国产盐酸氯普鲁卡因临床效应分析

目的 分析研究国产盐酸氯普卡因冻干粉与针剂分别应用于硬膜外麻醉、臂丛神经阻滞、局部浸润麻醉的效果。方法 采用随机双盲目的方法分组进行研究。硬膜外麻醉45例,分为3组（每组15例）：Ⅰ组1．7％利多卡因,Ⅱ组氯普鲁卡因粉剂稀释为3％,Ⅲ组3％氯普鲁卡因针剂;臂丛神经阻滞40例,分为4组（每组10例）;I组1．33％利多卡因,Ⅱ组2％普鲁卡因,Ⅲ组氯普鲁卡因粉剂稀释为2％,Ⅳ组2％氯普鲁卡因针刺;局部浸润麻醉30例（每例10例）分为3组：Ⅰ组1％普鲁卡因,Ⅱ组氯普鲁卡因粉剂稀释为1％,Ⅲ组1％氯普鲁卡因针剂。结果 硬膜外组中除Ⅲ组运动消失时间明显短于Ⅰ组外（P＜0．05）,其余指标无明显统计学差异;臂全神经阻滞组中,实验组疼痛恢复及运动恢复时间少于对照组I组,有统计学差异（P＜0．01）,实验组Ⅲ组疼痛及运动恢复时间均比对照组Ⅱ组长（P＜0．05）;局部浸润麻醉组中两实验组疼痛消失迅速,疼痛恢复时间均长于对照组,Ⅲ组短于Ⅱ组。结论 国产盐酸氯普鲁卡因麻醉起效迅速,性能稳定,粉剂比针剂更佳;作用维持时间介于盐酸普鲁卡因与利多卡因之间。     

医药卫生信息化与电子商务

介绍了我国医院信息系统的进展状况、电子商务的定义和发展趋势,分析了医疗信息化与电子商务领域存在的误区、误解与误导。提出了最有前途的医疗卫生电子商务项目,即医疗保险、医院药品及卫生材料的集中采购、应用服务供应商、多样化的患者服务、远程医疗。     

老年人群营养状况调查分析

目的 :探讨老年人的膳食及营养状况。方法 :选择 97名 60～ 69岁男性为调查对象 ;膳食调查采用 4天称量法 ;尿负荷试验 ,试验者于清晨空腹时口服维生素 B1、B2 各 5mg及维生素 C 50 0 mg,收集 4 h尿 ,用 2 ,4 -二硝基苯肼比色法测定尿中维生素 C含量 ;用荧光光度法测定尿中维生素 B1、B2 含量。结果 :维生素 A和钙的摄入量分别占供给量 2 1.5%和 52 .7% ,热能和其他营养素摄入量均超过或达到我国推荐的营养素供给量标准。结论 :老年人从膳食中摄入的热能和大多数营养素均达到了供给量标准     

518例泌尿生殖支原体感染的分类及药敏结果

应用支原体药敏试剂盒检测出的 5 18例支原体感染病例中 ,溶脲脲原体 (Uu)培养阳性为 30 8例 ,占5 9 4% ;人型支原体 (Mh)阳性 2 1例 ,占 4 1% ;Uu合并Mh感染者 189例 ,占 36 5 %。对大环内脂类的红霉素 (ery thromycin,Ery)、罗红霉素 (roxithromycin ,Rox)、交沙霉素 (josamycin ,Jos)、阿齐霉素 (azithromycin ,Azi)、四环素类的强力霉素 (doxycycline ,Dox)、美满霉素 (mincon ,Min)、喹诺酮类的氧氟沙星 (ofloxacin ,of1)、环丙沙星 (cipofloxacin ,Cip)等 8种抗生素进行药敏检测 ,发现Uu与Mh感染者对抗生素的敏感性有差异 ,Uu对大环内脂类较为敏感 ,Mh对喹诺酮类较为敏感 ,Uu合并Mh感染者对多种抗生素表现出耐药性。     

HPLC analysis of 16 compounds from Artemisia ordosica

Objective: To establish a high-performance liquid chromatographic method (HPLC) for the simultaneous determination of sixteen compounds from Artemisia ordosica. Methods: HPLC was used to analyze 16 quality indicators of A. ordosica. The HPLC conditions were as follows: Agilent Eclipse Plus C18 column (250 mm × 4.6 mm, 5 μm) with acetonitrile (A)-water (B) as mobile phase, gradient elution: 0?10 min, 75%?65% B; 10?30 min, 65%?35 % B; and finally 30?40 min, 35%?15% B. The flow rate was 1.0 mL/min, the column temperature was 40 °C, the injection volume was 10 μL, and monitored by absorbance at 285 nm for compounds 1?10, 12 and 225 nm for compounds 11, 13?16. Results: Under the selected experimental chromatographic conditions, compounds 1?16 showed good linearity (r > 0.9993) in a wide concentration range. Their average recoveries were 99.50%, 95.38%, 97.75%, 96.00%, 98.20%, 97.50%, 95.50%, 99.33%, 96.75%, 96.50%, 98.50%, 97.83%, 99.20%, 95.33%, 97.33% and 96.30%, respectively, and the RSD were 1.99%, 1.81%, 1.63%, 1.98%, 1.67%, 1.92%, 1.74%, 1.67%, 1.90%, 1.72%, 1.88%, 1.83%, 1.79%, 1.76%, 1.81% and 1.96%, respectively. Conclusion: Based on the results of the HPLC analysis, it was concluded that p-hydroxycinnamic acid (1), O-hydroxycinnamic acid (2), coniferyl alcohol (5), 5,4''-dihydroxy-7,3''-dimethoxyflavanone (8), 5,4''-dihydroxy-7-methoxyflavanone (9), 5-hydroxy-7,4''-dimethoxyflavanone (12), dehydrofalcarindiol (13), arteordoyn A (14), dehydrofalcarinol (15) and capillarin (16) are best suited for the role of quality indicators of A. ordosica grown in different ecological environments.     

卡氏乳香中1个新的降二萜

目的 研究卡氏乳香Boswellia carterii中的化学成分及其抗骨质疏松活性。方法 运用硅胶柱色谱、ODS柱色谱和制备高效液相色谱等方法进行化学成分分离,通过波谱数据及文献对比对其进行结构解析。结果 卡氏乳香的95%乙醇提取物中分离得到11个化合物,分别鉴定为 (1R,2E,8S,9R)-1,9-环氧-8-乙酰氧基-4,5-二氧代降西松烷型-2-烯（1）、rel(1S,3R,7E,11S,12R)-1,12-epoxy-4-methylenecembr-7-ene-3,11-diol（2）、boscartin F（3）、boscartene K（4）、fidmansumbin-13(17)-en-3,16-diene（5）、3α-acetoxyl-7-oxo-tirucalla-8,24-dien-21-oic acid（6）、boscartene N（7）、3β-hydroxy-tirucallic acid（8）、α-boswellic acid（9）、boscarterol O（10）、boscarterol F（11）。结论 化合物1是新化合物,命名为卡氏乳香素,化合物5为首次从乳香中分离得到,化合物2和10首次从该属植物中分离得到。对11个化合物进行抗骨质疏松活性筛选,发现化合物1、3、6和10具有良好的抑制破骨细胞活性。     

基于慢性乙型病毒性肝炎诊断路径的实验诊断学教学模式初探

探讨建立涵盖慢性乙型病毒性肝炎(CHB)诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程的疾病临床检验诊断路径的教学模式。根据CHB临床诊疗指南, 制订与疾病不同阶段相关的实验室检查检测策略, 建立CHB临床检验诊断路径, 以武汉大学第一临床学院2016级和2017级八年制本科生为研究对象, 通过随堂问卷比较其课堂教学效果。本研究首先建立了获得临床医生认可的CHB临床检验诊断路径, 其涵盖CHB疾病的诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程。该路径应用于2017级临床医学本科生课堂教学后, 教学质量评估指标均有较大程度的提升。此外, 随堂测验得分也有显著提高。综上, 基于CHB临床检验诊断路径的实验诊断学教学模式, 实现了实验诊断学与临床医学的融合, 提升了学生对CHB诊疗中各种实验室检查检测的整体认识, 教学质量得到了提高。     

Full‐Endoscopic Foraminotomy with a Novel Large Endoscopic Trephine for Severe Degenerative Lumbar Foraminal Stenosis at L5S1 Level: An Advanced Surgical Technique

To (i) introduce the technical notes of a novel full‐endoscopic foraminotomy with a large endoscopic trephine for the treatment of severe degenerative lumbar foraminal stenosis at L₅S₁ level; (ii) assess the primary clinical outcomes of this technique; (iii) compare the effectiveness of this full‐endoscopic foraminotomy technique and other previous techniques for lumbar foraminal stenosis. From January 2019 to August 2019, a retrospective study of L₅S₁ severe degenerative lumbar foraminal stenosis was performed in our center. All patients who were diagnosed with severe foraminal stenosis at L₅S₁ level and failed conservative treatment for at least 6 weeks were identified. Patients with segmental instability or other coexisting contraindications were excluded. A total of 21 patients were enrolled in the study. All patients were treated by full‐endoscopic foraminotomy using large endoscopic trephine. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated preoperatively and at 1, 3, 6 months, and 1 year after the surgery, and the modified MacNab criteria were used to evaluate clinical outcomes at the last follow‐up. There were 10 males and 11 females with a mean age of 66.38 ± 9.51 years. Five patients had a history of lumbar surgery. The mean operative time was 63.57 ± 25.74 min. The mean follow‐up time was 13.29 ± 1.38 months. The mean postoperative hospital stay time was 1.29 ± 0.56 days. The mean preoperative VAS score significantly decreased from 7.38 ± 1.02 to 2.76 ± 1.09 (t = 19.759, P < 0.01), 2.25 ± 1.02 (t = 21.508, P < 0.01), 1.60 ± 1.05 (t = 31.812, P < 0.01), and 1.45 ± 1.10 (t = 25.156, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. The mean preoperative ODI score significantly decreased from 64.66% ± 4.91% to 30.69% ± 4.59% (t = 33.724, P < 0.01), 29.44% ± 4.50% (t = 32.117, P < 0.01), 24.22% ± 4.14% (t = 33.951, P < 0.01), and 22.44% ± 4.94% (t = 30.241, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. At the last follow‐up, 19 patients (90.48%) got excellent or good outcomes. One patient suffered postoperative dysesthesia, and the symptoms were controlled by conversion treatment. One patient took revision surgery due to the incomplete decompression. There were no other major complications. Percutaneous endoscopic decompression is minimally invasive spine surgery. However, the application of endoscopic decompression for L₅S₁ foraminal stenosis is relatively difficult due to the high iliac crest and narrow foramen. Full‐endoscopic foraminotomy with the large endoscopic trephine is an effective and safe technique for the treatment of degenerative lumbar foraminal stenosis.     

Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.