背景目前呼吸窘迫综合征(NRDS)早产儿的治疗有多种辅助呼吸模式,而西藏高原地区条件有限,且气压、氧含量低,NRDS早产儿初始呼吸支持策略只能应用气管插管-注入肺表面活性物质-拔管后经鼻持续正压通气(INSURE技术)和机械通气(MV),西藏高...背景目前呼吸窘迫综合征(NRDS)早产儿的治疗有多种辅助呼吸模式,而西藏高原地区条件有限,且气压、氧含量低,NRDS早产儿初始呼吸支持策略只能应用气管插管-注入肺表面活性物质-拔管后经鼻持续正压通气(INSURE技术)和机械通气(MV),西藏高原地区NRDS早产儿初始呼吸支持策略受哪些因素影响尚不清楚。目的探讨高海拔地区NRDS初始呼吸支持策略的影响因素及不同支持策略的早期临床结局。方法回顾性分析2018年6月至2020年6月在拉萨市人民医院儿科新生儿病房住院确诊为NRDS的183例早产儿的临床资料及其母亲的一般资料。按照接受的初始呼吸支持策略分为INSURE组(n=122)和MV组(n=61)。采用多因素Logistic回归分析探讨NRDS应用MV的影响因素。结果MV组NRDS早产儿胎龄,出生体质量,生后1 min、5 min、10 min Apgar评分均低于INSURE组,母亲产前糖皮质激素治疗比例高于INSURE组(P<0.05)。INSURE组和MV组NRDS早产儿不同胎龄构成比比较,差异有统计学意义(P<0.05);INSURE组和MV组NRDS早产儿5 min Apgar评分构成比比较,差异有统计学意义(P<0.05)。MV组死亡率、肺出血发病率均高于INSUR组(P<0.05)。存活患儿MV组支气管肺发育不良(BPD)发病率为43.2%(16/37)高于INSURE组的16.1%(18/112)(P<0.05)。多因素Logistic回归分析结果显示,胎龄、生后5 min Apgar评分、母亲产前应用糖皮质激素治疗是NRDS早产儿应用MV的影响因素(P<0.05)。结论在西藏高原地区,出生胎龄、生后5 min Apgar评分、产前是否应用糖皮质激素与NRDS早产儿初始呼吸支持策略密切相关。展开更多
The projective test is not only helpful to find the potential psychological crisis,but also to overcome the language barrier and make up for the deficiency of the questionnaire test to a certain extent.In this study,4...The projective test is not only helpful to find the potential psychological crisis,but also to overcome the language barrier and make up for the deficiency of the questionnaire test to a certain extent.In this study,403 college students(205 Tibetan students and 198 Han students)from a national college were selected to test their mental health with Symptom Checklist-90(SCL-90)and House-Tree-Person test(HTP).By comparing the results of questionnaire test and drawing projection test,it is found that SCL-90 and HTP test are significantly related to the positive screening results of four factors:Somatization,Depression,Anxiety and Phobic Anxiety.Both HTP test and SCL-90 test results show that the scores of Somatization,Depression,Anxiety and Phobic Anxiety of Tibetan and Han college students were significantly different;the scores of Anxiety and Phobic Anxiety of different gender college students were significantly different.Using HTP test as a supplementary test of questionnaire test can effectively improve the accuracy of screening.展开更多
目的探讨高海拔地区妊娠期高血压疾病(hypertensive disorders in pregnancy,HDP)的发生情况、危险因素及其对母婴结局的影响。方法采用回顾性病例对照研究。选取2018年6月1日至2020年6月1日入住拉萨市人民医院新生儿重症监护病房且孕...目的探讨高海拔地区妊娠期高血压疾病(hypertensive disorders in pregnancy,HDP)的发生情况、危险因素及其对母婴结局的影响。方法采用回顾性病例对照研究。选取2018年6月1日至2020年6月1日入住拉萨市人民医院新生儿重症监护病房且孕母诊断HDP的220例新生儿(孕母216例)作为高海拔组,选取2018年1月1日至2021年12月31日入住北京首都儿科研究所附属儿童医院新生儿内科且孕母诊断HDP的235例新生儿(孕母231例)作为低海拔组。分析高海拔地区和低海拔地区孕母HDP类型的差异,以及引起高海拔地区子痫前期-子痫、早发型子痫前期发生率高的危险因素,比较高海拔和低海拔地区HDP对母婴结局的影响。采用t检验、Mann-Whitney U检验、Pearsonχ^(2)检验或连续校正χ^(2)检验、单因素及多因素logistic回归分析进行统计学分析。结果高海拔组孕母年龄以及高龄、初产、不规律产前检查、早发型子痫前期、子痫、子痫前期-子痫、慢性高血压伴发子痫前期的比例均高于低海拔组(P值均<0.05)。多因素logistic回归分析显示高海拔(OR=4.437,95%CI:2.582~7.626)是子痫前期-子痫发生的高危因素。不良孕产史(OR=2.576,95%CI:1.217~5.452)和不规律产前检查(OR=2.862,95%CI:1.412~5.800)是高海拔组孕妇发生早发型子痫前期的独立危险因素,双胎妊娠是高海拔组孕妇发生早发型子痫前期的保护因素(OR=0.183,95%CI:0.054~0.623)。高海拔组孕母发生心力衰竭[7.9%(17/216)与0.4%(1/231),χ^(2)=15.98]、胎盘早剥[7.9%(17/216)与3.5%(8/231),χ^(2)=4.11]、溶血肝功能异常血小板减少综合征[14.4%(31/216)与1.7%(4/231),χ^(2)=24.64]、早产[86.1%(186/216)与73.6%(170/231),χ^(2)=10.79]、胎儿生长受限[52.3%(115/220)与18.7%(44/235),χ^(2)=56.26]、胎儿窘迫[18.2%(40/220)与8.1%(19/235),χ^(2)=10.26]以及新生儿窒息[29.5%(65/220)与11.1%(26/235),χ^(2)=24.26]、重度窒息[8.6%(19/220)与2.6%(6/235),χ^(2)=8.10]、生后24 h需要机械通气[69.5%(153/220)与42.6%(100/235),χ^(2)=33.54]、生后7 d内死亡[5.5%(12/220)与1.3%(3/235),χ^(2)=6.22]的比例均明显高于低海拔组(P值均<0.05)。结论高海拔是引起子痫前期-子痫的危险因素,高海拔地区HDP对母婴造成的不良影响更重。展开更多
文摘背景目前呼吸窘迫综合征(NRDS)早产儿的治疗有多种辅助呼吸模式,而西藏高原地区条件有限,且气压、氧含量低,NRDS早产儿初始呼吸支持策略只能应用气管插管-注入肺表面活性物质-拔管后经鼻持续正压通气(INSURE技术)和机械通气(MV),西藏高原地区NRDS早产儿初始呼吸支持策略受哪些因素影响尚不清楚。目的探讨高海拔地区NRDS初始呼吸支持策略的影响因素及不同支持策略的早期临床结局。方法回顾性分析2018年6月至2020年6月在拉萨市人民医院儿科新生儿病房住院确诊为NRDS的183例早产儿的临床资料及其母亲的一般资料。按照接受的初始呼吸支持策略分为INSURE组(n=122)和MV组(n=61)。采用多因素Logistic回归分析探讨NRDS应用MV的影响因素。结果MV组NRDS早产儿胎龄,出生体质量,生后1 min、5 min、10 min Apgar评分均低于INSURE组,母亲产前糖皮质激素治疗比例高于INSURE组(P<0.05)。INSURE组和MV组NRDS早产儿不同胎龄构成比比较,差异有统计学意义(P<0.05);INSURE组和MV组NRDS早产儿5 min Apgar评分构成比比较,差异有统计学意义(P<0.05)。MV组死亡率、肺出血发病率均高于INSUR组(P<0.05)。存活患儿MV组支气管肺发育不良(BPD)发病率为43.2%(16/37)高于INSURE组的16.1%(18/112)(P<0.05)。多因素Logistic回归分析结果显示,胎龄、生后5 min Apgar评分、母亲产前应用糖皮质激素治疗是NRDS早产儿应用MV的影响因素(P<0.05)。结论在西藏高原地区,出生胎龄、生后5 min Apgar评分、产前是否应用糖皮质激素与NRDS早产儿初始呼吸支持策略密切相关。
基金This paper is one of a series of research results of the soft science research project"Application of Painting Art Therapy in the Mental Health Education of Tibetan College Students"(a key project at the provincial level,Project Approval No.:RK20180010)of the department of science and technology of Tibet Autonomous Region.
文摘The projective test is not only helpful to find the potential psychological crisis,but also to overcome the language barrier and make up for the deficiency of the questionnaire test to a certain extent.In this study,403 college students(205 Tibetan students and 198 Han students)from a national college were selected to test their mental health with Symptom Checklist-90(SCL-90)and House-Tree-Person test(HTP).By comparing the results of questionnaire test and drawing projection test,it is found that SCL-90 and HTP test are significantly related to the positive screening results of four factors:Somatization,Depression,Anxiety and Phobic Anxiety.Both HTP test and SCL-90 test results show that the scores of Somatization,Depression,Anxiety and Phobic Anxiety of Tibetan and Han college students were significantly different;the scores of Anxiety and Phobic Anxiety of different gender college students were significantly different.Using HTP test as a supplementary test of questionnaire test can effectively improve the accuracy of screening.
