2.65 大承气冲剂和针刺治疗胃肠运动功能障碍疾病的研究

目的本研究利用人体为对象,观察大承气冲剂和针刺足阳明胃经穴足三里、内庭对某些消化道运动功能障碍性疾病的治疗作用,阐明其作用机理.方法选择腹部手术后、糖尿病和习惯性便秘等胃肠运动障碍性疾病患者为观察对象,应用先进的胃窦、十二指肠和空肠灌注测压技术、体表胃电图描记技术、胃动素的放免测定、口-盲传输时间测定、99锝同位素描记测定胃排空等手段,直接观察中药下法常用方剂大承气汤的新剂型-大承气冲剂和针刺足阳明胃经的足三里、内庭穴对消化道运动功能障碍性疾病的治疗作用和对消化道运动功能的影响.结果大承气冲剂使腹部手术后患者胃电的低频波和高频波的比例明显减少 ,正常波的比例明显增高,可显著改善术后胃电节律的紊乱;大承气冲剂可提高腹部手术后患者胃窦、十二指肠和空肠MMC Ⅲ期的幅度和时间,显著减少胃肠逆蠕动波的数量,增加正蠕动波的比例;大承气冲剂可显著增加腹部手术后患者血中胃动素水平,促进胃肠运动功能的恢复;大承气冲剂可减少口-盲传输时间,改善糖尿病和习惯性便秘患者的胃肠运动功能 .针刺足三里和内庭穴通过增加胃电正常波的比例和减少低频波和高频波的数量,来改善腹部手术后消化不良患者的胃节律,增加胃电幅度;针刺足三里和内庭穴后胃的ROI区明显缩小,提示针刺足三里和内庭穴可促进腹部手术后消化不良患者的胃排空.结论大承气冲剂是显效的胃肠动力药,不仅可用于促进腹部外科患者的胃肠运动功能的恢复,提高手术的成功率,降低手术后并发症,还能改善糖尿病和习惯性便秘患者的胃肠运动功能状况,促进胃肠蠕动.针刺足三里和内庭穴可有效的促进腹部手术后消化不良患者胃肠运动功能的恢复,且无副作用,方法简便,可用于消化道运动障碍疾病的治疗.     

2.109结肠通过时间和盆底肌电图检测对功能性便秘分型的探讨

目的探讨结肠通过时间和盆底肌电图检测对功能性便秘分型的临床意义. 方法选择符合功能性便秘罗马Ⅱ诊断标准的患者32例,男性8例,女性24结结肠排出率(排出率=20-残量数/20×100)和传输指数(TI).同时进行盆底肌电图检查记录盆底肌和腹部肌群的肌电活动情况并观察两者有无矛盾运动的存在.结合两项检查结果最终对患者做出分型并选择相应的治疗方法.     

97例采用改良腹带固定T管前后的临床调查分析

胆道手术后患者带管出院,因自我护理不当容易出现T管滑脱的现象,从而影响手术效果,对患者的术后恢复和健康造成不良的影响.而T管滑脱的常见原因是T管固定不当,因此本院对腹带进行改良,制成T管固定带固定T管,提高患者的带管满意度,舒适度和生活质量.本文作者针对97例患者使用T管固定带前后的情况,进行了细致的调查,对调查结果进行分析和总结.     

冠心病冠状动脉搭桥术前后心电图变化的研究

目的探讨冠心病人冠状动脉搭桥术(CABG)前后心电图的变化。方法通过25例冠心病CAGB患者术前与术后7天、14天、21天及30天阶段比较心电图的动态变化。结果与术前(4.5±2.3天)比较,ST段压低>1.0mm。T波低平、双向和倒置第一周显著增多,此后ST段压低者减少到术前水平,T波低平、双向和倒置非常显著地减少。结论冠心病患者CABG后出现一过性ST段压低变化,T波低平、双向和倒置,此后上述改变逐渐减少至恢复到术前水平。     

2.122 中老年人胃肠电及动力的退行性改变

目的观察不同年龄组对象的消化道症状及中医脾胃虚产证型出现率的变化 ,作胃肠电检测及频谱分析,以探讨中老年人消化不良症状的胃肠动力机制,期望为中老年的胃肠功能保健及理脾抗衰老方药的基础与临床研究打基础.方法普通成年人80例,其中18～35岁45例,36～50岁21例,大于50岁14例 .观察比较3组对象消化道症状的出现率.所有对象以"微电脑胃肠电检测分析系统"作胃肠电检测和频谱分析.有关指标作组间比较及年龄相关分析.结果 1.年龄大于50岁组返酸(0.0%)、嗳气(85.7%)症状的出现率较18 ～35岁组(17.8%,42.4%)显著增多.腹胀的出现率也随年龄增高而倾向增多.2.年龄大于50岁组受检者大便软条的出现率较18～35岁组显著减少,而大便稀烂则显著增多.年龄大于50岁组受检者大便1次/日的出现率较18～35岁组倾向减少,而大便次数少于1次/日或多于 1次/日的出现率则倾向增多.结合大便性状与次数的分析还发现,年龄大于50岁组受检者正常大便软条1次/日的出现率(0%)较18～35岁组(28.9%)显著减少,而大便稀烂多于1次/日的出现率(35.7%)则较18～35岁组(11.1%)显著增多.3.频谱分析及统计处理发现,空腹胃电主频率与年龄相关的直线回归方程为Y=3.0753-0.0087X,相关系数r=-0.2863,P ＜0.02;即空腹胃电主频率与年龄增高呈明显的负相关关系.以该方程计算年龄相关的胃电主频率变化趋向;其结果显示老年人的空腹胃电频率代表值(如80岁时2.38次/min)较年轻人(如20岁时2.90次/min)明显降低.空腹安静状态胃电活动量亦随增龄而倾向下降.作胃电活动量与年龄的相关回归方程,并以该方程计算年龄相关胃电活动量变化代表值;发现 80岁老人的空腹胃电活动量代表值(4单位)降低为20岁年龄人(8单位)的一半.上述胃电频谱分析结果可解释中老年人消化不良症状出现率增多的部分机制.4.结肠电频谱分析及相关回归处理发现,随年龄增大,餐后升、降及乙状结肠的低频段肠电频率倾向增高,餐后升、降结肠高频段肠电频率,餐后升、降、乙状结肠收缩性复合肌电的频率都倾向降低,即结肠电活动的频率范围缩窄.该结果可解释中老年人大便异常出现率增多的部分机制.5.观察分析还发现,随年龄增高,受检者属脾胃实证(如肝胃不和证、肝肠气滞证等)的比率倾向减少;而属脾胃虚证(如脾胃气虚证、气虚便秘证等)的比率则倾向增多,其中36～50岁组、大于50岁组受检者脾虚便溏证的出现率(9.5%,14.3%)显著高于18～35岁组(0%).虚实错杂证型,则视其虚实偏重,随年龄增高,其出现率倾向减少(如肝郁脾虚证)或增多(如肝脾不调证).结论普通中老年人先后发生胃结肠电的退行性改变,并在临床上出现返酸、嗳气、腹胀、大便异常等消化不良和动力障碍症状.随年龄增高,中老年人中医辨证属脾胃虚证的比率倾向增多.     

内固定后电磁疗与中药热敷相结合促股骨干骨折愈合的作用CSCD

背景:研究表明,电磁疗与中药热敷分别可以促进骨折的愈合及功能的恢复,但电磁疗与热敷相结合疗法对股骨干骨折愈合的影响鲜有报道。目的:观察电磁疗与中药热敷相结合疗法促进股骨干骨折愈合的作用。方法:股骨干骨折切开复位内固定置入治疗57例股骨干骨折患者,固定后按照不同的康复疗法随机分成3组,电磁疗组、中药热敷组和电磁疗与中药热敷结合组,每组19例。于康复治疗8周后进行X射线摄片检查,根据股骨干骨折疗效评定标准对各组患者骨折愈合程度进行评价。结果与结论:电磁疗与热敷结合组患者下肢活动改善明显,局部疼痛感较轻或消失,X射线摄片检查结果显示,骨折愈合程度显著好于单纯电磁疗组或中药热敷组患者(P<0.05),电磁疗组与中药热敷组患者骨折愈合程度差异无显著性意义(P>0.05)。结果提示电磁疗与热敷结合疗法促骨折愈合作用优于单纯电磁疗或中药热敷疗法。     

2.79 功能性消化不良患者试餐前后体表胃肠电的变化

目的探讨功能性消化不良(FD)患者的试餐前后体表胃肠电变化规律.方法应用WCDF-4胃肠电分析仪观察91例FD和31名健康志愿者在空腹和进餐后的体表胃肠电频率、振幅改变,所有观察对象均经胃镜及病理学确诊.结果 FD患者空腹及餐后胃电节律紊乱率明显高于对照组,而餐后的紊乱率增高更明显空腹10.8%,餐后30.5%;对照组空腹4.0%,餐后7.2%(P＜0.01). 尽管FD组的平均振幅、最高振幅比与对照组无显著差异(P＞0.05),但FD组中餐后振幅无明显增高的比例明显高于对照组胃窦13.4%,胃体16.9%;对照组胃窦3.8%,胃体3 .8%(P＜0.05),而且FD组的餐后振幅恢复时间明显延长胃窦147.3min±43.8min ,胃体153.5min±47.4min;对照组胃窦87.6min±25.3min,胃体95.0min±33.0 min,P＜0.05,肠电改变,其中28例FD患者空腹及餐后肠电节律与对照组无显著差异( P＞0.05).结论 FD患者餐后体表胃电节律紊乱高,餐后胃电振幅无增高的比例较多, 振幅恢复时间延长,可能反映这些FD患者存在胃运动功能低下.FD患者肠电节律无明显变化 ,说明其运动异常主要表现在上消化道,尤以胃为主.检测餐后体表胃电变化可能更有意义 .     

行为护理干预对腹部手术后并发炎性肠梗阻患者肠蠕动及疼痛的影响分析

目的探讨行为护理干预对腹部手术后并发炎性肠梗阻肠患者肠蠕动及疼痛的影响。方法选取2018年5月～2019年10月在我院进行腹部手术的患者130例,根据护理的方法不同分为观察组和对照组,每组各65例。对照组给予常规护理,观察组在对照组的基础上增加行为护理干预。对比两组患者术后肠蠕动恢复、肛门排气时间及VAS评分。结果观察组患者术后肠蠕动恢复时间及肛门排气时间均明显短于对照组(P0.05);术后第3、5、7天,观察组患者VAS评分均明显低于对照组(P0.05)。结论行为护理干预可促进腹部手术后并发炎性肠梗阻患者胃肠蠕动,利于患者术后排气,有效缓解术后疼痛,临床应用价值大。     

腰椎间盘突出症患者远期疗效的神经肌电图观察

目的:观察经系统康复治疗的腰椎间盘突出症(LDH)患者7年后神经肌电图的变化情况.方法:对7年前经系统康复治疗的31例LDH患者进行神经肌电图复查,并与7年前的治疗前后神经肌电图的表现作比较.结果:与治疗前比较,经系统康复治疗后患者患肢的胫神经、腓神经F波的出现率明显提高,胫神经H反射弱化及消失的百分比明显降低,其他检测指标无明显变化;7年后复查的结果显示其患肢的胫神经、腓神经运动传导速度明显减慢,胫神经、腓神经F波潜伏期明显延长、出现率显著降低,胫神经H反射弱化及消失的百分比显著增高,胫前肌、腓肠肌运动单位电位的时限明显增宽,其他检测指标无明显变化.结论:LDH患者经系统的康复治疗后虽然能够暂时改善其近段神经根的传导功能,但神经根受损所引起的其他电生理改变并未随临床症状的缓解而好转,且远期疗效并不显著,其坐骨神经的传导功能仍然出现了显著的下降.     

电脉冲中药离子穴位透入治疗脑梗死患者运动功能障碍疗效观察

目的:观察电脉冲中药离子穴位透入治疗脑梗死患者运动功能障碍的疗效。方法:随机将60例脑梗死患者分为研究组和对照组。研究组使用常规药物治疗和一般康复治疗,同时辅以电脉冲中药离子穴位透入治疗。对照组只使用常规药物和一般康复治疗。两组治疗时间均为14天。治疗前后均进行运动功能测评。结果:研究组的运动功能恢复优于对照组,P<0.05。结论:常规药物及康复治疗辅以电脉冲中药离子穴位透入治疗对脑梗死患者运动功能恢复疗效确切,值得推广应用。     

Inguinal canal development: The muscular wall and the role of the gubernaculum

The inguinal canal is an anatomically complex region. Although much has been written about the gubernaculum and the descent of the testis, little is known about the development of the abdominal wall itself. We dissected this inguinal canal in 75 fetuses between 10 and 25 weeks of gestation, 42 males and 33 females. We identified the anterior body‐wall muscular layers, located the gonads and uterus, and observed the formation of the scrotum. The gubernaculum was dissected, from the deep to the superficial ends and its distal attachments were determined. We proved that the muscular‐fibrous layers of the wall were well‐differentiated and observed how the inguinal canal enlarged with embryological development. In only one of the cases, an abnormal testis was found located in the scrotum. The upper end of the gubernaculum inserted into the inferior pole of the testis or the lateral angle of the uterus, according to gender. The lower end was attached by one or multiple tails, mainly on the pubic bone. This fact explained the clinical findings of ectopic testis. Observations of the abdominal wall and its relationship with the gubernaculum assisted us in explaining the development of the inguinal region, the formation of the inguinal canal, and the presence of the gubernaculum, in both genders. We intend to explain how the deep inguinal ring moves upwards, bringing the gubernaculum along with it, and thus determines the final form of the inguinal canal. Clin. Anat. 22:614–618, 2009. © 2009 Wiley‐Liss, Inc.     

Inter‐rater reliability and variability of ultrasound measurements of abdominal muscles and fasciae thickness

Ultrasound (US) imaging is being increasingly used by Physical and Rehabilitation Medicine (PRM) specialists to measure the thickness of abdominal muscles. The current study set out to assess the inter‐rater reliability of US measurements of the thickness of the abdominal muscles/fasciae. Three raters (1 = orthopedic specialist, expert on fasciae; 2 = PRM resident; 3 = PRM specialist) with different levels of US training examined the abdominal muscles and fasciae of a healthy volunteer under supine resting and dynamic conditions following a standard US protocol. The probe was positioned along the right lateral abdominal wall at the height of the 12th rib: (1) above the umbilicus at the linea alba, (2) to the side of and approximately 2 cm from the umbilicus, (3) along the mammillary line, and (4) along the anterior axillary line. Each rater measured 17 anatomical structures six times during two sessions. The relative error of the measurements (intra‐rater variability) was slightly higher for the fasciae than for the muscles, and during the dynamic condition than the resting condition. Inter‐rater reliability was good under both conditions for the fasciae (Intraclass Correlation Coefficient = ICC = 0.83) and excellent for the muscles (ICC = 0.99). Knowledge of the fascial anatomy of the abdominal wall is essential for accurate ultrasound examinations and for improving reliability. These findings confirm that US imaging is a reliable, non‐invasive, cost‐effective instrument for evaluating the abdominal muscles/fasciae. Clin. Anat. 32:948–960, 2019. © 2019 Wiley Periodicals, Inc.     

经右股动脉行肾动脉下腹主动脉腔内球囊阻断血流的应用解剖学研究

目的探讨经右股动脉入路应用球囊导管阻断肾动脉下腹主动脉的可行性。方法解剖50例健康成人尸体标本（其中男性33例,女性17例）,测量身高;分别经血管腔内测量肾动脉下腹主动脉至右股动脉腹股沟韧带平面的长度,采用sPSs12．0统计学软件分析身高与血管长度之间的关系。结果身高与肾动脉下腹主动脉至右股动脉腹股沟韧带平面的长度之间存在直线回归及较强的相关关系。结论经右股动脉入路行血管腔内球囊阻断肾动脉下腹主动脉对于腹主动脉瘤,特别是破裂腹主动脉瘤是一个可行的安全阻断血流的方法,为临床工作提供了一个新的思路和方法。     

Experimental assay of a Dual Mesh polytetrafluoroethylene prosthesis (non-porous on one side) in the repair of abdominal wall defects

The porosity of the prosthetic biomaterials used to repair defects in the abdominal wall seems to influence the tissue repair process insofar as tissue integration of the prosthetic material and the formation of adhesions with abdominal viscera are concerned. We studied the behaviour of a new type of polytetrafluoroethylene prosthesis used for the repair of abdominal wall defects, Dual Mesh^® (DM), which has two different faces; one face has a porosity between 30 and 60 μm, while the other is nonporous. In 20 New Zealand White rabbits, a full-thickness (except skin) 7cm × 5cm defect was created in the anterior abdominal wall that was repaired with DM. At 14, 30, 60 and 90 days, samples were obtained and studied by light and scanning electron microscopy. An immunohistochemical study was made with antibody anti-rabbit macrophages (RAM-11). Tensile strength was measured with an Instron tensiometer using 2-cm-wide strips obtained parallel to the shorter axis of the implant. DM induced little tissue adhesion to the material on the visceral peritoneum interface and was surrounded by organized repair tissue. The biomaterial was integrated in the repair tissue on the subcutaneous interface, but not on the peritoneal interface. The macrophage response decreased between days 14 and 90 (P < 0.001). Tensile strength increased significantly (P < 0.05) at every study period. We conclude that the DM prosthesis has little tendency to formation of visceral adhesions, the DM prosthesis was well tolerated by the receptor organism and the tensile strength of the prosthesis/ receptor tissue interface increased with time.     

腹部创伤126例诊治分析

目的 进一步提高腹部创伤的诊治水平，降低救治失败率，为临床提供腹部创伤救治的措施和方法。方法 回顾性总结分析1998年至2003年收治的126例腹部创伤救治的临床资料。结果 126例中，男101例，女25例，年龄最小2岁，最大78岁，多为18～35岁。手术治疗89例，非手术治疗37例。痊愈90例，死亡15例，占11．9％，其中多器官功能衰竭障碍综合症（MODS）7例，失血性休克5例，感染性休克2例，循环衰竭1例。死亡者均为3处以上多脏器损伤，ISs评分61～75分之间的4例均死亡。结论 腹部创伤的围手术期的正确处理是提高救治成功的关键，可供临床参考采用。     

腹型癫痫80例脑电图分析

目的:探讨脑电图对腹型癫痫的诊断与疗效的观察。方法:使用日本1118型脑电图仪对80例腹型癫痫进行检查。结果:80例腹型癫痫患者脑电图75例(94％)异常。结论:脑电图对腹型癫痫的诊断和疗效的观察有一定的辅助价值。     

儿童腹型癫痫的脑电图分析

目的:探讨脑电图对腹型癫痫的诊断价值和疗效观察。方法:使用日本1A97型脑电图仪对131例腹型癫痫的儿童进行检查。结果:脑电图异常127例,总异常率97％。结论:脑电图对腹型癫痫的诊断和疗效观察有重要价值。     

超声检查在闭合性腹外伤诊断中的价值

目的 探讨超声检查在诊断闭合性腹外伤中的应用价值。方法 回顾性分析2013年1月~2018年1月在我院经超声检查后手术证实或CT证实的106例闭合性腹外伤患者的声像图表现。结果 106例闭合性腹外伤中95例超声探查到腹腔游离液体,均经手术证实为腹腔脏器挫裂,其中脾挫裂65例,包括延迟性脾挫裂12例,占脾挫裂18.46%。7例误诊,其中肝挫裂伤1例,复合挫裂伤3例,小肠挫裂伤3例。超声诊断与手术符合率为92.63%。11例超声未探及游离液体,均经手术或CT证实为腹腔脏器挫伤或血肿。结论 超声检查对腹腔游离液体检出在闭合性腹外伤的诊断中发挥着重要的作用。