芒硝敷脐促进大肠癌术后肠蠕动的临床研究

目的探讨芒硝敷脐促进大肠癌术后肠蠕动的临床效果。方法选择2015年1月~2017年6月在我院诊断并行手术治疗的大肠癌患者90例为研究对象,随机分为实验组与对照组各45例。两组采取统一的围手术期治疗方案以及护理措施,实验组在此基础上给予芒硝敷脐。比较两组肠鸣音恢复时间、肛门排气时间、排便时间、住院时间、腹胀情况,对两组效果进行分析。结果实验组肠鸣音恢复时间[(43.2±2.2)h]、肛门排气时间[(60.2±4.5)h],均显著短于对照组,差异有统计学意义(P0.01);实验组排便时间及住院时间较对照组早,但两组比较,差异无统计学意义(P0.05)。对照组2例患者为重度腹胀,实验组无重度腹胀患者,但两组患者腹胀情况比较,差异无统计学意义(P0.05)。两组均无在48 h内肛门排气患者,实验组所有患者均在48~72 h内恢复肛门排气,对照组1例患者在48~72 h内恢复肛门排气,44例均超过72 h恢复肛门排气,两组比较,差异有统计学意义(P0.01)。结论芒硝敷脐能够促进大肠癌术后肠蠕动,缩短肠鸣音恢复时间以及肛门排气时间。     

MRI电影对月经过多子宫肌瘤患者子宫蠕动的研究

目的应用MR电影成像技术(cine MRI)探讨月经过多子宫肌瘤患者排卵期子宫蠕动情况及肌瘤位置对子宫蠕动的影响。材料与方法采用1.5 T MRI仪对30名健康志愿者及30例月经过多子宫肌瘤患者于排卵期行盆腔T1轴面、T2-抑脂轴面、T2矢状面及子宫cine MR扫描。比较健康志愿者与月经过多肌瘤患者子宫正常蠕动存在率及蠕动频率,分析肌瘤位置与蠕动形式的关系。结果月经过多子宫肌瘤患者排卵期子宫正常蠕动存在率及蠕动频率较健康志愿者显著降低,两者均有统计学意义(P值均0.01),黏膜下肌瘤患者主要表现为无蠕动,肌壁间肌瘤患者蠕动形式多样。结论月经过多子宫肌瘤患者排卵期子宫正常蠕动显著减少,不利于排卵期精子快速进入输卵管;Cine MRI有助于月经过多子宫肌瘤患者子宫蠕动的评价,为临床提供子宫蠕动的功能信息。     

腹部手术后应用新斯的明镇痛对肠蠕动影响的临床研究

目的观察腹部手术后应用新斯的明镇痛对肠蠕动的影响。方法选择该院2012年1月至2013年8月行择期腹部手术患者共120例,将120例患者随机分设为观察组和对照组,每组60例,其中观察组药物配方:舒芬太尼100μg+甲磺酸罗哌卡因178.8 mg+新斯的明1 mg用生理盐水稀释至100 ml;对照组药物配方:舒芬太尼100μg+甲磺酸罗哌卡因178.8 mg用生理盐水稀释至100 ml。两组手术主刀者均为我院普外科高年资主治以上医师,操作手法及手术水平无显著性差异。结果观察组胃肠道蠕动功能恢复明显好于对照组。观察组恶心、呕吐、感染、电解质紊乱、消化道出血的发生率均显著低于对照组。观察组患者术后镇痛效果优于对照组,差异有统计学意义(P0.05)。结论对于胃肠手术后疼痛的患者,给予硬膜外腔恒速注入舒芬太尼、新斯的明、罗哌卡因的复合液进行镇痛,可以获得满意的镇痛效果,有助于患者胃肠功能的早期恢复。     

Functional magnetic stimulation of the vagus nerve enhances colonic transit time in healthy volunteers

Sacral magnetic stimulation (MS) of the full and empty rectum increases rectal and decreases anal pressures. Rectal evacuation was produced by intermittent MS. MS activates not only the muscles but also the nervous tissue. In the present study I investigated the effect of MS of the vagus nerve on the colonic transit to evaluate the possibility of using this method in the treatment of constipation due to colonic inertia. Forty healthy volunteers were divided into 2 equal groups: study (mean age 46.6 years; 13 men, 7 women) and control (mean age 43.9 years; 13 men, 7 women). MS was produced by a magnetic stimulator and a 2-cm coil placed in the middle of the ventral surface of the neck. MS parameters were set at 70% of maximal intensity, 40 Hz frequency, 10 seconds on, 10 seconds off for 20 minutes and followed by 60 minutes rest. This sequence was performed for 5 cycles. Colonic transit was determined by ingesting 20 radiopaque markers and by radiographing the subject. In the control group, 6 subjects had passed all the markers on the sixth day post-ingestion and all the remaining subjects except two on the seventh day; the last two subjects passed all the markers on the eighth day. In the study group, more than 50% of the subjects had passed all the markers already by the fifth post-ingestion day; the others completed passage of the markers by the sixth day. In the study group 100% of the markers had passed by the sixth post-ingestion day against 30% in the control group. These findings suggest that MS of the vagus nerve enhances colonic transit by augmenting the peristaltic activity of the gut. The procedure might thus be used for the treatment of constipation resulting from delayed colonic transit. Received: 17 May 1999 / Accepted in revised form: 30 July 1999     

The peristaltic reflex: An analysis of the nerve pathways and their pharmacology

Summary The enteric reflexes in isolated segments of the distal colon and rectum of the guinea-pig were studied by applying localized distensions and recording the consequent changes in circular muscle activity, and by recording tension changes in the circular muscle during the propulsion of a bolus in vitro. Lesions of the wall of the colon were made to locate nerve pathways involved in the reflexes and pharmacological tests were applied to investigate the natures of transmitters released and the types of receptors involved. Distension produced a transient contraction of the circular muscle on the oral side and sustained relaxation on the anal side. Both reflexes were nervemediated. They were elicited in segments deprived of mucosa and submucosa. Interruption of Auerbach's plexus, but not interruption of the submucosal plexus, prevented their conduction. The ascending excitatory reflex was partly blocked by hyoscine and was also partly blocked by methysergide or by making the preparation tachyphylactic to the excitatory action of 5-hydroxytryptamine. The ascending excitatory pathways apparently involve neurons releasing a 5-HT-like transmitter as well as cholinergic neurons. The descending inhibitory reflex was not antagonized by hyoscine, guanethidine, methysergide or mepyramine. It is assumed that the inhibitory neurons activated in this reflex are identical with the noncholinergic, non-adrenergic, enteric inhibitory neurons found throughout the intestine. If both the ascending excitatory and descending inhibitory reflexes acted simultaneously on the same area of circular muscle, the inhibitory response tended to dominate.Pellets of faeces, covered by a thin layer of resin, were introduced into the oral ends of isolated segments of colon. They were propelled analwards at speeds of 0.5–1.6 mm/s. Tension records showed that the pellets were preceded by relaxation and followed by a ring of contraction. The propulsion was blocked by both hyoscine and methysergide. Descending waves of contraction were also observed in empty segments of colon. These occurred spontaneously or were initiated by stretch. They did not occur in the presence of hyoscine or tetrodotoxin.It is postulated that three factors may contribute to propulsion in the guinea-pig distal colon: ascending excitatory reflexes which evoke contractions above a bolus; descending inhibitory reflexes which cause relaxations below; and contractions which, once set up in the circular muscle, travel in an anal direction.Preliminary reports of aspects of this work have been presented to the Australian Physiological and Pharmacological Society (Costa and Furness, 1974; Furness and Costa, 1974).     

舒芬太尼对小鼠胃肠道蠕动功能的影响

目的观察舒芬太尼对小鼠胃肠蠕动功能的影响。方法将120只小自鼠按给药方式的不同分为口服0．9％氯化钠溶液组（N0组）、口服舒芬太尼组（SO组）、腹腔内注射0．9％氯化钠溶液组（N7组）和腹腔内注射舒芬太尼组（sI组）,各30只。给药2min后,经口灌入亚甲蓝液0．2mL。30min后采用颈椎脱臼法将小白鼠处死,打开腹腔,剪开肠系膜。以幽门为起点测量亚甲蓝在肠管内移动距离和肠管全长,并计算亚甲蓝移动率。结果4组染色肠管长度及甲蓝移动率比较差异均有统计学意义（P〈0．05）。染色肠管长度：SO组低于NO组,SI组低于M组,SO组低于SI组,差异均有统计学意义（P〈0．05）。亚甲蓝移动率：SI组和NO组比较,SO组与NI组、SI组比较,差异均有统计学意义（P〈0．05）。小白鼠染色肠管长度和亚甲蓝移动率呈正相关（r=0．939,P〈0．01）。结论舒芬太尼无论口服还是腹腔内注射对小白鼠胃肠道蠕动功能都有抑制作用,口服更加明显。     

Effect of White Wine on Esophageal Peristalsis and Acid Clearance

Background: In a previous study it was demonstrated that white wine reduces the lower esophageal sphincter pressure and induces gastroesophageal reflux characterized by reflux episodes of long duration. In the present study, it was evaluated whether wine disturbs esophageal peristalsis and acid clearance. Methods: Twelve healthy volunteers (7F, 23-37 years) received 300 ml white wine (8% vol/vol; WW), an ethanol solution (8% vol/vol; ET) or tap water (WA) together with a standardized meal in a random order. Acid clearance was tested by instillation of 15 ml 0.1 N HCl into the distal esophagus. The number of swallows (dry swallow every 30 sec) were counted until pH rose again above 5. Five wet swallows (5 ml) were applied to test primary peristalsis and five insufflations of 20 ml of air were performed to test secondary peristalsis. Each test was done immediately after and 60 min after ingestion of the beverages. Results: A significantly higher number of swallows were needed to clear the esophagus immediately after ingestion of wine (P < 0.01; median number: WW 12; ET 8; WA 7) due to an increase in the frequency of failed, simultaneous, and low-amplitude contractions. The frequency of triggered secondary contractions was decreased (P < 0.02; WW 70%; ET 100%; WA 100%) and the latency between air injection and onset of secondary peristalsis was prolonged (P < 0.05; WW 9 sec; ET 7 sec; WA 6 sec) immediately after ingestion of white wine. Wet swallow induced primary peristalsis was not influenced by wine. No significant differences in the measured parameters were seen 60 min after ingestion of the three beverages. Conclusion: White wine disturbs temporarily esophageal clearance due to a disturbance of triggering secondary peristalsis and due to an increase in ineffective contractions. The ethanol content alone is not responsible for the effects of white wine on esophageal peristalsis and acid clearance.     

Uterine anatomy and function on cine magnetic resonance imaging

The female reproductive organ undergoes dynamic morphological changes under the influence of hormonal stimuli, and particularly those mediated by estrogen and progesterone. The uterus changes both its morphological appearance and its functional movements in function of these influences. Functionally, the uterus is known to exert two kinds of inherent contractility: sustained uterine contractions and uterine peristalsis. The former is focal and consists of the sporadic bulging of the myometrium, while the latter is rhythmic and manifests itself as the subtle stripping movement in the subendometrial myometrium. The mechanisms underlying these uterine movements, their relationship and their correlation to age, pharmaceutical administration, and a variety of gynecologic and obstetrical problems remain under discussion. Cine MR imaging may offer the potential to directly observe the changes undergone by the uterus in relation to important functions such as fertility and menstrual problems.