运用模拟医院加强中医骨伤科操作技能教学

为了加强中医骨伤科操作技能的教学效果,本校于2004年开始运用教学模拟医院进行骨伤科操作技能的教学,采用开放的教学方式,通过优化课程结构、完善考核方法、拓展素质教育等措施,明显地提高了学生临床操作水平,增强了学生观察问题、分析问题、解决问题等综合素质。实践证明,模拟医院能够加强中医骨伤科操作技能的教学效果。     

移位型髋臼骨折的手术治疗概述

过去的四十年间，移位型髋臼骨折（displaced acetabular fracture，DAF）的处理原则从保守治疗发展为手术治疗。Judet和Letournel的工作导致了DAF的治疗原则从保守治疗向手术治疗的转变，掀起了髋臼骨折治疗的革命。他们认识到移位型关节骨折解剖复位，坚强内固定加上早期功能锻炼的原则在髋臼骨折中同样适用。     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

不同厂商紫头真空采血管的血常规结果比对

目的：对不同厂商的紫头真空采血管进行评估，其血常规结果是否有差异。方法：同时使用美国BD公司和成都瑞琦公司生产的紫头真空采血管采集40份新鲜全血标本，分别在自动血液分析仪XE-2100进行检测，再进行白细胞（WBC）、红细胞（RBC）、血红蛋白（HGB）、血小板（PLT）等参数的相关性比较。结果：WBC、RBC、HGB和PLT等参数的差异百分率分别为：0．49％、0．05％、-0．13％和-1．01％；相关系数（r）分别是：0．9985、0．9964、0．9966和0．9932；t检验的P值分别是：0．9706、0．9020、0．9679、0．9061，均〉0．05。结论：真空采血管普遍应用于临床标本的采集，由于真空度、抗凝剂的量、管壁的质量对血常规结果均有影响，不同厂商的真空采血管质量不完全相同，通过新鲜全血的结果比对，美国BD公司和成都瑞琦公司生产的紫头真空采血管的血常规结果相关性好，其相关系数均在0．99以上，P值均〉0．05，无显著性差异，差异百分率小，均〈±2．0％的可接受范围，表明可用于临床。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

癔病的针灸疗法12例

1　临床资料12例均为农村病人 ,男 2例 ,女 10例 ;年龄 4 5～ 6 0岁 ,平均 5 2 5岁。 12例均未发现其他病变 ,其 6例发病时出现休克状态 ,发病就诊时间为 3～ 15小时 ,平均为 4小时。全组病人均为突发性 ,其典型病例有一中年妇女 (48岁 ) ,于发病前 10 0天曾患带状疱疹 ,给予抗生素及抗病毒类药物治疗痊愈后 ,感觉全身病毒感染瘙痒 ,日无宁日 ,于 10天前因与家人发生口角 ,出现休克状态 ,言语不清 ,苦笑无常 ,劝说无用 ,遂来所就诊。实验室检查 :血常规 ,ＲＢＣ4 0× 10 12 /Ｌ ,ＷＢＣ8× 10 3 /Ｌ ,ＨＧＢ130ｇ/Ｌ ,余 (- )。尿常规 ,均…     

三步折顶法整复桡骨下端伸展型骨折150例

桡骨下端骨折约占全身骨折的6.7%,其中伸展型骨折约占该部骨折的90%左右.笔者在中医传统拔伸、掌屈、尺偏的手法基础上,改良为“三步折顶法”,运用此法对150例桡骨下端伸展型骨折患者进行手法整复和跟踪治疗.1 临床资料本组150例中男性57例,女性93例;年龄最小12岁,最大82岁,平均年龄52.6岁;左臂65例,右臂85例;伤后一天内就诊者127例,2～5天内就诊者18例,6～14天内就诊者3例,还有2例分别在伤后32天和58天就诊;150例中粉碎性骨折,或非粉碎性骨折而骨折线贯穿关节面者27例,伴尺骨茎突撕脱性骨折55例,伴腕舟骨骨折者12例,伴尺桡下关节脱位者59例.     

用药理效应研究曲马朵对小鼠镇痛作用的药代动力学

目的：探讨曲马朵在小鼠体内镇痛作用的药代动力学，方法：采用药效－药代结合模型，以小鼠腹腔注射醋酸后扭体反应次数为镇痛效应指标，计算给药后不同时间间隔及不同给药剂量下的镇痛百分率，测量时－效，量－效关系，进一步求时间－体存生物相当药量曲线及相应药代动力学参数。结果：曲马朵对小鼠的镇痛作用呈显著的时－效，量－效关系，其镇痛作用效量半衰期T1／2（ED）为4．68min，消除速率常数K为0．148。结论：曲马朵母核药物与其多种代谢中间产物均有镇痛作用，此法比单纯测定曲马朵的血药浓度更能科学地反映药物在作用部位的药效变化规律。