早期进食并应用谷氨酰胺对严重烧伤并发应激性溃疡的…

为了防治烧伤并发消化道应激性粘膜病变，减少溃疡发生，对１２例严重烧伤病人（面积〉３０％）施行早期进食方案并辅以谷氨酰胺治疗，经行纤维胃镜及微量胃结果表明：本组在严重烧伤后早期１００％出现上消化道急性庆激性粘膜病变（ＡＳＭＬ）；本组病人无一例因烧伤伤及多次手术切痂而发生应激性溃疡；８６％的病人于伤后２周胃粘膜急性病变恢复。提示：严重烧伤病人早期进食并应用谷氨酰胺可以防治应激性胃溃疡的发生。     

早期进食并应用谷氨酰胺对严重烧伤并发应激性溃疡的防治

为了防治烧伤并发消化道应激性粘膜病变,减少溃疡发生,对12例严重烧伤病人(面积>30％)施行早期进食方案并辅以谷氨酰胺治疗,经行纤维胃镜及微量胃液检查结果表明:本组在严重烧伤后早期100％出现上消化道急性应激性粘膜病变(ASML);本组病人无一例因烧伤及多次手术切痂而发生应激性溃疡;86％的病人于伤后2周胃粘膜急性病变恢复。提示:严重烧伤病人早期进食并应用谷氨酰胺可以防治应激性胃溃疡的发生。     

思密达预防烧伤后胃肠粘膜应激性损伤

本文对胃粘膜保护剂思密达预防烧伤后胃肠粘膜应激性损伤进行实验研究和临床应用，结果表明：思密达能有效预防胃肠粘膜的应激性糜烂、溃疡、粘液性坏死及肠上皮坏死，间接减少胃酸分泌；与Ｈ２受体阻滞剂雷尼替丁等合用，可成功、高效预防严重烧伤后胃肠粘膜的应激性损伤．     

思达预防烧伤后胃肠粘膜应激性损伤

本文对胃粘膜保护剂思密达预防烧伤后胃肠粘膜应激性损伤进行实验研究和临床应用，结果表明：思密达能有效预防胃肠粘膜的应激性糜烂、溃疡、粘液性坏死及肠上皮坏死，间接减少胃酸分泌；与Ｈ２受体阻滞剂雷尼替丁等使用，可成功，高效预防严重烧伤后胃肠粘膜的应激性损伤。     

应激性溃疡的诊治体会

应激性溃疡是机体在应激状态下发生的急性胃肠粘膜病变。为提高其临床诊治水平，现就我科１９９４年６月至１９９７年６月收治的２２例因腹部手术、烧伤或颅脑手术后发生的应激性溃疡分析讨论如下。１临床资料本组２２例应激性溃疡患者中，男１４例，女８例，年龄３１～７...     

颅脑损伤并发应激性溃疡256例临床分析

应激性溃疡（SU）亦称急性胃粘膜病变（AGML），指机体遭受强烈的刺激（如严重颅脑损伤、大面积烧伤、严重感染，休克等）而发生的急性胃，十二指肠粘膜糜烂、出血、炎症及坏死。本院近6年来共收治此类病人256例，现报告如下。     

胰十二指肠切除术后早期并发症及预防

胰十二指肠切除（PD）是治疗壶腹周围癌的规范化手术，术中要对许多脏器做根治性切除与消化道重建，麻醉和手术时间长、创伤大、失血多，加上术前许多病人有黄疽，肝肾功能损害等不利因素，所以，术后早期并发症很多。我院1992～1998年共做PD40例，术后早期发生并发症22例，占55％，因并发症死亡4例，病死率为10％。很明显，对术后早期并发症的防治是否得力，直接关系到手术的成败。本文就PD术后早期的主要并发症及其预防，谈谈我们的认识与体会。一、应激性溃疡出血大手术后常发生应激性胃粘膜病变，有胃出血，但量很少。而应激性溃疡出…     

本刊关于一稿两投等问题处理的声明

颅脑损伤为常见外伤性疾病，其临床特点是病情重、变化快、死亡率高。重型颅脑损伤患由于长期昏迷，不能自动进食，常营养供给低于机体需要量，同时患因植物神经失调，使胃肠道粘膜功能破坏并使胃粘膜血运障碍，易发生应激性溃疡，上消化道出血。因此对重型颅脑损伤患早期进行管饲，不仅可供给高营养的流汁饮食．保证病人摄人足够的蛋白质与热量，促进机体修复，而且可防治应激性溃疡上消化道出血，促使疾病早日康复，现将我们的管饲护理体会介绍如下：     

应激性溃疡出血的预防性治疗

应激性溃疡是在严重创伤、烧伤、休克、感染、肺肝肾功能受损等应激状态下发生的上胃肠道急性粘膜病变。可在应激发生后数小时即出现。应激性溃疡的发病率取决于伤、病及其并发症的严重程度,伤、病情况越重,发生的机会越大,病变也越重。重症病房病     

湿润烧伤膏致严重皮肤过敏反应四例

湿润烧伤膏致严重皮肤过敏反应四例方振玉，张彩霞１９９３年我科短期内先后接诊４例在基层医院外用湿润烧伤膏发生严重过敏反应的烧伤病人。烧伤及涂药面积最大５５％，最小４％，均为浅Ⅱ度。过敏发生时间，最长为用药后１５天，最短为用药后第２天。４例病人烧伤后均应...     

Acute stress mucosal lesion of the upper gastrointestinal tract after burn--a clinical and endoscopic analysis of 31 cases

31 burned patients were studied by fiber-endoscopy. We found that the incidence rate of acute stress mucosal lesion (ASML) of upper gastrointestinal tract was 100% in which burns involved more than 30% of total body surface. The degree of severity of ASML appeared to be influenced by the areas of the burn and the duration between examination and occurrence of burn. It was also related to the existence of complications. The study of endoscopic findings revealed that ASML had a special development course. It consisted of congestion, edema, erosion, bleeding and ulceration. The acute ulceration was only a part of the whole course. The incidence rate of the stress ulcer of this group was 27.6%. The bleeding rate was 34.5%. The bile reflux was 87% in 29 patients. Endoscopic examination can not only recognize the nature of the ASML, but also can collect the incidence rate accurately and find the location of the bleeding and ulcer in time. So this provided an important method for the etiological study. If the examination is well prepared and handled carefully, the procedure is very safe.     

Parietal cell vagotomy for duodenal and pyloric ulcers: I. Clinical factors leading to failure of the operation

In a prospective study, 170 consecutive unselected patients with duodenal (n = 115) or pyloric (n = 55) ulcers underwent elective parietal cell vagotomy, with an additional drainage procedure in patients with stenosis. The patients were classified in two consecutive groups and were followed up for 3 to 7 years after operation, in 132 cases for more than 5 years. The follow-up was complete. Patients with symptoms suggestive of ulcer for more than 3 days, independent of roentgenographic or endoscopic findings, were classified as having symptoms of recurrent ulcer and were specially analyzed.There was no mortality; splenic injuries occurred in 5 cases (3 percent), dumping symptoms in 4 percent after parietal cell vagotomy but in 34 percent after vagotomy plus drainage. Diarrhea occurred in 3 percent of the patients after parietal cell vagotomy and in 20 percent after vagotomy plus drainage.Fifty-five patients had clinical recurrences, significantly more patients with pyloric ulcer (46 percent) than with duodenal ulcer (28 percent). In 27 patients, the symptoms responded well to conservative therapy. In the other 28 patients the symptoms were severe, and 14 underwent reoperation for proven recurrent ulcers. The difference in the recurrence rates for duodenal and pyloric ulcer was found only in patients who did not undergo a drainage procedure, while pyloric ulcer patients with stenosis and a drainage operation were comparable in this respect to duodenal ulcer patients with and without drainage.A decrease in the rate of recurrence was achieved between the earlier and later parts of the series, even considering the difference in length of follow-up. The decrease is considered to reflect mainly our increased experience with the method. The results in patients in the later part of the series, followed up for more than 5 years, were a 22 percent incidence of recurrent ulcer symptoms and an 8 percent incidence of proven recurrent ulcers in those with duodenal ulcer, and a 28 percent incidence of recurrent ulcer symptoms and a 22 percent incidence of proven recurrent ulcers in those with pyloric ulcer.The overall results in patients followed up to more than 5 years, according to a modified Visick scale which incorporates differences in the severity of recurrent ulcer symptoms and the results after reoperation, were satisfactory in 89 percent of the patients with duodenal ulcer and in 73 percent of those with pyloric ulcer.     

Results of long follow-up study for peptic ulcer patients treated with gastrectomy

This clinical study was based on 307 peptic ulcer patients treated with gastrectomy over a 15-year period in our department. Numbers of surgical cases for peptic ulcer remarkably decreased after the introduction of cimetidine in 1980. A median age of gastric ulcer patients was in sixth decades, whereas duodenal ulcer in fifth decades. Surgical indications were 60 percent in intractable ulcer, 30 percent in complication as bleeding, stenosis and perforation, and 10 percent in suspicious malignancy. After cimetidine introduction intractable cases decreased from 63 percent to 44 percent. There was no remarkable difference in the fasting and peak plasma secretin concentrations in postprandial period between peptic ulcer patients and normal controls, however, in gastrectomized patients the plasma secretin response decreased in postprandial state. Follow up study was made on a point of postoperative recurrence and postgastrectomy syndrome. Small stomach syndromes such as insufficient food intake and body weight loss were observed in 10 and 30 percent in the gastrectomized patients, but 86 percent of the patients were satisfied with the results of operation. We concluded that gastrectomy for peptic ulcer was treatment of choice from the point of low recurrence rate and no severe postgastrectomy disorders.     

Late problems after pharyngolaryngoesophagectomy and pharyngogastric anastomosis for cancer of the larynx and hypopharynx

The late problems of 136 patients who had undergone pharyngolaryngoesophagectomy and pharyngogastric anastomosis were studied. The proportions of patients who required long-term thyroxine supplementation were 67 percent, 13 percent, and 5.3 percent of the patients who had total thyroidectomy, hemithyroidectomy, and no thyroidectomy, respectively. The proportions of patients who required calcium and vitamin D supplementation were 67 percent, 23 percent, and 17 percent, respectively. Speech rehabilitation was unsatisfactory. Alimentary functions were satisfactory in that the majority of patients were able to take in solid food. Although a sensation of obstruction of food was occasionally felt, no organic abnormality was found in any patient. Regurgitation was noted in 23 percent of the patients, and hematemesis was an occasional symptom of gastritis or gastric ulcer, although symptomatic gastric ulcer was found in only two patients. It is concluded that the long-term morbidity after this extensive procedure is mild and acceptable. The operation is recommendable for extensive tumors of the laryngopharyngeal region.     

不同鼻饲模式防治重型颅脑损伤后应激性溃疡的临床研究

目的探讨防治重型颅脑损伤后应激性溃疡发生的最佳鼻饲模式。方法将重型颅脑损伤患者随机分为对照组(37例)、观察1组(52例)和观察2组(45例)。对照组按传统间断方法间隔2h经鼻饲管注入营养液,观察1组用微量输液泵将营养液24h持续恒速注入胃内,观察2组则采用间隔1h推注营养液的模式。三组采用同样的营养液。记录应激性溃疡的发生率及治疗效果,并监测胃液pH值。结果应激性溃疡发生率观察1组显著低于对照组和观察2组(P<0.01和P<0.05);pH值观察1组显著高于对照组和观察2组(均P<0.05)。治疗效果三组差异无显著性意义(P>0.05)。结论重型颅脑损伤患者采用24h持续恒速注入的鼻饲模式能显著降低应激性溃疡发生率。     

Management of giant duodenal ulcer

Giant duodenal ulcer is a variant of peptic ulcer that is 2 cm in diameter or greater and essentially replaces the duodenal bulb. Diagnosis by upper gastrointestinal series is often missed, due to the large size of the ulcer, which causes it to look like a scarred duodenal bulb or duodenal diverticulum. This study reviews our experience with 32 patients who presented with giant duodenal ulcer between 1963 and 1982. Seventy-five percent of the patients were men between 30 and 81 years of age (mean age 59 years). Gastrointestinal hemorrhage was a presenting symptom in 75 percent of the patients and free perforation in 9 percent. Diagnosis was made by upper gastrointestinal series (24 patients), and endoscopy (11 patients), alone or in combination. Three patients were diagnosed at surgery and one at necropsy. Mean size of the ulcer was 3.5 cm in diameter, range 2 to 6 cm. Twenty-four patients were initially managed medically (mean length of treatment 41 months), with 2 deaths (hemorrhage) and 20 recurrences (83 percent). Twenty-seven operations were required in 25 patients. In 17 of the 25, medical treatment had failed. Seven of these patients required emergency surgery. Eight patients were managed primarily by surgery, of whom five presented emergently. There were three deaths in the surgical group after emergency surgery. In two of these patients, medical treatment had failed. There were no deaths among the elective surgery group. Twenty-five of the 27 operative procedures were definitive, acid-reducing operations (15 vagotomy and antrectomy and 10 vagotomy and drainage). Two patients underwent emergency exploration and oversewing of a giant perforated ulcer alone, and both patients required subsequent surgery because of symptoms. The results indicate that giant duodenal ulcer should be primarily surgically managed and that an acid-reducing procedure should be performed during primary surgery. These patients do very poorly with medical therapy, and the mortality rate is increased if emergency surgery is required for hemorrhage. Medical treatment alone is associated with a high morbidity (92 percent). Should operation be required, a definitive acid reduction operation is the procedure of choice.     

Surgery for recurrent peptic ulceration.

Sixty-six patients having surgery for recurrent peptic ulcers over a 10-year period are reviewed. The majority of the patients were male and developed their initial ulcers at an early age. Bleeding was the most common presenting symptom. Seventy-one percent of the recurrences occurred within three years. Barium meal X-ray examination plus endoscopy gave the correct diagnosis in 96% of cases. The causes of the recurrent peptic ulcers were: (1) incomplete vagotomy; (2) inadequate gastric resection; (3) inappropriate surgery; (4) Zollinger-Ellison syndrome; (5) gastric outflow obstruction; and (6) bile reflux. Other factors such as alcohol, analgesic abuse and psychiatric disorders were found to be common associations. Resection plus vagotomy was the summation of primary and secondary surgery in 85%. The operative mortality was 3%. Eighty-five percent of patients had a Visick grading of I or II. Only one patient had a further recurrent ulcer and this healed on medical treatment.     

An evaluation of segmental gastrectomy for gastric ulcer: one to ten year follow-up.

Of 61 patients with gastric ulcer subjected to an improved technique of segmental gastrectomy, 26 were available for follow-up study for 1 to 10 years; evaluations were made mainly on the postoperative reduction of gastric acid secretion and motor function of the gastric remnant. Results: (1) x-ray observation revealed the gastric remnant to be larger than usually seen following Billroth I or II gastrectomy, with no dilatation or remarkable deformity; sphincteric function of the pylorus and peristaltic activity of the gastric remnant were satisfactory; (2) gastric emptying was usually complete in 60 to 180 minutes in 73 percent of the patients, similar to control patients; (3) no instance of dumping syndrome was recognized; (4) average rates of postoperative acid reduction were 58.3 percent for maximal acid concentration, 67.1 percent for maximal acid output, and 67.6 percent for peak acid output, indicating the reduction of gastric acid secretion to be fairly satisfactory. In none of the patients available for follow-up was identified a recurrence of ulcer. These follow-up results suggest the use of segmental gastrectomy for gastric ulcer and for other benign lesions in the mid portion of the stomach.