全胃切除术后两种消化道重建术的效果比较

目的 比较改良袢式空肠代胃术与P型空肠代胃术的优缺点及临床应用价值.方法 56例胃癌患者依据胃切除术后消化道重建方式分为两组,观察组35例采取改良袢式空肠代胃术；对照组21例采取P型空肠代胃术,比较两组临床效果.结果 两组手术时间和术中出血量差异无统计学意义(P＞0.05).观察组排空时间[(61±23)min]较对照组[(37±19)min]长(t=3.03,P＜0.05),每次饮食量[(308±44) ml]较对照组[(262±34) ml]高(t=2.55,P＜0.05),每天饮食次数[(4.2±1.2)次]较对照组[(5.7±2.3)次]少(t=2.46,P＜0.05).观察组术后并发症发生率(14.3％)显著低于对照组(42.9％)(x2=5.71,P＜0.05).结论 全胃切除术后,采用改良袢式空肠代胃术重建消化道,相对于P型空肠代胃术,能有效提高患者术后生活质量,降低并发症发生率,但并未使手术过程复杂化.     

82例肝硬化患者胃动力学的超声检查分析

目的:研究肝硬化患者的胃排空功能及临床意义,以及肝功能分级与胃排空时间的关系。方法:采用单切面实时超声法对82例肝硬化患者和32例健康对照者进行了B超流体餐动力学多项指标检测。结果:与对照组比较,肝硬化患者胃半排空时间(T1/2)延长1.96倍,全胃排空时间(T)延长1.53倍,胃窦收缩时间减慢61.59%,胃窦收缩幅度(△A/A)及胃窦运动指数(MI)均下降。结论:肝硬化患者胃排空明显障碍,超声测定肝硬化合作胃动力学改变简单、无创、经济、准确、易行。     

中医小儿推拿法治疗小儿厌食症的临床研究

目的:观察中医小儿推拿法治疗小儿厌食症的临床疗效。方法:将本院收治的厌食症患儿,随机分为观察组与对照组。对照组给予葡萄糖酸锌口服液治疗,观察组采用中医小儿推拿法治疗。结果:观察组患儿治疗后体质量(17.59±0.19)kg、胃排半空(27.63±1.43)min、胃窦收缩(2.55±0.06)次/min、治疗有效率96%。对照组患儿治疗后体质量(14.51±1.02)kg、胃排半空(40.18±0.84)min、胃窦收缩(1.56±0.01)次/min、治疗有效率72%。结论:采用中医小儿推拿法,辩证治疗小儿厌食症。能够有效改善患儿食欲,提高治疗有效率。     

不同性别体检人群体质指数与血尿酸水平及胰岛素抵抗的相关性研究

目的 研究体质指数与血尿酸水平及胰岛素抵抗之间的关系.方法 1725例体检者根据体质指数分为正常体重组(302例)、超重组(799例)和肥胖组(624例),按不同性别分析体质指数与血尿酸水平及胰岛素抵抗的关系.结果 超重组和肥胖组的血尿酸水平和胰岛素抵抗指数均明显高于正常体重组[(368±84) mol/L、(398±95)μmol/L比(327±89)μmol/L;(3.0±1.3)、(3.7±1.4)比(1.6±1.4),均P＜0.01],肥胖组血尿酸水平明显高于超重组(P＜0.0l).男性中血尿酸水平、胰岛素抵抗指数肥胖组和超重组均明显高于正常体重组[(413±90)μmol/L、(382±82)μmol/L比(366±84) μmol/L,(3.7±1.7)、(2.9±1.1)比(1.6士1.7),P＜0.05或P＜0.01],肥胖组明显高于超重组(P＜0.05或P＜0.01).女性中肥胖组和超重组血尿酸水平均明显高于正常体重组[(340±94) μmol/L、(315±72)μmol/L比(278±69)μmol/L,P＜0.01],肥胖组明显高于超重组(P＜0.05),肥胖组胰岛素抵抗指数明显高于正常体重组(P＜0.01).Pearson相关分析显示,无论在全部人群中,还是在男性和女性人群中,体质指数均与血尿酸水平(r分别为0.307、0.234、0.346)、胰岛素抵抗指数(r分别为0.162、0.168、0.147)呈正相关(均P＜0.01).多元线性回归显示,全部人群和男性人群中体质指数仍与血尿酸水平和胰岛素抵抗指数显著相关；女性人群中体质指数仅与血尿酸水平显著相关.结论 随体质指数增高,不同性别体检人群血尿酸水平及胰岛素抵抗指数明显增加.     

雷贝拉唑与马来酸曲美布汀对胃食管反流患者胃食管动力学的影响

目的 探讨雷贝拉唑与马来酸曲美布汀对胃食管反流患者胃食管动力学的影响.方法 选取我院消化内科收治的胃食管反流病患者200例作为研究对象,随机分为对照组和观察组各100例,对照组口服质子泵抑制剂雷贝拉唑片治疗,观察组采用雷贝拉唑联合马来酸曲美布汀胶囊治疗.检测两组患者治疗前后胃食管动力学和胃电活动指标,并对临床疗效进行统计学分析.结果 观察组总有效率(96％)明显高于对照组(79％),差异有统计学意义(x2=11.703,P＜0.05).观察组患者治疗后胃窦收缩幅度、胃窦运动指数及胃窦收缩频率分别为(1.91±0.44)、(2.03±0.81)、(2.47±0.95),对照组分别为(1.22±0.35)、(1.12±0.47)、(2.05±0.59),观察组均显著高于对照组(P＜0.05).观察组治疗后食管蠕动性收缩比、括约肌压力及食管括约肌松弛率分别为(94.2±16.0)％、(19.32±1.45)mmHg、(75.8±6.6)％,对照组分别为(86.1±13.8)％、(13.42±1.38) mmHg、(58.8±6.0)％,观察组均显著高于对照组(P＜0.05).观察组患者治疗后餐前及餐后的主频、主功率分别为(4.1±0.8)、(4.4±0.6)、(100.4±26.9)、(165.6±36.6),对照组分别为(3.3±0.9)、(3.3±0.5)、(91.1±28.5)、(155.1±35.0),观察组均显著高于对照组(P＜0.05).治疗8周后观察组空腹、餐后的正常慢波节律为(42.8±22.6)、(66.1±21.7),显著高于对照组的(41.5±20.0)、(50.4±21.6),而餐后胃动过缓(29.4±19.3)明显低于对照组(41.8±23.1)(P＜0.05).结论 雷贝拉唑与马来酸曲美布汀能够提高胃食管动力,增加收缩力,使患者正常慢波节律减少,增加餐后胃电正常慢波百分比,改善胃排空,是一种安全、高效的治疗GERD的方法.     

盐酸右美托咪定在全麻肥胖患者体内的药代动力学研究

目的探讨盐酸右美托咪定注射液在中国全麻肥胖患者的药代动力学特征。方法 8例肥胖患者全身麻醉后静脉泵注盐酸右美托咪定1.0μg·kg-1,高效液相色谱-质谱联用法(HPLC-MS/MS)测定血浆中右美托咪定浓度变化。以DAS 2.1.1软件进行数据处理,计算药代动力学参数。结果盐酸右美托咪定的药代动力学参数如下:Cmax为(3.33±1.20)μg·L-1,t1/2α为(2.49±0.56)min,t1/2β为(163.41±116.41)min,V1为(162.96±43.26)L,CLz(4.02±1.18)L·min-1,AUC0-t为(123.27±55.96)μg·min·L-1,MRT0-t为152.06min。肥胖患者的AUC、Cmax、CLz、V1较正常体质量患者均显著增大(P<0.05)。结论在肥胖患者临床麻醉中,给予右美托咪定负荷剂量时,应适当减少药物剂量;维持阶段时,应适当增加药物剂量。     

儿童血浆瘦素水平与肥胖度的关系

目的:研究9～12岁儿童血浆瘦素(leptin)水平与体脂和性别的关系。方法:用酶联免疫分析法(ELISA)测定30例正常体质量儿童(正常组)和53例肥胖儿童(肥胖组)的血浆瘦素水平。结果:正常组瘦素浓度男童为(1.44±1.22)μg/L,女童为(2.30±1.53)μg/L;体质量指数(BMI)男童为(16.61±1.22)kg/m2,女童为(15.16±1.68)kg/m2。肥胖组瘦素浓度男童为(15.05±7.97)μg/L,女童为(16.15±7.67)μg/L,BMI男童为(25.28±2.76)kg/m2,女童为(23.26±2.63)kg/m2。血浆瘦素水平与BMI呈正相关(男童r=0.76,女童r=0.87,P<0.05)。少数(5.7%)肥胖儿童具有瘦素相对性缺乏。结论:大多数肥胖儿童存在瘦素抵抗,少数为瘦素相对性缺乏的肥胖儿将成为瘦素治疗的对象。     

电子护理病历与手工护理病历优势比较的研究

目的 比较电子护理病历与手工护理病历的不同书写方式,从中找出丽者的差异.方法 采用临床调查的方式.2010年8月1-30日手工护理病历2031份,平均住院67.7人/天,为A组;2012年8月1-30日电子护理病历2132份,平均住院71人/天,为B组.调查体温表绘制、医嘱处理、护理记录书写速度、质量.手工护理病历与电子护理病历书写格式相同.结果 A组、B组体温表绘制耗时比较,A组:(82.93±1.92)批量/天(min),(1.23±0.02) min/份;B组:(14.97±0.46)批量/天(min),(0.21±0.00) min/份;t值分别为70.23与120.82,P均＜0.05.A组、B组医嘱处理耗时比较,A组:(187.93±5.89)批量/天(min),(2.78±0.05) min/份;B组:(80.67±3.05)批量/天(min),(1.13±0.04) min/份;t值分别为33.08与54.72,P均＜0.05.A组、B组书写耗时比较,首次护理记录单:A组(10.10±0.47) min,B组(2.85±0.21)min,t值为28.24,P＜0.05;护理记录单:A组(4.99±0.54)min/次,B组(1.72±0.23) min/次,t值为11.13,P＜0.05.结论 电子病历改变工作流程和方式,不仅提高工作效率和质量,还便于检索、查阅和管理护理病历.     

沙棘对功能性消化不良患儿神经肽Y、胃动力及体脂的影响

目的：探讨沙棘对功能性消化不良（ FD）患儿食欲因子神经肽Y（ NPY）水平及其胃动力、体脂的影响。方法选择符合FD诊断标准的患儿120例,采用单纯随机抽样方法分为三组,Ⅰ组单纯予以沙棘干乳剂治疗,Ⅱ组予以多潘立酮治疗,Ⅲ组予以沙棘干乳剂加多潘立酮治疗,共8周,治疗前后分别测血浆NPY水平,并采用B超检查作胃液体排空试验测餐后30 min、60 min、90 min和120 min的胃窦残留率,测量患儿皮下脂肪平均值、体脂比、上臂围、体质量、身高。结果Ⅰ组、Ⅱ组、Ⅲ组血浆食欲因子NPY水平治疗前分别是（107．52±24．12）ng/L、（114．63±17．95）ng/L和（114．56±25．10）ng/L,差异无统计学意义（F＝1．307, P＞0.05）;经治疗后,三组血浆NPY分别是（137．38±29．86） ng/L、（121．43±13．78） ng/L和（149．27±31．9） ng/L,差异有统计学意义（F＝11．23,P＜0．05）;Ⅰ组、Ⅲ组NPY水平治疗后明显高于治疗前（t＝4．95、5．40,均P＜0．05）。Ⅰ组、Ⅲ组餐后60 min、90 min和120 min的胃窦残留率比Ⅱ组同期均明显减少（ F＝4．93、6．40、4.61,P＜0．05）;Ⅰ组、Ⅲ组皮下脂肪平均值﹑体脂比、上臂围、体质量增加值显著高于Ⅱ组（ F＝16．80、46.9、21．06、12．08,均P＜0．05）。而Ⅰ组与Ⅲ组两组治疗后食欲因子NPY水平、胃窦残留率及皮下脂肪平均值﹑体脂比、上臂围、体质量比较,差异均无统计学意义（均P＜0．05）。结论沙棘对FD患儿食欲因子NPY有明显调节作用,促进胃排空,同时患儿体脂明显增加,体格发育明显改善。     

肥胖儿童血浆超敏C反应蛋白和血清肿瘤坏死因子α的测定及意义

目的 探讨单纯性肥胖儿童血浆超敏C反应蛋白(hsCRP)及血清肿瘤坏死因子α(TNF-α)水平变化及临床意义.方法 72例体重指数(BMI)≥25 kg/m2的单纯性肥胖儿童为肥胖组,28例BMI在18～23 kg/m2为对照组,测定并分析两组血浆hsCRP及血清TNF-α水平.结果 肥胖组儿童血浆hsCRP为(4.23±2.03) mg/L,较对照组的(2.54±1.42) mg/L显著增高(P＜0.01);肥胖组儿童血清TNF-α水平为(201.62±43.81) ng/L较对照组的(142.12±37.55) ng/L显著增高(P＜0.01);肥胖组血浆hsCRP和血清TNF-α均与BMI呈正相关(r=0.32和r=0.73,P＜0.01).结论 肥胖儿童血液中hsCRP和TNF-α水平均明显增高,高水平hsCRP和TNF-α可能是儿童肥胖的重要生物学标志之一.     

逆行胃电刺激后肥胖患者胃容受性、胃排空和胃肠激素变化

目的：探讨接受逆行胃电刺激后肥胖患者胃容受性、胃排空和胃肠激素变化。方法选择在我院进行治疗肥胖患者26例作为研究对象。给予逆行胃电刺激和假胃电刺激，分析不同刺激下胃容受性、胃排空和相关激素的变化。结果采用逆行胃电刺激后患者饱感时的进餐量和最大耐受程度进餐量均显著低于采用假胃电刺激后（P＜0.01）。采用逆行胃电刺激后和假胃电刺激后患者胃半排空时间、1h固体餐存留率、2 h固体餐存留率以及瘦素、生长激素释放肽、抵抗素、肽YY变化差异均无统计学意义（P＞0.05）。瘦素激素释放的变化与胃半排空时间变化呈正相关（r=0.577，P＜0.05）。结论急性逆行胃电刺激能够减少肥胖患者对液体的进餐量，但是对相关激素的释放影响不明显。     

Effect of cisapride on gastric emptying in diabetic patients without gastrointestinal symptoms.

The long-team effects of cisapride on gastric emptying and hormonal interaction in diabetic patients without gastrointestinal symptoms was evaluated. Gastric emptying was determined by the N-acetyl-p-amino-phenol (APAP) method before and after cisapride treatment. Gastric emptying improved significantly, from 5.95 to 8.04 micrograms/ml, after 6 weeks of treatment. Plasma concentrations of immunoreactive insulin (IRI), after 30 and 45 minutes in the gastric emptying test, increased significantly after treatment. It appeared that improvement of gastric emptying after loading with cisapride might be related to improved insulin secretion in diabetic patients without subjective symptoms of gastroparesis.     

Effects of the 5-HT3 receptor antagonist ICS 205-930 on fat-delayed gastric emptying and antral motor activity.

1. The selective 5-HT3 receptor antagonist, ICS 205-930 (Sandoz), has been reported to have potent effects on gastric smooth muscle in vivo and to enhance gastric emptying in animals and in man. 2. This study investigated the effects of ICS 205-930 on fat-delayed gastric emptying of a semisolid meal and antral motor activity in humans. 3. Twelve healthy men participated in each of three studies in which 10 or 20 mg of ICS 205-930 or placebo were infused i.v. in a random double-blind fashion. Gastric emptying and antral motor activity were studied scintigraphically. 4. Gastric emptying was not altered after 10 mg but slower after 20 mg of ICS 205-930 than after placebo. Emptying after 20 mg of ICS 205-930 was significantly slower than after 10 mg of ICS 205-930. 5. Antral contraction amplitude was slightly lower after 20 mg of ICS 205-930 than after placebo, whereas the effects of 10 mg ICS 205-930 did not differ from those of placebo. 6. The results suggest that the investigated doses of ICS 205-930 have only slight effects on gastric motor activity of healthy young men, with 20 mg reducing the rate of emptying.     

Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study

BACKGROUND: A potential approach to the treatment of morbid obesity is reduction of gastric emptying to achieve satiety. Botulinum toxin A (Btx-A) is a long-acting inhibitor of acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility. AIM: To investigate whether botulinum toxin A, injected in the antrum of obese patients, delays gastric emptying. METHODS: In a double_blind study, 18 healthy obese subjects (body mass index >30) were randomized into three groups (BTX133, BTX200 and Saline); they received Btx-A133U, Btx-A200U, or saline under endoscopic control. Gastric emptying was tested by scintigraphy before and 10 days after treatment. Body weight variations and appetite sensation were recorded after 5 weeks. RESULTS: Fourteen patients completed the study. The botulinum toxin A-treated groups showed weight reduction, which was not statistically significant. The effects on gastric emptying were variable. Most of the botulinum toxin A treated patients reported a reduced appetite. CONCLUSION: This pilot clinical trial suggests potential activity of botulinum toxin A for the manipulation of appetite.     

Assessment of gastric emptying in the mouse using the [13C]-octanoic acid breath test

1. Gastric emptying studies in small laboratory animals are hampered by the deficiency of a technique that is non-invasive and repeatable. The aim of the present study was to adapt the non-invasive [13C]-octanoic acid breath test, which has been validated in humans, to assess both liquid and solid gastric emptying in the mouse. 2. Gastric emptying rates were investigated for a liquid meal (Intralipid; Kabi Pharmacia AB, Stockholm, Sweden; n = 7) and two solid meals (egg yolk and mouse chow; n = 7) incorporating [13C]-octanoic acid. All meals were analysed for natural enrichment of [13C]. Mathematical analysis of the 13CO2 excretion rate allowed the determination of gastric emptying parameters. 3. Gastric emptying of Intralipid was more rapid than egg yolk (P < 0.0001). Gastric emptying of mouse chow could not be assessed due to intragastric separation of [13C]-octanoic acid and natural [13C] enrichment of the pellet. 4. The [13C]-octanoic acid breath test can reproducibly assess both liquid and solid gastric emptying non-invasively in the mouse. This method can now be used to assess gastric emptying in drug studies and disease studies for which there are established mouse models.     

胃实时超声显像观察肝硬化患者的胃排空功能

目的 研究胃实时超声显像观察肝硬化患者胃排空功能的价值.方法 采用实时测量胃窦面积(胃窦法)和胃底-体交界前后壁内径(胃体法)的方法 对20例肝硬化及20例健康志愿者进行超声检查,观察比较两组50%、80%及100%胃排空时间.结果 健康对照组、肝硬化组采用胃窦法与胃体法测定胃排空时间比较,差异无统计学意义(P＞0.0...     

两种枸橼酸莫沙必利片对健康志愿者胃排空的影响

目的对比进口药物加斯清与国产枸橼酸莫沙必利分散片(新络纳)对健康志愿者胃排空的影响。方法60例健康受试者随机均分为加斯清组和新络纳组,记录两组服药前和服药后0.5、1、2、4 h各时段的胃排空率。结果两组间比较,服药前、后各0.5、1、2 h时段的胃排空率无显著差异。同组服药后的胃排空率无显著差异,4 h则有显著差异。结论加斯清和新络纳均能促进键康成人2 h后的胃排空,新络纳更经济。     

Effect of treatment with Liu-Jun-Zi-Tang (TJ-43) on gastric emptying and gastrointestinal symptoms in dyspeptic patients

The effects of treatment with the Chinese herbal medicine Liu-Jun-Zi-Tang (TJ-43) on gastric emptying and gastrointestinal symptoms were investigated in 42 patients with chronic idiopathic dyspepsia. By random allocation, 22 patients received oral treatment with 2.5 g TJ-43 three times daily, and 20 patients received placebo. Gastric emptying was measured by the acetaminophen absorption method. After 7 days of treatment, gastric emptying was significantly accelerated and gastrointestinal symptoms were significantly reduced in patients treated with TJ-43. Placebo treatment produced no significant effects. These findings indicate that TJ-43 had a prokinetic action on gastric emptying and that it was useful in treating chronic dyspepsia.     

The rate of gastric emptying determines the timing but not the extent of oral tacrolimus absorption: simultaneous measurement of drug exposure and gastric emptying by carbon-14-octanoic acid breath test in stable renal allograft recipients.

Tacrolimus is characterized by a highly variable oral bioavailability and narrow therapeutic window. Tacrolimus absorption from the gastrointestinal tract is to a large extent determined by the genotypic, phenotypic, and functional expression of P-glycoprotein and CYP3A in the gut wall and liver. It is disputed whether the gastric emptying rate per se is important for determining oral bioavailability of tacrolimus and whether delayed gastric emptying is clinically relevant for therapeutic drug dosing. We conducted a pharmacokinetic study in 50 renal recipients, measuring simultaneously the rate of gastric emptying using a carbon-14-octanoic acid breath test and quantifying drug exposure by area under the concentration-time curve sampling. Gastric half emptying time (t1/2) significantly correlated with time to reach maximum blood tacrolimus (tmax) concentration (r2 = 0.30; p < 0.0001), whereas the gastric emptying coefficient, reflecting the overall gastric emptying rate, showed a weak inverse correlation with tmax (r2 = 0.14; p = 0.007). The time-dependent rate of gastric emptying strongly correlated with the simultaneously measured blood tacrolimus concentration over the first 4 h after oral drug administration (r2 = 0.96; p < 0.0001). Comparison between patients with and without delayed gastric emptying confirmed that maximum blood tacrolimus concentration was reached significantly more slowly in the former group (tmax, 2 +/- 1 h versus 1.48 +/- 0.68 h; p = 0.04), whereas the extent of tacrolimus absorption was not different. Despite a strong association between gastric emptying rate and the timing of tacrolimus absorption from the gut in stable recipients, gastric emptying rate does not affect the total extent of drug absorption and is not responsible for significant alterations in drug exposure, even in situations of delayed gastric emptying.     

老年脑梗死患者胃电活动及胃运动相关性的临床研究

目的探讨老年脑梗死恢复期患者胃电活动与胃运动之间的关系。方法测定老年脑梗死恢复期患者不同时期胃排空分数（EF）,同时行体表胃电图记录胃电节律变化,并与21例健康体检者进行比较。结果与健康人比较,老年脑梗死恢复期患者胃排空功能延迟、餐后正常胃电节律百分比及主功率比降低,以恢复期第7天为明显[正常慢波节律百分比（50．43±4．27）％,餐后、餐前功率比（0．71±0．32）],差异有统计学意义（P〈0．05）。结论老年脑梗死恢复期患者存在胃排空障碍及胃电节律紊乱,两者间有一定的相关性。