Objective To investigate the effects of epidural analgesia with 0.075％ or 0.1％ ropivacaine on the maternal fever and interleukin-6 (IL-6) during labor.Methods Eighty healthy term nulliparas (ASA Ⅰ-Ⅱ) were randomly assigned to receive epidural analgesia using 0.1％ ropivacaine and sufentanyl 0.5 mg/L (group H) or 0.075％ ropivacaine and sufentanyl 0.5 mg/L (group L),40 in each.Epidural analgesia was maintained with 7 ml bolus doses of the above mentioned analgesics every 30 min by the patient controlled epidural analgesia (PCEA).The measurements included the incidence of maternal fever, IL-6 in maternal and cord venous blood, labor events and neonatal outcomes.Results Epidural analgesia with 0.075％ ropivacaine could significantly lower the incidence of maternal fever than the one with 0.1％ ropivacaine (17％ vs 40％,P＜0.05).The duration of 2nd stage of labor and epidural analgesia in group H were longer than those in group L (P＜0.01).IL-6 in maternal serum rose during labor in both groups.There was no intergroup change of IL-6 in maternal or cord serum in group H versus group L.Comparing with afebrile group,febrile group had longer duration of epidural analgesia, shorter 3rd stage of labor and higher incidence of cesarean section.There was no intergroup change of IL-6 in matemal or cord serum in febrile versus afebrile.Conclusions Epidural analgesia with 0.075％ ropivacaine could significantly lower the incidence of maternal fever than the one with 0.1％ ropivacaine.This effect is not related with IL-6.

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄妇女常见的一种复杂的内分泌及代谢紊乱性疾病,是具有发病多因性、临床表现多态性的内分泌综合征.PCOS好发于青春期,多以月经稀发或继发性闭经等月经异常,及多毛、痤疮、肥胖等高雄激素表现为临床特征;进入育龄期后往往以无排卵性不孕为近期并发症影响患者的生育功能;在围绝经期及中老年期由于持续的胰岛素抵抗、高雄激素血症、血脂和血糖异常及月经紊乱,易导致PCOS患者发生糖尿病、高血压、心血管疾病及雌激素依赖性子宫内膜癌等一系列远期并发症.

目的 观察右美托咪定(DEX)对七氟醚吸入麻醉妇科腹腔镜手术患者血浆胃动素(MTL)及术后恶心呕吐(PONV)的影响.方法 妇科腹腔镜手术患者50例,随机分为DEX组(D组)和对照组(C组).D组予DEX 1 μg/kg并以0.2μg/(kg·)维持,C组则予生理盐水.记录手术、吸入麻醉时间,七氟醚用量,苏醒和气管导管拔除时间;检测术前(T0)、术后24h(T1)和术后48h(T2)血浆MTL水平;随访PONV的发生情况.结果 与C组比较,D组七氟醚用量减少(P＜0.05),苏醒和气管导管拔除时间无明显延长(P＞0.05),T1时点术后MTL水平显著降低(P＜0.05)且术后24h内PONV发生率明显降低(P＜0.05).结论 七氟醚吸入麻醉妇科腹腔镜手术应用DEX可减少七氟醚用量,不延长苏醒和气管导管拔除时间,减少MTL释放,显著降低PONV发生.

宫颈癌是最常见的妇科恶性肿瘤,全球有80％宫颈癌病例发生在发展中国家[1].近20年来,在中西部一些农村地区,其发病率和死亡率仍居高不下,且趋于年轻化[2],建立适合经济欠发达地区的宫颈癌早诊早治筛查方案是当今亟待解决的问题.世界卫生组织推荐在资源欠发达的地区应用醋酸肉眼观察进行宫颈癌的筛查[3].本研究旨在应用醋酸肉眼观察法(visual inspection with acetic acid,VIA)和碘染色肉眼观察法(visual inspection with Lugol's iodine,VILI)对筛查宫颈癌的作用进行综合评价,探讨VIA/VILI作为经济欠发达地区宫颈癌筛查方法的实用价值.

Objective To analyze the prevalence of common gynecological diseases in Beijing and to provide evidence for prevention and control of gynecological diseases.Methods The general survey results of gynecological diseases were checked by the physical examination center of Beijing Maternal and Child Health Hospital from 2004 to 201 1.The prevalence and development trend of common gynecological diseases were retrospectively analyzed.Results A total of 38 274 women received general survey of gynecological diseases.The total screening rate of gynecological diseases was 89.0％.Breast hyperplasia,reproductive tract infection,uterine myoma and ovarian cyst were the most common gynecological diseases.The incidence of uterine myoma increased year by year(15.7％) ; the incidence of breast hyperplasia(-47.7％) and reproductive tract infection(-31.9％) showed a decreasing trend.Conclusions The prevention and treatment of common gynecological diseases should be enhanced.In order to improve the quality of general survey,new screening technique should be used continuously with general survey of gynecological diseases.

目的 探讨运动的量、频率对女性乳腺癌发病的影响程度.方法 采用以人群为基础的回顾性病例对照研究方法,调查对象是北京地区35 ～ 60岁女性,共1210例,其中确诊乳腺癌患者(n =429)和健康人群对照(n=781),采用问卷调查的形式.结果 采用Logistic回归模型分析得出运动中无论是休闲、职业运动皆与乳腺癌有关,二者呈现一定的剂量反应关系.中度运动的频率、持续时间与乳腺癌的发生存在量的关系.中度适量、持久的运动可有降低乳腺癌风险的作用.结论 适宜运动的量、频率有降低女性乳腺癌危险性的作用,对降低乳腺癌的发病起到预防作用.

Objective To explore the influence of screening programme on awareness of cervical cancer prevention among 30 to 59 years old women who live in rural areas of Beijing.Methods A face-to-face cross-sectional survey on women's knowledge on cervical cancer prevention was conducted in 2008 and 2009 among subjects recurited by three-stage stratified random sampling.Results Univariate analysis showed that since the initiation of cervical cancer screening in Daxing District of Beijing,the overall awareness of cervical cancer was significantly increased among women residents,and the percentage of women with 5 or more correct answers was increased from 37.3％ to 51.0％ ( x2=62.06,P＜0.001).After adjusting confounding factors,multivariate analysis showed that cervical cancer screening programme contributed to improved awareness of cervical cancer-related knowledge ( OR =1.853,95％ CI1.590 -2.159).In addition,current place of residence,education level,household income per-capita and screening history within 5 years were major factors affecting women's awareness of cervical cancer ( OR vales were 1.766,2.580,1.350 and1.676,respectively),and higher education level and personal income were correlated with increased awareness rate.Conclusion Cervical cancer screening could improve general knowledge of cervical cancer,especially for those who have never participated in the screening programme.

Objective To evaluate the effect of low dose tramadol on prophylaxis of shivering during spinal anaesthesia.Methods In this prospective,randomized and double-blind study,90 cases American society of anesthesiologists(ASA) Ⅰ and Ⅱ patients ranging 21-43 years old undergoing selective cesarean section were included.The patients were randomly allocated to the control group (0.9％ normal saline were given as an intravenous bolus 30 min before intrathecal injection,n =30) ; observation group A (tramadol 0.5 mg/kg were given as an intravenous bolus 30 min before intrathecal injection,n =30) ; observation group B (tramadol 1.0 mg/kg were given as an intravenous bolus 30 min before intrathecal injection,n =30).All drugs were given as a bolus of 5 millilitres in 10 seconds.From the start of anaesthesia to 6 hours after surgery,the complications including shivering,oversedation,nausea,vomiting and dizziness; the Apgar scores of the newborns was observed.Results The incidence of shivering in the control group,observation group A and B was 40.0％ (12/30),13.3％ (4/30)and 10.0％ (3/30) respectively.Compared with the control group,the incidence of shivering in both observation group A and B was significantly lower (P ＜ 0.05) ; no statistical difference was observed between observation group A and B.The incidences of sedation in the control group,observation group A and B were 6.7％ (2/30),23.3％ (7/30) and 46.7％ (14/30) respectively.The incidence of sedation in the control group and observation group A was significantly lower than that in observation group B (P ＜ 0.05).No dizziness,oversedation or respiratory depression was observed in three groups and there was no statistics difference in the incidences of hypotension and bradycardia among three groups (P ＞ 0.05).Conclusions Compared with tramadol 1mg/kg,preconditioning tramadol 0.5mg/kg is alsó effective for prophylaxis of shivering during subarachnoid anaesthesia in patients undergoing cesarean section.Moreover,the incidence of complications can be reduced.

Objective To explore influence factors on compliance to colposcopy in cervical cancer screening and propose corresponding strategies.Methods The multistage,stratified,randomly,non-probability sampling was used to choose one street and four towns from Daxing District of Beijing and a cervical cancer screening cohort was established for two years.Women with positive result at first screening stage were given a face to face interview and then were required to have further colposcopy tests with reservation within 6 months.Results Of 458 women with positive result in the first screening procedure,301(65.7%)women had taken colposcopy screening test in given period under instruction,while 157(34.3%) failed.The multiple logistic regression showed that,compared to younger women aged 30~,women aged 40~ had 1.958(1.207-3.176) times the odds,of taking colposcopy examination.Besides,compared to women living in the most remote rural areas with poor transportation,women living in areas close to testing site for colposcopy had 2.014(1.097-3.695) times the odds,of taking follow-up colposcopy examination.Women with good awareness of four aspects of knowledge including "More than 1 of 3 of all lives lost to cancer could be saved by early detection followed by early diagnosis and treatment","early stages of cervical cancer","HPV is a necessary cause of cervical cancer","treatment of early stage cervical cancer",were more likely to take colposcopy test in given period than women with little awareness,with 1.817(1.078-3.060),2.061(1.220-3.482),2.539(1.254-5.143),1.820(1.123-2.949) times the odds,respectively.Women not fear of pain during screening tests had higher compliance rate,with 2.159(1.266-3.681) times the odds of taking colposcopy test than those who were.Conclusion In women,extensive health education projects focusing on cervical cancer prevention and cure knowledge and the great significance of screening should be vigorously implemented.

常见的乳腺疾病包括乳腺小叶增生、乳腺囊性增生、纤维腺瘤、乳腺炎、导管内乳头状瘤、乳腺癌等,其中乳腺增生、乳腺纤维瘤、乳腺癌较为常见.乳腺疾病中绝大部分是乳腺增生性病变(在乳腺专科中占50%～70%)为良性乳腺疾病,乳腺癌是世界范围内女性最常见、最多发的恶性肿瘤,其严重威胁着妇女的生命和健康.近年来研究表明[1]乳腺疾病的发病与社会、经济、精神心理因素有关.随着医学模式的转变,社会、心理等因素对乳腺疾病尤其是乳腺增生性病变的病因及对乳腺癌的治疗效果及预后等的影响越来越被人们所重视.

Objective To investigate the awareness status of knowledge on cervical cancer prevention and cure as well as relevant influencing factors to provide basis for developing corresponding intervention measures.Methods An epidemiological questionnaires survey was conducted among 2000 women recruited by the stratified cluster sampling after distributing propaganda materials in Daxing District,Beijing.Results The awareness rate about cervical cancer among women was rather low ranged from 15.8%(HPV infection was the main cause of developing cervix cancer) to 75.5%(keeping sexual hygiene was good for cervix cancer prevention).Multifactorial analysis indicated educational level,district,uptake of cervical cancer screening test or gynecologic examination in the past 5 years and annually average income of family members were major factors influencing awareness of women.The higher level of education the women were,the higher knowledge awareness rate the women had and so were the women with higher annually average income of family members.Among the 2000 women,the screening rate in past five year was 36% and no significant difference were found between urban and rural groups.Lack of knowledge or wrong perception towards cervical cancer screening and the subsequent physical and mental fear were the main factor influencing the screening rate among women in Daxing District.Conclusion Intelligible health education pattern should be applied to improve women's awareness of cervical cancer related knowledge especially among women with low education and low income in rural areas,which will help raise screening rate and contribute to the success of any cervical cancer prevention program.

Objective:To filter the risk factors of breast cancer in Beijing and Guangdong and establish the risk evaluation model,then compare it with the Gail model.Methods:The risk factors of breast cancer were screened by logistic regression analysis,then the new risk evaluation model was established on the basis of these important factors.Diagnostic efficiencies of new model and Gail model were compared by the calculation of area below ROC curve,then to find out the appropriate cut-off points of high,moderate and low risk.Results:The potential risk factors of breast caner included menopause,abortion,medicine-contraception,breast cancer-family history,bad emotions,undesirable life,the absence of emotion-adjusting ability,excess working and age.The cutpoints were set up according to the screening indexes and the demand of clinical practice:the prediction probability≤0.29 indicated the low risk,the prediction probability≥0.58 indicated high risk and the prediction probability between 0.29 and 0.58 indicated moderate risk.Conclusion:The Gail and the new model established are just preliminary self-assessment tools,the key point of breast cancer is prevention.

生殖道感染(reproductive treat infection,RTI)是指男女生殖系统受到细菌、病毒、霉菌、滴虫、支原体、衣原体等致病微生物感染的总称.从全球流行状况看,1999年全球每年生殖道感染的新发病例数高达3.4亿,我国目前RTI的流行状况亦十分严峻。

Objective To analyze the risk factors of breast cancer(BC) in Beijing areas,in order to provide scientific basis for prevention of breast cancer.Methods The stratified random sampling was performed from Nov.2006 to Apr.2007 on district basis.Eight hundred and fifty-eight hospitalized patients with breast cancer,who were followed up after operation,from Dongcheng District(downtown area),Haidian D.(suburb) and Tongzhou D.(exurbun) were selected as BC group,and other 781 women receiving medical examination were enrolled as control group.All the investigated subjects were Beijing residents,age from 35-60 years,and had lived in Beijing for longer than 5 years.The items in questionnaire included societal and economic status,and physiological conditions,fertility,heredity,biological and psychological status,daily life and work condition,and so on.Results The risk factors for breast cancer in Beijing areas included the menopause age after 55 years,negative emotion,negative life events,family history of breast cancer,BMI over 25,low education,introverted character,and sedentary over 3 hours each day for 5 years.However,breast feeding and number of pregnancies over three may decrease the risk of breast cancer.Conclusions The risk factors for breast cancer in Beijing areas are not only related to physiological and genetic conditions,but also to mental and psychological status.The incidence of breast cancer may be lowered by enhancing the knowledge of prevention of breast cancer and initiating a healthy life style.

目的:探讨如何在妇女病普查中提高女性常见恶性肿瘤的检出率。方法:采用流行病学回顾性研究方法对北京地区1996~2006年妇女病普查中筛查出的女性常见恶性肿瘤情况进行总结分析。结果:妇女病普查对宫颈癌、乳腺癌的筛查起到了早发现、早诊断、早治疗作用。但对于卵巢癌、子宫内膜癌等妇科其它恶性肿瘤还未起到早期筛查的作用,要对这些恶性肿瘤的筛查方法加以改进。结论:经济、安全、有效、易于操作的筛查方法是妇女病普查中筛查出女性常见恶性肿瘤的必要手段和有效途径。

目的:探讨饮食习惯与女性乳腺癌的关系。方法:采用以人群为基础的前瞻性病例对照研究,选择北京地区35～60岁女性共1210人进行问卷调查,其中确诊乳腺癌患者429人,健康人群781人。结果:饮食习惯中经常饮红酒、喝茶、喝咖啡、食豆制品及醋制品的女性乳腺癌发病率明显低于不经常食用此类食品的女性(P<0.05),采用非条件Logistic回归模型分析得出饮酒、喝茶、喝咖啡、食豆制品、醋制品、高脂食品与乳腺癌的发生呈负相关,与食用养殖水产品呈正相关。结论:饮食习惯在女性乳腺癌发生中起决定性作用,建立良好的饮食习惯是降低乳腺癌发生的重要途径。

近年,乳腺癌发病率在全球呈现上升趋势,在欧美发达国家及我国的一些大城市已成为危害妇女健康乃至生命的第一位恶性肿瘤.每年全世界大约有130万人被诊断为乳腺癌,而有约40万人死于该病[1].我国虽然属于乳腺癌的低发国家,但近20年来,乳腺癌的发病率亦在逐年攀升,特别是在京、津、沪等大城市,乳腺癌已位居女性恶性肿瘤发病率之首,严重威胁着广大妇女的身心健康.虽然,乳腺癌的病因目前还不十分清楚,但经过长期的流行病学研究,已发现诸多与乳腺癌密切相关的危险因素.

本文对北京市1993～2004年妇科肿瘤住院患者的构成和疾病谱变化趋势进行了分析,结果如下.