胃肠起搏的护理

胃肠起搏是近年来胃肠生理、病理生理及临床科学的一个热门课题。其工作原理是基于人胃肠起搏点的电活动可被外加的电流刺激所驱动，利用现代电子技术产生与正常人体胃肠基本电节律相似的胃肠生物电信号，并经胃体、胃窦和肠在体表的投影处输入，使胃肠起搏点电流动产生“跟踪效应”，恢复正常的节律，达到治疗胃肠功能性疾病的目的。功能性胃肠病是指具有腹胀、腹痛、腹泻及便秘暖气等消化系统症状，但缺乏器质性疾病（如胃炎、肠炎等）或其他证据的一组疾病，在普通人群的发生率达到23．5％～74％，且伴有一定程度的心理障碍，严重影响患者的生活质量。我院于2002年起对功能性胃肠病病人应用泰士WCH型胃肠起搏器（下称胃肠起搏器，杭州泰士生物科技有限公司生产）进行治疗，获得良好效果。现将护理体会报告如下。     

胃起搏对功能性消化不良患者胃排空障碍的疗效观察

目的观察胃起搏对功能性消化不良患者胃排空障碍的疗效。方法选择功能性消化不良胃动力障碍型患者38例，采用WCH型胃肠起搏仪进行胃起搏治疗，每日1次，每次30分，共14日。比较治疗前后胃对不透X线标志物的排空率。结果胃起搏治疗可提高患者的5小时胃内钡条排空率，改善患者临床症状。无不良反应发生。结论采用适宜的起搏参数从体表输入起搏信号治疗胃动力障碍患者，可提高胃排空功能，缓解患者的临床症状。     

抗抑郁药在功能性胃肠病中的应用研究

功能性胃肠病(FGIDs)是一组由慢性或再发性胃肠症状组成的而不能用结构或生化异常来解释的症候群,包括功能性食管疾病、功能性胃十二指肠疾病、功能性肠道疾病、功能性腹痛综合征、功能性胆囊和Oddi括约肌功能紊乱、功能性肛门直肠疾病[1-6].近年来,随着人们对FGIDs的认识是从单一生物模式向生物-心理-社会模式转变,心理社会医学因素在FGIDs发病中的作用日益受到重视[7].在此基础上,脑-肠轴学说(脑-肠轴及脑-肠互动)已成为目前FGIDs研究领域的热点,调节脑-肠轴功能稳态的研究和治疗方法被认为是目前最有前途的研究方向之一,而抗抑郁药在FGIDs中的应用有可能成为治疗FGIDs的有效方法之一.现拟就此作一综述.     

抗抑郁药在功能性胃肠病中的应用研究

功能性胃肠病(FGIDs)是一组由慢性或再发性胃肠症状组成的而不能用结构或生化异常来解释的症候群,包括功能性食管疾病、功能性胃十二指肠疾病、功能性肠道疾病、功能性腹痛综合征、功能性胆囊和Oddi括约肌功能紊乱、功能性肛门直肠疾病[1-6].近年来,随着人们对FGIDs的认识是从单一生物模式向生物-心理-社会模式转变,心理社会医学因素在FGIDs发病中的作用日益受到重视[7].在此基础上,脑-肠轴学说(脑-肠轴及脑-肠互动)已成为目前FGIDs研究领域的热点,调节脑-肠轴功能稳态的研究和治疗方法被认为是目前最有前途的研究方向之一,而抗抑郁药在FGIDs中的应用有可能成为治疗FGIDs的有效方法之一.现拟就此作一综述.     

功能性胃肠病的临床症状特点

功能性胃肠病包括食管、胃、肠、胰腺及胆道等多脏器在内的6大类、近百种疾病，以功能性消化不良、肠易激综合征、功能性便秘、胃食管反流病最为常见。不同的功能性胃肠病的临床表现也不同，患者往往表现有一种或几种消化道症状：如功能性消化不良的患者主要有上腹痛和上腹胀满、早饱、恶心等；肠易激综合征患者常伴有大便次数与性状异常的腹部不适，或以腹痛为主要症状；功能性便秘的表现主要为排便次数减少、排便困难或排便有未尽感等。有些患者可同时患有几种功能性胃肠病，导致临床表现更为复杂多样。     

冬季护好你的胃

俗话说,胃口不好,吃嘛嘛不香,干嘛嘛没劲。在我们生活的人群中,大约有85%的人不同程度患有胃肠疾病,故民间有“十人九胃”之说。近年来,我国每年因胃肠病变死亡的人数大约为160万人,那么如何在冬季保养好你的肠胃呢?原北京中医医院院长、著名中医胃肠病专家李乾构给大家支几招。把好饮食关根据《中医胃肠病学》记载,中医胃肠病有26个,西医胃肠病有38个。常见的有四种:功能性消化不良、胃炎、消化性溃疡、便秘。功能性消化不良,在每个人的一生中几乎都会遇到。症状为返酸、打嗝、腹胀,其发病率几乎占到消化科看病患者的一半。而胃炎和消化性…     

促动力药的临床应用

促动力剂是指能增强胃肠道收缩力和加速胃肠运动和减少通过时间的药物 ,具有增强胃肠平滑肌收缩力、协调胃肠运动规律性、促进胃肠排空和移动的作用 ,主要用于治疗由于胃肠运动减弱或其协调性障碍的原发性或继发性功能性胃肠病。如胃食管反流性疾病、胃轻瘫、肠道及肛、直肠功能障碍。临床上由运动功能障碍或动力异常所引起的疾病是很常见的 ,有较高的发病率。胃肠运动障碍包括胃肠收缩无力、节律紊乱和异常方向收缩 ,在临床上可表现为轻如恶心、呕吐 ,重至威胁生命的假性梗阻等众多的症状和疾病。因此 ,正规合理地应用胃肠动力药有着重要临…     

胃起搏仪治疗功能性消化不良50例临床观察

目的观察胃起搏仪治疗功能性消化不良的疗效及对胃电图参数的影响。方法选择符合罗马Ⅲ标准的功能性消化不良患者50例分成两组：实验组予以胃起搏仪治疗（2次／d,每次30rain,连续4周）;对照组予以多潘立酮（西安杨森药业10mg,3次／d,口服4周）。治疗前后分别记录症状改善情况、检查胃电图、比较胃电参数等。结果治疗组和对照组的总有效率分别为88．5％和58．3％,胃起搏治疗效果明显好于非起搏治疗者（P〈0．05）。胃起搏治疗后,胃电参数较治疗前显著改善（P〈0．05）、胃电节律紊乱百分比显著降低（P〈0．05）。结论胃起搏治疗可明显改善功能性消化不良的症状及异常的胃电参数。     

功能性胃肠病的临床分析

目的 探究分析功能性胃肠病患者在临床上主要症状表现、相关特点以及治疗方式.方法 选自我院2010-2012年消化内科收治的功能性胃肠病患者共50例,对其进行心理、饮食习惯调节以及药物等综合性治疗,对其临床资料以回顾性的方法进行分析,归纳该疾病的临床特点.结果 有27例功能性胃肠病患者出现严重的心理障碍,占据所有患者比例的54.0％;通过对患者进行联合治疗,有34例患者出现明显好转,临床治疗总有效率为68.0％.结论 功能性胃肠病对患者的生活质量以及生命健康造成严重的威胁,在临床上表现为慢性或者反复发作性,需要心理治疗与药物治疗相结合,最大程度提高临床治疗有效率.     

功能性胃肠病6问答

问答问答问答何谓功能性胃肠病功能性胃肠病是指患者有胃肠病症状,但检查胃肠却无器质性病变,所以又叫胃肠神经官能症。若进一步细分,以胃部症状为主者叫“非溃疡性消化不良”,以肠道症状为主者叫“肠易激综合征”。功能性胃肠病的发病情况如何本病在世界各地均有发生,据文献报道,一些发达国家比发展中国家罹患率更高,如美国女性发病率高达80%,主要发生在知识妇女。我国目前没有具体统计资料,但据专家估算,在普通人群(特别是中老年人群)中,约1/3的人有与本病相关的症状。另据上海市对数十家医院统计,本病约占消化系疾病就诊总数的2/3,可见本…     

Vitamin D Receptor Protects against Radiation-Induced Intestinal Injury in Mice via Inhibition of Intestinal Crypt Stem/Progenitor Cell Apoptosis

It is urgent to seek new potential targets for the prevention or relief of gastrointestinal syndrome in clinical radiation therapy for cancers. Vitamin D, mediated through the vitamin D receptor (VDR), has been identified as a protective nutrient against ionizing radiation (IR)-induced damage. This study investigated whether VDR could inhibit IR-induced intestinal injury and explored underlying mechanism. We first found that vitamin D induced VDR expression and inhibited IR-induced DNA damage and apoptosis in vitro. VDR was highly expressed in intestinal crypts and was critical for crypt stem/progenitor cell proliferation under physiological conditions. Next, VDR-deficient mice exposed to IR significantly increased DNA damage and crypt stem/progenitor cell apoptosis, leading to impaired intestinal regeneration as well as shorter survival time. Furthermore, VDR deficiency activated the Pmaip1-mediated apoptotic pathway of intestinal crypt stem/progenitor cells in IR-treated mice, whereas inhibition of Pmaip1 expression by siRNA transfection protected against IR-induced cell apoptosis. Therefore, VDR protects against IR-induced intestinal injury through inhibition of crypt stem/progenitor cell apoptosis via the Pmaip1-mediated pathway. Our results reveal the importance of VDR level in clinical radiation therapy, and targeting VDR may be a useful strategy for treatment of gastrointestinal syndrome.     

Gastrointestinal symptoms predictors of health-related quality of life in pediatric patients with functional gastrointestinal disorders

Objectives

To investigate the patient-reported multidimensional gastrointestinal symptoms predictors of generic health-related quality of life (HRQOL) in pediatric patients with functional gastrointestinal disorders (FGIDs).

Methods

The Pediatric Quality of Life Inventory? (PedsQL?) Gastrointestinal Symptoms Scales and PedsQL? 4.0 Generic Core Scales were completed in a 9-site study by 259 pediatric patients with functional constipation, functional abdominal pain (FAP), or irritable bowel syndrome (IBS). Gastrointestinal Symptoms Scales measuring stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea were identified as clinically important symptom differentiators from healthy controls based on prior findings, and subsequently tested for bivariate and multivariate linear associations with overall HRQOL.

Results

Gastrointestinal symptoms were differentially associated with decreased HRQOL in bivariate analyses for the three FGIDs. In predictive models utilizing hierarchical multiple regression analyses controlling for age, gender, and race/ethnicity, gastrointestinal symptoms differentially accounted for an additional 47, 40, and 60 % of the variance in patient-reported HRQOL for functional constipation, FAP, and IBS, respectively, reflecting large effect sizes. Significant individual gastrointestinal symptoms predictors were identified after controlling for the other gastrointestinal symptoms in the FGID-specific predictive models.

Conclusions

Gastrointestinal symptoms represent potentially modifiable predictors of generic HRQOL in pediatric patients with FGIDs. Identifying the condition-specific gastrointestinal symptoms that are the most important predictors from the patient perspective facilitates a patient-centered approach to targeted interventions designed to ameliorate impaired overall HRQOL.

     

Non-pharmacologic treatment of atrial fibrillation

The authors provide an update on non-pharmacological treatment of atrial fibrillation (AF). They emphasize that although antiarrhythmic drugs continue to be first-line therapy for the arrhythmia considered to be a cardiovascular epidemic, clinical research to develop non-pharmacological means of treatment has been unprecedentally intensified during the last decade. Electrical cardioversion is the most successful non-pharmacological method to restore sinus rhythm, also the efficacy and safety of AV node ablation for palliative ventricular rate-controll is established. "Hybrid" therapeutic procedures, involving combinations of pharmacological and non-pharmacological interventions have gained widespread use. Curative transcatheter ablation for arrhythmia prevention is to be considered in case of clinical suggestions that AF is initiated by a primary regular arrhythmia that is amenable to routine catheter ablation (secondary AF). Despite encouraging results, at this point in time, curative catheter ablation for primary AF may offer significant improvement or even cure only for a small subset of patients, mostly young individuals with normal heart, and paroxysmal AF with frequent, symptomatic episodes refractory to multiple antiarrhythmic drugs. These interventions are to be performed in the settings of a clinical research project in some institutions. Regarding pacemaker therapy in case of bradycardia indication, physiologic pacing (AAI or DDD) is associated with significantly lower incidence of atrial fibrillation than ventricular pacing. Large-scale randomized controlled trials are needed to assess the clinical value of specially designed implantable devices to prevent atrial fibrillation in patients with no conventional bradycardia indication. Also, technical optimization and proper clinical evaluation is needed for implantable atrioverters and implantable cardioverter defibrillators capable of atrial cardioversion therapy.     

Intestinal transplantation: indications, results and strategy

The term 'intestinal failure' is now often used to describe gastrointestinal function insufficient to satisfy body nutrient and fluid requirements. The first recognized condition of intestinal failure was short bowel syndrome. Severe motility disorders such as chronic intestinal pseudo-obstruction syndrome in children as well as congenital intractable intestinal mucosa disorders are also forms of intestinal failure, because no curative treatment for these diseases is yet available. Parenteral nutrition and home parenteral nutrition remain the mainstay of therapy for intestinal failure, whether it is partial or total, provisional or permanent. However, some patients develop complications while receiving standard therapy for intestinal failure and are considered for intestinal transplantation. Indeed, recent advances in immunosuppressive treatment and the better monitoring and control of acute rejection have brought intestinal transplantation into the realm of standard treatment for intestinal failure. Although it has been used in humans for the past two decades, this procedure has had a slow learning curve. According to the current results, this challenging procedure may be performed in children or adults, only under certain conditions.     

劳蒙毕综合征伴原发性甲状腺功能低下1例临床分析

[目的]提高对劳蒙毕综合征的临床特征、诊断及治疗的认识。[方法]对1例儿童劳蒙毕综合征的临床表现、诊断及治疗进行分析并复习相关文献。[结果]本病例符合劳蒙毕综合征诊断,合并原发性甲状腺功能低下。[结论]LMB综合征诊断主要依据临床表现,其治疗以对症治疗为主。     

上消化道出血合并急性冠状动脉综合征18例临床分析

目的探讨上消化道出血（UGIB）并发急性冠状动脉综合征（ACS）的可能原因及有效救治方法。方法回顾性研究某院2008年4月～2013年4月收治的UGIB合并ACS18例患者的临床资料,分析总结该病的临床特点及治疗方法。结果18例患者年龄58～93岁,平均（69．2±10．9）岁,发病以老年男性为主。口服抗血小板药物者15例（83．33％）。严密监护、积极输血、急诊内镜检查及镜下止血治疗是治疗的主要方法,胃镜下止血成功14例（77．80％）,病死3例（16．67％）。结论严密监护、积极输血、24h内急诊胃镜检查及镜下止血治疗是UGIB并发ACS救治成功的关键。需要长期口服抗血小板药物的患者,质子泵抑制药可降低消化道出血的发生率,改善预后。     

Stem cell transplantation in the treatment of gastrointestinal diseases

The stem cells with self-renewal ability are capable to form one or more cell types. They will be in the target of cell and gene therapy because of their multipotency and easy retrieval. Application of adult mesenchymal, neuronal, epidermal and haematopoietic stem cell can be favourable in the treatment of cardiac (myocardial infarction), bone (osteoarthritis), neurological (Parkinson's, Alzheimer's) and hematological (hemophilia, thrombocytopenia) disorders. Authors summarize the knowledge in connection with their application in the therapy of gastrointestinal diseases. Haematopoietic stem cell transplantation has been successful for the treatment of refractory Crohn's disease, as well as in selected group of celiac patients. Mesenchymal stem cell transplantation has been proved beneficial in the prevention of liver fibrotic process. It will gain more grounds in the treatment of autoimmune liver diseases: autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis in the future. Well-designed, multicentric, prospective studies are needed to confirm the results of case reports and clinical studies with small group of patients.     

微波治疗在上消化道息肉的临床应用

目的：总结微波治疗上消化道息肉的临床治疗经验。方法：回顾性总结260例上消化道息肉经内镜下微波点灼治疗的临床资料。结果：所有病例在内镜下得到治愈．单个息肉一次性治愈，多发性息肉须分次治疗。结论：掌握一定技巧，微波治疗上消化道息肉安全可靠，且具有并发症少，病人痛苦小，费用少的优点。     

肠内肠外营养对胃肠道肿瘤保守治疗患者生存质量的影响

目的探讨肠内肠外营养对胃肠道肿瘤保守治疗的患者生存质量的影响,以供临床工作参考。方法对我院2008年1月～2010年7月收治的18例保守治疗的胃肠道肿瘤患者,采用营养支持治疗,对比患者治疗前后的营养状况,使用QOL量表评价患者营养支持前后的生存质量。将结果进行统计学分析。结果患者经过营养支持治疗后,其营养状况得到明显改善,与治疗前相比,p<0.05;营养支持后,患者的生存质量得到明显提高,与治疗前相比,p<0.05。结论采用肠内肠外营养支持治疗后,患者的营养状况得到改善,生活质量提高,且不会加速患者的肿瘤生长,其效果显著,值得在临床推广使用。     

Probiotics as functional food in the treatment of diarrhea

PURPOSE OF REVIEW: A disturbance in microbial balance of the gastrointestinal tract is often associated with diarrhea. Therefore, probiotics, as beneficial microorganisms for host health, have attracted clinical attention for their potential therapeutic application in the treatment of diarrhea. This review focuses on new research findings relevant to the effects of probiotics on diarrhea prevention and treatment and potential mechanisms of action for this alternative therapy for diarrhea. RECENT FINDINGS: Clinical trials suggest potential beneficial effects of probiotic therapy for preventing and treating antibiotic-associated diarrhea, acute diarrhea including rotavirus-induced diarrhea, traveler's diarrhea, and diarrhea-predominant irritable bowel syndrome. The most extensively studied probiotics for diarrhea are Lactobacillus, Bifidobacterium and Saccharomyces, with potential mechanisms of therapeutic action based on the protection of intestinal epithelial cell and barrier function, prevention of enterotoxin binding to intestinal epithelial cells, and regulation of intestinal microbial environment. SUMMARY: Growing evidence suggests that probiotics may serve as a functional food in the treatment of diarrhea. Remaining challenges include identifying mechanisms of action to provide the basis of more refined hypothesis-driven clinical trials. The correct combination and concentration of probiotics applied to the appropriate gastrointestinal disorders may improve the efficacy of this approach for diarrhea and other diseases.