糖尿病人胃排空检查和普瑞博思疗效观察

本文采用标准试验餐加固体小钡条作胃排空检查以观察糖尿病人胃排空状态及糖尿病伴胃轻瘫病人普瑞博思治疗效果。结果显示：（１）糖尿病人胃排空障碍发生率３８８９％，与正常对照组相比有非常显著差异（Ｐ＜０．００５，ｘ２值为１０．９３）；（２）糖尿病伴胃轻瘫组与糖尿病无胃轻瘫组相比，具有病程长、血糖水平高的特点；（３）普瑞博思１０ｍｇ，３次／日治疗两周后，糖尿病伴胃轻瘫病人的胃排空时间明显缩短，胃轻瘫症状评分明显下降（Ｐ值分别为＜０．０１和＜０．００１）。结论：胃轻瘫是糖尿病常见的并发症之一，多见于病程长、血糖水平高的病人，普瑞博思是治疗糖尿病性胃轻瘫的有效药物。     

早产儿鼻饲护理研究进展

早产儿吸吮能力差,吞咽反射弱,传统的母乳喂养方式可能效果不佳,而鼻饲能保证早产儿每日足够的热量摄入防止出现低血糖,对于早产儿的给养和治疗有重要意义[1]。有研究显示[2]早期鼻饲喂养是向患儿提供必要营养的良好途径。鼻饲喂养可以减少窒息和呕吐发生,又可以提供充足的摄入量,极大地减少了患儿因吸吮带来的体力消耗,有利于体重的增长,可用于监测胃排空、及时发现胃潴留与胃出血等相关并发症。为了更好地发挥鼻饲在早产儿喂养中的作用,现就鼻     

神经节苷脂对早产儿脑发育影响的临床观察

目的观察神经节苷脂对早产儿脑发育的影响。方法将40例早产儿随机分成2组,干预组和对照组各20例,均常规治疗和康复训练,干预组则在此基础上于出生后3 d开始每月1次应用神经节苷脂治疗,10d为1疗程,共3个疗程,并对2组于纠正胎龄42 d、3个月、6个月、12个月追踪发育情况,以Gesell量表评价。结果干预组纠正胎龄3个月、6个月、12个月平均发育商均高于对照组。纠正胎龄6个月龄2组在适应性、大运动、精细动作方面均优于对照组。于纠正胎龄12个月时各方面发育均明显优于对照组。结论神经节苷脂对早产儿脑细胞发育有明显的促进作用。     

窒息早产儿凝血功能变化及临床意义

目的 探讨出生第一天窒息早产儿凝血功能的变化及其临床意义.方法 检测出生第一天住院的82例窒息患儿和37例非窒息早产儿凝血指标.结果 窒息早产儿活化部分凝血活酶时间(APTT)[(85.2±27.2)s]长于窒息足月儿[(64.4±25.8)s](P=0.032).窒息早产儿血小板(PLT)[(234.3±55.7)×109/L]低于窒息足月儿[(292.9±99.6)×109/L](P=0.049);重度窒息早产儿PLT[(182.0±80.3)×109/L]低于轻度窒息早产儿[(240.3±44.3)×109L](P=0.044);窒息早产儿PLT[(224.8±45.7)×109/L]低于非窒息早产儿[(272.0±56.7)×109/L](P=0.027).结论 窒息早产儿较窒息足月儿更易发生出血性疾病或出现弥散性血管内凝血(DIC)倾向.但是对第一天出生的重度窒息早产儿和轻度窒息早产儿以及窒息早产儿和非窒息早产儿想通过监测凝血功能指标来提示哪类患儿更易发生出血或前期DIC似乎并不可靠.     

早产儿胼胝体面积与神经运动发育关系的研究

目的 探讨早产儿胼胝体面积与神经运动发育之间的关系.方法 106例胎龄40周足月儿出生当天、130例极低出生体重(VLBW)早产儿于校正胎龄40周行颅脑高场MRI检查,获得228例合格图像,其中足月儿组100例,早产儿组128例,计算胼胝体及其分区面积.128例早产儿于校正月龄至3个月时行儿童0～1岁神经运动20项检查,分析胼胝体及其分区面积与神经运动检查结果之间的关系.结果 VLBW早产儿组整个胼胝体、前中体部、后中体部、峡部和压部面积均小于同龄足月儿组(P＜0.05),但膝部和前体部面积比较差异均无统计学意义(P＞0.05);VLBW早产儿神经运动异常组膝部面积明显小于正常组(P＜0.05),两组间整个胼胝体、前体部、前中体部、后中体部、峡部和压部面积比较差异均无统计学意义(P＞0.05).结论 早产儿胼胝体的发育受影响,尤其后部区域更容易受到影响;VLBW早产儿于校正月龄至3个月时神经运动发育异常可能与胼胝体膝部面积减少有关.     

早产儿早产原因及并发症分析

目的分析早产儿早产原因及常见并发症发生率,提出预防早产的措施,并为早产儿管理提供理论依据。方法选择2008年11月至2011年2月在昆明医科大学第二附属医院新生儿科住院及产科出生的共计439例早产儿为研究对象,按胎龄大小将其分为28-31^＋6孕周组（60例）和32-36＋6孕周组（379例）;按出生体质量将其分为出生体质量〈1 500g组（51例）和出生体质量≥1 500g组（388例）。回顾性分析其早产原因,并比较不同胎龄及出生体质量下并发症发生率及不同胎龄早产儿各并发症发生率差异。本研究遵循的程序符合昆明医科大学第二附属医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书。结果孕母既往终止妊娠术史、胎膜早破及不明原因是导致早产的主要原因,其比例分别为44.6%,44.2%及21.0%（同1例早产儿可能存在2种或2种以上原因,如双胎合并胎膜早破）。28-31^＋6孕周组并发症发生率高于32-36^＋6孕周组,其差异有统计学意义（χ^2=5.90,P〈0.05）;出生体质量〈1 500g组并发症发生率高于出生体质量≥1 500g组,其差异有统计学意义（χ^2=8.05,P〈0.05）。早产儿并发症主要有高胆红素血症、新生儿肺炎、酸中毒、低钙血症、呼吸暂停及新生儿硬肿症等。28-31^＋6孕周早产儿并发症以高胆红素血症、酸中毒、新生儿贫血为主,32-36^＋6孕周早产儿并发症以高胆红素血症、新生儿肺炎、酸中毒为主。28-31^＋6孕周组各并发症发生率均高于32-36＋6孕周组,且差异均有统计学意义（P〈0.05）。结论孕母既往终止妊娠术史及胎膜早破易导致早产。对胎龄〈32孕周及出生体质量〈1 500g早产儿更应密切观察其并发症的发生,积极救治以提高早产儿存活率。     

早产儿败血症病原体分布及耐药性分析

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小剂量红霉素促进早产儿喂养临床分析

目的 观察小剂量红霉素促进早产儿喂养的临床疗效.方法 早产儿180例,随机分成治疗组和对照组,每组各90例.两组患儿均采用母乳或早产儿配方奶粉喂养,并给予暖箱保暖,监测患儿生命体征,维持水、电解质代谢及酸碱平衡,静脉营养支持及对症治疗.治疗组在上述基础上分两次静脉滴注红霉素10 mg/(kg·d).结果 治疗组与对照组相比.治疗组的达足量肠内营养时间[(8.0±1.5)d]比对照组[(12.0±1.8)d]明显缩短,每日体重增长量[(55.0±0.7)g]也比对照组[(25.0±0.5)g]明显提高.差异均有统计学意义(P<0.05).结论 小剂量红霉素能促进早产儿喂养.     

非营养性吸吮对早产儿胃排空的影响

非营养性吸吮（NNS）对早产儿的有益作用尚存在不同意见，我们对无法经口喂养的早产儿，在给予胃管喂养的同时，给予吸吮空的橡皮奶头，称为非营养性吸吮（NNS）。NNS对早产儿的行为、生理、心理的发育具有重要作用。但有关NNS对胃肠功能的影响，许多方面尚存在争汉。本研究通过胃泌素（GAS）和胃动素（MOT）的测定，了解NNS对早产儿胃排空的影响。     

抚触对早产低出生体重儿生长发育的影响

目的:观察抚触对早产低出生体重儿体格发育、智能发育和疾病发生的影响。方法:将182例0~6个月的早产低出生体重儿随机分为抚触组102例和对照组80例。抚触组婴儿由父母进行抚触,每天1~2次,每次10~15 m in,持续3个月,观察时间为6个月。在实验中将婴儿按阶段0~2月和3~6月在进行智能测查(采用NBNA、CDCC量表),每月测量体重、身长、头围、胸围,询问并登记患病情况。结果:出生后即开始抚触并持续3个月的婴儿与对照组比较,体重0~5月时P<0.05,头围2~6月时P<0.05,胸围0~1月时和4~6月时P<0.05,均有显著性差异;智能发育P<0.05有显著性差异;0~2月时疾病发生AR I和DD经2χ检验P<0.05,均有显著性差异。结论:抚触可促进早产低出生体重儿的体格发育和智能发育,减少AR I与DD疾病的发生。     

Ghrelin does not influence gastric emptying in obese subjects

OBJECTIVE: To evaluate the relationship between fasting plasma concentrations of ghrelin and gastric emptying in obese individuals compared with lean subjects. RESEARCH METHODS AND PROCEDURES: We included 20 obese patients (9 men and 11 women, BMI > 30 kg/m2) and 16 nonobese control subjects (7 men and 9 women, BMI < or = 25 kg/m2). Gastric emptying of solids (egg sandwich labeled with radionuclide) was measured at 120 minutes with (99m)Tc-single photon emission computed tomography imaging. Ghrelin and leptin were analyzed by radioimmunoassay and ELISA methods, respectively. RESULTS: The gastric half-emptying time was similar in obese men and women (67.8 +/- 14.79 vs. 66.6 +/- 13.56 minutes) but significantly shorter (p < 0.001) than in the control population (men: 88.09 +/- 11.72 minutes; women: 97.25 +/- 10.31 minutes). Ghrelin levels were significantly lower in obese subjects (131.37 +/- 47.67 vs. 306.3 +/- 45.52 pg/mL; p < 0.0001 in men and 162.13 +/- 32.95 vs. 272.8 +/- 47.77 pg/mL; p < 0.0001 in women). A negative correlation between gastric emptying and fasting ghrelin levels was observed only in lean subjects (y = -0.2391x + 157.9; R2 = 0.95). Also, in the lean group, ghrelin was the only significant independent determinant of gastric emptying, explaining 98% of the variance (adjusted R2) in a multiple regression analysis. DISCUSSION: This report shows that, in humans, gastric emptying is faster in obese subjects than in lean controls and that, whereas ghrelin is the best determinant of gastric kinetics in healthy controls, this action is lost in obesity.     

胃肠超声造影对糖尿病胃轻瘫患者胃排空功能的评价

目的 应用胃肠超声造影技术检测糖尿病胃轻瘫（DGP）患者胃排空功能,为DGP患者的诊断与治疗提供依据.方法 采用胃肠超声造影技术检测35例DGP患者（DGP组）及35例健康体检者（对照组）胃的排空功能,观察DGP组患者饮用胃肠超声造影剂后胃排空率（GER）和胃排空时间（ET）,并与对照组比较.结果 DGP组GER显著低于对照组[（27.05±11.32）％比（45.38±15.08）％],ET显著长于对照组[（102.43±15.76） min比（75.31±11.52） min],差异有统计学意义（P＜0.05）.结论 胃肠超声造影检查是一种简单、可重复进行的实时评估DGP患者胃动力学改变的方法,并不影响胃肠道的正常功能,可作为临床检测DGP患者胃排空功能的一种可靠的无创检查手段.     

Development of gastric emptying in premature infants. Use of the (13)C-octanoic acid breath test

OBJECTIVE: The non-invasive (13)C-octanoic acid breath test ((13)C-OABT) has recently been used to monitor gastric emptying. We evaluated (13)C-OABT as a method for assessing gastric emptying in relation to the amount of milk ingested in preterm neonates during their first days of life. METHODS: The (13)C-OABT was performed in 16 stable preterm neonates born between weeks 31 and 37 of gestation (mean +/- standard deviation: 34.0 +/- 1.5 wk). Birth weight was 1400 to 2680 g (2076 +/- 350 g); four newborns were small for gestational age. The newborns underwent (13)C-OABT three times according to the amount of (13)C-primed breast milk being fed to them (<7 mL/kg, 7-13 mL/kg, and 10-19 mL/kg per dose). (13)C-primed breast milk (the test meal) was prepared by adding (13)C-octanoic acid to pasteurized breast milk to achieve a concentration of 1 microL of (13)C-octanoic acid/mL of milk. Exhaled air samples were taken through an original nasal mask. Amounts of (13)C and (12)C in the exhaled air samples were measured by mass spectrometry. Results were expressed as delta over baseline and related to the international standard of Pee Dee Belemnite Limestone. To assess the half-life of elimination (t(1/2)E), we modeled the process of elimination with the incomplete gamma-function, which has a convenient form for the empiric plotting of breath test data. We estimated the parameters of the function, f(x) = A x(b) e(-cx), by using the moment method. The curves were determined by the t(1/2)E of (13)CO(2) and characterized by the shape of the elimination curve. The half-time of gastric emptying (t(1/2)GE) was calculated as t(1/2)E reduced by the mean metabolic half-time of octanoic acid. RESULTS: Forty-eight (13)C-OABT results from 16 premature newborns were analyzed. The mean and median of t(1/2)GE calculated from all three tests were 50.3 (+/-29.9) and 43.7 min, respectively. The t(1/2)GE did not change significantly (P = 0.6811) with the administered dose of (13)C-primed breast milk in the stomach. The coefficient of variation among the studied infants was 4.0% to 33.6% (mean, 11.5%). In 12 infants, the characteristic type of elimination curve was the same for all three tests. CONCLUSIONS: In the first hours of gastric feeding, neither the age of the neonate nor the amount of administered (13)C-primed breast milk had any effect on t(1/2)GE. The gastric emptying rate and the evacuation curve shape for individual neonates were similar and independent of milk amount.     

Effect of guar gum on gastric emptying after gastric resection

Gastric emptying after a conventional semisolid meal containing 5 g of guar gum granules or placebo was measured in a double-blind, controlled trial, using a radioisotopic (technetium Tc-99m DTPA) technique, in 11 patients who had undergone gastric resection, and who were experiencing the dumping syndrome. Guar gum clearly slowed gastric emptying in five of the 11 patients, and the results suggest that the addition of guar gum to normal meals, especially those rich in monosaccharides or disaccharides, may be helpful to post-gastrectomy patients suffering from the dumping syndrome.