临床路径在腹腔镜胆囊切除术住院患者中的应用与评价

目的探讨实施临床路径对新型腹腔镜胆囊切除术患者临床效益的影响。方法纳入因胆囊结石合并慢性胆囊炎住院行腹腔镜切除术患者60例,均分为临床路径组30例（优化组）和非临床路径组30例（普通组）,临床路径组采用改进临床路径法,非临床路径组实施常规法,观察比较两组患者平均住院日、平均住院费用、住院手术并发症等指标,统计两组间有无差异。结果纳入临床路径患者住院费用比未纳入者下降2255．23元,平均住院日缩短1．83天,术前等待时间缩短2．22天。结论新型临床路径具有良好的实用性,能够在保证医疗安全的情况下提高各项医疗指标,提高医疗效益,解决病人看病贵的问题,值得进一步推广应用。     

急诊瑞替普酶溶栓治疗急性心肌梗死的临床分析

目的:评价急诊瑞替普酶(r-PA)溶栓治疗急性心肌梗死(AMI)的疗效与安全性,为基层医院提供理论与临床经验.方法:将近2年急诊就诊的105例r-PA溶栓联合阿司匹林、氯吡格雷等治疗的AMI患者,随机分为对照组33例与观察组72例,对照组在r-PA溶栓治疗前给予低分子肝素,观察组于溶栓治疗开始4～6h后给予低分子肝素,分析其再通率、出血并发症、急诊死亡率.结果:两组再通率为90.91％、90.28％;出血并发症发生率63.64％、9.72％;急诊死亡率9.09％、1.09％.两组再通率无统计学意义,但出血并发症发生及急诊死亡率显著统计学意义.结论:联合阿司匹林、氯吡格雷,r-PA溶栓治疗AMI后4～6h皮下注射低分子肝素不影响再通率,出血并发症和急诊死亡率低,可向基层医院推广普及.     

预防及治疗产后出血的临床探讨

目的探讨预防及治疗产后出血的方法及效果。方法将该院120例有产后出血倾向的产妇设为预防性用药组,将120例患者随机分为观察组和对照组两组,观察组给予欣母沛预防治疗,对照组采用缩宫素进行预防治疗。选取同期由于宫缩乏力而导致的产后出血患者60例做为药物治疗组,给予欣母沛治疗。结果预防性用药组中,观察组产后2h及产后24h平均出血量、产后出血率均显著少于对照组,P〈0.05;治疗性用药组中,总有效率为96.67%;全组共120例应用欣母沛,12例出现副反应,所有患者未予特殊治疗均自行缓解。结论欣母沛能够有效预防及治疗产后出血。     

人工股骨头置换与全髋关节置换术治疗股骨颈骨折临床疗效观察

目的：分析讨论人工股骨头置换术和全髋关节置换术治疗老年股骨颈骨折患者的临床疗效。方法：选取本院收治老年股骨颈骨折患者80例,随机分为对照组和观察组,每组各40例,分别接受人工骨头置换术和全髋关节置换术治疗,对比两组患者手术时间、出血量、引流量、住院时间,并对所有患者进行随访,评价关节功能效果。结果：对照组手术时间、出血量、引流量、住院时间均低于观察组,其中手术时间、出血量比较差异具有统计学意义（P〈0.05）;对照组优良率达62.5%,观察组87.5%,两组比较差异有统计学意义（P〈0.05）。结论：两种术式各具有优缺点,人工股骨头置换术在围手术期有很大优势,而全髋关节置换术术后关节功能恢复更佳。     

合并用药含醇辅料导致双硫仑样不良反应12例分析

通过对12例合并用药患者出现双硫仑样不良反应的分析,探讨合并用药时除了要注意药物之间的作用外,还要关注药物与辅料间的相互作用,最大程度的保障患者安全。     

Design and synthesis of novel galactosylated polymers for liposomes as gene drug carriers targeting the hepatic asialoglycoprotein receptor

The 18-mer oligodeoxynucleotides (ODNs) that can inhibit survivin gene expression were selected as a model gene drug to study hepatic-targeting drug delivery system. Novel galactosylated polymers (cholesteryloxycarbonylamino) ethylamine-α,β-polyasparthydrazied (CHE-PAHy-Lacs), which target asialoglycoprotein receptor on hepatic parenchymal cells (PC), were designed and synthesized as non-toxic, non-antigenic and non-teratogenic ligands for liposomes. The liposomes incorporating different CHE-PAHy-Lacs were prepared and characterized by zeta potential and particle size analyzer. The drug encapsulation efficiency was measured by gel filtration method. 1,1′-Dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate was used as a marker for all the liposome preparations in the in vivo experiments. The CHE-PAHy-Lac liposomes produced a significant improvement in the encapsulation efficiency of ODNs (28.73–51.37%) compared with conventional liposomes (9.88%). The in vivo results showed that the liposomes incorporating CHE-PAHy-Lac, which contained about 30% (w/w) galactosyl residues, exhibited marked accumulation in the liver and hepatic PC. These results suggest that the novel galactosylated polymers used for liposomes have a great potential as a gene delivery system for hepatic targeting.     

Two new steroidal glucosides from Tribulus terrestris L.

Two new furostanol saponins, tribufurosides D (1) and E (2), were isolated from the fruits of Tribulus terrestris L. With the help of chemical and spectral analyses (IR, MS, 1D, and 2D NMR), the structures of the two new furostanol saponins were established as 26-O-β-d-glucopyranosyl-(25S)-5α-furost-12-one-2α,3β,22α,26-tetraol-3-O-β-d-glucopyranosyl-(1 → 4)-β-d-galactopyranoside (1) and 26-O-β-d-glucopyranosyl-(25R)-5α-furost-12-one-2α,3β,22α,26-tetraol-3-O-β-d-glucopyranosyl-(1 → 4)-β-d-galactopyranoside (2).     

Two new sesquiterpenoids from the fungus Ceriporia alachuana

Two new sesquiterpenoids, tremulenolide D (1) and muurolane-10β,15-diol (2), together with four known sesquiterpenoids, tremulenediol A (3), 2β-hydroxy-α-candinol (4), epicubenol (5), and 3β-hydroxy-δ-candinol (6), were isolated from cultures of the fungus Ceriporia alachuana. The structures of new compounds were determined by extensive spectroscopic analyses. Structurally, compounds 1 and 3 are tremulane-type sesquiterpenoids with an unusual perhydroazulene carbon skeleton.     

Four new compounds from the roots of Uvaria macrophylla

Four new compounds, uvamalols A–C (1–3) and uvarimacrophin A (4), have been isolated from the roots of Uvaria macrophylla. Their structures have been elucidated by spectroscopic methods. The relative configurations of uvamalols A–C have been established by NOE experiments, and the relative stereochemistry of uvarimacrophin A inferred from the diagnostic NMR data by comparison with known model compounds.     

Steroids and alkaloids from the South China Sea sponge Axinella sp.

A new steroid 24β-methylcholasta-1,8,14,22,25-penten-3-one-5α-ol (1) and a new alkaloid 1-(1H-indol-3-yl)-2,3-dihydroxy-5-methyl-hexane (2), together with four known compounds, were isolated from the EtOH extract of the South China Sea sponge Axinella sp. The structures of 1 and 2 were determined on the basis of extensive spectroscopic analysis, including 1D and 2D NMR spectral data.