隔药灸神阙八阵穴对术后粘连性肠梗阻患者疗效及炎性反应因子的影响

目的：探讨隔药灸神阙八阵穴对术后粘连性肠梗阻（AIO）患者疗效及血清白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-α）水平的影响。方法：选取2013年1月至2017年4月唐山市人民医院收治的行腹腔手术患者280例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组140例，对照组采用常规治疗；观察组在对照组基础上给予隔药灸神阙八阵穴，均治疗1周。比较2组患者临床疗效、治疗后肠功能评分、治疗前后胃动素（MOT）水平、IL-6、TNF-α水平。结果：观察组总有效率为91.43%，显著高于对照组77.14%（P<0.05）；治疗后，观察组恢复排气时间、腹部症状缓解时间、肠鸣音恢复时间均短于对照组（P<0.05）、2组患者MOT水平均低于治疗前，且观察组的MOT水平低于对照组（P<0.05）、2组患者的血清IL-6、TNF-α水平均显著低于治疗前，且观察组的血清IL-6、TNF-α水平均低于对照组（P<0.05）。结论：隔药灸神阙八阵穴治疗AIO疗效显著，能改善患者胃肠功能，降低MOT水平，有效调节血清IL-6、TNF-α水平。     

Triple-drug therapy to prevent pancreatic fistula after pancreatectomy in a rat model

BackgroundPancreatic fistula (PF) is one of post-operative complications in pancreatic surgery, but there is no consensus about the optimal treatment for PF. Our group has established a rat model of PF, and we conducted the present investigation to determine the efficacy of the triple-drug therapy (somatostatin analogue, gabexate mesilate, and imipenem/cilastatin) against PF using our rat model.MethodsIn the PF rat model, the triple-drug therapy was administered to the treated (T) group (n = 4), and we compared the results with those of a control (C) group (n = 4). The rats were sacrificed on postoperative day 3 (POD 3) and the levels of amylase and lipase in serum and ascites were measured. The intra-abdominal adhesion was scored. Each pancreas was evaluated pathologically, and inflammation was scored.ResultsThe ascitic amylase levels on POD 3 were 1982 (1738–2249) IU/L in the C group and significantly lower at 136 (101–198) IU/L in the T group (p = 0.02). The ascitic lipase levels on POD 3 were 406 (265–478) U/L in the C group and significantly lower at 13 (7–17) U/L in the T group (p = 0.02). The intra-abdominal adhesion score on POD 3 was 2 (1–2) in the C group and significantly lower at 0 (0–1) in the T group (p = 0.02). The histological evaluation showed that the average of pancreatic inflammatory score was 8.5 (8–9) in the C group and significantly milder at 5 (5–7) in the T group (p = 0.01).ConclusionOur findings suggest that the triple-drug therapy could be useful as a treatment for PF in clinical settings.     

鼻肠减压管在重症急性胰腺炎中的应用

目的：探讨鼻肠减压管（NDT）在重症急性胰腺炎（SAP）患者中的应用价值。 方法：将56例SAP患者分为鼻肠减压管组（观察组）和普通鼻胃管组（对照组）,各28例。分别观察两组患者胃肠减压引流量、腹部胀痛缓解时间及转归,以及实验室检查项目和APACHE II及Binder合并症评分的动态变化。 结果：观察组与对照组对比,前者日平均胃肠减压引流量增多,腹胀痛缓解时间、平均住院时间缩短,中转手术率降低（均P<0.05）,两组病死率无统计学差异（P>0.05）;观察组血白细胞（WBC）、C-反应蛋白（CRP）,血清淀粉酶（AMY）、脂肪酶（LPS）及乳酸脱氢酶（LDH）恢复正常的时间均较对照组缩短（均P<0.05）;APACHE II及Binder评分从住院后第2~8天均明显低于对照组（均P<0.05）,直至第10天两组水平接近（均P>0.05）。 结论：NDT的应用可显著改善SAP患者的病情,减少并发症的发生,降低外科手术率,缩短住院时间,值得在临床中推广应用。     

奥曲肽联合泮托拉唑预防内镜逆行胰胆管造影术后胰腺炎

目的：探讨内镜逆行胰胆管造影（ERCP）术后胰腺炎的预防措施。 方法：将2010年7月—2012年11月间行ERCP术后的患者100例,随机分为观察组和对照组,每组各50例患者。观察组术后给予联合应用生长抑素（奥曲肽0.1 mg/8 h皮下注射连用24 h）和质子泵抑制剂作预防治疗（泮托拉唑40 mg/d静脉滴注连用2 d）,对照组给予生理盐水静脉滴注。比较两组患者ERCP术后3,12,24 h的血清淀粉酶情况,及胰腺炎的发生情况。 结果：两组一般资料比较具有可比性;在术后3,12,24 h各时间点比较,观察组血清淀粉酶水平均明显低于对照组（均P<0.05）;观察组术后12,24 h高淀粉酶血症发生率及术后急性胰腺炎明显均低于对照组（18% vs. 42%;8% vs. 22%;2% vs. 16%）（均P<0.05）。 结论：联合应用生长抑素和质子泵抑制剂可减少ERCP术后高淀粉酶血症与胰腺炎的发生率,是一种安全且有效的ERCP术后胰腺炎预防措施。     

生长抑素治疗急性胰腺炎对患者胰腺血流及胰腺功能的影响

目的探讨生长抑素对急性胰腺炎患者胰腺血流及胰腺功能的保护作用。方法选取2012年12月至2014年2月于本院进行诊治的76例急性胰腺炎患者为研究对象,所有患者根据随机数字表法分为对照组和观察组各38例,对照组采用常规治疗,观察组则在常规治疗的基础上增加生长抑素治疗,检测并比较两组患者治疗前和治疗后1 d、3 d及7 d的胰腺血流及胰腺内外分泌系统相关指标。结果治疗前两组患者间各项观察指标比较差异均无统计学意义(P>0.05)。治疗后1 d、3 d及7 d观察组患者的血清正铜蓝蛋白(CP)及胰岛素(INS)水平均高于对照组(P<0.05),胰高血糖素(GLU)、脂肪酶(LIP)、淀粉酶(AMY)和胰蛋白酶原-2(TPS-2)水平则低于对照组(P<0.05);观察组的血流量(BF)及血容量(BV)均高于对照组(P<0.05),毛细血管表面通透性(PS)则低于对照组(P<0.05)。结论生长抑素对急性胰腺炎患者胰腺血流及胰腺功能的保护作用均较为明显,对患者胰腺综合状态的改善作用较为突出。     

Neuropeptides in the posterodorsal medial amygdala modulate central cardiovascular reflex responses in awake male rats

The rat posterodorsal medial amygdala (MePD) links emotionally charged sensory stimuli to social behavior, and is part of the supramedullary control of the cardiovascular system. We studied the effects of microinjections of neuroactive peptides markedly found in the MePD, namely oxytocin (OT, 10 ng and 25 pg; n=6/group), somatostatin (SST, 1 and 0.05 μM; n=8 and 5, respectively), and angiotensin II (Ang II, 50 pmol and 50 fmol; n=7/group), on basal cardiovascular activity and on baroreflex- and chemoreflex-mediated responses in awake adult male rats. Power spectral and symbolic analyses were applied to pulse interval and systolic arterial pressure series to identify centrally mediated sympathetic/parasympathetic components in the heart rate variability (HRV) and arterial pressure variability (APV). No microinjected substance affected basal parameters. On the other hand, compared with the control data (saline, 0.3 µL; n=7), OT (10 ng) decreased mean AP (MAP₅₀) after baroreflex stimulation and increased both the mean AP response after chemoreflex activation and the high-frequency component of the HRV. OT (25 pg) increased overall HRV but did not affect any parameter of the symbolic analysis. SST (1 μM) decreased MAP₅₀, and SST (0.05 μM) enhanced the sympathovagal cardiac index. Both doses of SST increased HRV and its low-frequency component. Ang II (50 pmol) increased HRV and reduced the two unlike variations pattern of the symbolic analysis (P<0.05 in all cases). These results demonstrate neuropeptidergic actions in the MePD for both the increase in the range of the cardiovascular reflex responses and the involvement of the central sympathetic and parasympathetic systems on HRV and APV.     

思他宁联合早期内镜治疗急性胆石性胰腺炎

目的 探讨应用思他宁联合早期内镜治疗急性胆石性胰腺炎(AGP)的疗效。方法 应用思他宁联合早期逆行胰胆管造影术(ERCP)、经内镜鼻胆管引流(ENBD)及经内镜乳头括约肌切开(EST)治疗AGP32例，其中轻症胰腺炎21例，重症胰腺炎11例。结果 治愈30例，2例重症胰腺炎内镜治疗后转外科手术治疗，1例术后死亡。结论 思他宁联合内镜治疗AGP是安全和有效的，对明确诊断AGP应及早应用思他宁及内镜介入治疗。     

消化性溃疡,胃癌患者胃窦粘膜中胃肠激素含量变化及其意义

研究了胃十二指肠疾病患者胃窦粘膜胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ－物质（ＳＰ）的含量变化及其意义。结果表明：胃窦粘膜ＳＳ含量在胃溃疡组低于其余各组（Ｐ均〈０．０５），而在胃癌时则显著增高（Ｐ〈０．００１）；ＳＰ浓度在十二指肠溃疡组显著低于其余各组（Ｐ均〈０．０５）；胃癌患者Ｇａｓ水平显著高于对照组（Ｐ〈０．０５）；ＳＳ与ＳＰ在十二指肠溃时呈明显负相关。提示：胃粘膜中Ｇａｓ、ＳＳ、ＳＰ的含量变