经腹胃切开途径放置经皮内镜下胃造口管在晚期喉癌病人中的应用

目的:报道在晚期伴食管完全梗阻的喉癌病人中通过经腹胃切开途径成功放置经皮内镜下胃造口管的应用体会。方法:18例喉癌术后复发伴食管完全梗阻的病人,在局麻或硬膜外麻醉下经腹胃切开途径放置经皮內镜下胃造口管,术后行肠内营养支持。结果:16例在局麻下、2例在硬膜外麻醉下成功放置经皮內镜下胃造口管,手术平均时间32.1±5.8分钟,无手术及导管相关性并发症发生。结论:经腹胃切开途径放置经皮內镜下胃造口管是安全、简便及有效的营养支持途径,术后耐受好、易于护理,适合喉癌伴食管完全梗阻病人建立长期营养支持途径的需要。     

超声定位下经皮肾镜碎石术并发症的防治进展

泌尿外科工作大约有三分之一与结石有关,其中较为复杂的是肾结石的治疗。肾结石的治疗除一般药物治疗外,常用的手段有开放手术、体外震波碎石、经皮肾镜碎石和输尿管软镜碎石。     

E-cadherin在胃癌术后复发预测中的临床意义

目的:探讨E-cadherin在胃癌术后复发预测中的临床意义。方法:选择我院2006年1月至2010年7月收治的胃癌或者胃食管连接部癌行胃癌根治性切除术后259例患者为研究对象,将其分为术后复发组(115例)和术后未复发组(144例),采用免疫组织化学方法检测其E-cadherin的表达,并分析E-cadherin的异常表达与胃癌术后复发的相关性。结果:胃癌癌旁正常组织与胃癌组织间E-cadherin的表达有显著差异(P0.05);胃癌术后复发与未复发患者的胃癌组织E-cadherin的表达比较有显著差异(P0.05)。E-cadherin的异常表达与胃癌的浸润深度、淋巴结转移和TNM分期显著相关(P0.05)。单因素Logistic回归分析发现,E-cadherin的异常表达的与胃癌术后复发有显著的相关性(P=0.039,RR=1.711,95%Cl为1.486-1.970)。结论:E-cadherin的异常表达与胃癌根治性切除术后复发显著相关。     

饮食提示卡在经皮冠状动脉介入治疗术后患者中的应用

目的:探讨饮食提示卡在经皮冠状动脉介入治疗(PCI)术后患者护理中的临床效应。方法:选取62例冠心病行PCI治疗术后患者,随机分为对照组和试验组,各31例。对照组采用常规护理,试验组在对照组的基础上采用饮食提示卡进行护理干预,比较两组患者血压、血脂、血糖的控制情况,饮食知识的知晓率,治疗的依从性以及护理的满意度。结果:实施干预后,试验组血压、血脂、血糖的控制率优于对照组(P0.05),饮食知识知晓率高于对照组(P0.01),治疗的依从性与护理的满意度优于对照组(P0.01)。结论:饮食提示卡能使PCI术后患者对危险因素进行有效地控制,提高对知识的掌握,增加治疗的依从性,提高护理质量。     

饮食提示卡在经皮冠状动脉介入治疗术后患者中的应用

目的：探讨饮食提示卡在经皮冠状动脉介入治疗（PCI）术后患者护理中的临床效应。方法：选取62例冠心病行PCI治疗术后患者,随机分为对照组和试验组,各31例。对照组采用常规护理,试验组在对照组的基础上采用饮食提示卡进行护理干预,比较两组患者血压、血脂、血糖的控制情况,饮食知识的知晓率,治疗的依从性以及护理的满意度。结果：实施干预后．试验组血压、血脂、血糖的控制率优于对照组（P〈0．05）,饮食知识知晓率高于对照组（P〈0．01）,治疗的依从性与护理的满意度优于对照组（P〈0．01）。结论：饮食提示卡能使PCI术后患者对危险因素进行有效地控制,提高对知识的掌握,增加治疗的依从性,提高护理质量。     

医患通平台在经皮冠状动脉介入治疗术后患者中的应用

目的：探讨医患通平台对经皮冠状动脉介入治疗（PCI）术后患者进行护理的临床效应。方法：选取54例冠心痛行PCI治疗术后患者,随机分为对照组和试验组,各27例。对照组采用常规护理,试验组在对照组的基础上采用医患通平台进行护理干预,比较两组患者血压、血脂、血糖的控制情况,主要不良心脏事件（MACE）的发生情况,并采用汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）对两组患者进行心理状况调查。结果：实施干预后,试验组血压、血脂、血糖的控制率优于对照组（P〈0．05）,MACE的发生率低于对照组（P〈0．05）;两组患者两组干预前HAMA、HAMD评分比较无明显差异（P〉0．05）,干预后试验组患者HAMA评分、HAMD评分有所下降,与干预前及对照组比较差异显著（P〈O．01）,对照组干预前后无变化（P〉0．05）。结论：医患通平台能有效地让PCI术后患者对危险因素进行控制,降低MACE的发生,改善患者的负性情绪,是较好的健康教育方式．     

医患通平台在经皮冠状动脉介入治疗术后患者中的应用

目的:探讨医患通平台对经皮冠状动脉介入治疗(PCI)术后患者进行护理的临床效应。方法:选取54例冠心病行PCI治疗术后患者,随机分为对照组和试验组,各27例。对照组采用常规护理,试验组在对照组的基础上采用医患通平台进行护理干预,比较两组患者血压、血脂、血糖的控制情况,主要不良心脏事件(MACE)的发生情况,并采用汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)对两组患者进行心理状况调查。结果:实施干预后,试验组血压、血脂、血糖的控制率优于对照组(P0.05),MACE的发生率低于对照组(P0.05);两组患者两组干预前HAMA、HAMD评分比较无明显差异(P0.05),干预后试验组患者HAMA评分、HAMD评分有所下降,与干预前及对照组比较差异显著(P0.01),对照组干预前后无变化(P0.05)。结论:医患通平台能有效地让PCI术后患者对危险因素进行控制,降低MACE的发生,改善患者的负性情绪,是较好的健康教育方式。     

丽珠肠乐在胃癌术后早期化疗中的应用

目的 :探讨丽珠肠乐在术后早期化疗中对消化道及骨髓造血系统的保护作用。方法 :胃癌术后第 2～ 7天以 5 -氟尿嘧啶 (5 - Fu) +甲酰四氢叶酸钙 (CF) +羟基喜树碱 (HCPT)进行辅助化疗 ,所有患者随机分成 2组 ,治疗组在化疗同时给予丽珠肠乐 1～ 2粒 ,3次 / d,另一组作对照。结果 :治疗组 6 3例 ,患者均耐受良好 ,无中途停药 ,无吻合口瘘及全身严重感染病例。血象低于 3.5× 10 9个 / L 共 8例 ,其中治疗组 3例 ,对照组 5例 ,发生率分别为 4.8%与 11% ,P<0 .0 5。腹泻 (稀溏便 3次 / d以上 )共 7例 ,其中治疗组 1例 ,对照组 6例 ,发生率分别为 1.6 %与 13% ,P<0 .0 5。结论 :丽珠肠乐可减轻胃癌术后早期联合化疗的消化道及骨髓造血系统副反应 ,使之更安全可行。     

经皮电穴位电刺激足三里穴对胃癌患者术后血清IgG、IgM水平的影响

目的:观察经皮穴位电刺激对胃癌根治术患者术后血清免疫球蛋白M(Ig M)、免疫球蛋白G(Ig G)水平的影响。方法:选择全麻择期行胃癌根治术的患者102例(男88例,女14例),年龄40~75岁,将其随机分为经皮穴位电刺激组、假电刺激组和对照组。经皮电刺激双侧\"足三里\"(ST 36)、\"三阴交\"(SP 6)穴,于手术当日、术后第1日和术后第2日进行经皮电刺激治疗。于术前30分钟、术后24 h、术后72 h采集静脉血标本,测定免疫球蛋白G(Immunoglobulin G,Ig G)、免疫球蛋白M(Immunoglobulin M,Ig M)的水平。术后监测和记录肛门的排气时间。结果:在术后第1天,对照组外周血Ig G水平显著低于术前30分钟(P0.05),TEAS组外周血Ig M水平显著高于术前30分钟(P0.05),TEAS组外周血Ig G和Ig M水平显著高于对照组(P0.05)。在术后第3天,对照组外周血Ig G、Ig M水平显著低于术前30分钟(P0.05),TEAS组外周血Ig G、Ig M水平均显著低于术后1天(P0.05)。三组患者术后肛门排气时间比较无统计学差异(P0.05)。结论:经皮穴位电刺激可以升高胃癌根治术患者术后1天降低的外周血Ig G和Ig M水平,减轻其术后免疫抑制。     

钬激光在胆总管下段嵌顿结石术中的应用

目的探讨钬激光在胆总管下段嵌顿性结石手术中的应用价值。方法通过腹腔镜下胆道镜工作通道,应用钬激光,功率为0．6—0．8J／10Hz,直径为200um光导纤维,在直视下接触结石,将嵌顿结石击碎后注水冲出,或用取石篮套出。结果11例均取石碎石成功,手术时间75—205min,平均95．5min,出血80—130ml,平均89．4ml。平均住院8．2d。术后无胆道出血,胆漏。术后2W照影无结石残留,胆总管下段通畅无胆道狭窄。术后肝功能2W恢复正常6例,5例1月均恢复正常。随访3—6月未见结石复发。结论钬激光治疗胆总管下段嵌顿结石,具有创伤小、恢复快、碎石确切、操作容易、安全有效等优点,为治疗复杂性胆总管结石开辟了一条新的治疗途径。     

Corticotropin-releasing factor inhibits gastric emptying in dogs

The purpose of the present study was to evaluate the effect of ovine corticotropin-releasing factor (CRF) on the gastric emptying of a saline meal in conscious dogs. Intravenous infusion of CRF (220-880 pmol . kg-1 . h-1), induced a significant linear dose dependent inhibition of gastric emptying (16-71%). CRF action was not modified by naloxone and not associated with vomiting or other side effects. Intravenous infusion of sulfated cholecystokinin octapeptide (CCK-8, 50-200 pmol . kg-1 . h-1) inhibited gastric emptying by 29-52%. The relative potency of CRF with respect to CCK-8 is 4 times less. These studies demonstrated that CRF given intravenously in picomolar amount inhibits gastric emptying of a liquid meal in dogs through a mechanism unrelated to opiates. The role of endogenous CRF in stress-induced inhibition of gastric emptying needs to be investigated.     

Effect of CCK and its antagonists on gastric emptying

Cholecystokinin (CCK) belongs to the group of substances known as brain-gut peptides: it functions both as a neuropeptide and a gut hormone. The peptide and its synthetic derivatives (like for instance CCK-8 and the amphibian counterpart caerulein) significantly delay emptying of gastric contents in both animals and humans. The fact that CCK, in doses mimicking postprandial plasma levels, strongly affects emptying rate suggests the peptide to be a physiologic regulator of gastric emptying. Unfortunately, clear definition of the role of CCK in the physiology of gastric motor activity has long been hampered by the lack of specific and potent non-peptide antagonists of CCK-receptors. The availability of such compounds has stimulated a broad array of investigations into the physiological actions of this hormone and examination of its putative role in certain diseases. This paper summarizes the available data concerning the effect of CCK and its antagonists on gastric emptying. The use of selective CCK-antagonists has allowed to establish that the gastric motor effect of the peptide is direct and mediated through the stimulation of CCK-A receptors. As a consequence, CCK-A antagonism results in acceleration of emptying rate under certain experimental and clinical conditions. This peculiar pharmacologic effect of CCK-A antagonists, which could be useful in the treatment of functional dyspepsia (idiopathic or diabetic), gastroparesis and gastro-esophageal reflux disease (where patients often display a delayed emptying rate of solid food) needs to be further investigated, in order to fully explore their potential as gastrokinetic drugs.     

Adaptation to low-protein diet increases inhibition of gastric emptying by CCK

Chronic nutritional disorders such as protein malnutrition are associated with delayed gastric emptying and increased postprandial cholecystokinin (CCK) levels. This study investigated the mechanisms involved in gastric emptying adaptation to low-protein diet. Two groups of 12 rats were adapted to a low-protein (LPD) or standard diet (SD) for 3 weeks. As compared to rats fed a SD, in rats adapted to a LPD gastric emptying was delayed, whereas postprandial CCK levels were increased. LPD enhanced antral muscle contractile response to CCK and cerulein without altering response to acetylcholine. This increased contractility was associated with up-regulation of CCK-A receptor mRNA levels in antral muscle. Our data suggest that modulation of gastric emptying after adaptation to a low-protein diet involves up-regulation of both CCK-A receptors and CCK-induced contraction of antral smooth muscle.     

Regulative effects of essential oil from Atractylodes lancea on delayed gastric emptying in stress-induced rats

Gastric motor dysfunction induced by psychological stress results in many symptoms of functional dyspepsia (FD). There are a number of herbal medicines that are reported to improve gastrointestinal motor. However, the mechanisms of considerable herbal medicines are not explicit. In the present study, the effects of an essential oil (EO) extracted from Atractylodes lancea on delayed gastric emptying, gastrointestinal hormone and hypothalamic corticotropin-releasing factor (CRF) abnormalities induced by restraint stress in rats were investigated and the mechanism of the EO is also explored.Oral administration of EO for 7 days did not affect normal gastric emptying, but accelerated delayed gastric emptying induced by restraint stress in rats. The EO significantly increased the levels of motilin (MTL) and gastrin (GAS) and decreased the levels of somatostatin (SS) and CRF. The EO did not modify gastric emptying in vagotomized rats that underwent restraint stress, but antagonized delayed gastric emptying induced by intracisternal injection of CRF. These results suggest that the regulative effects of the EO on delayed gastric emptying are preformed mainly via inhibition of the release of central CRF and activation of vagal pathway, which are also involved in the release of gastrointestinal hormones such as MTL, GAS and SS.     

Faster gastric emptying for glucose-polymer and fructose solutions than for glucose in humans

This study examined the rates of gastric emptying for water and 13 different carbohydrate-containing solutions in seven subjects, using conventional gastric intubation techniques. The rates of gastric emptying for water and a 10% glucose-polymer solution were also measured during 90 min of treadmill running at 75% of each subject's maximum oxygen consumption (VO2max). At rest, 15% glucose-polymer (P) and fructose (F) solutions emptied more rapidly from the stomach and provided a faster rate of carbohydrate delivery than did a 15% glucose (G) solution (p less than 0.05). The G solutions showed a constant energy delivery rate of 3.3 kcal.min-1; energy delivery from P and F solutions rose with increasing solution concentrations. The osmolality of the gastric aspirate predicted the rate of gastric emptying for all solutions (p less than 0.05) but overestimated rates of emptying for 10% and 15% P solutions and underestimated emptying rates for 10% and 15% F solutions. Exercise at 75% VO2max decreased the rate of gastric emptying of water but not of 10% P solutions. Thus the different rates of gastric emptying for different carbohydrate-containing solutions were not entirely explained by differences in osmolality. Furthermore, exercise may have different effects on the gastric emptying rates of water and carbohydrate solutions.     

Species-specific effects of bombesin on gastric emptying and neurohypophyseal secretion

Previous reports have demonstrated that systemic injection of cholecystokinin (CCK) in rats produces dose-related decreases in food intake, increases in neurohypophyseal secretion of oxytocin (OT), and decreases in gastric emptying. The present studies determined whether systemic injection of bombesin (BBS), another peptide that potently reduces food intake in rats, had similar effects on OT secretion and gastric emptying. Although BBS produces a dose-dependent inhibition of food intake, even very high doses did not significantly affect plasma OT levels and only slightly decreased rates of gastric emptying. Consequently, despite their similar inhibitory effects on food intake, BBS does not appear to activate the same network of central nervous system pathways as does CCK in rats. However, parallel studies in monkeys demonstrated that systemic injection of BBS was effective in stimulating neurohypophyseal secretion of vasopressin rather than OT, in a pattern both qualitatively and quantitatively analogous to the effects of CCK in this species. Together with previous findings that BBS more potently inhibits gastric emptying in primates than in rats, these results therefore also suggest the presence of significant species differences in the central mechanisms by which BBS acts to reduce food intake.     

Latent structure of dermatoglyphics in gastric cancer patients

Gastric cancer is a very common malignant disease, which etiology is still unknown. It is believed that it is caused by a joint activity of both genetic and environmental factors. Gastric cancer between relatives in some families is almost four times higher and in connection with truncating mutations in the E-cadherin gene. The Helicobacter pylori are also established carcinogen and this infection increases the cancer risk by about 5 times. Digito-palmar dermatoglyphics have already been used for determining hereditary base of some malignant diseases (breast, lung, colorectal cancer etc.), which was the encouragement to investigate the latent structure in patients with gastric cancer (36 males and 32 females) and the control groups (50 males and 50 females). The factor analysis has shown that in both males and females with gastric cancer 5 factors were extracted and in males 77.17% and in females 78.92% of total variance was explained, and this result is different from control group where in males 5 factors and 75.97% of total variance were explained while in control females 6 factors and 82.86% of total variance were explained. The finger ridge counts are extracted on the first factor in all groups. In patients the second factor is formed by the first, fourth and fifth fingers, while in controls mostly by palmar variables. From the obtained findings it can be concluded that the results of latent structure in quantitative analysis of digito-palmar dermatoglyphics are affirming the existence of genetic differences in patients suffered with gastric cancer.     

Intracerebroventricular administration of neuronostatin delays gastric emptying and gastrointestinal transit in mice

Neuronostatin is a 13-amino acid amidated peptide widely distributed in various organs including gastrointestinal tract. However, the effect of neuronostatin on gastrointestinal motility has not been well characterized. In the present work, effects of central administration of neuronostatin on gastric emptying and gastrointestinal transit were investigated. The results indicated that intracerebroventricular (i.c.v.) administration of neuronostatin (1, 5, 10 or 20nmol/mouse) delayed gastric emptying and gastrointestinal transit in a dose-related manner in mice. The effects were significantly reversed by melanocortin 3/4 receptor antagonist SHU9119 or classical opioid receptor antagonist naloxone, suggesting that the central melanocortin system and opioid system may be involved in the gastrointestinal effects elicited by i.c.v. administration of neuronostatin. In addition, we found that C-terminal amidation modification of neuronostatin is essential to exert its gastrointestinal effects. These results indicated that neuronostatin may play an important role in regulating gastrointestinal function.     

胃排空检测方法的研究及展望

胃排空是衡量消化道功能的一个重要指标,在探讨消化道疾病病因学、药物动力学以及疾病的诊断和治疗方面有着不可或缺的作用。近年来,一系列成熟的检测方法已经被用来测量人体胃排空,包括插管法、实时超声、放射性显像及呼吸试验等,但这些检测方法在实验动物及动物临床医学的应用还相对较少,正确评估实验动物胃排空能力的技术对于药物药理学、生物利用度和胃肠疾病诊断等的研究非常重要。本文就常用的几个胃排空检测方法做一阐述,希望这些方法能为动物胃排空检测提供新思路。     

Inhibition of satiety by a cholecystokinin antagonist is independent of gastric emptying

The ability of a cholecystokinin antagonist Proglumide to inhibit satiety induced by intraperitoneal injections of cholecystokinin octapeptide (CCK-OP) and bombesin was examined in rats equipped with chronic gastric cannulae. Both CCK-OP and bombesin significantly suppressed sham feeding. Proglumide administered alone did not alter sham feeding but it abolished the suppression of feeding induced by CCK-OP. In contrast, Proglumide did not inhibit the effect of a low dose of bombesin, but partially inhibited satiety induced by a high dose of bombesin, thus confirming our previous findings. These results indicate that the effect of Proglumide is independent of its recently described effects on gastric emptying in rat.