[目的]探究制药废水中活的但非可培养（viable but non-culturable，VBNC）状态细菌的组成与系统关系。[方法]利用土质滤材构建生物反应器，基于复苏促进因子（resuscitation promoting factor，Rpf）对 VBNC细菌的复苏刺激生长作用，采用 MPN (most probable number)法，稀释平板法分离其中复苏可培养化的 VBNC 菌株并解析其16S rRNA基因系统关系。[结果]在 MPN培养系中，Rpf对部分细菌有生长刺激作用。制药废水中存在对 Rpf敏感、复苏可培养化的 VBNC优势菌群；制药废水中对 Rpf敏感的 VBNC优势细菌主要有革兰氏阳性放线菌Microbacterium、Gordonia 和 Leucobacter 属近缘菌，革兰氏阴性菌 Candidimonas、Xanthobacter和 Aminobacter属近缘菌，其中菌株 ZYM1、ZYM3、ZYZR4和 ZYXR1可能属于新种。[结论]研究结果揭示了制药废水中存在 VBNC状态细菌，为研究其形成机理、复苏活性化机制以及制药废水的深度处理等提供重要的思路与方法。

We aimed to investigate the composition and phylogenetic rela-tionships of the viable but non-culturable (VBNC) state bacteria in pharmaceutical wastewater. [Method] Soil filter was used for constructing bioreactor. Based on the resuscitation- and growth-promoting function of Resuscitation Promoting Factor (Rpf) for VBNC bacteria, VBNC bacteria were isolated by most probable number (MPN) method and dilution-plating method and 16S rRNA gene phylogenetic analysis was carried out. [Result] In MPN culture system, Rpf could promote the resuscitation and growth of some bacteria. There were VBNC advantage floras that sensitive to Rpf in pharmaceutical wastewater. The culturable VBNC bacteria in pharmaceutical wastewater consisted of high-GC gram-positive actinomycetes including genera Mi-crobacterium, Gordonia and Leucobacter, and gram-negative bacteria including gen-era Candidimonas, Xanthobacter and Aminobacter. Four strains (ZYM1, ZYM3, ZYZR4, ZYXR1) could be potential novel species. [Conc

目的：探讨剖宫产术后再次妊娠分娩方式的选择，了解阴道试产的可行性。方法：对2012年1月～2014年1月在山西省汾阳市人民医院妇产科分娩的剖宫产术后再次妊娠者185例在产时出血量﹑产后感染﹑平均住院天数﹑先兆子宫破裂方面进行回顾性研究分析。结果：185例患者中，手术产率77．30％，选择阴道试产率38．92％，试产成功率58．33％。 ERCS与VBAC﹑VBNC在产时出血量﹑产后感染﹑平均住院天数﹑先兆子宫破裂差异有统计学意义（P＜0．05）， VBAC与VBNC 在产时出血量﹑产后感染﹑平均住院天数﹑先兆子宫破裂差异均无统计学意义（ P＞0．05）。2例先兆子宫破裂者均是发生于剖宫产术后再次妊娠阴道试产者，可见总体上VBAC患者子宫破裂发生率仍较ERCS和VBNC患者高。结论：掌握好阴道试产的适应证，个体化选择剖宫产患者分娩方式，由专人严密监测产程，剖宫产术后再次妊娠者选择阴道分娩安全可行。

Obje ctive:To investigate the delivery mode of the secondary pregnancy after cesarean section selection , to understand the feasibility of vaginal delivery .Methods:In 2012 January --2014 year in January in the Department of Obstetrics and Gynecology deliv-ery people''s Hospital of Fenyang city Shanxi pregnancy after cesarean section of 185 cases with postpartum hemorrhage , puerperal infec-tion, average hospitalization days , threatened uterine rupture were retrospectively analyzed .Results:In 185 patients,operation in 77.30%yield, selection of vaginal delivery rate was 38.92%, successful trial production rate of 58.33%.ERCS and VBAC, VBNC in postpartum hemorrhage , puerperal infection , average inpatient days , threatened uterine rupture , the difference was statistically significant ( P 0.05).Two cases of threatened uterine rupture were occurred again in pregnancy vaginal delivery after cesare -an section, visible on the whole VBAC patients the incidence of uterine rupture