中国小肠镜临床应用指南

中华医学会消化内镜学分会第五届委员会小肠镜和胶囊内镜学组于2008年制订了《双气囊内镜临床应用规范草案》［1］,对我国规范小肠镜的临床应用起到了重要作用。近10年来,小肠镜设备及诊治技术有了长足的进步和发展,有必要对原草案进行补充更新。此次由中华医学会消化内镜学分会第七届委员会小肠镜和胶囊内镜学组撰写初稿并反复讨论修改,于2018年8月24日在南京经专家现场讨论定稿。     

中国小肠镜临床应用指南

正中华医学会消化内镜学分会第五届委员会小肠镜和胶囊内镜学组于2008年制订了《双气囊内镜临床应用规范草案》~([1]),对我国规范小肠镜的临床应用起到了重要作用。近10年来,小肠镜设备及诊治技术有了长足的进步和发展,有必要对原草案进行补充更新。此次由中华医学会消化内镜学分会第七届委员会小肠镜和胶囊内镜学组撰写初稿并反复讨论修改,于2018年8月24日在南京经专家现场讨论定稿。     

双气囊小肠镜临床应用进展

小肠疾病一直是消化系统疾病诊疗的瓶颈,但随着消化内镜技术的不断发展,尤其是双气囊小肠镜的问世,使我们对不明原因消化系出血、小肠肿瘤等的诊断有了新的认识.并且随着双气囊小肠镜技术的逐步成熟使得小肠疾病的内镜下治疗,如出血灶止血、息肉切除、内镜下黏膜切除、狭窄肠腔扩张成为可能.本文综述双气囊小肠镜诊断和治疗领域的最新进展,并且对其应用前景进行分析.     

纤维小肠镜临床应用总结

纤维小肠镜检查术由于操作难度大,技术条件要求高,有一定风险,需要配套设备等因素,目前我国在临床上开展的还不够广泛,边疆地区更是少有应用,医学杂志亦报道不多.但对于某些空肠疾患,唯有行小肠镜检查方可明确诊断,并且可行镜下治疗.我院自1985年8月始,将日本Olympus公司生产的SIF—B型纤维小肠镜,在国内较早地应用于临     

双气囊电子小肠镜临床应用初探

目的探讨小肠疾病检查新方法——双气囊电子小肠镜的操作、诊断效果、适应证等问题。方法应用双气囊电子小肠镜对13例疑诊小肠疾病的患者进行双气囊小肠镜检查。分别从口侧或肛侧进镜，利用外套管、内镜前端的双气囊交替充气、放气和交替滑进，推进小肠镜进入小肠检查。记录检查范围、时间、耐受性及病变等。结果13例患者共行小肠镜检查19例次(11例次接受了口侧进镜，8例次接受了肛侧进镜)，每侧进镜术程平均80min。从口侧进镜均达第3～6组小肠，从肛侧进镜达4～6组小肠。发现空肠良性问质瘤1例、空肠淋巴瘤1例、回肠溃疡狭窄及憩室2例、空肠息肉2例、空肠糜烂2例。口侧进镜患者，术中多数出现恶心、消化液自口及外滑管口溢出，偶尔出现一过性轻微腹痛；肛侧进镜患者无明显不适及反应；未出现出血、穿孔等并发症。结论双气囊小肠镜是一种新型小肠疾病检查手段，平均2～3h可检查完所有小肠，进镜迅速。于操作直视下观察病变，通过活检对病变进行定性检查。病变检出率明显优于小肠钡剂造影，具有安全、可控性、直视、图像清晰等优点，适用于无肠粘连及严重脏器功能不全的小肠疾病患者。     

螺旋管式小肠镜临床应用价值初探

目的初步评估螺旋管式小肠镜在小肠疾病诊治中的应用价值。方法对2009年7月至9月间采用经口螺旋管式小肠镜诊治的8例患者的临床资料进行总结分析,包括内镜插入深度、检查时间、并发症发生情况以及活检与治疗结果等。结果2例诊断为小肠克罗恩病,活检病理提示为活动性炎症和肉芽组织;1例诊断为小肠肿瘤,活检病理提示为高级别上皮内瘤变;1例检出空肠溃疡;1例检出空肠术后吻合口及空回肠多发息肉,并行息肉氩离子凝固术（APC）治疗;3例未发现明显异常。螺旋管式小肠镜均成功插至屈氏韧带处,最深至屈氏韧带下3．6m处,平均插入深度为屈氏韧带下2．2m;检查时间为25～77min,平均41min。术中操作与气囊式内镜相同,APC治疗未遇任何困难。未发生相关并发症。结论螺旋管式小肠镜操作简便、安全,进镜速度快,具有较高的临床应用价值。     

CSC 2016:中国高血压防治指南修订问题的解读

正2010年修订的高血压防治指南坚持预防为主、防治结合原则,制定了符合我国人群的高血压防治策略,但随着各种研究的深入,高血压防治指南面临着修订问题,在中华医学会第十八次全国心血管大会(CSC 2016)上,中国医学科学院阜外医院的王文教授对此解读如下。1高血压防治指南的修订背景近年来流行病学调查研究结果显示,我国18岁以上居民高血压患病率不断升高,从2010年公布的25.2%上升到2014年公布的27.2%。结合我国国情,高血压防治工作要以政府主导为主。2009年,高血压被纳入社区公共卫生服务范畴,每年被管理的高血压患者数量呈上升趋势,而     

ERS 2016:中国哮喘防治指南2016修订版解读

正近日,浙江大学医学院副院长、浙江大学附属二院呼吸与危重症中心主任沈华浩教授在欧洲呼吸协会年会(ERS)中国专场对中国哮喘防治指南2016年修订版进行了解读,要点如下。1相比2008年的指南新增的4部分内容与2008年哮喘指南相比,增加了流行病学、哮喘评估、重度哮喘和哮喘特殊问题处理4部分内容。流行病学调查结果显示,我过目前约有3千万哮喘患者,其中14岁及以上人群哮喘患病率约为1.24%。2哮喘诊断标准的修订     

小肠镜的应用进展

本文对小肠镜的应用现状进行了综述,介绍了3种主要类型小肠镜的操作技术及应用适应证。小肠镜检查可使26％～77％的胃肠道隐源性出血作出正确诊断并明确出血部位,同时在诊断小肠疾病尤其是诊断小肠肿瘤具有不可替代的精确作用。     

Standardized guidelines for the interpretation of dobutamine echocardiography reduce interinstitutional variance in interpretation

Subjective interpretation of dobutamine echocardiograms provides only moderate interinstitutional observer agreement if nonunified data acquisition and assessment criteria are applied. The present study was undertaken to evaluate parameters associated with low interinstitutional observer agreement in the interpretation of dobutamine echocardiograms and to analyze whether standardized interpretation criteria improve interinstitutional observer agreement. One hundred fifty dobutamine echocardiograms (dobutamine up to 40 μg/kg/min body weight and atropine up to 1 mg) were evaluated at 5 centers. Clinical, procedural, and echocardiographic parameters were included in the analysis of variables with significant impact on interinstitutional agreement. Standardized interpretative criteria were established, and 90 dobutamine echocardiograms were reanalyzed by 3 observers using a standardized image display. Multivariate analysis demonstrated low image quality (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08 to 0.45, p = 0.0002), low severity of induced wall motion abnormality (OR 0.17, 95% CI 0.07 to 0.40, p <0.0001), and a low peak rate-pressure product (OR 0.93, 95% CI 0.43 to 2.27, p = 0.0382) to result in a low interinstitutional agreement. Standardization of image display in cine loop format and of dobutamine stress echo interpretation criteria resulted in improvement in test result categorization as normal or abnormal, with a kappa value of 0.50, compared with 0.39 using the original subjective interpretation. In conclusion, image quality, the severity of induced wall motion abnormalities, and the obtained rate-pressure product have a significant impact on the interpretation homogeneity of dobutamine echocardiograms. Standardization of image display in cine loop format and of reading criteria results in improved interinstitutional agreement in interpretation of stress echocardiograms.     

Updated postexposure guidelines stress need for expert advice

The Centers for Disease Control and Prevention (CDC) revised its guidelines for managing postexposure prophylaxis (PEP) for health care workers who are occupationally exposed to HIV. The CDC did not recommend preventive therapy until 2 years ago, when results from a PEP study indicated that transmission could be reduced by 81 percent, with the use of AZT as the PEP. The new guidelines are straightforward, and recommend a 4-week AZT and 3TC regimen for most common exposures, or an expanded regimen including a protease inhibitor for those at increased risk of transmission. All doctors are urged to consult with experienced physicians regarding the best course of treatment. Rapid HIV testing is also recommended for occupational exposure. Contact information is included for PEP consultation.     

Double balloon enteroscopy in the old: experience from China

AIM: To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases.METHODS: DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis.RESULTS: Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively.CONCLUSION: DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.     

卵圆孔未闭相关卒中预防中国专家指南

卵圆孔未闭（PFO）发生率高,约1/4的成年人均存在PFO。随着4项经导管封堵PFO和药物治疗相对比的随机对照研究结果的相继发表,各国相继更新了PFO相关指南或共识。我国关于PFO治疗的推荐仍停留在2017年的“卵圆孔未闭预防性封堵术中国专家共识”上,鉴于PFO人群基数庞大,为规范PFO封堵术的临床应用,在借鉴国内外最新研究的基础上,结合我国具体情况,国内本领域专家形成了卵圆孔未闭相关卒中预防中国专家指南,以供参考。     

中国儿童肝移植临床诊疗指南(2015版)

正1前言儿童肝移植是临床肝移植的重要组成部分。自1963年世界首例儿童肝移植手术实施以来,经过半个世纪的发展,儿童肝移植的术后生存率已得到极大提高。在美国、日本等发达国家,儿童肝移植比例均超过肝移植总例数的10%,术后5年生存率约为80%,儿童活体肝移植的生存率则更高[1-2]。目前,国外儿童肝移植方面的指南有美国肝病学会与美国移植学会     

An expert system for synoptic interpretation of lung function tests

We simulate the interpretation process by the testing of preformed working hypotheses. A clinical syndrome, “bronchial obstruction,” is described by a set of suitable parameters (FEV₁, MMEF, R_aw, etc.). For a given patient, this set forms a normalized vector. It has to be compared with equivalent data derived from patients which fulfilled the criteria for the clinical syndrome in question. If the patient’s vector has a similar direction as the vector of the collective, the working hypothesis is accepted. The length of the vector is then used to quantify the severity of the functional disturbances in verbal terms (“slight,” “moderate,” “severe”). The limits used for severity grading and the typical parameter pattern for the given syndrome are adapted to the user’s criteria by a built-in learning capability. On the other hand, the assembled data may be used for the training of newcomers. The use of vector algorithms allows for a high flexibility of our program with respect to all methods used in lung function testing.     

Double-balloon enteroscopy for obscure gastrointestinal bleeding: A single center experience in China

AIM: To evaluate the diagnostic value of double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB). METHODS: The data about 75 OGIB patients who underwent DBE in January 2007-June 2009 in our hospital were retrospectively analyzed. RESULTS: DBE was successfully performed in all 75 patients without complication. Of the 75 patients, 44 (58.7%) had positive DBE findings, 22 had negative DBE findings but had potential bleeding at surgery and capsule endoscopy, etc . These 66 patients were fi...