结论 可计量宫口测量器可较准确测量临产妇宫口开大距离,为临床提供了一种简便、客观、无创的宫口测量方法.

目的 探讨髂筋膜间隙阻滞复合喉罩通气全麻在儿童股骨手术中的应用效果.方法 选择嘉兴市妇幼保健院2014年5月-2015年6月收治的股骨干骨折择期手术儿童80例,按随机数字表法分为2组,每组40例,观察组(A组)行髂筋膜间隙阻滞+喉罩通气全身麻醉,对照组(B组)行气管插管全身麻醉.观察组气管插管后采用超声引导下髂筋膜间隙阻滞,2组均使用丙泊酚4 ～8 mg/(kg·h)复合浓度2％七氟烷麻醉维持,使BIS值维持在40 ～55之间、收缩压在基础值20％的范围内波动.记录2组喉罩或气管导管置入前后、切皮、术中血流动力学参数[收缩压(SBP)、舒张压(DBP)和心率(HR)]变化,丙泊酚、舒芬太尼用量,拔管时间、离开恢复室时间.观察苏醒期躁动、术后咽喉疼痛及呼吸抑制等并发症的发生情况.采用视觉模拟评分(VAS)评价患者术后即刻、4h、8h、12 h、16 h及24h的疼痛程度.结果 置管后和术中2个时间点2组患者SBP、DBP和HR比较差异有统计学意义(均P ＜0.05),但麻醉前和手术结束时2组SBP、DBP和HR比较差异无统计学意义(均P＞0.05).术毕观察组舒芬太尼、丙泊酚用量较对照组明显减少;拔管时间和恢复室停留时间均明显短于对照组,2组比较差异有统计学意义(均P＜0.05).2组术后4～12h组间VAS评分比较差异有统计学意义,术后12h后组间VAS评分比较差异无统计学意义.观察组无髂筋膜间隙阻滞相关并发症发生,咽喉疼痛1例;对照组有2例患儿发生苏醒期躁动,咽喉疼痛4例,呼吸抑制1例,无其他并发症.结论 在儿童股骨手术中,髂筋膜间隙阻滞复合喉罩通气全麻能够维持血流动力学平稳,减少全麻药及阿片类药物的用量,减少苏醒期躁动,缩短术后恢复时间,且术后镇痛效果良好.

目的 研究产钳助产术对产后出血量的影响及其原因分析.方法 回顾性分析我院2016年167例行产钳助产术产妇的产后出血量,分别与175例自然分娩产妇和51例经阴道分娩过程中行会阴侧切术产妇的产后出血量进行比较.同时针对行产钳助产术的三病因(6例胎位不正,118例胎儿宫内窘迫以及43例第二产程延长)分别与自然分娩产妇的出血量相比较.结果 产钳助产组的平均产后出血量为(294.97±84.28)ml,较自然分娩组的平均产后出血量(242.17±56.96)ml多,两组之间具有显著性差异(P＜0.05).同时,产钳助产组出血量较会阴侧切组(245±46.41mL)多,具有统计学差异(P＜0.05).另外,产钳助产组三病因的平均出血量(胎位不正组(316.67±68.31)mL,胎儿宫内窘迫组(285.59±60.63) ml,第二产程延长组(317.67±128.21) mL均较自然分娩组多,存在统计学差异.结论 产钳助产对产后出血量的增加提示产钳助产本身或产钳运用的病因可能会增加产后出血,但产钳助产对困难分娩依然有着其独特的优势.

Objective To compare the effect of in-plane and out-of-plane technology on the arterial catheterization in different subcutaneous distances.Methods A total of 120 patients scheduled for radial artery catheterization were divided into four groups (n =30):group A (in-plane performance with subcutaneous distance ≥2.8 mm),group B (out-of-plane performance with subcutaneous distance≥2.8 mm),group C (in-plane performance with subcutaneous distance＜2.8 mm),and group D (out-of-plane performance with subcutaneous distance＜ 2.8 mm).The total times of puncture,puncture attempts,the first successful cases and the first successful puncture time were recorded.Results The subcutaneous distance and radial artery diameter of groups A and B were significantly longer than those of groups C and D (all P＜0.01).Compared with those in groups A and C,the first puncture success rate were significantly increased in groups B and D (both P＜0.05),while the first successful puncture time were significantly decreased (both P＜0.05).Compared with those in groups A and B,the first puncture success rates were significantly increased in groups C and D (both P＜0.05),while the first successful puncture times were significantly decreased (both P＜0.05).There were no significant difference in puncture time or attempts between the groups (all P ＞ 0.05).Conclusion Ultrasound-guided radial artery cannulation can be performed easily when subcutaneous distance is greater than 2.8 mm.Compared with in-plane technology,radial artery cannulation guided by out-of-plane technology needs less time,and with higher first success rate.

目的：探讨蛛网膜下腔（鞘内）复合小剂量舒芬太尼对肥胖产妇剖宫产术脊麻布比卡因的半数有效量（ED50）的影响。方法选取60例择期剖宫产的肥胖产妇，ASAI或II级，体重指数（BMI）>30kg/m2，行腰硬联合麻醉，按随机数字表法分为观察组和对照组，每组各30例。观察组鞘内复合舒芬太尼2.5μg，用序贯法测定两组产妇腰麻后0.5%布比卡因的ED50，观察产妇不良反应情况和新生儿状况。结果观察组脊麻布比卡因的ED50为2.9mg（95%CI：2.7~3.1），对照组为6.3 mg （95%CI：6.2~6.5），组间差异有统计学意义（P<0.05）。与对照组比较，观察组术中不良反应发生率较低（P<0.05）。结论肥胖产妇剖宫产术蛛网膜下腔复合小剂量舒芬太尼可减少布比卡因剂量，降低不良反应的发生率。

目的：探讨超声引导下桡动脉穿刺置管技术的两种穿刺方法的穿刺效果及并发症。方法选择择期外科手术患者60例，随机分为平面内技术组（A组）和平面外技术组（B组）。记录两组总穿刺时间，穿刺尝试次数，第一次成功率，第一次成功者穿刺时间，并观察并发症发生情况。结果 B组与A组相比穿刺时间[(172±2)s vs.(168±3)s]和穿刺次数2(1,2) vs.1(1,3)差别无统计学意义（P>0.05），但B组与A组相比，第一次穿刺成功率高于A组(76% vs.60%)，第一次成功穿刺时间短于A组[(94±1)s vs.(106±2)s]，穿透法例数多于A组(40% vs.20%)，动脉周围血肿发生率多于A组(20% vs.10%)，两组间差异有统计学意义（P<0.05）。结论超声引导平面外桡动脉置管技术与平面内技术相比能提高一次性穿刺置管成功率，所需操作时间更短，但穿透法发生率增高。

Objective To investigate the efficacy of continuous fascia iliaca compartment block withdifferent concentrations of ropivacaine for postoperative analgesia in patients undergoing total hip arthroplasty.Methods One hundred and sixty ASA physical status Ⅰ or Ⅲ patients,aged 52-84 yr,body mass index 18-26 kg/m2,scheduled for total hip arthroplasty,were randomly divided into 4 groups (n =40 each) using a random number table:0.20％ ropivacaine group (group A),0.25％ ropivacaine group (group B),0.30％ ropivacaine group (group C) and 0.35％ ropivacaine group (group D).A catheter was inserted into the fascia iliaca compartment on the affected side within 30 min after operation.The corresponding concentrations of ropivacaine 20 ml were given in each group.The catheter was then connected to a patient-controlled analgesia pump programmed to deliver 10 ml with a lockout interval of 60 rin for postoperative analgesia (72 h).When VAS score at rest≥4,parecoxib sodium 40 mg was injected intravenously.At 12,24,48 and 72 h of blockade,the passive and active exercise VAS scores were recorded.The consumption of ropivacaine within 72 h after the end of blockade,and requirement for parecoxib sodium and development of adverse reactions during blockade were recorded.Results Compared with group A,the passive and active exercise VAS scores were significantly decreased in C and D groups (P ＜ 0.05),and no significant change was found in group B (P ＞ 0.05),and the consumption of ropivacaine within 72 h after the end of blockade was significantly decreased in B,C and D groups (P ＜ 0.05).There was no significant difference in the passive and active exercise VAS scores between group C and group D (P ＞ 0.05).There was no significant difference in consumption of ropivacaine within 72 h after the end of blockade between B,C and D groups (P ＞ 0.05).There were no significant differences in the requirement for parecoxib sodium and incidence of vomiting among the four groups (P ＞ 0.05).Conclusion The optimum concentration of ropivacaine is 0.30％ when used for continuous fascia iliaca compartment block in patients undergoing total hip arthroplasty.