三维超声检测非溃疡性消化不良患者胃排空功能的研究

目的：了解非溃疡性消化不良（NUD）患者胃运动功能障碍情况,以及促胃动力药对NUD患者症状和排空的影响,探讨NUD症状与胃排空的关系。方法：采用三维超声技术检测30例NUD患者治疗前后进食液体试餐后胃排空的指标,经计算机拟合出不同时点胃容积的变化,计算出胃半排空时间（T1/2）、胃排空时间（T）及液体胃排空曲线,并与正常对照组比较。结果：NUD组胃半排空时间及胃排空时间均较正常对照组延长（P〈0.01,P〈0.001）,30名NUD患者中有13名患者存在胃排空延迟,约占43.33%。口服胃肠动力药枸橼酸莫沙必利分散片治疗4周后部分患者腹胀、返酸、嗳气等症状明显改善,此前无胃排空延迟者症状改变不明显,全组胃半排空时间及胃排空时间缩短。结论：应用三维超声技术检测液体胃排空功能,方法简单易行、患者易接受、可多次重复,为临床治疗功能性消化不良提供一种可靠、无创性的检测手段。     

推拿与西沙必利治疗功能性消化不良的疗效比较及其机理探讨

对推拿与促胃肠动力药西沙必利治疗功能性消化不良（FD）的疗效作比较研究,并探讨推拿治疗的作用机制。随机将各亚型功能性消化不良患90例分成推拿组、服药组及安慰剂组。并以30名健康作对照。于治疗前后作B超胃排空及胃动力检测,并测定血清胃泌素,胃动素、胆囊收缩素。结果表明,各组FD患治疗前的胃窦平均收缩幅度（△S）,平均收缩频率（f)及运动指数（Mi）,较正常健康显降低（P<0.05,P<0.01,P<0.05),而半排空时间、全排空时间又显延长（P<0.01).FD各组餐后2小时的胃动力指标P、f及Mi均显低于正常组（P<0.01)。推拿组和服药组治疗1个月后的△S,较治疗前无明显差别（P>0.05),f及Mi均较治疗前显（P<0.05),半排空时间T50,全排空时间T均较治疗前显缩短。胃动力指标及症状评分均较治疗前有显改善（P<0.01),而安慰剂组上述指标治疗前后均无明显差异（P>0.05)。说明推拿与西沙必利可效治疗功能性消化不良。消化期B超胃排空检测指标胃窦收缩幅度（P）,f,Mi及胃动力指标可作为评估疗效的客观依据。     

胃电图和胃肠激素水平在化疗相关性消化不良中的作用

背景：该研究目的是调查对化疗后呕吐得到有效控制的癌症患的胃肠动力失调和消化不良症状及血浆胃肠激素水平的关系。方法：25例接受标准剂量的止吐剂及常规化疗的癌症患完成该研究。胃肠症状通过详细的调查问卷和可视模拟评分确定。通过记录化疗前和后7d体表胃电图（EGG）同时测定血浆胃泌素、5-羟色胺、抗利尿激素和P物质水平来判定胃肠动力状况。结果：化疗前，没有患主诉有消化不良症状，EGG或胃肠肽水平在化疗后出现消化不良症状和未出现症状的患中没有显性差异。化疗后，13例患主诉有动力失调样症状（总体症状评分，中位值为11．5，95％CI2．5～37．9），主要表现为易恶心、早饱感、餐后饱胀感。根据EGG参数，作发现消化不良的患与无症状的患相比，正常的慢波比例显下降（P=0．04；秩和检验），胃动过速的比例显增高。胃动过速的比例与恶心的敏感性评分显相关，成非线性关系（R^2=0．37）。     

十二指肠溃疡患者胃排空,血浆胃泌素及胃动素的变化

以双同位素标记试餐ＳＰＥＣＴ技术检测１７例活动性十二指肠溃疡（ＤＵ）患者和１７例健康志愿者的胃排空功能，并以放免法测定其空腹和餐后胃泌素（ＧＡＳ）和胃动素（ＭＯＴ）水平。结果显示：５８．８％患者固体食物的延迟相消失，起始排空较快，继后的排空变缓，液体和固体半排空均延迟，而食物胃内分布与对照组无异。ＤＵ患者ＧＡＳ并无过度释放，而空腹及餐后ＭＯＴ水平均高于对照组，但这与胃排空参数无显著相关性。这些结果提示活动性ＤＵ患者以食物胃排空延迟为主，ＭＯＴ水平的改变可能是胃排空延迟反馈调节的结果，但胃排空延迟并未导致ＧＡＳ过度释放。     

营养不良患儿胃运动及排空检测

为了解营养不良患儿的胃动力及排空情况，应用Ｂ型实时超声对３０例营养不良患儿液体试验餐后的胃运动与排空功能进行检测。结果：与正常组比较，营养不良患儿餐后胃体蠕动和胃窦收缩频率明显减少，液体胃排空速度明显减慢（Ｐ均＜０．０１），提示对营养不良症的治疗可应用促进胃动力药物（如吗丁林，普瑞博恩）或采取其他相应措施，以增加胃排空速度，增加能量的摄入，提高治疗效果。     

功能性消化不良患者多通道胃电图记录的胃肌电活动与胃排空的相关性

目的:研究功能性消化不良患者多通道胃电描记术(M EGG)的参数与胃排空的相关性。患者与方法:该M EGG研究共纳入19例功能性消化不良患者和19例健康受试者。在禁食状态下行M EGG记录30m in,在标准试验餐(450kcal)后记录60m in。M EG G参数包含功率比(PR)、2～4cpm胃慢波的正常百分比(N%)和慢波偶联百分比(%SW C)。对19例患者行SPECT(单光子发射计算体层摄影)以测定胃排空,胃排空指数包括延迟相(LP)、胃半排空时间(T1/2)、稳定相排空率(ER SP)、1h残留率(1H RR)和2h残留率(2H R R)。结果:正常受试者和患者M EGG参数的差异无…     

Bilroth Ⅱ术后残胃排空和小肠转运功能变化

目的：探讨ＢｉｌｒｏｔｈⅡ（ＢⅡ）术后固体餐的残胃排空和小肠转运动能。方法：应用ＰＨＹ９９ｍＴｃ标记的固体餐,对正常健康者（Ａ组）、胃窦癌病人（Ｂ组）和ＢⅡ病人（Ｃ组）,分别进行胃排空和小肠转运功能的研究。结果：Ｃ组餐后１０ｍｉｎ胃排空率比Ａ、Ｂ组显著增加（Ｐ＜０．０１）;胃半排空时间明显减少（Ｐ＜０．０１）。而初排后胃的排空率Ｃ组［（２８３±５４）％／ｈ］及Ｂ组［（２６±５２）％／ｈ］均比Ａ组［（３８７±４５）％／ｈ］低。小肠转运时间Ｃ组比Ａ、Ｂ组显著延长（Ｐ＜０．０１）。结论：ＢⅡ病人和胃窦癌病人胃初排空后存在胃排空延迟现象。同时,前者初排空显著加快,且小肠转运时间明显延长     

运动障碍样型功能性消化不良患者症状与胃排空相关性的研究

为探讨运动障碍型功能性消化不良患症状与胃排空是否存在相关性，我们选择健康志愿３０例作为对照；选择功能性消化不良（ＦＤ）患４２例，通过Ｂ超法测定胃排空时间，以胃排空时间超过正常对照组ｘ＋１９６ｓ为运动障碍样型。共３０例，询问其症状并记分。结果：ＦＤ患胃排空时间较对照组显延长（Ｐ〈０．０１）；在ＦＤ患中运动障碍样型占７１．４％；运动障碍样型ＦＤ患症状总分与胃排空时间有显的正相关性（ｒ＝０．７３８９，Ｐ〈０．０１）。笔认为：运动障碍样型ＦＤ患症状总分与胃排空时间有显的正相关性。     

糖尿病胃轻瘫中医证型与胃动力改变关系的研究

目的：探讨糖尿病胃轻瘫（DGP）中医证型与血浆胃动素（MOT）及体表胃电图（EGG）改变的关系。方法：对38例3种不同中医证型的DGP患进行血浆MOT及体表EGG检测,并与正常人20例进行对照。结果：DGP3种中医证型患血浆MOT水平明显高于正常对照组,组肝胃不和组最高,胃阴不足组次之,其次是脾胃虚弱组;DGP3种中医证型的EGG餐前、餐后主频率及主功率、正常胃电慢波百分比、胃电节律紊乱百分比与正常对照组比较,差异具有显性,以胃动过缓百分比明显增加、正常节律百分比减少为其特征。结论：DGP的中医证型不同,血浆MOT含量及胃电参数不一,胃肠动力功能存在明显差异,因此MOT及胃电参数可作为DGP中医辨证分型的客观依据之一,对指导治疗有积极意义。     

慢性肾衰患者胃排空功能的改变(附9例病例分析)

用同位素检测方法,对9例慢性肾功能衰竭(CRF)患者和27例健康人的胃排空时间进行了观察。结果表明:CRF 患者均存在胃排空功能障碍,排空时间延长与病情的严重程度似呈正相关。文中还对其机理进行了初步探讨。     

Aortic root pseudoaneurysm following surgery for aortic valve endocarditis

Prosthetic aortic valve replacement for aortic valve endocarditis remains a primary practice of most cardiac surgeons. Usually it cures endocarditis and restores cardiac function. However, in advanced aortic valve endocarditis with complex annular destruction, complications following prosthetic aortic valve replacement do occur and present a formidable challenge for reoperation. Herein, we describe a case of an adult man who was operated on initially for advanced aortic valve endocarditis with a large periannular abscess cavity and who developed congestive heart failure 3 months later. Furthermore, he was diagnosed with a giant pseudoaneurysm around the aortic root without evidence of recurrent infection or aortic prosthetic incompetence. During his reoperation, a cryopreserved aortic homograft as a root replacement that included reimplantation of bilateral coronary artery buttons was used to exteriorize this pseudoaneurysm and reconstruct a left ventricular outflow tract. The postoperative course was unremarkable, and the patient, during a follow-up of 2 years, remained in New York Heart Association functional class I. Aortic root pseudoaneurysm following prosthetic aortic valve replacement for infective endocarditis is rare in clinical practice and can cause rapid hemodynamic deterioration which requires imminent reoperation. Homograft aortic root replacement has proven to be a versatile treatment option of this complex disease.     

Extensive aortic valve ring abscess formation: a rare complication of Q fever endocarditis

We report the successful management and 2 year follow up of a young patient with Q fever endocarditis on a congenitally bicuspid aortic valve complicated by extensive abscess formation in the aortic valve ring and interventricular septum. Aortic root abscess formation complicating Q fever endocarditis has been reported in only one previous patient. Serological tests may thus be indicated in patients with aortic abscesses. Despite extensive aortic and intramyocardial abscess formation it proved possible to control the progression of disease by open drainage of the abscess and aortic valve replacement. Although the requirement for aortic root replacement was anticipated in this patient, it has not been required.     

Successful treatment of Brucella endocarditis with aortic root abscess

Brucella endocarditis is a rare but fatal complication of Brucellosis, it causes destructive valvular lesions. The aortic valve is the most common affected site. We present a case of Brucella endocarditis with aortic root abscess, the patient received a prolonged combination of antibiotic therapy, and underwent aortic valve replacement. After one and a half years of follow up, the patient is still without signs of recurrence. The high mortality in Brucella endocarditis can be overcome by early diagnosis and aggressive therapy.     

Aortic root abscess presenting as unstable angina due to extrinsic compression of the left coronary artery

Coronary ischaemia in acute endocarditis is usually due to pre-existing coronary disease or occasionally as a result of embolism from vegetations. A 68 year old man with known mixed aortic valve disease presented with a four week history of progressive exertional angina, which became unstable. He was apyrexial with no peripheral signs of endocarditis. Three sets of blood cultures were negative. Transthoracic echocardiography with suboptimal windows confirmed moderate mixed aortic valve disease. Marked reversible ST segment depression with angina recurred at rest. Aortography showed severe aortic regurgitation with a distorted aortic root. Coronary angiography showed severe proximal narrowing of the left anterior descending and circumflex arteries with an unusual long and tapering contour. Emergency surgery revealed a large anterior aortic root abscess which had destroyed the left and right coronary cusps. Aortic root abscess and other rare causes of extrinsic coronary compression are discussed.     

Combined brucella melitensis and streptococcal viridans endocarditis

Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis.     

主动脉瓣心内膜炎伴瓣周脓肿的手术治疗

目的探讨手术治疗主动脉瓣心内膜炎合并瓣周脓肿的方法与疗效。方法1991年6月至2006年6月手术治疗21例主动脉瓣心内膜炎合并瓣周脓肿患者,其中男性14例、女性7例;平均年龄39.2岁(14~60岁);自体主动脉瓣心内膜炎15例,人造心脏瓣膜心内膜炎6例。术中采用补片修补主动脉壁及瓣周缺损者9例,其中包括升主动脉左侧壁脓肿清除后形成瘘道,致主动脉与主肺动脉相通者3例;1例因主动脉壁及瓣周组织破坏严重难以用补片修补者,行Bentall手术,3例以自体心包或牛心包片重建主动脉瓣环,8例未作补片修补。全组行主动脉瓣置换术20例,Bentall术1例,所用21只人造心脏瓣膜均为机械瓣。结果2例(9.5%)人造瓣膜心内膜炎患者,术后早期死于多器官衰竭。长期存活19例,术后随访3月~15年(平均5.7年),无晚期死亡,未见心内膜炎复发及瓣周漏。结论主动脉瓣心内膜炎合并瓣周脓肿手术治疗的原则为彻底清除感染病灶,妥善处理主动脉瓣病变,改善心脏等器官功能,应用有效的抗生素抗感染与预防再感染。     

先天性主动脉瓣二叶畸形的外科治疗

目的 总结先天性主动脉瓣二叶畸形患者的临床特点及外科治疗经验.方法 回顾性分析2008年1月-2010年12月我科行外科手术治疗的先天性主动脉瓣二叶畸形患者34例,年龄23-78(51.0±12.4)岁,其中男性28例(82.3%),女性6例(17.6%).单纯主动脉瓣狭窄10例(29.4%),主动脉瓣狭窄伴关闭不全19例(55.8%),单纯主动脉瓣关闭不全5例(14.7%).合并主动脉根部扩张30例(88.2%),合并感染性心内膜炎6例(17.6%).行单纯主动脉瓣置换术32例,行Bentall 术1例,主动脉瓣置换+ 升主动脉置换术1例.其中21例植入机械瓣,13例植入生物瓣.结果 无死亡及其他严重并发症.术后超声心动图示升主动脉内径((45.4±5.9)mm vs(40.9±6.5)mm,P<0.05)及左室舒张末内径(LVEDD)((56.9±15.5)mm vs 年44.3±9.0)mm,P<0.05)较术前明显减小.结论 先天性主动脉瓣二叶畸形合并主动脉根部扩张要根据病情行不同方式手术.     

感染性心内膜炎的外科治疗

目的:对21例手术治疗感染性心内膜炎的疗效进行回顾分析.方法:本院自1989年-2005年对21例感染性心内膜炎进行了瓣膜置换手术.21例中,主动脉瓣病变7例,二尖瓣病变9例,主动脉瓣与二尖瓣联合病变4例,三尖瓣病变1例.对各种瓣膜病变均采用瓣膜置换手术,其中主动脉瓣置换术7例,二尖瓣置换术9例,双瓣置换术4例,三尖瓣置换术1例.结果:在本组病人中,无围手术期死亡病例.随访至今,无死亡病例.结论:手术治疗感染性心内膜炎取得了良好的临床效果,采用瓣膜置换术治疗感染性心内膜炎,效果确切.     

Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

Background Aortic root replacement with pulmonary autograft （Ross procedure） has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease. Methods From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28＋15 years （range, 5-56 years）. Congenital heart disease （CHD） with aortic valve stenosis （AS） and/or aortic valve insufficiency （AI） in 40 cases including one associated with ventricular septal defect （VSD）, degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis （SBE） with AI in 1 were studied. The diagnosis was made by ultracardiography （UCG） in all patients. The mean aortic valve annulus diameter （AVD） was （2.45±0.31） cm and pulmonary valve annulus diameter （MPVD） was （2.34±0.21） cm. All patients had normal pulmonary valves. The New York Heart Association （NYHA） function class was Ⅱ in 36 cases and Ⅲin 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass （CPB） with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft. Results There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was （6.11±0.12） mmHg. The left ventricular diastole diameter （LVDD） decreased significantly from （62±5） mm to （56±3） mm （P 〈0.001）. The mean postoperative left ventricular ejective fraction （LVEF） was 0.49±0.23. All patients were in NYHA class Ⅰ-Ⅱ. Follow-up was completed in 38 cases for a mean period of 3.2 years （range 1-10 years）. All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year af     

先天性二叶式主动脉瓣17例临床分析

本文通过对17例先天性二叶式主动脉瓣(CBAV)病例的临床分析,发现29.4％的CBAV合并其他心脏畸形,可能是一种常见的复杂性先天性心脏畸形。我们的结果表明:①二维超声心动图是诊断CBAV的一种无创性检查方法,其诊断正确率高达85.7％;②感染性心内膜炎和钙化性主动脉瓣狭窄是CBAV的主要并发症,并认为感染性心内膜炎是我国CBAV病人进行主动脉瓣置换术的主要指征。