目的 调查全预约制挂号模式下,影响儿童口腔科就诊患儿家长情绪的因素,并探讨可能的干预措施.方法 采用自设调查问卷,随机抽取 2021 年 3 月 1 日至 4 月 25 日期间来首都医科大学附属北京口腔医院儿童口腔科就诊患儿家长 402 名,进行情绪影响因素调查分析.结果"挂号难""孩子牙齿坏的严重"、"候诊时间长"、"就诊次数多"是影响家长情绪的主要因素.54.73%的家长接受 30 min以内的候诊,39.05%的家长可以接受 1h之内的候诊.40%的家长担心候诊时间过长会影响患儿就诊情绪.候诊期间,家长主要采用自我调节方式调节不良情绪,其中 48.60%的家长认为"分诊台护士态度和善"可以安抚焦虑的情绪,48.20%的家长认为"候诊环境温馨舒适"有利于情绪调节.高达 67.70%希望科室播放有关口腔卫生知识宣教的内容,52.10%的家长希望播放儿童娱乐短片分散患儿注意力,缓解患儿焦虑情绪.结论 全预约制模式下,挂号难仍是家长最焦虑的问题.候诊时间控制在 1h内、与分诊护士良好的沟通交流,以及舒适的候诊环境可以改善家长情绪.播放口腔卫生知识宣教视频和娱乐短片可以转移患儿家长和患儿注意力,抚慰情绪.

目的 探讨妊娠期急性脂肪肝的临床特点、诊断、治疗及预后,以期改善妊娠结局.方法 回顾性分析2006年1月—2021年12月首都医科大学附属北京友谊医院及复兴医院产科诊治的21例妊娠期急性脂肪肝患者的临床资料,整理检查检验结果、总结治疗方法、记录并发症及母儿结局.结果 21例妊娠期急性脂肪肝患者的年龄为25～39岁,孕周28+2～38+6周,单胎20例,双胎1例,初产妇15例、经产妇6例,18例因恶心、呕吐、上腹部不适等消化道症状入院,3例因胎动消失入院;21例妊娠期急性脂肪肝患者均出现胆红素升高、低血糖、白细胞升高、尿酸升高、转氨酶升高、血氨升高及凝血功能障碍,14例出现肾功能损伤,6例出现腹水,均未行肝脏活检;实施产钳助产阴道分娩3例,实施剖宫产终止妊娠18例;孕产妇死亡1例,死胎2例,新生儿死亡2例,重度窒息2例、轻度窒息3例,其余13例新生儿均健康.21例患者均转入ICU病房,15例给予纠正凝血、药物保肝、抗感染等治疗,6例在此基础上加用血浆置换.结论 妊娠期急性脂肪肝患者的肝肾功能、凝血功能及血常规均有异常,尽早诊断、尽快终止妊娠、尽快建立快速反应MDT团队是救治成功的关键.

Objective:To explore the perinatal management of patients with WD during pregnancy, and to determine its genetic etiology and the possibility of fetal morbidity using the genetic detection of amniotic fluid and umbilical cord blood.Method:In terms of fine management during the perinatal period, a case of K-F ring was found in the Ophthalmology Department of Beijing Friendship Hospital, Capital Medical University in March 2019 due to eye astringency and eye swelling, and the hepatology department further diagnosed WD for one artificial abortion. After the second pregnancy in October 2020, multidisciplinary consultation and standardized treatment during pregnancy including gynecology and obstetrics, liver disease center, anesthesiology department, gastroenterology department and nutrition department were carried out. The genomes of patients' venous blood, amniotic fluid and umbilical cord blood were extracted and analyzed for ATP7B gene variation by Sanger sequencing.Result:Through multi-disciplinary collaborative management, the patient gave birth successfully in the case of pregnancy complicated with liver cirrhosis, portal hypertension, splenomegaly with hyperfunction, thrombocytopenia, anemia, esophageal and gastric varices and other complications. The phenotype of the newborn was normal, and the Apgar score was 10-10-10. Sequencing results showed that the patient had ATP7B p.Arg778Leu and p.Val890Met, which were missense heterozygous variants reported in the mutation database, and ACMG was classified as pathogenic variants. The results of amniotic fluid and umbilical cord blood showed that the fetus had only p.Arg778Leu single heterozygous variation, and it was predicted that there would be no clinical phenotype of WD.Conclusion:Perinatal multidisciplinary collaborative management has important protective significance for the successful pregnancy of patients with WD. Genetic screening of amniotic fluid and umbilical cord blood is conducive to early detection of fetal WD.

Background The correct reference range for maternal thyroid function during pregnancy is essential for making an accurate diagnosis of thyroid disease and delivering proper interventions in pregnant women. But there is still no universal standard for this in women with a twin pregnancy. Objective To determine a rational reference range for maternal thyroid function during twin pregnancies. Methods Healthy pregnant women who underwent antenatal examination in Obstetric Clinic, Beijing Friendship Hospital, Capital Medical University from January 2009 to September 2019 were retrospectively selected, including 352 with a twin pregnancy (twin group) , and 988 with a singleton pregnancy (singleton group) . Clinical and laboratory data were collected. The lower and upper limits for determining normal maternal thyroid function during twin pregnancies were the 2.5 (P2.5) and 97.5 (P97.5) percentiles of TSH and FT4. Clinical hyperthyroidism was defined as TSHP97.5 (total FT4) . Clinical hypothyroidism was defined as TSH>P97.5 (total TSH) and FT4P97.5 and P2.5≤FT4≤P97.5. Low T4 syndrome was diagnosed by P2.5 (total TSH) ≤TSH≤P97.5 (total TSH) and FT4

目的 分析妊娠期甲状腺功能减退症(以下简称甲减)女性产后甲状腺功能转归的相关影响因素.方法 选择2012年1月 ～2017年12月期间,在首都医科大学附属北京友谊医院产检并分娩的产妇.按照笔者医院制定的妊娠期甲状腺功能特异参考标准,将妊娠期诊断的亚临床甲减、低T4血症、甲状腺自身抗体阳性的产妇作为研究对象,共纳入870例.分娩后42天、3个月、6个月、1年、2年进行随访.观察甲状腺功能的变化.其中对妊娠期亚临床甲减产妇根据TPOAb情况分为妊娠期亚临床甲减+TPOAb阳性组及妊娠期亚临床甲减+TPOAb阴性组,前者孕期和产后全部给予左旋甲状腺素钠片治疗.按其产后治疗时间分为持续治疗0～6个月组及>6个月组,观察其产后甲状腺功能减退的患病情况.结果 影响产后甲状腺功能转归的相关因素:单因素Logistic回归分析影响妊娠期亚临床甲减+TPOAb阳性组患者产后甲状腺功能转归的因素为TPOAb效价、产后药物干预及甲状腺摄碘率;影响低T4血症+TPOAb阳性组产后甲状腺功能转归的因素为TPOAb效价和甲状腺摄碘率;影响单纯甲状腺自身抗体阳性患者产后甲状腺功能转归的因素为TPOAb效价及诊断孕周.多因素Logistic回归分析显示,TPOAb效价(>1000U/ml)是妊娠期亚临床甲减+TPOAb阳性、低T4血症、单纯甲状腺自身抗体阳性组患者产后发生甲状腺功能减退的独立高危因素;产后药物干预是亚临床甲减患者产后发生甲状腺功能减退的独立保护因素.结论 产后持续治疗是影响妊娠期亚临床甲减合并TPOAb阳性患者产后甲状腺功能转归的独立保护因素.妊娠期亚临床甲减和低T4血症合并TPOAb阳性患者和单纯甲状腺自身抗体阳性患者的TPOAb效价高低是影响产后甲状腺功能转归的独立高危因素.

妊娠期母体患有明显的甲状腺功能减退时会对子代的远期智力造成不良影响.本文主要对妊娠期母体轻度甲状腺功能减退对子代远期智力的影响进行综述,得出母体轻度甲状腺功能减退可能影响子代的智力发育,但是对于引起这种变化的具体机制以及如何消除这类危险因素,目前还没有确切的方案,仍需大量临床试验和基础实验提供治疗依据.

目的 分析妊娠合并抗磷脂抗体综合征的诊断、临床表现、发病机制及治疗.方法 收集首都医科大学附属北京友谊医院2018年1月至2018年12月收治的6例妊娠合并抗磷脂抗体综合征患者的临床资料,对其一般情况、临床表现、辅助检查、治疗措施及妊娠结局等进行回顾性分析.结果 6例患者中,5例患者诊断时间在妊娠前5个月～3年,1例患者妊娠10周诊断,狼疮抗凝物和抗β2糖蛋白均阳性.诊断后均给予抗凝治疗,其中1例患者妊娠期出现血小板进行性下降,最低19×109/L;1例患者妊娠31周出现重度.结论 抗磷脂综合征对妊娠有不良影响,注意筛查抗磷脂抗体,以尽早确诊和治疗,从而改善妊娠结局.

目的 研究不同TSH水平对亚临床甲状腺功能减退孕妇妊娠结局的影响.方法 选择2016年3月至2017年10月在首都医科大学附属北京友谊医院产科建档的妊娠妇女.分别于妊娠8～10周、25～26周、36～37周行甲状腺功能(TSH、FT4)检测.妊娠8～10周同时行甲状腺过氧化物酶(thyroid peroxidase,TPO)及甲状腺球蛋白(thyrthyroglobulin,TG)抗体检测.按照妊娠早期TSH＞ 2.5 mIU/L、妊娠中晚期TSH＞ 3.0 mIU/L诊断亚临床甲减并进一步分为:亚甲减组1(SCH1)即TSH水平位于早孕期2.5 mIU/L、孕中晚期3.0 mIU/L和本单位建立的妊娠期特异的TSH上限之间者;亚甲减组2(SCH2)即TSH≥本单位建立的妊娠期特异性TSH上限者.对照组为同一队列中甲状腺功能正常且自身抗体阴性者.分别比较三组不良妊娠结局的发生率.结果 以妊娠早期TSH＞ 2.5 mIU/L、妊娠中晚期TSH＞ 3.0 mIU/L诊断的亚临床甲减发病率为26.53％(1 474/5 554),以本单位建立的妊娠期特异的TSH上限诊断的发病率为8.96％(498/5 554).亚临床甲减1组的剖宫产率显著高于对照组(P＜0.05);亚临床甲减2组低出生体重儿的发生率显著高于对照组(P＜0.05);矫正了年龄、体重指数、分娩孕周后TSH大于妊娠期特异性参考值上限仍显著增加低出生体重儿的发生风险(OR值为1.474,P＜0.05),TSH大于妊娠期特异性参考值上限使低出生体重儿的风险增加47.4％.结论 TSH水平大于妊娠期特异性参考值上限显著增加低出生体重儿的发生风险.

目的 探讨妊娠合并急性胰腺炎的临床特点、诊断和治疗办法,以改善妊娠结局.方法 回顾性分析本院近10年来诊治的15例妊娠合并急性胰腺炎患者的临床资料.结果 (1)患者年龄20-38岁,初产妇14例,1例孕27周发病,12例为晚孕期(孕30+4-39+5周),自然分娩和剖宫产后各1例.重型急性胰腺炎(severe acute pancreatitis,SAP)9例,轻型急性胰腺炎(mild acute pancreatitis,MAP)6例,胆源性7例,脂源性6例,特发性2例.(2)典型临床表现14例,不典型表现1例,13例患者血清淀粉酶(amylase,AMY)明显升高,2例AMY升高未达正常值3倍.2例B超未确诊,9例行腹腔CT诊断明确.(3)1例胆源性SAP促肺治疗期待至34周剖宫产分娩,2例胆源性MAP内科治疗后顺产,余10例患者均剖宫产终止妊娠,术中行胰腺探查加引流7例.2例术后腹腔感染,3例胆源性AP(1例SAP,2例MAP)产后行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP).(4)1例院外子痫转入时已胎死宫内,3例新生儿窒息.1例患者因重度脓毒症,多脏器功能衰竭死亡.结论 急性胰腺炎如能在24小时内确诊及处理可降低不良妊娠结局.CT具有较高诊断价值.治疗上应积极抗炎;胆源性胰腺炎应积极ERCP取石或胆道探查引流;脂源性胰腺炎可行血浆置换以缩短病程.

首都医科大学附属北京友谊医院妇产科教研室引用SIMone胎儿分娩模拟系统用于产科异常分娩的见习教学中,极大地激发了学生的学习兴趣,提高了学生的操作技能及临床思维能力,明显改善了教学效果.

目的 探讨甲状腺自身抗体与妊娠期甲状腺功能异常的相关性.方法 选择2016年3月至2017年10月在首都医科大学附属北京友谊医院妇产科门诊首次就诊并建立围产保健档案的妊娠妇女共4399例进行前瞻性研究.于妊娠第8～10周行甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)和甲状腺功能(TSH、FT 4)的测定;于妊娠第24～26周、妊娠第36～37周行甲状腺功能(TSH、FT 4)的测定.根据妊娠期特异性参考值范围对妊娠期甲状腺功能异常进行诊断.计算早孕期妇女甲状腺自身抗体的阳性率,并分析甲状腺自身抗体阳性对妊娠期甲状腺功能异常发生率的影响.结果 纳入的4399例研究对象中,TPOAb阳性率为12.0％(529/4399);TGAb阳性率为9.1％(399/4399);TPOAb和TGAb均阳性孕妇占总人数的5.0％(220/4399).TPOAb阳性和TGAb阳性孕妇妊娠期临床、亚临床甲状腺功能减退症和低T4血症的发生率分别为3.0％、9.3％、3.8％和5.0％、11.0％、3.5％;TPOAb和TGAb均阳性妇女中上述三种甲状腺功能异常的发生率分别为6.8％、10.9％、4.5％.三组与TPOAb和TGAb抗体均阴性者比较差异均具有统计学意义(P<0.05).TPOAb阳性(OR值分别为4.79、12.9、1.91,P<0.05)、TGAb阳性(OR值分别为5.76、38.4、1.77,P<0.05)、TPOAb和TGAb均阳性(OR值分别为5.07、31.1、2.4,P<0.05)均显著增加妊娠期临床、亚临床甲状腺功能减退症、低T4血症的发生风险.TPOAb阳性、TGAb阳性、TPOAb和TGAb均阳性组与TPOAb和TGAb抗体均阴性者比较妊娠期临床、亚临床甲状腺功能亢进症、高T4血症的发生率差异均无统计学意义(P>0.05).结论 甲状腺自身抗体阳性妇女妊娠期发生甲状腺功能异常的风险明显增加.对甲状腺自身抗体阳性妇女加强甲状腺功能筛查对诊断和治疗妊娠期甲状腺功能异常有重要价值.

目的 比较不同诊断标准下妊娠期亚临床甲状腺功能减退(SCH)的患病率,探讨不同诊断标准下妊娠期SCH与不良妊娠结局的相关性.方法 选择2016年3月至2017年10月在首都医科大学附属北京友谊医院妇产科门诊首次就诊并建立围产保健档案的妊娠妇女共5554例进行前瞻性队列研究.于妊娠第8～10周行甲状腺过氧化物酶抗体(TPOAb)和甲状腺功能(TSH、FT4)的测定;于妊娠第24～26周、妊娠第36～37周行甲状腺功能(TSH、FT4)的测定.并随访至分娩,收集妊娠期糖尿病、妊娠期高血压疾病、胎盘早剥、前置胎盘、早产、产后出血、巨大胎儿、低出生体重儿等不良妊娠结局资料.比较不同诊断标准下SCH的发生率及妊娠期SCH与不良妊娠结局的相关性.结果 按照本单位标准、2011年美国甲状腺学会(ATA)标准和2017年ATA标准分别研究SCH的患病率如下:妊娠期SCH患病率分别为8.96％(498/5554)、26.53％(1474/5554)、7.67％(426/5554);按照本单位标准和2017年ATA标准诊断的SCH伴TPOAb阳性组的低出生体重儿的发生率显著高于甲状腺功能正常组(8.77％vs.6.22％;9.52％vs.6.32％,P<0.05);按照本单位标准和2017年ATA标准诊断的SCH伴TPOAb阳性组的巨大胎儿的发生率显著高于甲状腺功能正常组(8.77％vs.6.80％;9.95％vs.7.03％,P<0.05);按照2011年ATA标准诊断的SCH TPOAb阳性组、SCH TPO-Ab阴性组与甲状腺功能正常组比较,妊娠结局差异均无统计学意义(P>0.05).结论 建议本单位妊娠期特异性参考值或以TSH>4.0 mIU/L作为的参考值上限诊断妊娠期SCH;大多数妊娠期SCH发生于孕早期和孕中期;妊娠期SCH与巨大胎儿及低出生体重儿的发生存在相关性.

It is considered that insulin resistance(IR)and its signaling pathway disorder are one of pathogenesis that causes insulin target-organs/issues lesions and their slow progression. The clinical diagnosis index of IR is the homeostatic model of insulin resistance(HOMA-IR)based on fasting blood-glucose and fasting serum insulin. Furthermore, the emerging IR biomarkers including adiponectin may be the references for clinical diagnosis. The influence factors of IR are obesity, chronic microinflammation and a lack of exercise. The major signaling pathways of IR include insulin receptor substrate 1(IRS1)/phosphatidylinositiol-3-kinase(PI3 K)/serine-threonine kinase(Akt)pathway, mitogen-activated protein kinase(MAPK)pathway and Smad3 pathway. In clinics, insulin sensibility and IR could be increased and improved via promoting insulin secretion and enhancing insulin signaling activation. At present, insulin sensitizers treating IR not only have the classic thiazolidinediones and its ramifications but also have the newly discovered metformin and vitamin D. In addition, it is reported that some extracts from single Chinese herbal medicine(CHM)and Chinese herbal compound prescription such as total flavone from the flowers of Abelmoschl manihot, berberine, astragalus polysaccharides and Huang-qi decoction also have the beneficial effects in ameliorating IR. In the field of chronic kidney disease, targeting a common insulin target-organs/issues lesion, the early renal damage in diabetic mellitus, the intervention studies regarding to regulating podocyte IR signaling pathways by CHM will be one of the significant directions in the future.

Objective To investigate the incidence and pregnant outcome on trial of labor after previous cesarean delivery (TOLAC). Methods From 2015 to 2016,clinical data of 165 cases with TOLAC in Beijing Frendship Hospital of Gynecology Obstetrics were studied retro-spectively. The pregnancy outcome was analyzed between the vaginal birth after cesarean delivery (VBAC)group and TOLAC groups respectively. Results ①165 cases attempted TOLAC,108 cases had VBAC,the success rate of vaginal delivery was 65. 45％ . 57 cases delivered by emergen-cy cesarean. ②Higer Bishop score,fewer inhospital days after dilivery,fewer bleeding,more spontaneous labor,body mass at prenatal visit,de-livery week had significant difference between VBAC group and TOLAC group (P < 0. 05). Maternal age,height,postpartum hemorrhage,birth-weight,body mass index at prenatal visit and delivery,weight gain during pregnancy,neonatal asphyxia,interval between first and subsequent de-livery had no significant difference (P > 0. 05). Conclusion It is feasible for pregnant women after cesarean section to conduct vaginal delivery with indications.

Objective To analyze the incidence,risk factors,clinical characteristics and pregnant outcomes of perinatal pulmonary embolism(PPE).Methods Clinical data of eight patients who were admitted to Beijing Friendship Hospital of Capital Medical University for PPE from January 2006 to March 2016 were collected.General condition,symptoms,laboratory examinations,images,treatments and outcomes of these patients were analyzed retrospectively.Results The ten-year incidence of PPE was 0.029％ (8/27 560) in this hospital.Among the eight cases,two cases were diagnosed in the first trimester,and treated successfully by thrombolytic therapy.But one of two cases stopped growth,while the other one was premature labor.There were one case in the third trimester who had successful anticoagulant therapy and five cases in the postpartum period after cesarean delivery.Among the five cases,three cases were recovered after anticoagulant therapy,one case was recovered after thrombolytic therapy and one case died.All of the eight patients were immobilized before the onset of PPE,and five of them were diagnosed after cesarean section.Four out of the eight patients were obese.Five patients had three or more high-risk factors for pulmonary embolism and the other three had two.Conclusions It is necessary to pay close attention to gravidas who have two or more high-risk factors of PPE due to its fatal outcome.

Objective To investigate the fluctuations in serum concentration of human epididymal secretory protein human epididymis -specific protein 4( HE4)during the phases of the menstrual cycle and the correlation between HE4 values and age in healthy young women. Methods Forty - five women with regular menstrual cycles were included in the study. All selected candidates are divided into two groups based on age. Blood samples were collected at follicular(FP),ovulatory(OP),and luteal(LP)phases of the hormonal cycle. Results The values of HE4 observed were 38. 9 ± 1. 2 pmol/ L(FP),45. 7 ± 1. 1 pmol/ L(OP),and 41. 9 ± 1. 2 pmol/ L(LP). The difference between FP and OP was statistically significant( P = 0. 0002). By contrast,serum CA125 levels were 13. 9 ± 0. 7 IU / ml( FP),13. 2 ± 0. 4 IU / ml( OP),and 13. 6 ± 0. 4 IU / ml(LP),respectively. The differences between the three phases of the hormonal cycle were not statistically significant( P >0. 05). The levels of HE4 observed in serum samples of women less than or equal to 35 years were 37. 6 ± 1. 3 pmol/ L in the FP,46. 7 ± 1. 3 pmol / L in the OP,and 42. 7 ± 1. 5 pmol/ L in the LP. In this group,a statistically significant difference was observed in the FP compared with the OP( P < 0. 0001). The levels of HE4 observed in serum samples of women over 35 years were 44. 2 ± 0. 8 pmol/ L in the FP,42. 3 ± 1. 7 pmol/L in the OP,and 39. 1 ± 2. 0 pmol/ L in the LP,no statistically significant difference was observed during the different hormonal phases in the group of women over 35. The levels of CA125 observed in serum samples of women less than or equal to 35 years old were 12. 8 ± 0. 7 IU/ ml in the FP,12. 5 ± 0. 7 IU/ ml in the OP,and 13. 2 ± 0. 7 IU/ ml in the LP. There wasnˊt a statistically significant difference in the group. The levels of CA125 observed in serum samples of women over 35 years were 13. 3 ± 0. 7 IU/ ml in the FP,13. 6 ± 0. 8 IU/ ml in the OP,and 13. 7 ± 0. 6 IU/ml in the LP,no statistically significant difference was observed during the different menstrual phases in the group of women over 35 years old. Conclusion In the young women ,it is essential to define a threshold of normality of the HE4 marker which is affected by menstrual cycle;but the CA125 has little change during different phases of menstrual cycle.

Objective To explore the monitoring value of human telomerase RNA component( HTERC) gene in cervical intraepithelial neapalsia( CIN) after the treatment.Methods Totally eight-three patients confirmed as cervical intraepithelial neapalsia were chosen. Those patients were examined with thin prep cytologic test(TCT), high risk-human papillomavirus(HR-HPV) detection, multi-point biopsy and HTERC gene preoperative.Then we examined TCT, HPV, HTERC gene and colposcopy biopsy at the time of 6 months and 1 year follow-up.Results ① With the histological lesion degree increasing, HTERC gene positive expression rate increased, and the increased difference is statistically significant.② Half year after the treatment, we discovered that the cytology, high-risk type HPV positive rate and positive HTERC gene detection rate( HTERC gene positive rate was 0%after the treatment) , were significantly reduced compared with preoperative, and it suggested that the surgery could effectively reduce the degree of cervical lesions, high-risk type HPV positive rate and positive rate of HTERC gene.③Comparing those tests, we found that the TCT had the highest positive predictive value, the HR-HPV had the highest sensitivity and negative predictive value, and the HTERC had the highest specificity.Conclusion When patients have HR-HPV infection, and especially have the CIN, it will help predict the direction of development of the disease with the HTERC gene detects added.

目的 评价手和足部穴位按摩对于缓解子宫切除术后疼痛的效果,为缓解子宫切除术后患者的疼痛提供有效的干预措施.方法 选取2012年6-8月行子宫切除术的患者60例,其中开腹组和腹腔镜组各30例,将两组患者随机分为干预组和对照组各15例.术后6h在常规护理基础上对干预组进行手、足部穴位按摩30 min,对照组仅接受常规护理.采用疼痛脸谱评分法(VAS)对干预组进行按摩前及按摩后即刻、按摩后30 min和60 min四个时间点的疼痛进行评分,同时记录对照组相对应时间点的疼痛评分情况.结果 干预组按摩后即刻和30 min,疼痛评分显著低于按摩前,按摩后即刻疼痛评分下降最明显,其中腹腔镜组下降27％,开腹组下降26％;按摩后60 min疼痛评分虽低于按摩前,但差异无统计学意义(P＞0.05).对照组按摩前后相对应时间点的疼痛评分差异无统计学意义(P＞0.05).按摩前干预组疼痛评分与对照组比较差异无统计学意义(P＞0.05),按摩后即刻、30 min及60 min疼痛评分显著低于对照组,差异均有统计学意义(P＜0.01).结论 子宫切除术后6h,腹腔镜组患者的疼痛强度低于开腹组;经过专人对患者进行手和足部穴位按摩后,无论开腹或腹腔镜哪种术式,均可以有效缓解疼痛,但随着时间延长,疼痛缓解的程度减弱.

Objective To analyze the changes of thyroid function of healthy primipara before 20 weeks of gestation to establish normal gestational age-specific reference interval of thyroid hormones,and to investigate the prevalence of maternal thyroid disorders during the first half of pregnancy.Methods A total of 1605 healthy primipara without risk factors of thyroid diseases before 20 gestational weeks and 200 non-pregnant healthy women who accepted pre-conception care in Beijing Friendship Hospital from September 2010 to June 2011 were tested for serum thyroid stimulating hormone (TSH),free thyroxine (FT4) and thyroid peroxidase antihody (TPOAb) by chemiluminometric immunoanalysis.One thousand two hundred and fourty-three pregnant women among them with negative thyroid antibooly and without previons thyroid diseases were selected as the standard population for normal interval.Gestational age-specific percentile categories for TSH and FT4 were calculated.The prevalence of maternal thyroid disorders was examined by gestational agespecific intervals.Results (1) Compared with non-pregnant women,the median value of serum TSH in pregnant women decreased by 29.56％ to the value of 0.91 mU/L; while that of FT4 rose by 7.79％ to the value of 11.33 pmol/L before 12 weeks; and TSH increased while FT4 decreased during 13 to 20 weeks.(2) The median values and reference intervals (2.5th percentile,97.5th percentile) for TSH were 1.59 mU/L (0.15 mU/L,5.19 mU/L) in no-pregnant women,1.12 mU/L (0.03 mU/L,3.67 mU/L) at 8-12+6 gestational weeks,1.21 mU/L (0.05 mU/L,3.74 mU/L) at 13-16+6 gestational weeks,1.50 mU/L (0.31 mU/L,4.33 mU/L) at 17-19+6 gestational weeks; and the median values and reference intervals (2.5th percentile,97.5th percentile) for FT4 were 9.91 pmol/L (6.69 pmol/L,14.03 pmol/L),10.68 pmol/L (7.98 pmol/L,18.66 pmol/L),10.04 pmol/L (6.18 pmol/L,16.22 pmol/L),9.40 pmol/L (6.44 pmol/L,13.51 pmol/L) respectively.(3) According to gestational age-specific reference intervals,the general prevalence of maternal thyroid disorders,including hyperthyroidism,hypothyroidism,subclinical hypothyroidism and hypothyroinemia,was 3.55％ (57/1606).At 8-12+6 gestational weeks,13-16+6 gestational weeks and 17 19+6 gestational weeks,the occurrence of hyperthyroidism was 0.00％,0.13％ and 0.00％;that of hypothyroidism was 0.00％,0.13％ and 0.00％; the incidence of subclinical hypothyroidism was 3.60％,2.76％ and 3.00％; the occurrence of hypothyroxinemia was 0.16％,0.26％ and 0.86％,respectively.The positive rate of TPOAb at 8-12+6,13-16+6 and 17-19+6 gestational weeks were 22.91％ (140/611),16.56％ (126/761) and 15.45％(36/233),and the total positive rate of TPOAb was 18.82％ (302/1605).The median level of TPOAb was 38.90,41.87 and 39.10 mU/L,respectively.Conclusions Before 20 gestational weeks,specific changes occur in maternal thyroid function.TSH level decreases during 8 to 12 gestational weeks,and then increases gradually; while FT4 level increases during 8 to 12 weeks,and then decreases gradually.Thyroid dysfunction during pregnancy is common and subclinical hypothyroidisum is the leading problem in thyroid disorders.Screening for thyroid function during early pregnancy is suggested.

神经管畸形(neural tube defect,NTD)是最常见的中枢神经系统先天性畸形,我国每年有8万～10万NTD患儿出生,NTD在各种出生缺陷中占首位[1].叶酸是体内重要的甲基供体,可影响许多基因功能的表达,叶酸缺乏可导致胚胎NTD和先天性心脏畸形[2].调查资料显示,中国膳食中叶酸摄入量一般均达不到推荐摄入量.由于营养结构的原因,我国人群体内叶酸普遍处于低水平状态.研究证实,育龄妇女服用叶酸补充剂和改善营养状况对胎儿NTD有明显的预防作用[3-4]。