直视医学临床见习难——浅析面临困境及其对策

随着社会发展、医学模式的转变，医疗改革和学校扩招政策的实施，传统的临床见习教学遇到了前所未有的冲击与困惑。本文根据临床见习现状进行分析，力求找到最佳的解决方法。     

高渗氯化钠高氧液对失血性休克家兔血乳酸和动脉血气的影响

目的:观察高渗氯化钠高氧液对失血性休克家兔动脉血气和血乳酸值的影响，评价其对失血性休克的早期救治效果。方法:制备高渗氯化钠溶液(HS)、生理盐水高氧液（NSO）和高渗氯化钠高氧液(HSO)。30只雄性家兔制备失血性休克模型［于10min内使平均动脉压（MAP）降至40mmHg（1mmHg＝0.133kPa），维持60min］，随机分为NSO，HS，HSO组3个治疗组。分别按6mL/kg剂量5min内静脉输入NSO,HS和HSO。记录休克前后及给药后心率（HR）、呼吸（RR）、MAP及尿滴（UD），测定休克前、休克60min，给药后30，60，120min时血乳酸（BL）和动脉血气值。最后观察尸肺，测定肺系数。结果:HS和HSO组均显著地改善MAP，HR和UD，降低BL，改善代谢性酸中毒,肺系数明显低于NSO组。HSO与NSO及HS比较，能更显著地降低血BL，提高动脉血氧饱和度（SaO2）和动脉血氧分压（PaO2）。结论:HSO较HS和NSO能更显著地降低血BL,提高SaO2和PaO2，对失血性休克的早期救治具有较高的使用价值。     

复方决明子口服液的制备工艺研究

目的 :用正交法优选复方决明子口服液的最佳工艺条件。方法 :以决明子中蒽醌的含量及浸出物的含量为指标 ,应用L9(3′)正交试验法优选复方决明子口服液的最佳工艺条件。结果 :最佳提取条件为 :加 1 0倍量水 ,煎煮 3次 ,每次 1 .5h。结论 :优越工艺验证表明 ,最佳提取工艺为A1 B2 C1 。说明优选工艺稳定可靠。     

耳鼻喉科住院患者医院感染的原因分析及对策

耳鼻喉科患者具有基数大、病情差异较大的特点,在临床多种因素的影响下,极易导致患者在诊疗的过程中并发感染,促使患者的治疗周期延长,加剧患者的痛苦,严重影响患者的治疗效果,而治疗效果的优劣与医院的声誉和形象之间关系密切,自身的免疫能力低下、气管插管引发的误吸等患者因素;临床护理人员经验的缺乏,未严格遵守无菌操作原则等护理因素;侵入性的操作治疗、手术病灶切除的大小和抗菌药物的使用等治疗因素以及院方的重视度等管理因素均是导致感染症状发生的主要原因。该文对导致耳鼻喉患者发生医院感染的上述原因进行分析,并针对性地提出相关策略,为降低医院感染方案的制定提供借鉴。     

100例急性心肌梗塞病人溶栓治疗的护理

通过对100例急性心肌梗塞再灌注的治疗实践,从护理学角度对溶栓的治疗护理工作进行讨论分析,认为护理工作在该项技术的实施当中至关重要.其目的是为了使更多的心肌梗塞患者得到及时、准确、有效地治疗和护理.     

Comparative study of the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds

BackgroundChronic wounds are of many etiologies and difficult to treat. Many commercial products to manage such wounds are available, which claim to have good outcomes. Aim of this study was to compare the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds.MethodsPatients with chronic wounds were randomly placed in two groups-Group A (Ionic Silver Solution) and Group B (Super Oxidized Solution) with 30 patients each. The dressings were continued until the wound healed completely or the wound was ready for a definitive procedure. Wound parameters were recorded as per Bates Jensen Wound Assessment Tool (BJWAT) Score.ResultsFIfty patients completed the study. The scores were compared at the initiation and endpoint of treatment. The pretreatment total for BJWAT was 916 and 924 in group A and group B respectively, which was not statistically significant. Post-treatment improvement was noticed in both the groups and the score decreased to 510 and 675 in group A and group B respectively (p = 0.001). Ionic Silver Solution and Super Oxidized Solution both were found to be effective in improving the overall wound condition. However, Ionic Silver Solution was found to be more effective than Super Oxidized Solution in the healing of chronic wounds. Complete healing was noticed in a small number (6%) of patients. These agents can therefore best prepare the wounds for early surgical intervention.ConclusionBoth the agents were found to be safe and useful in the management of chronic wounds. However, Ionic Silver Solution was found to be more effective than the super oxidized solution in this study.     

HX-Ⅰ液作为腹部内多器官灌注液可行性研究

采用大鼠肝脏非循环离体灌注模型,观察HX-Ⅰ液对大鼠肝组织含水量、肝窦内皮细胞死亡率,Krebs－Henseleit液天门冬氨酸转移酶活性、分泌胆汁的肝脏数量;观察HX-Ⅰ液对糖尿病大鼠胰腺移植术后血糖（Pod＋2,7,14）、糖耐量、胰岛素变化;观察HX-Ⅰ液对狗肾移植术后血肌酐、存活率及肝、胰、肾脏的形态学。结果表明,HX-Ⅰ液保存大鼠肝脏达24h,胰腺48h,狗肾脏达72h。说明HX-Ⅰ液作为腹部内多器官灌注液是可行的。     

A loudspeaker-driven system for rapid and multiple solution exchanges in patch-clamp experiments

A new and inexpensive system allowing rapid and synchronized changes of solutions around a membrane patch or a cell under voltage-clamp conditions is described. Four plastic capillary tubings (OD 640 m; ID 430 m) were glued together horizontally and attached to a coil of a commercially available loudspeaker. Servo-control of the position of the coil allowed the mouth of any of the capillaries to be positioned near the pipette tip within 6 ms. A high flow speed of the test solution was crucial to achieve rapid solution exchange. At a flow speed of 5 cm/s, complete exchange of the external environment of a frog ventricular cell was achieved within 20–30 ms. The time course of solution change was found to be 3–5 times faster at the tip of an open patch pipette. To preserve the physical integrity of the cell, the cell was usually perfused by a control capillary at a slow velocity (0.2 –0.4 cm/s) and test solutions flowing out of adjacent capillaries at high velocity (4–5 cm/s) were applied to the cell only for short periods. Determination of the three-dimensional contamination profile around the mouth of the control capillary allowed the optimal conditions for the use of the system to be established and possible sources of contamination to be avoided between adjacent capillaries with unmatched flow speeds. Successive and multiple changes in external solutions could be easily synchronized with voltage-clamp depolarizations to examine the time course of the effect of drugs on voltage-operated ion channels. An example of this application is given with rapid applications of the dihydropyridine agonist (-)BayK 8644 to the L-type Ca²⁺ channel current in frog ventricular myocytes.     

消痔液质量标准研究

目的：建立消痔液（大黄，黄芩，赤芍，土茯苓等）的质量标准。方法：采用TLC法对药液中的大黄，黄芩，赤芍进行了鉴别；用HPLC法同时测定药液中大黄素，大黄酚的含量。结果：TLC鉴别的分离度好，专属性强，含量测定中，所建方法能同时测定消痔液中的2种有效成分。平均回收率为：大黄素97.87%(RSD=1.88%)，大黄酚98.61%(RSD=1.21%)。结论：该方法可用于消痔液的质量控制。     

通过杀菌试验观察隐形眼镜护理液杀菌活性成分的吸附作用

目的：为观察隐形眼镜护理液杀菌活性成分的吸附作用。方法：采用悬液定量杀菌试验方法。结果：对分别含0．00014％西吡氯铵（CPC）和含0．0001％聚亚已基缩二胍（PHMB）的两种隐形眼镜护理掖进行杀菌试骏。结果显示：（1）对含0．00014％西吡氯铵（CPC）的护理液．作用时间6h：用经护理液样品预处理过的玻璃和塑料试管进行试验，对金黄色葡萄球菌．大肠杆菌、绿脓杆菌三种细菌的平均杀灭率在99．90％以上；而用未经护理液样品预处理过的玻璃和塑料试管进行试验，对三种细菌的平均杀灭率在99．90％以下。试管处理与否对三种细菌的杀菌效果存在明显差异。（2）对含0.0001％聚亚已基双胍（PHMB）的护理液，作用时间4小时：塑料试管处理与否对三种细菌的杀菌效果无明显差异；玻璃试管处理与否对金黄色葡萄球菌和大肠杆菌的杀菌效果有影响。结论：玻璃和塑料试管壁对CPC都有吸附作用。玻璃试管对PHMB有少量吸附作用。