正交试验法优化丹参总酮提取工艺

目的：优化丹参总酮的提取工艺。方法：采用L9（34）正交试验设计,以丹参酮ⅡA和丹参总酮的含量为指标,优选丹参总酮的最佳工艺条件。结果：丹参饮片中丹参总酮的最佳提取工艺为：6倍量60%乙醇回流提取3次,0.5h/次。结论：该提取工艺设计合理,简单易行。     

初发2型糖尿病强化治疗的血压和血糖及血脂变化

目的:比较初发2型糖尿病强化治疗与常规治疗的血糖和血脂及血压控制情况.方法:160例初发糖尿病患者按照入组时间顺序分成2组(先收集常规治疗组80例,再收集强化治疗组80例),治疗前检测空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血压、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-C(LDL-C)和谷丙转氨酶(ALT)及谷草转氨酶(AST).常规治疗组予门诊常规治疗,强化治疗组定期检测血压和血糖及血脂,对未达标患者调整治疗方案,直至血压和血糖及血脂达到治疗标准.6个月后再次检测相关指标,比较2组各观察指标的差异.结果:6个月时强化治疗组TC和LDL-C,与常规治疗组比较均有明显降低(P<0.05).结论:2型糖尿病强化干预治疗在控制血糖的同时能使血脂得到进一步控制.     

浅谈《辅行诀五脏用药法要》五脏辨证论治

《辅行诀五脏用药法要》是梁.陶弘景对《汤液经法》一书的摘录和总结,本文旨在通过《辅行诀五脏用药法要》中的五脏用药规律探讨间接反映该时期辨证论治理论。     

红花中羟基红花黄色素A含量测定方法的改进

目的改进现有红花质量标准中羟基红花黄色素A含量测定色谱系统中色谱峰易变形的缺陷,并建立一个新的高效液相色谱方法。方法采用HPLC法,Diamonsil（钻石）C18（4.6 mm×250 mm,5μm）色谱柱,甲醇-乙腈-0.4%的磷酸溶液（30：2：68）为流动相,流速为1.0 mL/min,检测波长为403 nm。结果羟基红花黄色素A在0.03264～0.1984 mg/ml范围内呈良好的线性关系（R2=1）,回收率为100.37%（n=5）,RSD为0.9%。结论本法准确,专属性好,可用作控制红花的质量。     

早期肠内营养联合微创腹腔引流在重症急性胰腺炎中的临床应用

目的探讨早期肠内营养(EN)+微创腹腔引流在治疗重症急性胰腺炎(SAP)中的应用价值。方法随机对照研究2007年1月至2010年12月重症急性胰腺炎患者35例,17例接受经鼻空肠管肠内营养+微创腹腔引流治疗,18例接受全肠外营养治疗,比较两组患者症状改善情况、生化指标恢复时间、住院天数、住院费用的差异。结果鼻空肠管肠内营养+微创腹腔引流比全肠外营养症状体征改善明显,生化指标恢复及住院时问显著缩短,住院费用明显减少(均P<0.05)。结论 EN+微创腹腔引流是重症急性胰腺炎治疗的重要手段,合适的肠内营养能有效降低SAP患者感染性并发症的发生和病死率,治疗费用明显减少,缩短了住院天数,值得临床推广。     

人性化护理在手术室护理的应用效果

目的探讨人性化护理对提高手术室护理质量的效果。方法选择2010年5月～2011年5月本院收治的126例手术患者,随机分为对照组及观察组,每组63例,对照组实施常规护理模式,观察组在此基础上实施全面、系统的人性化护理干预,观察两组效果。结果观察组焦虑评分为(31.58±11.04)分,心率为(91.02±10.17)/min,血压为(95.29±11.38)mmHg,均显著低于对照组[(42.49±10.15)分、(109.68±13.41)/min、(112.06±13.42)mmHg](P<0.05);观察组患者满意度及护理质量评分均显著高于对照组(P<0.05)。结论人性化护理应用于手术室护理工作中,可显著提高护理质量,值得临床推广应用。     

严重创伤或全身性感染时内皮细胞损伤机制的认识

有研究提示,内皮细胞在机体严重创伤时易受损害,可作为分泌细胞分泌血管活性物质和黏附分子参与凝血和炎症反应,还可作为新生血管刺激因子促进烧伤或创伤的创面修复。近年大量研究发现,严重创伤或全身性感染时内皮细胞损伤的表现呈多样化．而导致内皮细胞损伤的原因也是多方面的。     

早期应用冬眠合剂对严重烫伤大鼠小肠的保护作用

Objective To study the protective effect of early application of lytic cocktail on small intestine of severely scalded rats. Methods Sixty-six male SD rats were divided into sham injury group (SI, n =6) , scald group (S, n = 30) and scald + lytic cocktail group (SL, n =30) according to the random number table. After anesthesia, rats in the latter 2 groups were inflicted with 30% full-thickness scald, while rats in S group were sham scalded with 37 ℃ water. Resuscitation was carried out by intraperitoneal injection with 2 mL · kg-1 · %TBSA-1 lactated Ringer's solution in all rats; meanwhile 12 mL/kg lytic cocktail [ 1 mL pethidine (50 mg/mL) + 1 mL chlorpromazine (25 mg/mL) + 1 mL promethazine (25 mg/mL) + 125 mL saline] was hypodermically injected to rats in SL group, while 12 mL/kg saline was injected into rats in the other 2 groups. Samples of blood and small intestine were harvested from S and SL groups at post scald hour (PSH) 3, 6, 12, 24, 48 and from SI group at PSH 3, with 6 rats in each group at each time point. Pathological changes in intestine were observed, and the expression of intercellular adhesion molecule 1 (ICAM-1) and CD68 were determined with immunohistochemistry at PSH 24 for S and SL groups and at PSH 3 for SI group. Plasma levels of D-lactate, diamine oxidase (DAO) , IL-1β, TNF-α, IL-10 were determined with ELISA. Data were processed with one-way analysis of variance. Results (1) At PSH 24, mild hemorrhage, inflammatory cell infiltration and epithelial cell shedding were observed in small intestinal mucosa of rats in S group.Compared with S group, the intestinal villi of SL group were arranged regularly without obvious hyperemia and edema. (2) Expression levels of ICAM-1 and CD68 [(1. 69 ± 0.27)%, (0.80 ±0.09)%] in S group were significantly higher than those in SI group [(0.77 ± 0. 10) % , (0. 30 ± 0. 05) % , with F value respectively 77. 303 and 66. 933 , P < 0.05 or P < 0.01] and SL group [(0. 53 ± 0.09) % , (0. 32 ± 0. 06) % , with F value respectively 77. 303 and 66. 933 , P values all below 0.01]. (3) D-lactate levels of rats in SL group were significantly lower than those of rats in S group at PSH 12, 24 (with F value respectively 20. 936 and 19. 854, P values all below 0.01), while DAO levels of rats in SL group were significantly lower than those of rats in S group at PSH 3, 12 (with F value respectively 21. 930 and 11. 342 , P values all below 0. 05).(4) The levels of IL-1β and TNF-α in S group were significantly higher than those of SI group at each time point (P values all below 0.01). The levels of IL-1β and TNF-α in SL group were significantly higher than those of S group at PSH 6, 12 and 24 (with F value respectively 96. 517 , 17.365, 79.715 and 21. 328, 17. 682, 28.424, P <0.05 or P <0.01). IL-10 level in SL group was higher than that in S group at each time point, and the differences were statistically significant at PSH 6 and 24 (with F value respectively 8. 668, 19. 634, P < 0.05 or P < 0.01). Conclusions Early administration of lytic cocktail can attenuate edema and injury of intestinal mucosa in severely scalded rats. The mechanism may lie in that it can reduce the expression of ICAM-1 in intestinal mucosa, decrease the number of intestinal inflammatory cells and regulate the levels of inflammatory cytokines.     

大面积深度烧伤应用混合皮肤嵌植与微粒皮移植的比较

目的 了解大而积深度烧伤后混合皮肤嵌植与微粒皮移植疗效的差异. 方法 回顾性总结笔者单位1992-2008年17年间收治的101例大面积深度烧伤患者临床资料.将患者分为混合嵌植组52例、微粒皮组49例.比较2组患者首次自体供皮面积、首次自体皮覆盖创面面积,首次自体皮移植成活率、自体皮理论扩展倍数、自体皮实际扩展倍数、自体供皮总面积,以及术后残余创面情况、大关节功能状况等. 结果 混合嵌植组、微粒皮组的首次自体供皮面积分别为(3.25±0.48)%、(3.01±0.21)%TBSA,首次自体皮覆盖创面面积分别为(30.4±3.6)%、(41.4±1.3)%TBSA,首次自体皮移植成活率分别为(99.9±1.9)%、(87.5±6.8)%,自体皮理论扩展倍数分别为(9.5±1.3)、(13.9±1.4)倍,自体皮实际扩展倍数分别为(9.5±1.3)、(12.0±1.5)倍,上述指标组间比较,差异均有统计学意义(P<0.05);混合嵌植组、微粒皮组自体供皮总面积分别为(14.2±1.9)%、(14.0±2.1)%TBSA,2组比较,差异无统计学意义(P>0.05).混合嵌植组、微粒皮组残余创面超过0.5%TBSA者分别有23例占44.2%、37例占75.5%;混合嵌植组大关节功能状况较好者34例占65.4%,微粒皮组18例占36.7%. 结论 微粒皮移植法自体皮扩展倍数明显大于混合嵌植法,能更充分利用有限皮源;混合嵌植法创而愈合质量和大关节功能恢复状况优于微粒皮移植法.     

宫颈冷刀锥切后手术缝合方法探讨

宫颈冷刀锥形切除术（简称冷刀锥切,cold knife conization,CKC）是子宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）的经典治疗方式。本文就缝合法中改良的Sturmdorf缝合与左右两侧半荷包缝合方法进行了对照观察,报道如下。1临床资料40例患者均已婚,有手术适应证,排除内、外科合并症,排除生殖道炎症。随机分为观察组20例,年龄24—60岁,平均35岁;对照组20例,年龄22—55岁,平均33岁。术前根据宫颈细胞学检查和阴道镜活检病理,