妊娠期糖尿病(gestationaI diabetes meIIitus,GDM)是指在妊娠期首次发生的糖代谢异常疾病,是妊娠期常见的合并症之一,严重影响母婴健康.目前GDM在孕24～28周行75g口服葡萄糖耐量试验(oraI gIucose toIerance test,OGTT)检查才能确诊,但母婴可能在孕早期就暴露在机体高糖的环境中.因此,寻找孕早期筛查GDM的标志物尤为重要.近年来,国内外开展了大量对GDM早期预测的相关研究,以期为GDM高危孕妇早期干预提供依据,改善母婴不良结局.目前,研究热点集中在血糖标志物、炎症因子及脂肪因子等方面.现对相关标志物预测GDM的研究进展进行综述.

① 目的 比较孕足月无产兆孕妇采用COOK球囊联合催产素与欣普贝生引产的效果,探讨更安全有效的引产方法 .② 方法选取在华北理工大学附属医院住院的孕37～42周的孕妇,根据引产方法的不同分为COOK球囊组70例,欣普贝生组85例,进行促宫颈成熟效果 、取出指征 、产程进展和母婴结局的比较.③ 结果 两组引产后宫颈评分均明显提高,平均均提高2分以上,经检验,差异均有统计学意义(P＜0.05).但两组孕妇促宫颈成熟的有效率在80％ 以上,两者相比,差异无统计学意义(P＞0.05);欣普贝生引产过程中胎心异常 、子宫过度刺激 、发热所占比例高,经检验,胎心异常差异存在统计学意义(P＜0.05),余无统计学意义(P＞0.05).COOK球囊组干预到临产时间,明显长于欣普贝生组,经检验,差异有统计学意义(P＜0.05),但总产程 、第一产程 、第二产程,经检验,差异均无统计学意义(P＞0.05);两组的剖宫产率,经检验,差异无统计意义(P＞0.05),而欣普贝生组的24小时分娩率明显高于COOK球囊组,差异有统计学意义(P＜0.05).两组引产方法的分娩结局,经检验,差异无统计学意义(P＞0.05).④ 结论 欣普贝生诱导宫颈成熟度较好,但需注意子宫过度刺激造成的影响.COOK球囊引比较温和,适合妊娠合并症孕妇.

目的 比较控释地诺前列酮栓(欣普贝生)和催产素对孕晚期引产的临床效果.方法 选取2015年2月-2016年1月在华北理工大学附属医院住院的220例产妇为研究对象,根据引产方法分为研究组(地诺前列酮栓)和对照组(催产素),每组各110例,比较两组促宫颈成熟效果、引产成功率和分娩结局.结果 用药12 h、24h后研究组宫颈Bishop评分(7.46±2.70、8.98±2.44)高于对照组的(6.25±1.65、7.26±1.77)(P＜0.05).研究组总促宫颈成熟率77.3％、引产成功率74.5％、阴道分娩率70％,对照组促宫颈成熟率56.4％、引产成功率41.8％、阴道分娩率为48.2％,两者比较差异有统计学意义(P＜0.05).两组产后出血量、新生儿体重、新生儿Apgar评分、新生儿窒息发生率差异无统计学意义(P＞0.05).结论 欣普贝生促宫颈成熟效果明显,引产成功率高、增加了阴道分娩率,是一种有效的促宫颈成熟方法.

Objective To investigate the relationship between fluorine exposure during early and midtrimester pregnancy and the offspring brain development.Methods 47 pregnant women with fluorosis treated in our hospital from April 2013 to September 2016 and 47 healthy pregnant women who had physical examinations in our hospital during the same period were selected as the observation group and the control group.The urinary fluoride content of two groups was analyzed.The body weight,body length in recumbent position of the two groups at the postnatal 1h,1mon,6mon,and 12mon,the Apgar score at the postnatal 1min and 5min,the intelligence development index and motor development index of two groups evaluated by the Children's Developmental Center of China (CDCC) were analyzed and compared.Results There was no miscarriage and stillbirth in both groups.The uri-nary fluoride content in the observation group was significantly higher than that in the control group,with a significant difference (P<0.05); The Apgar score of the two groups had no significant difference (P>0.05); The body weight,body length in recum-bent position of the two groups at the postnatal 1h,1mon,6mon,and 12mon of the observation was lower than that of the control group (P<0.05); The MDI and PDI at the postnatal 3mon,6mon and 12mon in the observation group were lower than that of the control group (P<0.05).Conclusion The fluorine exposure during early and midtrimester pregnancy have adverse effects on the brain and physical development of infants,while there is no significant effect on Apgar scores within 1 min and 5 min after birth.

Objective Objective Detection ovarian cancer patients ovarian cancer tissue and peripheral blood leuko -cyte and ascites in cancer drug Resistance Gene MDR 1 (Multidrug Resistance Gene 1) expression,this paper discusses the re-lation among the three ,better clinical guidance .Methods Specimens from October 2008 to October 2011 in hebei united uni-versity affiliated hospital and surgical patients ,the clinical and pathology confirmed for ovarian cancer patients treated first 32 cases.In the age of 31~67 years old between ,intraoperative return ovarian cancer organization and its peripheral blood all 32 cases,ascites and an example,(4 patients without ascites) application RT-PCR method to detect ovarian cancer tissue and pe-ripheral blood and ascites MDR 1 of expression ,and discusses the relationship between the three .Results 32 cases of ovarian cancer patients ovarian cancer tissue and peripheral blood leukocyte and ascites and cases of cancer cells positive MDR 1 ex-press respectively(31.2%,21.9%,28.6%),three specimens difference was not statistically significant (P>0.05).Three kinds of specimen between two testing ,after statistics processing ,the difference was not statistically significant ( P>0.05 ) ,and two kinds of specimen MDR1 betweenExpress has consistency .Conclusion Beginning to ovarian cancer in ovarian cancer tis-sue and peripheral blood leukocyte and ascites cancer cells of MDR 1 express has consistency .

Objective To explore the effect of chemotherapeutics effect on blood glucose in patients with ovarian car-cinoma. Methods The clinical data of 236 patients wit ovarian carcinoma were retrospectively analyzed. The influence of chemotherapy on blood glucose was observed. Results The incidence of hyperglycemia of the patients with ovarian carcinoma after chemotherapy was 7. 63%(n=18 cases),4 cases were diagnosed as diabetes among them. The effect of chemotherapy with paclitaxel on blood glucose was obviously higher than that of the other chemotherapy drug,there is significant difference (P﹤0. 05). Conclusion Chemotherapeutics might interfere with glucose metabolism. It is necessarily monitored blood glu-cose in patients with ovarian carcinoma with chemotherapy.

Objective To investigate the changes of zinc in maternal plasma and MMP-9,collagen Ⅳ levels in serum and matrix metalloproteinases-9 (MMP-9) level in amniotic fluid in patients with premature rupture of membranes at term(TPROM).Methods Thirty cases who were diagnosed as PROM at term during Nov.2012 to Mar.2013 were enrolled as case group,and 30 cases delivered during the same time without PROM were enrolled as control group.Maternal blood and ammiotic fluid were collected from all the cases.The level of zinc in maternal plasma was measured by atomic absorption method and the levels of MMP-9 in serum and amniotic fluid were detected by enzyme linked immunosorbent assay(ELISA),while the level of collagen Ⅳ in serum was measured by up-conversion luminescence method.The relationship among them was analyzed.Results Compared to control group,there were statistically significant difference between TPROM and control groups in terms of the level of zinc,collagen Ⅳ,MMP-9 in serum and MMP-9 in amniotic fluid (zinc:(109.10 ± 16.07) μmol/L vs.(90.54 ± 10.99) μmol/L; t =-5.22,P ＜ 0.001 ; collagen Ⅳ:(56.86 ±41.26) μg/L vs.(88.61 ±44.87) μg/L;t =2.852,P =0.006;MMP-9 in serum:(1 463.25 ±483.6) μg/L vs.(1 196.9 ± 357.43) μg/L,t =-2.426,P =0.018 ; MMP-9 in amniotic fluid:(125.48 ± 67.18) μg/L vs.(72.64 ± 60.74) μg/L,t =-2.873,P =0.006).Zinc level in maternal plasma and collagen Ⅳ in serum had a negative relationship in TPROM (r =-0.261,P =0.044).Zinc level in maternal plasma and MMP-9 level in serum had a positive relationship in TPROM (r =0.274,P =0.034).MMP-9 levels in serum and amniotic fluid had a positive relationship in TPROM (r =0.264,P =0.047).There were no significant relationship between zinc level in maternal plasma,MMP-9 level in amniotic fluid,collagen Ⅳ and MMP-9 levels in serum,collagen Ⅳ in serum and MMP-9 in amniotic fluid (r =0.215,-0.172,-0.172 ; P ＞ 0.05).Conclusion The level of zinc in maternal plasma and increase of MMP-9 in serum and amniotic fluid of women and decrease of the level of collagen Ⅳ in serum are related to the occurrence of TPROM.

Objective To investigate the effect of recombinant human growth hormone (rhGH) action on pregnancy rate of polycystic ovarian syndrome(PCOS).Methods The PCOS who were client in our hospital in February-August,2012 were investigated.The rhGH group (41 cases) were that all patients took rhGH at the same time ovulation.The control group (41 cases) were no medication group.The two groups had sex action after ovulation.Ovulation rate,pregnancy rate and endometrial score of the two groups were compared.Results Ovulation rate of rhGH group was 90.2％ (37/41),the control group was 68.2％ (28/41),the difference was statistically significant (x2 =3.459,P =0.036).Clinical pregnancy rate of RhGH group was 32.7％ (12/37),the control group was 25.0％ (7/28).The difference was statistics significance (x2 =4.319,P =0.032).Endometrial score of rhGH group was (14.96 ± 2.18),the control group was (12.77 ± 2.60) points,the difference between groups was statistically significant (t =-3.356,P =0.032).Conclusion Giving rhGH ovulation cycle specification can promote ovulation PCOS patients and improve the adverse factors affecting pregnancy,improving the pregnancy rate.

目的探讨异位妊娠患者腹腔镜治疗后妊娠前再次腹腔镜探查在预防重复异位妊娠中的作用。方法对126例输卵管妊娠患者腹腔镜治疗后的生殖状况进行回顾性分析,按1∶2配比分为观察组42例和对照组84例。2组均行腹腔镜下保留患侧输卵管手术,观察组于术后计划妊娠前采用腹腔镜探查(评估病情,必要时行黏连松解或/和输卵管修复整形术),对照组术后仅行抗感染等治疗。结果观察组宫内妊娠率为64.3%,高于对照组的36.9%,重复异位妊娠率为7.1%,低于对照组的21.4%,差异均有统计学意义(P<0.05)。观察组不孕率为28.6%,低于对照组的41.7%,但差异无统计学意义(P>0.05)。结论首次异位妊娠的患者,妊娠前再次腹腔镜盆腔探查或治疗可降低重复异位妊娠的发生率。

目的:探讨剖宫产同时行子宫肌瘤剔除术的安全性及可行性。方法:回顾性分析华北煤炭医学院附属医院2003年1月~2006年1月152例剖宫产同时行子宫肌瘤剔除术患者及304例妊娠未合并子宫肌瘤仅行剖宫产术患者的临床资料。结果:剖宫产同时行子宫肌瘤剔除术组手术操作时间较对照组延长(P<0.05),缩宫素用量增加(P<0.05),但两组的术中出血量、术后血红蛋白下降值及术后恢复情况差异均无统计学意义。结论:对于有经验的产科医生在病例选择合适的情况下,选择性地行剖宫产同时行子宫肌瘤剔除术并不增加手术风险。

<正>子宫异常出血是妇科常见病之一,许多妇产科疾病,如功血、妊娠相关性疾病、肿瘤等均可引发该病,本文分析216例子宫异常出血患者诊刮后的子宫内膜情况,探讨诊刮的临床价值,为进一步治疗奠定基础。

目的:对预测胎儿出生体重的7种公式进行比较分析,以找出一种较准确的公式。方法:对分娩巨大胎儿的104例孕妇测量宫高、腹围及B超检查胎儿双顶径、股骨长、腹围,分别用7种公式预测胎儿体重。预测公式如下:公式(1)EFW=187×FAC-3 069;公式(2)EFW=514.3×BPD-1 516.9;公式(3)EFW=2 616.26+82.419×FFL;公式(4)EFW=(BPD+FFL)FAC2/5.8;公式(5)EFW=2 900+0.3×宫高×腹围;公式(6)EFW=宫高×腹围+500;公式(7)EFW=宫高×100±250。结果:与巨大儿实际出生体重比较,误差≤250 g为符合。结果预测准确性最高的公式为公式(4)和公式(7),二者比较差异无统计学意义。结论:公式(4)和公式(7)值得在临床推广应用。

目的:观察补气下乳方对剖宫产术后产妇肠蠕动及乳汁分泌量的影响。方法:将160例剖宫产产妇随机分为治疗组80例和对照组80例,对照组采用产科常规处理,治疗组在对照组基础上加服中药补气下乳方(厚朴、枳壳、藿香、大黄、通草、王不留行、穿山甲、党参、丹参、黄芪等)。结果:治疗组产妇术后肠蠕动恢复时间、肛门首次排气时间、初乳分泌时间、乳汁满足新生儿需要时间及产后42d纯母乳喂养率等各项指标均明显优于对照组。结论:补气下乳方对剖宫产术后产妇的肠蠕动及乳汁分泌有良性调整作用。

患者,女,21岁,于2009年7月30日入院,2009年8月10日手术.患者既往无药物及食物过敏史.术后恢复良好,2009年8月28日行紫杉醇化疗,单次剂量240mg.用药前12h、6h各口服地塞米松20mg,用药前30min分别予以苯海拉明50mg肌内注射,生理盐水100ml静脉滴注,西咪替丁0.3g入壶静脉滴注,地塞米松10mg入壶静脉滴注.行心电监测,生命体征无异常后,先予以生理盐水250ml加入紫杉醇30mg先行静脉滴注30～40min,在输入紫杉醇液体2min后,患者突感胸闷、眼花,恶心、呕吐,濒死感.查体为心动过速,呼吸急促,头面部潮红、口唇发绀,立即停液,吸氧4L/min、更换液体及输液器,再次建立静脉通路.

[Objective] To improve the awareness of lower limb deep vein thrombosis after cesarean section,and the prevention of deep vein thrombosis. [Methods] The methods included preoperative assessment of puerperant by individual education with cooperation of the family,oral presentations,guiding the early activities and nursing interventions. [Results] Deep vein thrombosis decreased from 0.26% to 0. [Conclusion] Health education and nursing intervention play an important role in the prevention of deep vein thrombosis after cesarean section.

Objective :To investigate the gynecological tumor deep venous thrombosis (DVT) risk factors and the formation of traditional Chinese and western medicine treatment observation. Methods: Retrospective analysis of 16 cases of hospital patients with gynecologic tumors of the causes of lower extremity DVT, the use of urokinase at the same time western medicine, such as drug treatment and ligustrazine necessary surgery; taking the pulse of TCM decoction (astragalus, angelica, peach kernel, earthworm, radices salviae miltiorrhizae, uckahoe, grifola, etc.). Results: 16 cases of patients with 12 cases of conservative treatment and surgery combined with thrombolytic therapy in four cases of anti-coagulation, treatment 2 to 3 weeks significantly improved signs and symptoms, review of color Doppler ultrasound confirmed venous recanalization and no complications occurred. Conclusion: Gynecologic oncology DVT formation after the merger is often a combination of factors, early diagnosis, treatment of traditional Chinese and western medicine can improve the curative effect.

[Objective] To investigate the value of laparoscopic treatment before pregnancy to prevent recurrent ectopic pregnancy.[Methods] A retrospective case-control study was carried out to analysis the reproductive outcome of 126 women after laparoscopic management of tube pregnancy.The patients were divided into experimental and control groups.Laparoscopic surgery was carried in experimental group to evaluate the circumstance of pelvic cavity,release the pelvic adhesion and repair the tube if necessary before next pregnancy.The control group only takes anti-infective treatment.The Chi-square criterion was performed to determine the difference of fertility between the groups.[Results] The recurrent ectopic rate was 7.1% and the interuterine pregnancy rate was 64.3% in the experimental group.There was significance difference between the groups of the two indexes(21.4% and 36.9%)(P﹤0.05).The infertility rates in experimental and control groups were 28.6% and 41.7%,respectively(P﹥0.05).[Conclusion] Laparoscopic treatment for the pregnancy of patients with previous ectopic pregnancy is benefit for reducing the recurrent ectopic pregnancy.

目的:探讨中药、针灸联合治疗妇科恶性肿瘤行广泛子宫切除术后并发尿潴留的疗效.方法:对我院2年来妇科肿瘤患者行广泛子宫切除术后并发尿潴留进行临床分析.结果:238例术后有42例(占17.65%)不能排尿或能排尿但通而不畅,且残余尿>100mL,为尿潴留,经过中药黄芪茯苓汤(黄芪、茯苓、升麻、白术、车前草、红参等)及针刺关元、中极、三阴交等穴,治疗后均能顺利排尿.结论:中药及穴位注射治疗对妇科恶性肿瘤行广泛子宫切除术后并发尿潴留效果明显,有利于膀胱神经功能的恢复.

目的对预测胎儿出生体质量的7种公式进行比较分析,以找出较准确的预测巨大儿体质量的方法。方法测量104例孕巨大胎儿孕妇的宫高、腹围,B超检查胎儿双顶径、股骨长、腹围,分别用7种公式预测新生儿体质量。预测公式:公式A:胎儿体质量(EFW)=187×胎儿腹围(FAC)-3069;公式B:EFW=514.3×胎儿双顶径(BPD)-1516.9;公式C:EFW=2616.26+82.419×胎儿股骨长(FFL);公式D:EFW=(BPD+FFL)FAC2/5.8;公式E:EFW=2900+0.3×宫高×腹围;公式F:EFW=宫高(cm)×腹围(cm)+500;公式G:EFW=宫高(cm)×100±250。计算结果与出生后的巨大儿实际出生体质量比较,误差≤250g为符合。结果预测准确性最高的公式为公式D,其灵敏度为89.7%,特异度为74.4%。结论预测巨大儿体质量公式D较准确。

[Objective] Cervical intraepithelial neoplasia(CIN) is a precancerous disease of cervix.Recently,more and more young women were found with CIN,and how to correctly treat it is the purpose of clinic objective.This paper was to explore the proper method to treat CIN by analyzing the pathologic status of CIN treating by Cold knifeconization.[Methods] 132 patients with CINⅡ-Ⅲ treated by conization of cervix were retrospectively analyzed from January 2002 and June 2007.The pathologic diagnosis before and after treatment were compared,and the recurrent situation was followed up and analyzed.[Results] Among 132 cases who received conization,the surgical pathology of 4 cases showed negative,10 cases showed high grade pathology and 8 cases of the ten showed invasive cancer.There were 4 histopathological diagnosis cases in 10 cases with continuous treated after conization.There were 4 recurrent cases anong 122 cases with CINⅡ-Ⅲ treated by conization.[Conclusion] The cervical conization is a better method to correctly diagnose cervical cancer and CIN.It is suggestion to perform cervical conization,and further treatment schedule should be made according to the pathologic status and requirement of pregnance.