胃楔形切除术致胃电节律改变的实验观察

目的：观察楔形切除胃的不同部位对术后胃电节律的影响。方法：将30只雄性新西兰兔按照完全随机原则分为胃体近端楔形切除组、胃体远端楔形切除组及对照组3个处理组,每组10只。记录在自然恢复状态下术后3日、6日、9日胃体近端及胃窦处30分钟内慢波总数及正常慢波次数并计算正常慢波百分比。用析因设计分析切除部位、测量部位、术后时间三因素对胃慢波节律的影响。结果：上述三因素均对术后慢波节律有影响,切除胃体近端与切除胃体远端相比,前者引发的术后胃电节律紊乱的程度更严重且恢复更缓慢;术后测量胃窦处与测量胃体处相比,前者发生的胃电节律紊乱的程度更严重且恢复更缓慢。结论：大弯侧胃底与胃体交医院界处的“胃电起始区域”即为“胃电起搏区”,“胃电起搏区”的切除时术后胃电节律的影响大于传导区域切除对其影响、     

胃多导电刺激及胃液体排空犬动物模型的建立

目的建立胃浆膜多导联电刺激和胃排空动物模型。方法在12条英国比格犬的胃大弯浆膜层包埋四对心内起搏电极,距幽门40cm空肠近端行一造瘘口。结果①造瘘管收集食糜的方法简单易行,通过其排空量,能了解不同的电刺激和不同的电刺激参数对胃动力的作用。②胃浆膜多导联电极记录的胃体、胃窦慢波电信号清晰、稳定,能准确地记录不同时间和不同实验的胃慢波变化。③单导联和多导长脉冲电刺激均能控制胃慢波。结论胃浆膜多导联电极是研究胃电生理、胃电起搏及胃电起搏对胃排空的影响较理想的方法。英国比格犬是此模型的理想材料。     

P物质尾核微量注射抑制小鼠胃肌电活动和胃运动

本文观察了小鼠尾核微量注射Ｐ物质或乙酰胆碱对胃肌电和胃运动的ｍ影响;并初步探讨了两者作用的关系。用双极康铜导线引导胃窦部肌电;用水囊连接压力换能器记录胃窦部运动。上述信息经生物电放大器和载波放大器放大后,由四道记录仪描记曲线,同时输入微机进行采集、贮存和处理。计算出注药前后每分钟胃肌电快波、慢波和胃运动波的频率和总幅度的变化百分数。结果如下：尾核注射ＳＰ或ＡＣｈ胃电快波和胃运动呈明显的抑制效应。用     

电针对狗胃电的影响

在狗胃壁埋植慢性电极,观察了电针对胃电的影响,实验结果显示,在清醒空腹情况下,胃电节律为每分钟5次左右,每一周期中以慢波为主,在有的情况下出现快波。进食时此节律减慢或紊乱,进食后快波成分增加,电针足三里穴,对慢波的影响很小,但能明显的增加快波振幅与摆动频率;这种变化在电针停止后仍能持续40-60分钟。吗啡能引起胃电节律的反复紊乱,对胃电快波的影响,表现为先增强后抑制的双相性变化。     

关于胃电的研究

本文对胃电的特征、胃电与胃运动的关系、影响胃电的各种因素等生理学的新进展作了简要的介绍。也提出了胃电的临床应用和目前存在的问题。胃电分为慢波和快波。慢波也称为基础电节律,是一种比较规律的在任何生理情况下都能记录到的电波,在切除神经组织后仍能节律地发生,因此是肌原性的;这种波发生后不伴有肌肉收缩,为具有自律性的纵行平滑肌细胞所特有。胃电快波是负载于胃电慢波之上或其后的一系列峰电位,是胃运动的动作电位。故只有在胃运动时才有。胃电慢波的节律决定着每组胃电快波和胃运动的节律。神经系统和胃肠道的激素都能影响胃电活动。但关于这方面的研究,目前还存在着很多问题。     

清醒猫摄食过程中的胃电活动

本文报告慢性清醒猫正常摄食过程中胃电的变化,以及脑室注射心得安和动物麻醉对胃电的影响。结果显示,空腹饥饿状态下,猫胃电图上出现具有特征性的高振幅的“饥饿波”;摄食时胃电慢波抑制,可见较小快波;进食后半小时左右,胃电开始出现每分钟4—5次的振幅逐渐增大的正弦形慢波,多数慢波负载有快波。脑室注射心得安,可使饱猫胃电慢波抑制期出现饥饿波。动物在饥饿时麻醉,胃电慢波幅度显著降低,饥饿波完全不出现,苏醒后逐渐恢复。     

近端胃切除与全胃切除在治疗近端胃癌中的疗效比较

目的:观察近端胃切除和全胃切除对近端胃癌的疗效。方法:比较28例患有早期近端胃癌接受近端胃切除28例患者与100例患有早期近端胃癌接受全胃切除的患者,观察近端胃切除是否优于全胃切除。结果:两种治疗方法手术时间、术后并发症(包括吻合口瘘)没有差异。两组患者胃切除后的代谢变化结果相似,体重,血清血红蛋白以及血清总蛋白浓度变化相近。近端胃切除后腹泻(32%)和胃食管返流(28%)最为常见,而全胃切除后餐后腹胀(21%)最为常见。二者的术后5年生存率没有明显差别。结论:近端胃切除不会由于残余胃的生理优势而优于全胃切除术。     

刺激尾核对狗胃电的影响

在狗的急性实验中,刺激尾核对胃电快波和胃的运动功能呈双相性影响。当刺激尾核时.引起胃电快波活动减弱,胃紧张度及其节律收缩的波幅降低,在刺激结束后甚或在刺激末期,胃电快波则增强,胃紧张度增高,胃节律收缩的波幅增大。刺激尾核对胃电慢波的周期和振幅影响较小,且表现多种形式,但多数实验在给予刺激后先表现为周期延长,振幅略有增高,继而发生周期缩短,延长,波幅减小增大的交替性波动。同时观察到胃紧张度与胃节律收缩的强度,决定于胃电快波的活动,与胃电慢波的关系不明显.     

银杏内酯对大鼠胃平滑肌电活动的作用

目的：探讨银杏叶提取物银杏内酯Ａ对胃肌电活动的影响。方法：离体灌注大鼠胃平滑肌标本,细胞外记录方法观察用药后平滑肌自发电活动的变化特点及其规律。结果：银杏内酯Ａ在１μｍｏｌ／Ｌ浓度时可显著压抑甚或消除外源性乙酰胆碱所倡导的峤民位活动增强作用（ｎ＝１２,Ｐ〈０．０１）,但对平滑肌的正常慢波和自发峰电位活动无明显影响;在较高浓度（５０μｍｏｌ／Ｌ）时,银杏内酯Ａ则使胃电慢波频率较对照增加,峰电位的活动     

十二指肠内胆盐对胃肌电和运动的影响及其神经机制探讨

本文观察了牛磺胆酸钠(ST)灌入小鼠十二指肠后胃肌电快波、慢波和胃收缩波的变化,并对其神经机制作了探讨。用胃壁双电极和胃内水囊-压力换能器法将胃电和胃运动信号输至放大器,然后由记录仪及电子计算机对该信号进行记录、采集、贮存和处理。以5min为单位,计算出灌注 ST 前、后胃电快波、慢波和收缩波频率与总幅度变化的百分数。结果为:十二指肠灌注 ST(n=10)后,胃电快波频率、幅度和收缩波幅度明显抑制。腹腔神经丛麻醉,利血平化和碳酰胆碱可消除 ST 引起的抑制效应。酚妥拉明不能去除该抑制效应,心得安可部分消除 ST 的抑制效应。上述结果表明,十二指肠灌注 ST 对胃电快波和胃运动有抑制效应,并提示该抑制效应的神经传出途径可能为交感肾上腺素能纤维,由β受体介导。     

Gastric Electrical‐Stimulation Effects on Canine Gastric Emptying,Food Intake,and Body Weight

Objective: It has been reported that electrical stimulation at the distal stomach can disrupt intrinsic gastric electrical activity and delay gastric emptying. Gastric dysrhythmia and impaired gastric emptying are associated with upper gastrointestinal symptoms and weight loss. The purpose of this study was to evaluate the effect of low‐frequency/long‐pulse gastric electrical stimulation (GES), at proximal and distal stomach, on canine gastric emptying, food intake, and body weight. Research Methods and Procedures: Eight dogs were surgically implanted with four pairs of electrodes along the greater curvature and a gastric tube at the dependent part of the stomach. Liquid gastric emptying at baseline, during proximal and distal GES at 6 cycles per minute, was assessed first by a dye dilution technique. Proximal and distal GES were then randomly delivered during feeding for 10 consecutive days, and food intake and body weight were recorded daily. Results: There was no significant difference in gastric emptying parameters among the various sessions. The mean daily food consumption was significantly reduced during both sessions of GES, resulting in significant immediate weight loss. Percentage weight loss was comparable between both sessions of GES. Discussion: Short‐term GES significantly reduced canine food intake and weight. This effect may not be related to changes in gastric emptying. GES may have a potential role in the treatment of obesity.     

胃炎性纤维性息肉的临床特征及内镜下诊治

摘要 目的：研究胃炎性纤维性息肉（IFP）的临床特征及内镜下诊断和治疗情况。方法：收集2010.1.1~2021.1.1陕西省人民医院确诊的11例IFP,重点分析其超声内镜表现及临床特征,探索其内镜下治疗价值。结果：IFP多发生在胃窦,均发生于40岁以上人群,男女比例无明显差别,平均直径1.2 cm,大部分临床无症状,有时可引起出血或腹痛。超声内镜示其为粘膜下隆起,孤立、界清,表面多光滑,均起源于粘膜下层,呈低回声,界清,类圆形;内镜下粘膜挖除术治疗IFP,手术时间短,恢复快,并获得完整的标本,术后病理有助确诊。结论：胃炎性纤维性息肉多发生40岁以上人群,多为胃窦孤立的粘膜下病变,多无症状,超声内镜有助于IFP的术前精确评估,内镜下粘膜挖除术是治疗IFP一项安全有效的方法,术后病理最终确诊。     

The Best Gastric Site for Obtaining a Positive Rapid Urease Test

Background Rapid urease tests (RUTs) provide a simple, sensitive method of detecting Helicobacter pylori infection.
Objectives. Our aim, therefore, was to determine whether the yield of detecting H. pylori infection by RUT varied depending on the site of gastric biopsy.
Materials and Methods. Gastric biopsies were obtained from 50 patients for RUT by use of hp fast (GI Supply, Camp Hill, PA). Biopsies were taken from the prepyloric greater curve antrum, from the gastric angle, and from the greater curve in mid-corpus. One biopsy specimen was placed in the RUT gel, and the biopsy from the adjacent mucosa was placed in formalin for subsequent histological evaluation by using the Genta stain. RUTs were examined and scored at intervals of 5, 10, 15, 30, and 45 minutes and after 1, 2, 4, and 24 hours.
Results. Fifty patients were entered in the test (150 RUTs), 32 having H. pylori infection. There were no false-positive RUTs (specificity, 100%). The gastric angle site was positive in 100%. The prepyloric site was positive in 87%, and the corpus site was positive in 84.4% ( p < .052 for angle or prepyloric antrum versus corpus). The most common pattern was for all to be positive (74%). The median time to positivity was similar with angle and prepyloric sites (37.5 and 60 minutes, respectively, p = not significant) and shorter than the corpus biopsy (180 minutes); ( p < .05 for angle or prepyloric antrum versus corpus).
Conclusion. The maximum probability for detecting H. pylori infection using a RUT is to obtain a biopsy from the gastric angle. To prevent missing a positive result when intestinal metaplasia is present, we recommend that (at a minimum) biopsies be taken from both the angle and the corpus.     

胃癌患者术后生存质量与心理健康调查及干预效果探讨

目的:调查胃癌患者术后的生活质量及心理健康状况,探讨护理干预对胃癌患者术后恢复的积极意义,为胃癌的围术期护理提供参考。方法:选取2009年7月-2012年1月在我院接受手术治疗的胃癌患者70例,手术治疗方式根据患者的具体情况采用肿瘤剔除术、近端胃切除、远端胃切除及胃大切除术等。按照术后所采取的护理方式,将所选病例分为干预组和对照组。观察并比较两组患者治疗前后的焦虑、抑郁发生率及生活质量的评分变化。结果:对照组焦虑发生率为76.6%,抑郁发生率为83.3%;干预组焦虑发生率为55%,抑郁发生率为50%。干预组患者焦虑及抑郁的发生率显著低于对照组患者(P0.05)。两组患者治疗后的生理机能、躯体疼痛、社会功能、情感功能及认知功能评分均比治疗前有所改善,干预组患者改善更明显,差异具有统计学意义(P0.05)。结论:护理干预不仅可以缓解胃癌患者术后出现的负面情绪,而且有利于改善患者术后的生存质量,值得在临床进一步推广。     

Changing pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the gastric mucosa and gastroesophageal junction

It is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a different pathogenesis. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett's esophagus or whether it is related to a generalized atrophic process of the stomach. Data from recent studies regarding the expression of cytokeratin CK7 and CK20 in intestinal metaplasia (IM) found at the gastroesophageal junction are conflicting. Prompted by these data we undertook the present study: a) to evaluate the expression of CK7 and CK20 in IM of the gastric cardia and to compare the findings with those in patients with Barrett's esophagus and IM of the gastric corpus and antrum mucosa; and b) to evaluate the immunophenotype of non-intestinalized cardiac mucosa and to compare it with that of normal gastric epithelium. We studied the expression of CK7 and CK20 on biopsy specimens from patients with long-segment Barrett's esophagus (n=17) and surgical resection and biopsy specimens of gastric cardia (n=15), corpus (n=14) and antrum (n=22) from patients with histological evidence of IM. Eighty-four biopsy specimens from 42 patients (antrum n=15, corpus n=20, cardia n=7) without evidence of IM were studied as a control group. We observed an immunophenotype characterised by diffuse moderate to strong CK7 staining on the surface and crypt epithelium combined with strong CK20 staining on the surface and superficial part of the crypts in 94.1% (16/17) of the cases with long-segment Barrett's esophagus, but in none of the 36 cases with IM in distal stomach (antrum and corpus). IM in the gastric cardia expressed the immunophenotype seen in IM of the gastric mucosa in 93.3% (14/15) of the cases. On the other hand, normal cardiac epithelium expressed patchy strong CK7 staining on the surface epithelium and on both, superficial and deep parts of the pits combined with patchy strong CK20 staining on the surface epithelium and superficial pits, a feature permitting distinction of the normal cardiac epithelium from those of the normal gastric antrum and corpus epithelium. We conclude that the expression of cytokeratins 7 and 20 can be used to distinguish the origin of IM of the gastroesophageal junction. The CK7/20 immunophenotype of IM in the gastric cardia closely resembles that of the IM in the gastric antrum and corpus and is different from IM in long-segment Barrett's esophagus. In contrast, the CK7/20 immunophenotype of the cardiac epithelium is different from that of the gastric antrum and corpus mucosa, suggesting that cardiac epithelium might not be a native normal gastric epithelium but one that is acquired as a consequence of longstanding inflammation. Changing pattern of CK7 and CK20 expression from normal to intestinalized epithelium suggests that IM arising from cardiac epithelium might have distinctive features.     

Effects of aspirin on gastric mucus glycoprotein in fed and fasted rats

Gastric lesions induced by aspirin increased the ulcer index and incidence with prolongation of fasting time. Aspirin decreased gastric mucus glycoprotein in both the corpus and antrum. However, the rate of decrease in mucus glycoprotein induced by aspirin differed according to feeding habits and the gastric region. Qualitative change in corpus mucus glycoprotein was induced by aspirin.