乳果糖联合氟哌噻吨/美利曲辛对伴有焦虑状态老年便秘患者的疗效观察

目的观察乳果糖联合氟哌噻吨／美利曲辛对伴有轻中度焦虑状态老年便秘患者治疗后的便秘、焦虑状态改善情况,以及不良反应的发生率。方法选择2011年1月至2012年12月在复旦大学附属华东医院门诊治疗的80例伴有轻中度焦虑状态老年便秘患者[年龄65～86（74．6±7．6）岁],随机分为治疗组和对照组,治疗组1：3服氟哌噻吨／美利曲辛片1片,1次／d,同时给予乳果糖口服液15ml,2次／d;对照组单纯给予乳果糖口服液15ml,2次／d,疗程均为4周。分别在第2周和第4周记录患者便秘治疗的有效率以及焦虑自评量表（SAS）评分变化情况。结果两组患者在治疗4周后便秘状况均得到改善,但在治疗2周时,治疗组患者的总有效率高于对照组,差异有统计学意义（P=0．029）;治疗2周和4周时,治疗组患者的SAS评分降低值与对照组比较,差异均具有统计学意义（P=0．020,P=0．012）。两组患者均未出现严重不良反应,两组间不良反应发生率差异无统计学意义（P〉0．05）。结论乳果糖合并氟哌噻吨／美利曲辛治疗伴有轻中度焦虑状态的功能性便秘老年患者是有效且安全的。     

慢性病毒性肝炎患者血清抗氧化能力状况与乳果糖保护效应

目的研究不同内毒素水平的慢性病毒性肝炎患者血抗氧化能力差别,探讨乳果糖对慢性病毒性肝炎患者体内抗氧化能力的影响。方法 72例慢性病毒性肝炎患者根据内毒素水平分为两组,比较两组体内抗氧化水平;并随机分为乳果糖治疗组(n=36)和对照组(n=36),观察两组病人治疗前及治疗2周后血清抗氧化能力、血内毒素水平的变化。结果内毒素血症阴性患者(内毒素水平<45ng/L)与内毒素血症阳性患者(内毒素水平≥45ng/L)比较,丙二醛(MDA)水平降低,超氧化物歧化酶(SOD)活性明显升高,差异均有统计学意义(t分别=4.27、-3.47,P均<0.05),而一氧化氮合酶(NOS)活性在两组间比较,差异无统计学意义(t=1.26,P>0.05)。Pearson相关性分析显示,血内毒素水平与MDA水平呈正相关(r=0.57,P<0.05),内毒素水平与SOD和NOS水平呈负相关(r分别=-0.62、-0.30,P均<0.05)。乳果糖治疗组治疗后血中SOD水平和NOS水平明显升高,MDA和内毒素水平明显下降,治疗前后差异均有统计学意义(t分别=-3.88、-3.12、4.69、3.74,P均<0.05)。且与对照组治疗后比较,SOD水平升高,内毒素水平下降,差异均有统计学意义(t分别=-3.08、3.19,P均<0.05),但两组治疗后MDA和NO水平差异均无统计学意义(t分别=1.63、-1.54,P均>0.05)。结论乳果糖能改善慢性病毒性肝炎患者抗氧化系统损伤,可能与降低血清内毒素水平有关。     

The Colon in Carbohydrate Malabsorption: Short-Chain Fatty Acids,pH, and Osmotic Diarrhoea

Holtug K, Clausen MR, Hove H, Christiansen J, Mortensen PB. The colon in carbohydrate malabsorption: short-chain fatty acids, pH, and osmotic diarrhoea. Scand J Gastroenterol 1992;27:545-552.

Short-chain (C₂-C₆) fatty acids (SCFA) are the major anions in colonic contents and the result of anaerobic fermentation of mainly saccharides. The effects and regulation of saccharide fermentation were studied in vitro and in vivo. In vitro faecal incubation was used to study the effects of lactose, glucose, and galactose and of pH on SCFA formation. Changing the pH to below 5 or above 11 abolished SCFA formation in the faecal incubates; in the pH 5-9 interval SCFA production was high, with only minor pH dependence. Adding glucose, galactose, or lactose to the incubation system increased SCFA production, but at high saccharide concentrations (100-300 mmol/1) SCFA formation was inhibited by the pH change. In vivo disaccharide malabsorption with increasing doses of lactulose caused a decrease in faecal pH to < 5, values inhibitory to fermentation, before the appearance of carbohydrate in faeces. In 6 of 12 volunteers diarrhoea occurred suddenly and was caused by malabsorbed non-fermented carbohydrate. The six other volunteers had a gradual increase in faecal output with lactulose dose and developed diarrhoea before the appearance of saccharide in faeces. The intake of lactulose tolerated before diarrhoea ensued varied between individuals, with the majority having diarrhoea of more than 1 1/day at 160 g lactulose per day. At this dose SCFA absorption was estimated to be in the range 550 to 1150mmol/day.     

Intestinal permeability and complications in liver cirrhosis: A prospective cohort study

Aim: Increased intestinal permeability (IP) has been implicated as an important factor for bacterial translocation (BT), leading to bacteremia and endotoxemia, resulting in various septic complications, variceal bleeding (VB), hepatic encephalopathy (HE), hepatorenal syndrome (HRS) and death in patients with liver cirrhosis (LC). This study was planned to assess IP in patients with LC and follow them for the occurrence of complications. Methods: Patients with Child B and C cirrhosis without a history of disease‐related complications were followed up for 6 months. IP was measured by lactulose and mannitol excretion ratio (LMR) in patients and 50 healthy controls (HC). Serum endotoxin levels were also assessed in 48 patients and 20 HC. Results: Eighty patients (74 male), 41 (51.3%) Child B and 56 (70%) Child C, with a mean age of 40.7 ± 9.8 years were enrolled. IP was increased in 28 (35%) patients. LMR of patients was higher than HC (patients vs HC = 0.0238 [0.0010–1.557] vs 0.0166 [0.0018–0.720]; P = 0.007]. No significant difference was seen in the LMR of patients among various Child classes and etiologies. Serum endotoxin levels (GMU/mL) were higher in patients than HC (patients vs HC = 1.42 [0.68–2.13] vs 0.994 [0.067–1.382]; P = 0.001), but comparable between patients with abnormal and normal IP. At follow up, there was no significant difference in the incidence of complications like spontaneous bacterial peritonitis, HRS, VB, HE and death between patients with abnormal and normal IP. Conclusion: IP was increased in 35% of patients with LC; however, it was not associated with a higher incidence of disease‐related complications.     

改良术前肠道准备在原发性肝癌患者中的应用

目的探讨原发性肝癌患者术前肠道准备的改良措施。方法方便性抽样法选择2010年9月至2011年3月在东方肝胆外科医院肝外一科住院的80例原发性肝癌患者,按随机数字表法将其分为研究组组和对照组,每组40例,分别采用乳果糖+双歧杆菌三联活菌散剂(研究组)及聚乙二醇电解质(对照组)口服作为肠道准备药物,观察肠道准备后当天排便次数、肠功能恢复情况,以及术前后内毒素和白细胞的变化情况。结果研究组患者肠道准备当天的排便次数少于对照组,肠功能恢复时间短于对照组,术后72h的内毒素水平及第7天的白细胞计数低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论乳果糖+双歧杆菌三联活菌散剂应用于肝癌患者术前肠道准备是安全可行的,不仅提高了患者的舒适度、促进了肠功能恢复,而且维持了肠道菌群的生态平衡,减少了内毒素的产生,具有保护肝脏的作用。     

Evidence-based Pain Management and Palliative Care in July Issue for 2010 of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. The July issue for 2010 contains 4309 complete reviews, 1935 protocols for reviews in production, and 12,893 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 625,000 randomized controlled trials, and 13,320 cited papers in the Cochrane methodology register. The health technology assessment database contains over 8600 citations. Eighty-four new reviews have been published in the last 3 months, of which 8 have potential relevance for practitioners in pain and palliative medicine.     

乳果糖在老年人功能性便秘中的应用

目的观察乳果糖治疗老年人功能性便秘的疗效及安全性。方法本研究将112例患有功能性便秘的老年人随机分为2组;治疗组(A组)58例口服乳果糖15～30 mL.d-1;对照组(B组)54例,服用麻仁软胶囊每天2～4粒,分别于第3周记录每日大便次数,并按Bristol粪便量表记录便型及排便困难程度。观察A组受试者治疗后出现的不良事件。结果治疗后A组总有效率82.7%(48/58)明显高于B组(53.7%,29/54)。整个研究过程中,A组无严重不良事件发生,受试者的生命体征、体检均无异常;仅有轻度胃肠道反应发生,其中胃肠胀气、腹泻、恶心发生率分别为8.6%、6.8%及6.8%。结论研究表明乳果糖在老年人功能性便秘的治疗中有效且安全。     

四磨汤联合乳果糖治疗老年人假性肠梗阻

目的： 观察四磨汤联合乳果糖治疗老年人假性肠梗阻（SIPO）的疗效。 方法： 选择46例SIPO确诊病例,随机分为治疗组和对照组,所有入选病例均给予禁食、胃肠减压、通便灌肠、营养支持等常规处理,治疗组同时加用乳果糖口服液10 mL,3次/日;四磨汤口服液20 mL,3次/日,疗程1周。 结果： 对照组和治疗组总有效率分别为56.5%,78.3%,组间比较差异有显著性（P<0.05）。治疗组肠梗阻症状积分改善明显,其总有效率明显高于对照组,组间比较差异有显著性（P<0.05）。 结论： 乳果糖与四磨汤联用对SIPO具有较好治疗效果。