校园网络环境下的病理生理学自主学习模式研究

目的探讨校园网络环境下的病理生理学自主学习模式。方法随机选取学院2012级临床医学6-7班、10-11班分别为对照组(传统教学模式)和教改组。教改组实施以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式,对学生考核成绩进行对比分析和问卷调查。结果教改组学生成绩高于对照组,学生的自主学习能力明显提高(P<0.05)。结论以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式可以实现以学助教,有利于学生的终身发展。     

低分子量有机酸含量测定方法探讨

目的: 用色谱法构建一种简洁、快速、准确度高的检测低分子量有机酸的方法。方法: 气相色谱法和
离子色谱法同时测定甲酸、乙酸、丙酸、丁酸和乳酸。结果: 由于甲酸和乳酸的沸点问题,用气相色谱法不能同时
测定,而离子色谱法前处理简单,操作方便,可以同时测定。结论: 离子色谱法是同时测定低分子量有机酸含量
的有效方法。     

酪酸菌对小鼠有害气体排放的影响

目的 探讨酪酸菌对小鼠有害气体排放的影响.方法 80只KM小鼠分4组,每组20只,雌雄各半,Ⅰ组为对照组,Ⅱ组、Ⅲ组、Ⅳ组分别连续21 d灌胃酪酸菌500 mg/kg、1 000 mg/kg、1 500 mg/kg,每日测定独立通气笼内氨(NH3)和硫化氢(H2S)浓度,试验21d测定各组小鼠生长性能、小鼠粪便中脲酶活性.结果 与对照组相比,Ⅲ组、Ⅳ组小鼠的平均日增重略有提高,但没有统计学差异;灌胃后7d,Ⅲ组、Ⅳ组笼内NH3含量明显低于Ⅰ组和Ⅱ组(P＜0.05),各组均未检测到H2S.结论 酪酸菌可能会影响小鼠的生长性能和氨的排放.     

气相色谱法测定野艾叶中桉油精的含量

目的建立野艾叶中桉油精的气相色谱含量测定方法。方法采用气相色谱法测定野艾叶中桉油精的含量。色谱柱为安捷伦DB-5毛细管柱(30.00 m×0.32 mm,0.25μm),载气为99.99%高纯氮气,流速0.6 m L/min;氢气流量30 m L/min,空气流量350 m L/min,分流进样,分流比5∶1,进样量1μL;进样口温度230℃,氢火焰离子化检测器温度250℃;程序升温,起始温度60℃,以每分钟5℃升至210℃,保持5 min。结果桉油精回归方程为Y=3471.49X+13 424.5(r=0.9998),线性范围为33.02～412.70μg/m L;平均加样回收率为98.84%,相对标准偏差(RSD)为0.97%; 10份样品中,桉油精含量最高0.060%、最低0.020%。结论该法简便、准确、专属性强、重复性好,经方法学验证,本法可用于野艾叶中桉油精的含量测定,建议修订野艾叶质量标准时,将桉油精作为指标性成分进行质量控制。     

Reduced 11beta-hydroxysteroid dehydrogenase activity in experimental nephrotic syndrome.

BACKGROUND: The disease state of the nephrotic syndrome is characterized by abnormal renal sodium retention that cannot be completely explained by a secondary hyperaldosteronism for the following reasons. Firstly, in rats an enhanced sodium retention is observed before proteinuria with intravascular volume depletion occurs. Secondly, in patients with the nephrotic syndrome, volume expansion with hypertension has been reported despite suppression of the renin-aldosterone system. Therefore, another mechanism for sodium retention must be postulated for this disease state. We hypothesize that this mechanism is a reduced 11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) activity, a phenomenon known to cause enhanced access of cortisol or corticosterone to the mineralocorticoid receptor. METHODS: We assessed the 11beta-HSD activity by measuring the urinary ratio of tetrahydrocorticosterone (THB) plus 5alpha-tetrahydrocorticosterone (5alpha-THB) to 11-dehydro-tetrahydrocorticosterone (THA) by gas chromatography-mass spectrometry in rats with puromycin aminonucleoside (PAN)-induced proteinuria and with adriamycin nephrosis. Furthermore, the plasma ratios of corticosterone to 11-dehydrocorticosterone were measured. RESULTS: The urinary ratio of (THB+5alpha-THB)/THA increased in all animals following injection of PAN or adriamycin, indicating a reduced activity of 11beta-HSD. The reduced activity of 11beta-HSD was confirmed by an increased plasma ratio of corticosterone to 11-dehydrocorticosterone. The changes in the glucocorticoid metabolite ratios were already present before significant proteinuria appeared. CONCLUSION: PAN- or adriamycin-treated rats develop proteinuria with a reduced activity of 11beta-HSD, a mechanism contributing to the abnormal sodium retention in nephrotic syndrome.     

高频喷射通气对重度烧伤合并吸入性损伤患者早期的呼吸支持

目的　观察高频喷射通气 (highfrequencyjetventilation ,HFJV)对重度烧伤合并吸入性损伤患者早期的治疗作用。　方法　 2 0例重度烧伤 (TBSA 79.6 %± 2 9.3% )并吸入性损伤患者 ,其中 19例行气管切开手术 ,1例经鼻插管。为防低氧血症 ,所有患者均应用HFJV ,观察通气前和通气后 11d内血气、呼吸率和脉搏等指标的变化。　结果　气管切开时间为伤后 (2 .7± 2 .4 )d ,HFJV时间为伤后(4.4 0± 2 .9)d。HFJV后 1～ 3d ,PaO2 显著高于通气前水平 (P <0 .0 1) ,随后HFJV 1周 ,PaO2 仍维持在较高水平。在整个通气期间 ,PaCO2 、呼吸率和脉搏率均无明显变化。结论　在重度烧伤合并吸入性损伤早期 ,HFJV有利于氧合作用的改善而无明显副作用 ,是一较为适用的呼吸支持方式     

Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO₂ and higher PO₂ at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA. Electronic Publication     

肝移植术中门静脉阻断前后血液成分变化的研究

目的 研究肝移植术中门静脉阻断前后血液成分变化及临床意义。方法 32例肝病患者于静吸复合全麻下行无转流原位肝移植术。常规麻醉监测，并放置Swan-Ganz导管检测心输出量，无肝前期、无肝期给予抑肽酶输注，通过输液、给予去甲肾上腺素及多巴胺，维持无肝期平均动脉压〉70mmHg，心输出量指数〉2.5L·min^-1·m^-2。分别于门静脉阻断即刻、门静脉开放即刻采集门静脉血液测定电解质、血气及炎性细胞因子浓度（肿瘤坏死因子tumor necrosis factor alpha，TNF-α；白介素Interleukin-6，IL-6）。结果 阻断前、后血钙、血镁浓度均明显低于正常值。无肝期后门静脉血钾、乳酸、TNF-α及IL-6浓度显著升高（P〈0.05）；门静脉血血氧分压显著降低（P〈0.05），但仍超过40mm Hg。与C级患者相比，A级患者门静脉阻断前后血乳酸、IL-6的净变化量增加；门静脉血氧分压、二氧化碳分压净变化值呈下降趋势。结论 无肝期门静脉阻断后，其血液成分发生明显变化，开放循环前门静脉放血可能具有重要临床意义，Child A级患者门静脉开放前放血意义可能更大；但对心、肺功能影响的意义还有待探索。     

早期护理干预对子宫颈癌根治术后患者肠功能恢复的影响

目的探讨早期护理干预对子宫颈癌根治术后患者肠功能恢复的作用。方法将118例子宫颈癌行广泛性根治术患者按住院号分为干预组(60例)和对照组(58例),对照组按照常规护理;干预组术前教会患者相关锻炼方法,术后2 h开始干预,如给予按摩、下肢屈伸等被动运动。结果干预组首次肛门排气时间、首次排便时间较对照组显著提前,便秘发生率、腹胀程度显著低于对照组(均P<0.01)。结论早期护理干预可促进子宫颈癌根治术后患者的肠功能恢复。     

Plasma exchange before surgery for left ventricular assist device implantation

Abstract:  Left ventricular assist device (LVAD) implantation in end-stage heart failure patients is frequently associated with hemorrhagic complications requiring reoperation. The preoperative coagulopathic profile includes prolonged prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time; platelet dysfunction; decreased coagulation factor activity; and increased inflammatory markers. We compare outcomes in LVAD patients treated with preoperative plasma exchange with concurrent, nonrandomized control patients. We reviewed data from 68 consecutive elective patients who received LVADs at our institution. Thirty-five received LVADs after preoperative plasma exchange (replacement of one plasma volume of fresh frozen plasma), and 33 received LVADs without plasma exchange. Groups were comparable in age, sex, body weight, New York Heart Association class, intra-aortic balloon pump insertion, cardiac index, pulmonary capillary wedge pressure, creatinine, total bilirubin, hemoglobin levels, PT, international normalized ratio, PTT, and platelet count. Early mortality was lower in the plasma exchange group (0% [0/35] vs. 18% [6/33], P  = 0.026), and postoperative chest tube drainage decreased by 33% ( P  = not significant). Blood transfusion requirements were similar.Perioperative mortality decreased in patients treated with plasma exchange before LVAD implantation.