组氨酸脱羧酶、肠脂肪酸结合蛋白和二胺氧化酶在肠梗阻患者肠黏膜损伤诊断中的价值

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.     

慢性乙型肝炎肝组织损伤的相关因素研究

Objective To study the expression of adiponectin and α-smooth muscle actin (α-SMA) in liver from the patients of chronic hepatitis B(CHB) overlapped non-alcoholic fatty liver disease( NAFLD), and to explore the mechanism of CHB patients with NAFLD. Methods 94 patients of CHB overlapped NAFLD (case group)underwent liver biopsy, 119 cases of patients with CHB alone (control group) as control, the fasting venous blood sample was taken for liver biochemical and virological indicators. Liver biopsy specimens were immunohistochemically stained for histology, adiponectin and α-SMA, and integral absorbance. Results The serum ALT, total cholesterol, triglyceride, low density lipoprotein cholesterol and fasting glucose levels in case group were significantly higher than that in control group (Z = 3.425,4.488,4.858、2.265, P < 0.05) .There was no significant difference in HBV DNA viral load and HBeAg between the two groups( Z = 0.825, χ2 = 0.323, P > 0.05). In case group, adiponectin expression was no significant correlation with steatosis, inflammation and fibrosis(r = 0.032, -0.107, -0.133, P>0.05); however, in control group adiponectin was negatively related to inflammation and fibrosis(r= -0.223, -0.259,P<0.05). In case group,α-SMA expression was significant correlation with inflammation and fibrosis( r = 0.323,0.355, P < 0.05). In control group, its expression was no correlation with inflammation and fibrosis( r = 0.172,0.155, P > 0.05). Conclusions The occurrence of NAFLD is mainly related to metabolic factors and no relation with viral factors. Adiponectin is not directly related to liver injury of patients of CHB overlapped NAFLD. α-SMA may be important indicator of liver injury,and NAFLD may promote the progress of liver injury in patients with CHB.     

急性白血病患儿治疗期人体组成成分的变化

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

血清C-反应蛋白测定在绞窄性肠梗阻早期诊断中的应用价值

目的探讨血清C-反应蛋白在绞窄性肠梗阻早期诊断中的应用价值。方法在治疗前测定47例单纯性肠梗阻和15例绞窄性肠梗阻患者的血清C-反应蛋白值,对照130例健康成年的血清C-反应蛋白值,同时比较在绞窄性肠梗阻中经手术证实的9例肠坏死者与6例未发生肠坏死者的血清C-反应蛋白值。结果单纯件肠梗阻的血清C-反应蛋白值明显低于绞窄性肠梗阻（P〈0.01）,在绞窄性肠梗阻中已有肠坏死者血清C-反应蛋白值高于未发生肠坏死者（P〈0.01）。结论肠梗阻患者血清C-反应蛋白测定值可以作为判断肠管是否发生绞窄及坏死的辅助诊断指标。     

丙氨酰-谷氨酰胺双肽对术后肠道通透性和全身炎性反应的影响

目的:观察丙氨酰-谷氨酰胺(Aln-Gln)双肽对腹部手术后病人早期肠道通透性的影响,并探讨其与术后全身炎性反应的关系。方法:20例腹部手术病人分为研究组和对照组,每组各10例。从术后第1天开始,研究组静脉供给Aln-Gln双肽0.5 g/(kg.d),共4 d;对照组用同等容量生理盐水替代。于手术前、后分别检测血浆Gln浓度、尿乳果糖/甘露醇比值(L/M)、血浆二胺氧化酶(DAO)、白细胞介素-6(IL-6)和临床指标(体温、心率、呼吸和血白细胞计数)等。结果:术后第5天,对照组病人的血浆Gln浓度较术前下降16%,研究组较术前升高17%,且研究组显著高于对照组(P0.05)。研究组病人术后第5天尿L/M、血浆DAO和IL-6显著低于对照组;研究组病人术后全身炎症反应综合征(SIRS)的发生率亦显著低于对照组。结论:术后静脉供给Aln-Gln能提高血浆Gln浓度,改善肠屏障功能,减轻术后早期全身炎性反应,有利于术后的快速康复。     

脂肪酸结合蛋白在重症急性胰腺炎诊断中的应用

目的:研究肠型脂肪酸结合蛋白(I-FABP)在重症急性胰腺炎(SAP)早期肠屏障损伤中的诊断价值。方法:选取25例发病7d内入院的SAP病人,评价病人的疾病严重程度、胃肠功能障碍程度,并在相应时间点检测病人血清I-FABP、C-反应蛋白(CRP)和瓜氨酸浓度。结果:病人入院时,血清I-FABP浓度升高,胃肠功能障碍评分和血清CRP水平高于正常值,血清瓜氨酸水平下降。I-FABP与胃肠功能障碍评分、APACHEⅡ评分以及血清CRP呈显著正相关,与瓜氨酸呈负相关。结论:I-FABP可用于评价SAP病人的胃肠功能障碍程度和疾病严重程度。     

磷脂酶A2在小儿急性绞窄性肠梗阻早期诊断中的价值

目的研究小儿不同程度肠梗阻与血清磷脂酶A2浓度间的关系。方法检测不同类型、不同阶段肠梗阻患儿血清中磷脂酶A2的浓度,通过统计学分析两者之间的关系。结果急性绞窄性肠梗阻患儿血清中磷脂酶A2浓度明显高于单纯性肠梗阻组和动力性肠梗阻组(P<0.01)。在急性绞窄性肠梗阻患儿中,肠坏死组血清中磷脂酶A2浓度明显高于肠缺血组(P<0.01)。单纯性肠梗阻组血清中磷脂酶A2浓度与动力性肠梗阻组比较,差异无统计学意义(P>0.05)。结论血清磷脂酶A2对临床上早期判断是否出现急性绞窄性肠梗阻有意义,可为早期手术治疗提供参考。     

103例绞窄性肠梗阻死亡原因及预后影响因素的探讨

目的 探讨绞窄性肠梗阻的死亡原因和预后影响因素.方法 回顾性分析2001年8月至2009年11月收治的103例绞窄性肠梗阻患者的临床资料.结果 所有患者均经手术治疗,术前确诊绞窄性肠梗阻55例(53.4%),其余48例(46.6%)均在开腹探查时确诊.治愈92例,死亡11例,病死率为10.7%(11/103).主要死亡原因为感染性休克、多器官功能障碍综合征、急性呼吸窘迫综合征和急性肾衰竭,其中感染性休克是影响预后最重要的独立因素.结论 尽早明确诊断,合理把握手术时机,采取及时有效的手术治疗是降低绞窄性肠梗阻病死率的关键.     

超声诊断早期绞窄性小肠梗阻的临床价值(附148例报告)

目的　探讨腹部超声对早期绞窄性肠梗阻的诊断价值。方法　对 14 8例经手术或保守治疗证实的小肠梗阻患者进行分析 ,其中绞窄性肠梗阻 32例 ,单纯性肠梗阻 116例。对比临床物理学诊断 :实验室检查WBC升高、X线检查和腹部超声对绞窄性肠梗阻的诊断价值进行研究探讨。比较各项指标的敏感性、特异性、阳性预测值、阴性预测值及符合率。结果　超声检测的敏感性为 81 3% ,特异性 89 7% ,符合率为 89 2 % ;X线检查的敏感性、特异性分别为 2 5 0 %和 94 8% ;物理检查符合率为 75 7% ,WBC大于 10× 10 9/L的符合率为 79 7%。结论　腹部超声对早期绞窄性肠梗阻有较高的诊断价值 ,应列为常规检查方法     

肠液回输对肠外瘘患者小肠黏膜屏障功能的影响

目的 探讨肠液回输对唇状瘘患者肠黏膜屏障功能和机体营养状态的影响。方法 选取1995年7月至2008年5月我院收治的16例唇状瘘患者,所选病例均符合以下条件：肠道功能基本恢复、腹腔感染基本控制、完全依赖肠内营养、肠液回输肠襻的长度＞ 50 cm。分别于实施肠液回输当天、第7和14天,在肠镜引导下距小肠远端瘘口25～30 cm处取肠黏膜,行HE染色后统计肠上皮内淋巴细胞(IIELS)百分数、免疫组织化学染色后分析增殖细胞核抗原(PCNA)阳性细胞百分数。同时测定血清蛋白水平。结果 实施肠液回输第14天瘘口远端小肠黏膜内IIELS百分数为19.06％±4.81％,显著高于肠液回输当天的12.81％±2.95％ (P=0.000),PCNA阳性细胞百分数为12.13％±4.33％,显著高于肠液回输当天的6.44％±2.34％ (P=0.000)。肠液回输第14天血清纤维连接蛋白水平由( 152.80±16.50)上升至(227.05±45.36) mg/L (P=0.000)、转铁蛋白水平由(2.16±0.52)上升至（2.62±0.41）g/L (P =0.017)。结论 实施肠液回输对于肠外瘘患者的肠黏膜具有保护作用。     

双歧杆菌联合美沙拉嗪对溃疡性结肠炎患者氧化应激及肠道菌群的影响研究

目的探讨双歧杆菌联合美沙拉嗪对溃疡性结肠炎(UC)患者氧化应激及肠道菌群的影响。方法选择2016年2月-2018年2月本院收治的UC患者60例,随机分为常规组(30例)和研究组(30例)。常规组采用美沙拉嗪治疗,研究组采用美沙拉嗪联合双歧杆菌三联胶囊治疗。比较2组UC患者治疗前后肠黏膜屏障、氧化应激指标及肠道菌群的变化。结果研究组患者D-乳酸、DAO及ET水平均显著低于常规组和治疗前(P<0.05)。研究组患者乳酸杆菌、双歧杆菌水平显著高于研究组和治疗前,大肠杆菌、肠球菌水平均显著低于常规组和治疗前(P<0.05)。研究组患者CAT、SOD及GSH-Px水平显著高于常规组和治疗前,MDA水平均显著低于常规组和治疗前(P<0.05),上述差异均有统计学意义。结论双歧杆菌联合美沙拉嗪治疗可缓解氧化应激反应,改善肠黏膜屏障及肠道菌群紊乱,值得临床推广应用。     

小儿急性粘连性肠梗阻手术时机的选择对治疗效果的影响研究

目的分析手术时机选择对小儿急性粘连性肠梗阻临床疗效的影响。 方法择取山东省胶州市人民医院2012年6月至2015年9月接收的急性粘连性肠梗阻患儿84例,其中男性56例,女性28例,平均年龄(8.3～11.2)岁,阑尾炎36例,肠套叠19例,肠绞窄7例,肠扭转不良13例,膈疝6例,巨结肠3例。采用随机单盲法将84例患儿均分为试验组和对照组。试验组于发病48 h内接受手术,对照组于发病48 h后接受手术。观察两组疗效,比较死亡率和并发症发生率。 结果试验组总有效率为95.24%,明显高于对照组的76.19%(P<0.05)。试验组并发症发生率和病死率分别为9.52%、0.0%,明显低于对照组的35.71%、7.14%(P<0.05)。 结论对急性粘连性肠梗阻患儿早期实施手术治疗,可降低并发症发生率和病死率,疗效显著。     

肠梗阻导管对结直肠癌合并肠梗阻患者术后感染的影响

目的探究肠梗阻导管对结直肠癌合并肠梗阻患者术后感染并发症发生率的影响。方法选择2015年2月-2019年10月上饶市立医院收治的235例结直肠癌合并肠梗阻患者作为研究对象,根据是否应用肠梗阻导管将患者分为两组,对照组102例患者行急诊结直肠癌肿瘤切除术,研究组133例患者行肠梗阻导管置入术后择期行根治术。收集患者围手术期指标及并发症发生情况,对术后感染患者进行病原菌分析。结果研究组患者全部行择期一期吻合术,且24 h症状缓解率96.99%显著高于对照组的11.76%(P<0.05);研究组患者术后排气时间(3.22±1.01)h、住院时间(11.23±2.13)d均较对照组缩短(P<0.05);研究组切口感染4.51%(6/133)、总感染率7.52%(10/133)和低钠低钾蛋白血症发生率30.08%(40/133)均低于对照组(P<0.05);29例感染患者共分离出46株病原菌,其中革兰阴性菌28株,占60.87%,革兰阳性菌17株,占36.96%,真菌1例,占2.17%。结论梗阻性导管置入后择期手术术后恢复较快,可降低结直肠癌合并肠梗阻患者术后感染并发症发生率,有较高的临床应用价值。