超短波治疗妇产科腹部切口脂肪液化的临床分析

目的 探讨使用超短波治疗妇产科腹部手术切口脂肪液化的临床疗效.方法 将2009年9月～2011年10月在我科行腹部手术后发生切口脂肪液化的60例患者随机分为观察组和对照组,每组各30例.观察组:扩开切口脂肪液化处,去除无生机的脂肪组织,纱条填塞引流,然后用超短波电疗机对切口处进行治疗.每日换药1次,超短波治疗1次,每次15 min,切口干燥后用蝶形胶布拉拢固定.对照组:扩开切口脂肪液化处,去除无生机的脂肪组织,纱条填塞引流,每日换药1次,切口干燥后用蝶形胶布拉拢固定.结果 观察组切口完全愈合时间、换药次数、住院天数与对照组比较,差异均有显著性(P＜0.01或P＜0.05).结论 超短波能促进组织细胞再生,促进炎症渗出物的吸收,加快切口愈合.     

妇产科腹部切口脂肪液化38例临床分析

目的 探讨妇产科腹部切口脂肪液化的原因及治疗方法.方法 回顾性分析本院2006年1月-2008年12月38例腹部切口脂肪液化病例.结果 妇科手术16例,剖宫产手术22例.合并症如糖尿病、贫血、咳嗽、妊娠水肿、滞产、术中失血多、术时较长、肥胖等因素都增加了妇产科腹部切口脂肪液化的几率.38例腹部切口脂防液化经上述方法处理后均痊愈出院,无1例行Ⅱ期缝合.无1例院内感染,愈合时间最短4天,最长10天.结论 尽早发现腹部切口脂肪液化,及时处理,引流彻底、每天换药、使用白糖填撒伤口、蝶形胶布拉拢等方法治疗,可明显加快伤口愈合时间,可有效治愈腹部切口脂肪液化.     

丹参注射治疗腹部切口脂肪液化13例

目的:观察丹参切口内注射对于腹部切口脂肪液化的治疗效果。方法:将我科2011年6月~2013年6月期间术后发生切口脂肪液化的26例患者随机分成两组,治疗组(n=13例)切口换药时纱布用丹参针剂浸湿置入裂开部分,隔日1次。待切口无明显渗出,用宽胶布固定粘贴。对照组(n=13例)用凡士林纱条换药,隔日1次。切口干燥后,用宽胶布固定或二期缝合。结果:治疗组脂肪液化切口愈合时间、感染情况及换药次数与对照组比较,均有显著性差异(P<0.01、P<0.05、P<0.05)。结论:丹参能促进组织细胞再生,促进炎症渗出物的吸收,加快切口愈合。     

腹壁切口裂开蝶形胶布拉拢术108例治疗体会

腹壁切口裂开是妇产科腹部手术较常见的并发症之一,以往处理方法常用局部清创二次缝合、红外线照射换药自行愈合、局部用生肌散类药物自行愈合等方式,但均疗程长、住院时间长、费用大、精神压力大、痛苦多。我院自2003年采用高渗糖清洗创面蝶形胶布拉拢切口治疗切口裂开,效果满意,病人易接受,既简单又实用,现将108例做一回顾性分析:     

冰片和芒硝联合治疗剖宫产腹部切口脂肪液化临床研究

目的观察冰片、芒硝治疗剖宫产腹部手术切口脂肪液化的治疗效果。方法将我院2009年1月至2011年12月期间剖宫产术后腹部切口发生脂肪液化60例患者随机分为两组。试验组（n=30例）脂肪液化之切口,用冰片和芒硝按比例混匀后外敷,1次/d。对照组（n=30例）应用普通换药及挤压方法,每日换药1次。结果试验组的切口愈合时间,二次清创缝合术的几率与对照组比较,均有统计学差异（P〈0.05）。结论中药外敷能促进脂肪液化伤口炎症渗出物吸收,加快切口愈合。     

腹部手术切口脂肪液化的临床分析

目的：对腹部手术切口脂肪液化的处理进行临床分析。方法：术后出现有淡黄色水样渗出物及血性渗出液时,及时清除分泌物,若渗出液较多时,则拆除该处缝线一针,并于该处放置皮片引流,每日更换敷料1次。结果：A组予局麻下行2次清创缝合术,术后8d拆线;B组予白糖撒于创面,每3天更换敷料1次,用蝶形胶布（直切口可加用腹带）将切口拉拢至完全愈合。结论：患者腹部切口脂肪液化原因主要与血供差、组织受损坏死、渗液引流不畅等有关,提高手术技能、通畅引流可以有效预防脂肪液化。脂肪液化发生后,应根据情况采取针对性处理措施。     

高渗糖胰岛素配合蝶形胶布在腹部切口愈合不良中的应用

目的探讨高渗糖胰岛素配合蝶形胶布治疗腹部切口愈合不良的效果。方法实验组（蝶形胶布组）37例，为妇科手术后腹部切口愈合不良，采用局部清创，切口周围注射高渗糖胰岛素，并用蝶形胶布闭合切口。对照组（清创缝合组）为同期腹部切口愈合不良者23例，采用常规清创换药和／或二次缝合术。结果蝶形胶布组伤口愈合率97．3％，1例（2．7％）未愈合，清创缝合组伤口愈合率91．3％，2例（8．7％）未愈合，两组差异无统计学意义，P〉0．05；蝶形胶布组平均住院（10．4±1．2）d。清创缝合组平均住院（17．4±2．2）d，两组差异有统计学意义，P〈0．01；蝶形胶布组处理伤口的费用平均（108．3±27．1）元，清创缝合组平均（607．9±57．4）元，两组差异有统计学意义，P〈0．01。结论高渗糖胰岛素配合蝶形胶布对治疗腹部切口愈合不良有良好的效果，且方法简单易行，已被患者接受，值得临床推广应用。     

蝶形胶布牵拉合并方纱填塞治疗剖宫产术后腹部伤口脂肪液化38例

目的研究蝶形胶布牵拉合并方纱填塞对剖宫产术后腹部脂肪液化的临床治疗效果。方法选取2011年2月~2014年9月产科收治的38例剖宫产后腹部伤口脂肪液化的患者为研究对象,采用对照研究的方式将其分为观察组和对照组,每组19例,对照组患者行常规换药、湿敷治疗;观察组患者行蝶形胶布牵拉固定后合并方纱填塞,换药治疗;对比分析两组患者的临床疗效。结果两组患者腹部脂肪液化伤口在甲级愈合率、乙级愈合率以及丙级愈合率上比较,x2=33.4230、24.5461、5.1026,住院时间及住院费用的比较t=3.1823、3.5411,差异具有统计学意义(P均0.05)。结论蝶形胶布牵拉合并方纱填塞对剖宫产术后腹部伤口脂肪液化的临床疗效显著,有效促进患者伤口愈合,缩短住院时间,降低住院费用,具有较高的临床使用价值。     

外用溃疡散外敷治疗剖宫产术后切口脂肪液化60例效果观察

目的：观察外用溃疡散外敷治疗剖宫产术后切口脂肪液化的疗效。方法：选择剖宫产术后腹部切口脂肪液化患者60例,随机分为治疗组30例与对照组30例,其中治疗组予外用溃疡散酒精纱条外敷切口换药促进切口愈合,对照组应用95％酒精纱条外敷切口换药治疗,观察两组的腹部切口术后愈合时间和治疗效果。结果：治疗组在切口愈合时间和治疗效果上明显优于对照组,差异有统计学意义（P〈0．05）。结论：腹部切口脂肪液化外敷外用溃疡散能明显缩短切口愈合时间。     

浅析中西医结合治疗外科腹部手术后切口脂肪液化的疗效观察

目的:观察自拟生肌散和高渗糖配伍胰岛素混合均匀涂抹于腹部脂肪液化手术切口并外敷中药袋的治疗效果。方法:将腹部切口脂肪液化病例38例,随机分为2组,治疗组20例在西医常规清创后以灭菌自拟生肌散和高渗糖配伍胰岛素局部治疗并外敷中药袋;对照组18例清创常规换药后创面用高渗糖配伍胰岛素冲洗,再用无菌干纱布覆盖,两组均辅以红外线灯局部照射切口,并观察两组创面愈合时间。结果:治疗组创面愈合时间明显短于对照组。治疗组平均治愈时间为9.30±0.51 d,对照组为14.52±0.91 d,两组差异有统计学意义(P0.01)。结论:中西医结合治疗腹部切口脂肪液化能明显缩短创面愈合时间。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.