盐酸坦洛新联合个体化拔尿管在预防盆底脱垂修补术后尿潴留中的作用

目的:观察盆底脱垂修补术后患者口服盐酸坦洛新片同时联合排尿监测、个体化选择拔尿管时间在预防术后尿潴留发生中的作用.方法:在2009年10月1日至2011年09月30入住我院的患者中选择126例全盆底修补术或前盆底修补术患者,随机分成两组,观察组69例,对照组57例,观察组予以盐酸坦洛新片口服并行个体化拔尿管;对照组予以安慰剂口服并采用传统的术后留置尿管方法.结果:观察组的术后尿潴留发生率为5.7％,对照组的尿潴留发生率为19.2％,观察组尿潴留发生率明显降低(P＜0.05),其残余尿量、平均留置尿管时间亦均明显降低(P＜0.05),且未观察到明显的药物不良反应.结论:盆底脱垂修补术后口服盐酸坦洛新片并进行排尿训练及个性化拔管对预防术后患者的尿潴留有明显效果,无明显不良反应,故该方法值得临床推广.     

凝结芽孢杆菌活菌片预防剖腹产术后胃肠功能紊乱的临床观察

目的 观察和评价凝结芽孢杆菌活菌片(商品名:爽舒宝)预防剖腹产术后胃肠功能紊乱的临床疗效.方法 将60例妊娠期患者随机分为预防组和对照组,预防组和对照组均为30例.其中预防组住院后开始口服凝结芽孢杆菌活菌片,首次2.1g,以后1.05 g/次,3次/d,温水送服.观察两组患者剖腹产术后便秘、腹部不适、腹胀、腹痛、食欲不振等消化道症状.结果 预防组术后首次排便时间明显短于对照组,大便频率增加,腹部不适、腹胀、排便费力等伴随症状发生率明显低于对照组(P＜0.05).结论 凝结芽孢杆菌活菌片预防剖腹产术后胃肠功能紊乱疗效显著,值得临床推广.     

地佐辛复合丙泊酚静脉麻醉应用于无痛胃肠镜检查的临床观察

目的:观察地佐辛复合丙泊酚静脉麻醉在无痛胃肠镜检查中的临床应用效果。方法:选取接受100例无痛胃肠镜检查的患者,随机分为观察组和对照组,每组50例,观察组采用地佐辛复合丙泊酚麻醉,对照组采用芬太尼复合丙泊酚静脉麻醉,比较两组患者麻醉起效时间、意识消失时间、术后睁眼时间、丙泊酚用量以及呼吸和血液动力学变化。结果:1观察组患者睁眼时间、丙泊酚用量显著低于对照组,比较差异均有统计学意义(t1=2.243,t2=69.724,t3=2.451,均P0.05);2对照组患者麻醉前、插管后1min、术中、术毕30min组内RR、SpO2比较差异有统计学意义(F1=12.442,F2=99.133,P0.05),插管后1min、术中两项指标均降低,MAP、HR组内比较差异无统计学意义(F1=15.241,F2=11.383,P0.05);而观察组患者MAP、HR、RR、SpO2组内比较差异无统计学意义(F1=9.34,F2=12.35,F3=5.34,F4=12.83,均P0.05)。3观察组患者不良反应发生率为4%,明显低于对照组的12%,比较差异有统计学意义(c2=8.452,P0.05)。结论:地佐辛复合丙泊酚麻醉应用于无痛胃肠镜检查镇痛效果好,安全性高,值得推广应用。     

超声引导下神经阻滞麻醉联合全身麻醉对股骨头置换老年患者麻醉效果及术后认知功能的影响

摘要 目的：研究超声引导神经阻滞麻醉联合全身麻醉对股骨头置换老年患者的麻醉效果及对术后认知功能的影响。方法：选取2019年1月至2021年12月期间我院收治的150例拟行股骨头置换术的老年患者,随机分为对照组和观察组,各75例。对照组患者行常规全身麻醉,观察组在对照组的基础上行超声引导下神经阻滞麻醉,比较两组患者的血流动力学指标,拔管时间、苏醒时间和复苏室停留时间,苏醒后疼痛,术后认知功能及不良反应的发生率。结果：观察组患者各时间点的心率（HR）和平均动脉压（MAP）均较对照组低（P＜0.05）。观察组拔管时间、苏醒时间和复苏室停留时间均较对照组短（P＜0.05）。观察组患者术后视觉模拟评分（VAS）均低于同一时间点的对照组（P＜0.05）。与对照组相比,观察组患者术后1 h、12 h和24 h的简易智力状态检查（MMSE）评分均较高（P＜0.05）,观察组术后1 h、12 h和24 h术后认知功能障碍（POCD）发生率较对照组低（P＜0.05）。两组患者不良反应发生率无差异（P＞0.05）。结论：超声引导神经阻滞麻醉可稳定血流动力学,缩短拔管、苏醒及复苏室停留时间,减轻术后疼痛,改善术后认知功能,减少POCD的发生,值得临床推广。     

宝乐安预防抗生素相关性腹泻的临床疗效

目的观察宝乐安(酪酸梭菌活菌散)预防抗生素相关性腹泻的临床疗效。方法将符合入选标准的101例肺炎患儿随机分为对照组和预防组,其中对照组53例患儿给予抗菌药以及对症治疗;预防组48例患儿在此基础上加服宝乐安,500 mg/次,3次/d,停用抗菌药后继续服用至少7 d的宝乐安;两组患儿在出现继发腹泻后均给予宝乐安治疗至腹泻痊愈;观察两组患儿出现腹泻情况、大便性状恢复正常时间及伴随症状发生情况。结果预防组患儿腹泻发生率(12.5%)明显低于对照组(39.6%),腹泻发生时间明显晚于对照组,且伴随症状发生率也明显低于对照组,两组比较差异均有统计学意义(P0.05)。结论宝乐安预防抗生素相关性腹泻的效果显著,值得临床推广使用。     

循证医学在预防肛肠手术后排尿障碍中的应用效果分析

目的探讨循证护理在预防肛肠术后排尿障碍中的应用效果。方法选取2013年4月~2015年4月我院收治行肛肠手术患者86例,按护理措施不同分为对照组42例和观察组44例,对照组42例患者实施常规临床护理,观察组给予循证护理干预,观察两组患者术后肠鸣音恢复时间、肛门排气及排便时间、住院时间及排尿障碍改善情况。结果实施循证护理干预后,观察组的肠鸣音恢复时间、肛门排气及排便时间、住院时间均优于对照组(P0.05),而且治疗后排尿障碍恢复有效率优于对照组(P0.05)。结论循证医学护理在肛肠术后患者的应用效果显著,能缩短治疗时间,提高治疗的有效性,值得临床推广应用。     

腹腔镜下行TME联合PANP手术治疗男性直肠癌的临床研究

目的:探讨腹腔镜下行直肠全系膜切除术(TME)联合保留骨盆自主神经的直肠癌根治术(PANP)手术治疗男性直肠癌的临床价值及手术技巧,为男性直肠癌的临床治疗提供更多的参考依据。方法:回顾性分析我院收治的81例男性直肠癌患者的临床资料,将其中41例采取腹腔镜下保留盆腔自主神经全直肠系膜切除术的患者设为观察组,将40例开腹下行保留盆腔自主神经全直肠系膜切除术患者设为对照组,比较两组患者的手术相关指标、肿瘤相关指标、性功能、排尿功能障碍及术后局部复发情况。结果:1观察组患者的术中出血量、术后肠功能恢复时间、术后恢复饮食时间和术后下床活动时间明显少于或短于对照组(P0.05),全程手术时间长于对照组(P0.05),两组术后并发症的发生率比较无显著性差异(P0.05);2术后,随访患者1年,观察组患者勃起功能障碍、射精功能和排尿功能障碍的发生率均明显低于对照组(P0.05);两组患者1年后局部复发率比较无明显差异(P0.05)。结论:腹腔镜下实施TME+PANP手术治疗男性直肠癌可在根治的基础上,降低对患者排尿和性功能的影响,值得在临床进一步推广。     

坦洛新对输尿管下段结石患者体外冲击波碎石术后排石及血清IL-6，IL-10和CRP水平的影响

目的:探讨输尿管下段结石行体外冲击波碎石术(ESWL)后应用坦洛新辅助排石的临床效果及对患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)水平的影响。方法:选取我院2015年1月～2016年12月收治的122例输尿管下段结石患者,采用随机数字表法均分为两组。于ESWL术后,对照组给予硝苯地平治疗,观察组予以坦洛新治疗。记录比较两组术后排石效果、疼痛情况,治疗前后血清IL-6、IL-10和CRP水平的变化及不良反应的发生情况。结果:治疗后,观察组无石率(91.8%)明显高于对照组(78.7%)(P0.05);观察组排石时间短于对照组,排石直径大于对照组(P0.05);观察组患者血清IL-6,IL-10及CRP水平均显著低于对照组(P0.05)。与对照组相比,观察组肾绞痛发生率、镇痛剂使用率及VAS评分均较低(P0.01)。用药期间,两组均未发生明显不良反应(P0.05)。结论:坦洛新能有效提高输尿管下段结石患者体外冲击波碎石术的排石效果,减轻机体损伤,缓解术后疼痛,并且安全性较高。     

七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响

目的:分析七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响。方法:选取我院妇科收治行腹腔镜子宫肌瘤摘除术患者148例,采取数字随机法分成观察组和对照组,观察组采取七氟醚-瑞芬太尼静吸复合麻醉,对照组采取丙泊酚-瑞芬太尼静脉复合麻醉,比较两组麻醉方式对术后认知功能的影响。结果:对照组患者术后1天认知功能评分低于术前1天,差异有统计学意义(P0.05)。观察组患者术后1天认知功能评分高于对照组,差异有统计学意义(P0.05)。对照组患者术后1天TMT完成时间慢于术前1天,差异有统计学意义(P0.05)。观察组患者术后1天TMT完成时间快于对照组,差异有统计学意义(P0.05)。观察组患者术后呼吸抑制、恶心呕吐、躁动、嗜睡、头晕发生率均低于对照组,差异有统计学意义(P0.05)。结论:七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响较小,并且比较安全,是较为适宜的麻醉方法。     

中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果评价

目的:评价中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果和安全性。方法:选择2013年12月至2016年9月我院收治的60例宫颈癌术后出现尿潴留症状的患者,按其意愿将其分为对照组(30例)与研究组(30例),对照组接受水流声诱导、盆底肌锻炼等常规治疗方法,研究组在对照组基础上加以中医多途径综合疗法,比较两组治疗前后中医症状症状积分、自主排尿功能恢复时间、膀胱残余尿量、尿路感染率等情况。结果:治疗前,两组排尿无力、小腹坠胀、倦怠乏力、腰膝酸软积分比较差异均无统计学意义(P0.05);治疗后,两组以上指标均较治疗前明显降低,且研究组小腹胀痛、倦怠乏力积分均明显低于对照组,差异具有统计学意义(P0.05);研究组自主排尿功能恢复时间、膀胱残余尿量均明显低于对照组,差异具有统计学意义(P0.05);研究组尿路感染率为6.78%,明显低于对照组(23.33%),差异具有统计学意义(P0.05)。结论:中医多途径综合疗法治疗宫颈癌术后尿潴留的疗效肯定,可明显缩短病程,并降低尿路感染发生率。     

坦洛新联合托特罗定对老年膀胱过度活动综合症患者P2X3受体表达的影响

目的:探讨坦洛新联合托特罗定对老年膀胱过度活动综合症患者P2X3受体表达的影响。方法:收集我院收治的膀胱过度活动综合症患者60例,随机分为对照组和实验组,每组各30例,对照组患者给予盐酸坦洛新缓释胶囊,实验组患者在对照组的基础上给予酒石酸托特罗定。观察并比较所有患者的最大尿流速率、膀胱残余尿量、排尿次数、单次最大尿量水平以及患者的治疗效果。结果:治疗后,两组患者治疗后单次最大尿量、最大尿流速率均升高(P0.05),膀胱残余尿量、排尿次数以及P2X3水平均降低(P0.05);与对照组相比,实验组患者治疗后单次最大尿量、最大尿流速率较高(P0.05),膀胱残余尿量、排尿次数以及P2X3水平较低(P0.05);实验组患者临床总有效率与对照组相比较高(P0.05)。结论:坦洛新联合托特罗定能够显著提高老年膀胱活动度综合征患者临床疗效,可能与其降低患者血清P2X3受体水平有关。     

In vitro and in vivo evaluation of guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride

The objective of the study was to develop guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride. Matrix tablets of diltiazem hydrochloride, using various viscosity grades of guar gum in 2 proportions, were prepared by wet granulation method and subjected to in vitro drug release studies. Diltiazem hydrochloride matrix tablets containing either 30% wt/wt lowviscosity (LM1), 40% wt/wt medium-viscosity (MM2), or 50% wt/wt high-viscosity (HM2) guar gum showed controlled release. The drug release from all guar gum matrix tablets followed first-order kinetics via Fickian-diffusion. Further, the results of in vitro drug release studies in simulated gastrointestinal and colonic fluids showed that HM2 tablets provided controlled release comparable with marketed sustained release diltiazem hydrochloride tablets (D-SR tablets). Guar gum matrix tablets HM2 showed no change in physical appearance, drug content, or in dissolution pattern after storage at 40°C/relative humidity 75% for 6 months. When subjectd to in vivo pharmacokinetic evaluation in healthy volunteers, the HM2 tablets provided a slow and prolonged drug release when compared with D-SR tablets. Based on the results of in vitro and in vivo studies it was concluded that that guar gum matrix tablets provided oral controlled release of water-soluble diltiazem hydrochloride. Published: June 30, 2005     

Design and evaluation of 1- and 3-layer matrices of verapamil hydrochloride for sustaining its release

The present study was performed to design oral controlled delivery systems for the water-soluble drug, verapamil hydrochloride, using natural and semisynthetic polymers as carriers in the forms of 1- and 3-layer matrix tablets. Verapamil hydrochloride 1-layer matrix tablets containing hydroxypropylmethylcellulose, tragacanth, and acacia either alone or mixed were prepared by direct compression technique. 3-layer matrix tablets were prepared by compressing the polymers as release retardant layers on both sides of the core containing the drug. The prepared tablets were subjected to in vitro drug release studies. Tragacanth when used as the carrier in the formulation of 1- and 3-layer matrices produced satisfactory release prolongation either alone or in combination with the other 2 polymers. On the other hand, acacia did not show enough prolonging efficiency in 1- and 3-layer matrix tablets. The results also showed that the location of the polymers in the 3-layer tablets has a pronounced effect on the drug release. Kinetic analysis of drug release from matrices exhibiting sustained release indicated that release was predominantly attributable to the contribution made by Fickian diffusion, while the erosion/relaxation mechanisms had a minor role in the release. Published: December 7, 2005     

排石汤联合盐酸坦洛新辅助体外冲击波碎石术治疗上尿路结石的临床疗效分析

目的:探讨排石汤联合盐酸坦洛新辅助体外冲击波碎石术(ESWL)治疗上尿路结石的临床疗效。方法:选择我院2015年1月~2016年9月收治的120例上尿路结石患者,采取随机数字表将其分成两组,每组60例。两组患者均行ESWL治疗,并于术后辅助使用盐酸坦洛新,观察组在上述治疗基础上联合排石汤治疗,对比两组的临床疗效以及治疗前后血清肌酐(Scr)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cys-C)、肾小球滤过率(GFR)水平的变化情况。结果:观察组总有效率为96.60%,对照组为86.67%,观察组总有效率明显高于对照组(P0.05)。观察组结石排净率为95.00%,明显高于对照组(P0.05);肾绞痛发生率为6.67%,明显低于对照组(P0.05),结石排出时间、血尿持续时间均显著短于对照组(P0.01)。两组1年复发率对比差异无统计学意义(P0.05)。两组患者术后2 h、1 d血清NGAL、Cys-C水平逐渐升高,GFR逐渐下降,术后3 d上述指标逐渐恢复。观察组术后1 d、3 d NGAL、Cys-C水平明显低于对照组,GFR明显高于对照组(P0.01)。两组术前术后各时点Scr比较差异均无明显统计学意义(P0.05)。结论:排石汤联合盐酸坦洛新辅助ESWL治疗上尿路结石的临床疗效显著,并可有效改善ESWL引起的肾损伤。     

壳愈宁对混合痔术后肛缘水肿的临床疗效观察

目的:观察壳愈宁(壳聚糖生物喷膜剂)对混合痔术后肛缘水肿的临床疗效。方法:将我院肛肠外科2007年1月-2010年12月混合痔术后患者80例随机分为对照组、治疗组两组,每组40例,对照组常规换药,治疗组加用壳愈宁外喷治疗,疗程1周。结果:治疗组治疗后肛缘水肿的减轻程度与对照组比较有显著性差异(P<0.01),具有统计学意义。结论:壳愈宁对于混合痔术后水肿有确切的治疗效果,适合临床应用。     

Fabrication of Triple-Layer Matrix Tablets of Venlafaxine Hydrochloride Using Xanthan Gum

The objective of present investigation was to develop venlafaxine hydrochloride-layered tablets for obtaining sustained drug release. The tablets containing venlafaxine hydrochloride 150 mg were prepared by wet granulation technique using xanthan gum in the middle layer and barrier layers. The granules and tablets were characterized. The in vitro drug dissolution study was conducted in distilled water. The tablets containing two lower strengths were also developed using the same percentage composition of the middle layer. Kinetics of drug release was studied. The optimized batches were tested for water uptake study. Radar diagrams are provided to compare the performance of formulated tablets with the reference products, Effexor XR capsules. The granules ready for compression exhibited good flow and compressibility when xanthan gum was used in the intragranular and extragranular fractions. Monolayer tablets failed to give the release pattern similar to that of the reference product. The drug release was best explained by Weibull model. A unified Weibull equation was evolved to express drug release from the formulated tablets. Lactose facilitated drug release from barrier layers. Substantial water uptake and gelling of xanthan gum appears to be responsible for sustained drug release. The present study underlines the importance of formulation factors in achieving same drug release pattern from three strengths of venlafaxine hydrochloride tablets.     

Bilayer Matrix Tablets for Prolonged Actions of Metformin Hydrochloride and Repaglinide

A combination therapy of metformin hydrochloride (MH) and repaglinide (RG) achieves a perfect glycemic control; however, the combination formulation of immediate release must be taken several times a day, compromising the therapeutic benefits and causing inconveniences to the patients. Herein, a bilayer matrix tablet that aimed at continuously releasing both MH and RG over time was developed, in which the two drugs were formulated into two separated layers. The tablets were prepared by wet granulation method, and the optimized formulation was obtained by evaluating the factors that affected the drug release. The bilayer tablets simultaneously released the two drugs over 12 h; and a better in vivo performance with a steady plasma concentration, markedly lower C_max, prolonged T_max, and perfect absorption was obtained. Summarily, the bilayer matrix tablets sustained both MH and RG release over time, thereby prolonging the actions for diabetic therapy and producing better health outcomes.KEY WORDS: bilayer tablets, metformin hydrochloride, pharmacokinetics, repaglinide, sustained release     

Development and Evaluation of a Novel Modified-Release Pellet-Based Tablet System for the Delivery of Loratadine and Pseudoephedrine Hydrochloride as Model Drugs

Modified-release multiple-unit tablets of loratadine and pseudoephedrine hydrochloride with different release profiles were prepared from the immediate-release pellets comprising the above two drugs and prolonged-release pellets containing only pseudoephedrine hydrochloride. The immediate-release pellets containing pseudoephedrine hydrochloride alone or in combination with loratadine were prepared using extrusion–spheronization method. The pellets of pseudoephedrine hydrochloride were coated to prolong the drug release up to 12 h. Both immediate- and prolonged-release pellets were filled into hard gelatin capsule and also compressed into tablets using inert tabletting granules of microcrystalline cellulose Ceolus KG-801. The in vitro drug dissolution study conducted using high-performance liquid chromatography method showed that both multiple-unit capsules and multiple-unit tablets released loratadine completely within a time period of 2 h, whereas the immediate-release portion of pseudoephedrine hydrochloride was liberated completely within the first 10 min of dissolution study. On the other hand, the release of pseudoephedrine hydrochloride from the prolonged release coated pellets was prolonged up to 12 hr and followed zero-order release kinetic. The drug dissolution profiles of multiple-unit tablets and multiple-unit capsules were found to be closely similar, indicating that the integrity of pellets remained unaffected during the compression process. Moreover, the friability, hardness, and disintegration time of multiple-unit tablets were found to be within BP specifications. In conclusion, modified-release pellet-based tablet system for the delivery of loratadine and pseudoephedrine hydrochloride was successfully developed and evaluated.     

壳愈宁对混合痔术后肛缘水肿的临床疗效观察

目的：观察壳愈宁（壳聚糖生物喷膜剂）对混合痔术后肛缘水肿的临床疗效。方法：将我院肛肠外科2007年1月．2010年12月混合痔术后患者80例随机分为对照组、治疗组两组,每组40例,对照组常规换药,治疗组加用壳愈宁外喷治疗,疗程1周。结果：治疗组治疗后肛缘水肿的减轻程度与对照组比较有显著性差异（P〈0．01）,具有统计学意义。结论：壳愈宁对于混合痔术后水肿有确切的治疗效果,适合临床应用。     

两种微创术式治疗老年混合痔的临床疗效比较

目的:比较两种微创手术方式治疗老年混合痔的临床疗效和安全性。方法:选取2012年10月至2013年4月在湖南中医药大学第一附属医院肛肠科住院的162例老年混合痔患者并随机分成治疗组82例和对照组80例,治疗组采用自动痔疮套扎(RPH)术+外痔切除术治疗,对照组采用痔上粘膜环切钉合(PPH)术+外痔切除术治疗,观察周期为21天,随访3年。观察并比较分析两组患者术后疼痛积分、手术时间、术中出血量、术后恢复时间、术后并发症情况及远期疗效。结果:治疗组手术时间、术中出血量、术后恢复时间、术后24 h疼痛积分、首次排便疼痛积分及术后并发症(出血、水肿)的发生率均明显短于或低于对照组,差异有统计学意义(P0.05)。两组的远期疗效相当,差异无统计学意义(P0.05)。结论:自动痔疮套扎(RPH)术治疗老年混合痔患者的近期疗效和安全性较粘膜环切钉合(PPH)术+外痔切除术更好,而远期疗效与其相当。