应用人工补片和腹腔引流对胸腹联体婴儿分离术后粘连性肠梗阻的影响

目的:探讨胸腹联体耍儿分离术后粘连性肠梗阻的预防及处理措施.方法:回顾性分析我院1例胸腹联体婴儿进行分离术的临床资料.结果:联体婴儿A婴和B婴分离成功,分离后腹壁巨大缺损应用Preclude心包膜加聚丙烯网片修复成功.术后A要恢复较顺利,无腹腔并发症发生,至今仍存活.B婴于术后第14 d出现肠梗阻,经保守治疗无效,于第25 d急行剖腹探查术.术中见:Preclude心包膜与肠管无粘连,冗长的引流管被肠管包绕粘连,通道有3处肠管成角粘连,形成2处洞孔,并有肠管疝入绞窄.行肠粘连松解、肠切除肠吻合、回肠造瘘术.术后因并发严重肺部感染抢救无效,于第53 d死亡,共存活78 d.尸体解剖:Preclude心包膜与肠管无粘连,第2次手术粘连松解处又见轻度肠粘连,原腹腔引流管及回肠造瘘管处有肠粘连.结论:选择防粘连的人工补片修复腹壁缺损及正确放置和管理腹腔引流管,有助于防止胸腹联体婴儿分离术后粘连性肠梗阻的发生;严密观察、准确把握中转手术的时机,有利于改善分离术后粘连性肠梗阻的预后.     

腹腔镜治疗粘连性肠梗阻临床观察

目的探讨腹腔镜松解粘连性肠梗阻的治疗效果。方法回顾分析我院自2001—2007年因粘连性肠梗阻行腹腔镜松解术40例的临床资料。结果患者均治愈。术中平均出血量10m1,术后平均住院时间4d,术后无并发症,随访至今无复发。结论腹腔镜肠粘连松解术创口小、腹膜创面少、腹腔干扰少,能较大限度地减少术后腹腔内再粘连,为粘连性肠梗阻的外科治疗提供了一种新方法。     

顽固性肠粘连、粘连性肠梗阻的诊治及预防

目的 探讨腹腔镜松解术治疗反复发作顽固性的肠粘连、粘连性肠梗阻的可行性和临床效果.方法 在腹腔镜下使用分离钳、电凝、分离剪及超声刀对23例肠粘连、粘连性肠梗阻患者行粘连松解术.结果 患者均确诊为肠粘连、粘连性肠梗阻,术后随防2～24个月,恢复良好,其中4例偶有腹胀、腹痛,自行缓解,其余均无腹痛、腹胀等症状复发,均未再有肠粘连、粘连性肠梗阻的表现.结论 利用腹腔镜对肠粘连、粘连性肠梗阻有选择地进行粘连松解手术安全、可行,且其具有创伤小、出血少、恢复快、瘢痕少、费用少等微创外科的优点,基本没有再粘连的发生.     

透明质酸钠预防腹部手术后肠粘连效果

临床上腹腔内手术是发生腹腔内粘连的主要原因,肠粘连发生率为67%～93%,约1/3肠梗阻病例是术后粘连的结果,术后早期机械性肠梗阻90%以上为粘连性肠梗阻[1]。因此,预防腹腔手术后肠粘连对于减轻患者痛苦、降低医疗费用有重要意义。笔者应用透明质酸钠预防腹部手术后肠粘连,取得较好效果,报道如下:     

肠扭转致乳糜腹1例

患者,男,24岁,转移性右下腹痛,伴恶心24h入院．查体：右下腹固定性压痛,无肌紧张及反跳痛,移动性浊音阴性．腹透：未见异常．急诊以阑尾炎行阑尾切除术,人腹见腹腔内较多乳糜样渗液,立即改剖腹探查术,见部分肠管与腹壁粘连,部分小肠扭转720度．肠管色灰白,腹腔乳康样渗液500ml,松解粘连,复位肠管,色恢复,未见破裂处．取渗液送化验,报告乳糜阳性．术后诊断：肠粘连,场扭转,淋巴管阻塞性乳糜腹水．抗炎治疗,sd出院．讨论乳糜腹成人少见,多因外伤或手术误伤淋巴管,大多发病在儿时,因光无异常,损伤、寄生虫等引起淋巴管…     

浅谈妇产科手术脏器副损伤的防治措施

1妇产科多次手术致盆腔广泛粘连由于患者多次腹部手术,导致盆腔脏器广泛粘连,因病再次进行妇产科手术时,可见有腹壁与子宫附件粘连,腹壁与肠管粘连,肠管与子宫及附件粘连,膀胱与子宫及附件粘连。并和大网膜.附件.阔韧带后叶和盆壁腹膜,子宫间粘连此类手术有一定难度,如腹腔粘连严重无法切开腹膜,术者应将腹壁切口向上方延长尽量避开粘连处贴腹壁分离粘连组织。     

紫绀胸腹联体婴儿分离术的麻醉体会

联体双胎为一种罕见的先天畸形，其患病率为１／５～１０万，大多数于胚胎时或出生后即死亡，约２０万次以上分娩有１例出生后存活犤１犦。能接受手术的患者非常少，合并完全型大动脉转位（TGA）能成功进行分离手术麻醉，未见报道。我院于２００１－１１成功行首例紫绀胸腹联体婴儿分离术麻醉，由于麻醉方法选择适宜，加强术中、术后监测和管理，取得较满意效果。现介绍如下。１临床资料１．１病例资料联体儿甲婴和乙婴，均为男性。于出生后发现联体１０月入院。该对婴儿系足月顺产，父母均无特殊病史。出生时呈面对面联体，共用同一脐带…     

腹腔镜肠粘连松解术26例报告

目的探讨腹腔镜下肠粘连松解治疗粘连性肠梗阻的方法及疗效。方法分析太康县中医院2005年1月到2009年10月收治的26例粘连性肠梗阻腹腔镜下行粘连松解,配合留置应用医用几丁糖或透明质酸钠防止术后再粘连的临床资料。结果 22例腹腔镜下成功实施粘连松解术,未出现手术并发症和留置药物过敏现象,术后随访4月～24个月,无梗阻症状再发;4例中转开腹。结论腹腔镜下肠粘连松解配合留置医用几丁糖或透明质酸钠治疗粘连性肠梗阻安全、实用、经济,疗效满意。     

四磨汤预防小儿肠粘连的临床观察

腹腔粘连是小儿腹部手术的主要并发症之一,由于粘连和牵拉造成腹部不适或持续疼痛,推移或压迫脏器引起功能障碍,以致发生粘连性肠梗阻.为了进一步探讨预防腹腔粘连和肠粘连的方法,本组对60例小儿腹部术后应用四磨汤口服预防肠粘连及肠梗阻的发生,效果满意,报告如下.     

腹腔引流管口嵌顿疝1例

1病例报告患者男,80岁,主因:发现右侧腹壁肿物不可还纳1d。查体:右侧腹壁可见长约10cm纵行手术瘢痕,右侧腹壁可见约6×5×5cm3大小包块,质韧,触之微痛,移动度差,表面无破溃、红肿。腹部CT示:腹壁疝合并小肠梗阻。患者既往3年前曾行消化道穿孔修补术,并于术后留置腹腔引流管约3d。考虑右侧腹壁缺损处嵌顿疝。     

分子嵌合MHC-Ⅰ基因对小鼠DC反应的研究

目的:构建分子嵌合主要组织相容性复合体(MHC)-Ⅰ基因小鼠骨髓造血干细胞,并探讨其诱导脾脏T细胞对异基因小鼠树突状细胞(DC)反应的机制。方法:密度梯度法分离培养BALB/c小鼠骨髓造血干细胞。构建携带C57BL/6小鼠MHC-Ⅰ基因慢病毒载体(病毒感染组),携带无意义基因慢病毒载体(阴性对照组)。分别感染BALB/c小鼠骨髓造血干细胞,构建分子嵌合细胞。分别取病毒感染组、阴性对照组及未加入病毒的空白对照组造血干细胞输注BALB/c小鼠后7d,获取脾脏T淋巴细胞,分别与C57BL/6小鼠DC进行混合淋巴细胞培养,测定刺激指数。结果:成功体外分选及培养BALB/c小鼠骨髓造血干细胞。病毒感染组C57BL/6小鼠MHC-Ⅰ蛋白表达率可达98.17%。单向混合淋巴细胞培养结果显示,C57BL/6小鼠DC对输注病毒感染组细胞后BALB/c小鼠脾脏T细胞刺激指数明显降低(P<0.01)。结论:输注分子嵌合MHC-Ⅰ基因造血干细胞后,小鼠脾脏T细胞对异基因小鼠DC反应明显减低。     

Application of first-derivative UV-spectrophotometry, TLC-densitometry and liquid chromatography for the simultaneous determination of mebeverine hydrochloride and sulpiride

Three methods are described for the simultaneous determination of mebeverine hydrochloride (MB) and sulpiride (SU) in combined pharmaceutical tablets. The first method depends on first-derivative ultraviolet spectrophotometry, with zero-crossing measurement method. The first derivative amplitudes at 214.2 and 221.6 nm were selected for the assay of MB and SU, respectively. Calibration graphs follow Beer's law in the range of 10-30 and 2-8 microg/ml(-1), and the linearity was satisfactory (r = 0.9999), for MB and SU, respectively. The second method was based on the application of the thin layer chromatographic separation of both drugs followed by the densitometric measurements of their spot areas. After separation on silica gel GF254 plates, using ethanol: diethyl ether: triethylamine (70:30:1 v/v) as the mobile phase, the chromatographic zones corresponding to the spots of MB and SU were scanned at 262 and 240 nm, respectively. The calibration function was established in the ranges of 4-12 microg for MB and 2-8 microg for SU. The third method was an internal standard procedure based on high performance liquid chromatographic separation of the two drugs on a reversed-phase, Bondapak CN column. The detection was done at 243 nm using buclizine hydrochloride as internal standard. All chromatographic methods showed good linearity, precision and reproducibility. No spectral or chromatographic interference from the tablet excipients were found. The proposed methods were successfully applied to the assay of commercial tablets and content uniformity test. The procedures were rapid, simple and suitable for quality control application.     

高效液相色谱法测定利拉萘酯乳膏的含量

目的:建立利拉萘酯乳膏的含量测定方法。方法:选用Angela C18色谱柱(25cm×4.6mm,5μm),流动相:甲醇-水(80:20);柱温40℃,流速:0.8ml·min-1,检测波长:281nm。结果:利拉萘酯线性范围8～32μg·ml-1(r=0.9996),回收率为99.3%(RSD为0.3%,n=9)。结论:本方法专属性强,可用于利拉萘酯的质量控制。     

焦谷氨酸对映体的手性高效液相色谱分离

目的:采用大环抗生素游壁菌素键合硅胶手性分离柱 Chirobiotic T 对焦谷氨酸手性对映体进行分离。方法:以 Chirobi-otic T 柱为色谱柱,流动相为甲醇-三乙胺缓冲溶液(醋酸调 pH)体系和甲醇-醋酸-三乙胺极性有机溶剂体系,检测波长为214 nm,考察了焦谷氨酸对映体的分离,并与大环抗生素万古霉素键合硅胶手性分离柱 Chirobiotie V 进行了比较。结果:在甲醇-0.1%三乙胺(80:20,以醋酸调 pH 4.0)为流动相时,焦谷氨酸对映体在 Chirobiotic T 柱上可以实现基线分离,但有系统峰干扰;而甲醇-醋酸-三乙胺极性有机溶剂体系则更利于焦谷氨酸对映体的分离,并可对实际样品进行定量分析,无系统峰干扰。而在这2种条件下,Chirobiotic V 柱无法基线拆分焦谷氨酸对映体。结论:Chirobiotie T 柱对焦谷氨酸手性对映体有很好的拆分能力,可用于实际样品的定量分析。     

Chiral separation of pemoline enantiomers by cyclodextrin-modified micellar capillary chromatography

Micellar electrokinetic chromatography (MEKC) was successfully applied to the chiral separation with the addition of cyclodextrins (CDs) as chiral selector to running buffer. Chiral separation depended on the type of CDs. Mono-3-O-phenylcarbamoyl-beta-CD was effective for the chiral separation of pemoline. We investigated the type and concentration of CD and other parameters such as buffer pH, the concentration of SDS and the effect of organic modifier. The conditions for enantiomeric separation of pemoline were as follows: 40 mmol/l borate buffer at pH 9.0 with 40 mmol/l SDS, 20 mmol/l mono-3-O-phenylcarbamoyl-beta-CD and 10% 2-propanol. Baseline separation (Rs=2.21) of pemoline can be achieved.     

HPLC法拆分氟比洛芬对映体

建立氟比洛芬手性药物的高效液相色谱拆分方法。方法:手性流动相添加剂HPLC法:利用C18柱,以羟丙基-β-环糊精作为手性流动相添加剂,调节有机修饰剂甲醇的比例和添加不同量的三乙胺对氟比洛芬进行拆分;手性固定相HPLC法:利用Chiral-pakAD手性柱,以正己烷-乙腈为流动相基本成分,调整两者不同比例和添加不同量的三乙胺,对氟比洛芬进行拆分。结果:手性流动相添加剂法:使用C18柱对氟比洛芬对映异构体进行拆分,调节流动相中有机修饰剂甲醇浓度、手性流动相添加剂羟丙基环糊精浓度、峰型修饰剂三乙胺的浓度等都不能使氟比洛芬对映体达到基线分离,只能部分分离。手性固定相法:氟比洛芬对映体在Chiral-pakAD手性柱上能达到较好的分离。在正己烷-乙腈流动相系统中,正己烷体积含量为90%,三乙胺体积含量为0.05%的条件下,氟比洛芬对映体得到了较好的分离,分离度为10.0。结论:建立的手性固定相法能有效拆分氟比洛芬对映体而手性流动相添加剂法不能拆分氟比洛芬对映体。     

Optimization of a Raman Microscopy Technique to Efficiently Detect Amorphous–Amorphous Phase Separation in Freeze‐Dried Protein Formulations

A confocal Raman microscopic technique was optimized to more efficiently detect amorphous–amorphous phase separation in freeze‐dried protein formulations. A Renishaw Raman inVia confocal microscope was used to collect 100–200 μm line maps (2 μm step size) of freeze‐dried protein–excipient formulations. At each point across the line map, the composition was evaluated from the intensity of the nonoverlapping peaks representative of each component. Collection aperture, scan time, and line map length significantly contributed to the phase‐separation analysis, whereas different sample preparation methods did not affect the analysis. Using the optimized parameters (i.e., large aperture 5 s scan time, 200 μm line map), phase separation was successfully detected in binary polymer formulations and was comparable to the previously developed Raman method. However, the previous method required 2.5 h/sample, whereas the optimized method only requires 0.5 h/sample. Phase separation was detected in the following protein–excipient formulations: lysozyme–trehalose (1:1), lysozyme–isomaltose (1:1), β‐lactoglobulin–dextran (1:1), β‐lactoglobulin–dextran (1:3), and β‐lactoglobulin–trehalose (1:1). Phase separation was not detected in lysozyme–sucrose (1:1) and β‐lactoglobulin–sucrose (1:1) formulations. The optimized method successfully detected phase separation in several protein formulations, where phase separation was previously suspected, and promised to be a useful tool for detection of phase separation in amorphous therapeutic formulations. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 103:2749–2758, 2014     

LC-ESI-MS method for the determination of bisoprolol in human plasma

A sensitive liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) method has been developed and validated for the determination of bisoprolol in human plasma, using metoprolol as internal standard (I.S.). After alkalization with sodium hydroxide, the samples were extracted with ethyl acetate and separated by HPLC on a ZORBAX SB-C18 column with a mobile phase of 10 mM ammonium acetate buffer containing 0.1% formic acid-methanol (32:68, v/v) at a flow rate of 1 ml/min. The chromatographic separation was achieved in less than 5 min. The linearity was established over the concentration range of 0.05-120 ng/ml. The intra- and inter-run standard deviation was less than 3.8 and 7.5%, respectively. The method had been successfully applied to study the relative bioavailability of bisoprolol fumarate tablets in healthy Chinese volunteers. The pharmacokinetic parameters of the reference and test tablets have been compared.     

Determination of thiocolchicoside in its binary mixtures (thiocolchicoside-glafenine and thiocolchicoside-floctafenine) by TLC-densitometry

The proposed method is based on TLC separation of thiocolchicoside from its binary mixtures (thiocolchicoside-glafenine and thiocolchicoside-floctafenine) followed by densitometric measurement at 375 nm. Separation was carried out on silica gel plates GF(254) using ethyl acetate:methanol:acetic acid (84:13:3%, v/v/v). Various conditions affecting separation and measurement were studied and optimized. Calibration was performed using third-order polynomial equation. It was found superior to first-order with respect to quantification range (0.25-25 microg per spot), correlation coefficient and standard error of estimation. The proposed method was successfully applied for the determination of thiocolchicoside in its synthetic binary mixtures and commercial tablets. Results were compared with those obtained by reference methods and non-significant difference was obtained regarding accuracy and precision. Assay precision using two-way ANOVA was performed on results of inter- and intra-day applications of the method.     

血小板去除术联合高三尖杉酯碱和α-2b干扰素治疗原发性血小板增多症的临床观察

目的:观察血小板去除术联合高三尖杉酯碱和α-2b干扰素治疗原发性血小板增多症(ET)的疗效.方法:对22例ET患者采用血小板去除术2～4次后,给予高三尖杉酯碱和α-2b干扰素治疗.结果:血小板去除术后,患者外周血中血小板计数明显下降,再予高三尖杉酯碱和α-2b干扰素治疗.所有患者病情均得到明显好转.结论:血小板去除术联合高三尖杉酯碱和α-2b干扰素治疗ET有显著疗效.