The effect of a therapeutic trial of high-dose rabeprazole on symptom response of patients with non-cardiac chest pain: a randomized, double-blind, placebo-controlled, crossover trial

BACKGROUND: Therapeutic trials with high-dose lansoprazole and omeprazole have been shown to be sensitive clinical tools for diagnosing patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. AIM: To determine the clinical value of a therapeutic trial of high-dose rabeprazole over 7 days in detecting patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. METHODS: Double-blind, randomized, placebo-controlled, crossover study. Patients referred by a cardiologist after a comprehensive cardiac work-up were enrolled into the study. Oesophageal mucosal disease was determined by upper endoscopy and 24-h oesophageal pH monitoring assessed acid exposure. Patients were then randomized to either placebo or rabeprazole 20 mg am and 20 mg pm for 7 days. After a washout period of 1 week, patients crossed over to the other arm of the study for an additional 7 days. Patients completed a daily diary assessing severity and frequency of chest pain throughout the baseline, treatment and wash-out periods. The rabeprazole therapeutic trial was considered as a diagnostic tool, if chest pain scores improved > or =50% from baseline. RESULTS: Of the 35 patients enrolled, 16 (46%) were diagnosed as gastro-oesophageal reflux disease-positive and 19 (54%) as gastro-oesophageal reflux disease-negative. Of the gastro-oesophageal reflux disease-positive patients, 12 of 16 (75%) had a significant symptom improvement on rabeprazole when compared with 3 of 16 (19%) on placebo (P = 0.029). Of the gastro-oesophageal reflux disease-negative group, only two of 19 (11%) improved significantly on the medication and four of 19 (21%) on placebo (P = 0.6599). The calculated sensitivity and specificity of the rabeprazole therapeutic trial was 75% and 90%, respectively. CONCLUSIONS: A rabeprazole therapeutic trial is highly sensitive and specific for diagnosing gastro-oesophageal reflux disease-related non-cardiac chest pain patients.     

多层螺旋CT在急诊胸痛患者中的诊断效果

目的探讨多层螺旋CT在急诊胸痛中的诊断效果。方法 120例急诊胸痛患者,随机分为对照组和实验组,每组60例。对照组患者给予常规冠状动脉造影检查,实验组患者给予多层螺旋CT扫描。比较两组患者的检查结果、心率水平及满意度。结果两组患者的急性主动脉夹层、冠状动脉狭窄和肺栓塞检出率比较差异无统计学意义(P>0.05)。检查后,实验组患者的心率(67.63±1.42)次/min低于对照组的(72.28±1.67)次/min,差异具有统计学意义(P<0.05)。实验组患者的满意度为100.0%,对照组患者的满意度为90.0%,实验组患者的满意度高于对照组,差异具有统计学意义(P<0.05)。结论常规冠状动脉造影和多层螺旋CT扫描检查对急诊胸痛患者的检出情况相似,但多层螺旋CT扫描诊断不影响患者心率,且患者满意度高。     

老年高血压伴胸痛病人临床与冠状动脉造影分析

目的 为了解老年高血压伴胸痛的临床诊断问题。方法 本组回顾性分析86例老年高血压伴胸痛病人诊断为冠心病，心绞痛行冠状动脉造影检查的临床资料。冠心病组44例：冠脉造影血管狭窄≥75%或冠脉狭窄50%-75%且临床有心肌缺血证据；对照组42例；冠脉造影结果除外冠心病，并对两者有关冠心病的危险因素与临床特点进行比较。结果 两者之间临床上较难鉴别，但典型心绞痛可高度提示冠心病的可能。结论 确诊冠心病冠状动脉造影是必需的。     

优化急诊预检分诊流程在急性胸痛患者中的应用效果

目的 探讨优化急诊预检分诊流程在急性胸痛患者中的应用效果。方法 选取2019年8月至2020年2月大连市第三人民医院收治的47例急性胸痛患者为对照组,选取2020年3月至8月收治的47例急性胸痛患者为研究组,对照组凭经验进行分诊,研究组应用优化急诊预检分诊流程。比较两组患者满意度、分诊时间及急救时间。结果 研究组的满意度为95.74%,高于对照组的80.85%,差异有统计学意义（P<0.05）。研究组的分诊评估时间为（1.86±0.22）min、急救时间为（24.39±5.46）min,均短于对照组的（3.26±1.01）、（27.62±6.11）min,差异有统计学意义（P<0.05）。结论 优化急诊预检分诊流程用于急性胸痛患者中,成效显著,值得推广应用。     

心理护理对降低产妇分娩期疼痛的临床效果分析

目的探讨心理护理对降低产妇分娩期疼痛的临床效果。方法选取来笔者所在医院生产的待产产妇中160例作为研究对象,分为观察组和对照组各80例。对照组采用传统方式对产妇进行护理,观察组在对照组的基础上对待产妇进行心理护理干预;将两组护理后分娩期疼痛情况进行对比分析。结果观察组产妇疼痛平均评分为(1.7±0.5)分,低于对照组的(2.6±0.7)分;观察组产程平均时间为(10.4±2.7)h,低于对照组的(12.5±3.2)h;观察组产后平均出血量为(184.6±52.4)mL,低于对照组的(237.8±76.5)mL,差异均具有统计学意义(P<0.05)。结论采取心理护理对待产产妇进行护理干预并与传统护理对比,能够有效降低其疼痛情况,缩短产程时间和减少产后出血量。     

Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome

Background Irritable bowel syndrome is the most common disorder diagnosed by gastroenterologists. Although several randomized‐controlled trials have assessed the therapeutic role of antidepressant drugs, there is insufficient evidence to support their use. Aim To compare the effects of low‐dose amitriptyline in the treatment of diarrhoea‐predominant irritable bowel syndrome in a double‐blind randomized‐controlled trial. Methods Fifty‐four patients who fulfilled Rome II criteria for diarrhoea‐predominant irritable bowel syndrome were included in this study. Organic causes were ruled out by standard laboratory and radiological tests, and rectosigmoidoscopy. Patients were randomly assigned to receive either 10 mg amitriptyline daily or placebo. Subjects were followed up for 2 months and symptoms were assessed using a questionnaire. Intention‐to‐treat and per‐protocol analysis was performed. Results Fifty patients completed the study. At 2 months, the amitriptyline group showed greater (P < 0.05) reduction in the incidence of loose stool and feeling of incomplete defecation. Patients receiving amitriptyline showed greater complete response, defined as loss of all symptoms, compared with those receiving placebo (68% vs. 28%, P = 0.01). Adverse effects were similar between the two groups. Conclusion Amitriptyline may be effective in the treatment of diarrhoea‐predominant irritable bowel syndrome and at low dose is well tolerated.     

抗抑郁药文拉法辛对精神分裂症阴性症状、社会功能恢复的临床疗效研究

目的:探讨抗抑郁药文拉法辛对精神分裂症患者的治疗效果。方法:回顾性分析2013年11月-2015年1月收治的64例精神分裂症患者的临床资料,其中,对照组采用利培酮治疗,而观察组采取文拉法辛联合利培酮治疗,比较2组患者的阴性症状、社会功能恢复情况以及不良事件发生情况。结果:治疗后,观察组与对照组患者的PANSS阴性症状、PSP评分均较治疗前出现明显改善,且在12周时,观察组患者的以上指标改善效果均优于对照组,组间差异具有统计学意义(P<0.05);2组不良反应发生率最高的主要为锥体外系副反应但组间各项相比,差异均无统计学意义(P>0.05)。结论:抗抑郁药文拉法辛可有效改善精神分裂症患者的阴性症状,提高患者的认知能力,从而较大程度改善患者的社会功能,促进患者的预后,其疗效显著且安全可靠,值得临床应用。     

Clinical trial: effects of tegaserod on gastric motor and sensory function in patients with functional dyspepsia

BACKGROUND Tegaserod, a serotonin receptor type-4 partial agonist, stimulates gastrointestinal motility and has been shown to increase gastric volumes before and after a meal in healthy volunteers. Its effect on gastric motor and sensory function in patients with functional dyspepsia is unclear. AIM To evaluate the effects of tegaserod on gastric compliance, accommodation and gastric sensory function in patients with functional dyspepsia and healthy volunteers. METHODS Sixteen patients with functional dyspepsia and 12 healthy volunteers were studied on two occasions, each after a 7-day treatment with either placebo or tegaserod 6 mg b.d. using a double-blind, randomized, crossover design. After each treatment period a gastric barostat study was performed fasting and during intraduodenal lipid infusion. RESULTS Tegaserod increased postprandial gastric compliance in functional dyspepsia patients (P = 0.04). Healthy volunteers showed enhanced postprandial gastric compliance after placebo (P = 0.03). Between-treatment analysis of gastric accommodation revealed a significant increase in intrabag volumes after tegaserod in healthy volunteer (P = 0.04); no difference could be seen in functional dyspepsia patients. Tegaserod had no effect on gastric sensation. CONCLUSIONS Tegaserod enhances postprandial gastric compliance in functional dyspepsia patients and gastric accommodation in healthy volunteers. The improvement of proximal gastric motor function suggests a beneficial role of tegaserod in patients with functional dyspepsia.     

冠脉CT血管成像联合TIMI危险评分在急性胸痛患者中的临床应用价值

目的探讨冠脉CT血管成像（CTA）与心肌梗死溶栓疗法（TIMI）危险评分联合检测在急性胸痛患者中的临床应用价值。方法 2008年6月至2010年6月就诊于海南医学院附属医院急诊科、心内科的急性胸痛患者71例。仔细询问病史、体检、进行心电图检查及检测心肌损伤标志物。按TIMI危险评分的7个变量进行计分,将患者分成不同的危险层次。同时患者完成冠脉CTA检查及冠脉造影。对TIMI评分、CTA结果与冠脉造影结果进行分析,比较三者的关系。结果缺血性胸痛患者TIMI危险评分显著高于非缺血性胸痛者。TIMI评分结合冠脉CTA对冠脉病变的检测的准确性更高。结论冠脉CTA与TIMI危险评分联合检测对急性胸痛患者冠脉病变的检出具有重要价值。     

Oesophageal eosinophilic infiltration in patients with noncardiac chest pain

Aliment Pharmacol Ther 2011; 33: 1194–1201

Summary

Background Eosinophilic oesophagitis clinically presents with recurrent episodes of dysphagia and food impaction. Recently, we observed patients with noncardiac chest pain and eosinophilic oesophagitis. Aims To estimate the prevalence of abnormal eosinophilic infiltration in noncardiac chest pain patients and examine diagnostic utility of demographic, clinical and endoscopic variables to predict eosinophilic oesophagitis. Methods Retrospective study of 171 consecutive patients referred for EGD evaluation of noncardiac chest pain. Endoscopic signs consistent with eosinophilic oesophagitis were recorded. The histological findings were grouped as normal: 0–5 eosinophils/high power field (e/hpf), indeterminate: 6–20 e/hpf, and eosinophilic oesophagitis: ≥21 e/hpf. Abnormal eosinophilic infiltration was defined as ≥6 e/hpf. Results Abnormal eosinophilic infiltrate was noted in 24 patients (14%). Thirteen (8%) had indeterminate counts, while 11 (6%) had eosinophilic oesophagitis. Compared with normal, those with abnormal oesophageal eosinophilic infiltration were more likely to be male (71% vs. 34%, P = 0.001), have allergies (29% vs. 12%, P = 0.050), have current GER symptoms (42% vs. 18%, P = 0.013), rings (54% vs. 22%, P = 0.002), furrows (21% vs. 1%, P < 0.001) and abnormal eosinophilic oesophagitis findings on endoscopy (67% vs. 32%, P = 0.001). Of the 24 abnormal patients, 23 (96%) were either male or had rings, furrows, or white specs. Conversely, 68 of 69 patients (99%) who were female did not have rings, furrows, or white specs, and endoscopy was normal. Eight patients (33%) with abnormal eosinophilic infiltration had a normal endoscopy. Conclusions Eosinophilic oesophagitis should be considered in the evaluation of noncardiac chest pain. Our findings suggest that oesophageal biopsies should be obtained particularly in males with recurrent unexplained chest pain, whether endoscopy is normal or abnormal.     

多指标联合预测急诊胸痛患者的心血管不良事件

探讨血清B型脑钠肽（BNP）联合急性胸痛评分对急诊胸痛患者心血管不良事件的预测价值。回顾性分析我院收治的588例急性胸痛患者的临床资料,计算患者心肌梗死溶栓疗法（TIMI）评分、全球急性冠状动脉事件注册（GRACE）评分,检测血清BNP并进行30 d随访。采用Logistic回归进行多因素的分析;用ROC曲线下面积来评价评分的方法对不良事件的预测能力。急诊入院的患者TIMI评分、GRACE评分和BNP水平均高于急诊观察的患者（P＜0.05）,30 d死亡的患者TIMI评分、GRACE评分和BNP水平均高于生存下来的患者（P＜0.05）,有其他重要不良症状的患者这三项指标与无不良症状患者比较均有升高（P＜0.05）。TIMI评分、GRACE评分和BNP对急诊胸痛患者心血管不良事件的预测结果准确。血清B型脑钠肽联合急性胸痛评分及对急诊胸痛患者心血管不良事件可起到很好的预测作用,对合理地区分急性胸痛患者中的高危患者提供良好的依据。     

Upper gastrointestinal evaluation of Chinese patients with non-cardiac chest pain

AIMS: To test the usefulness of upper gastrointestinal investigations and quality of life assessment in Chinese patients with non-cardiac chest pain. METHODS: Seventy-eight consecutive patients with non-cardiac chest pain underwent upper endoscopy. Eight patients had upper gastrointestinal pathology (10%). The remaining 70 patients received acid perfusion test, oesophageal manometry and 24-h ambulatory oesophageal pH (n=65)/manometry (n=61), and the results were compared with those of healthy controls (n=20). Symptoms and quality of life (SF-36) were assessed by standard validated questionnaire. RESULTS: Significant acid reflux symptoms were present in five (5/70, 7%) patients. Abnormal 24-h oesophageal pH, indicating gastro-oesophageal reflux, was found in 19 (19/65, 29%) patients. The percentage of simultaneous contractions was higher and the percentage peristalsis was lower in patients with non-cardiac chest pain when compared with normal subjects by 24-h ambulatory manometry. Patients with non-cardiac chest pain had a lower SF-36 score when compared to controls. CONCLUSIONS: Typical acid reflux symptoms are uncommon in Chinese patients with non-cardiac chest pain, but abnormal 24-h pH results, indicating gastro-oesophageal reflux, were found in 29% of patients. Ineffective contractions were more frequently found in patients with non-cardiac chest pain by 24-h ambulatory manometry, which may have a bearing on the impaired quality of life in such patients. Upper gastrointestinal investigations are useful for the evaluation of Chinese patients with non-cardiac chest pain.     

应用双源CT诊断胸痛的卫生经济学分析

目的：对疑诊冠心病的低危胸痛患者的两种诊断程序进行卫生经济学评价。方法：采用前瞻性研究方法,根据是否采用双源CT诊断程序,将2007年7月～2009年12月本院心内科确诊的120例胸痛患者分为运动平板组和双源CT诊断程序组,分别接受运动平板或双源CT检查,计算其就诊费用、检查费用、住院时间、确诊时间等,运用经济学最小成本分析法进行评价。结果：两组平均检查费用、平均就诊费用差异无统计学意义,双源CT诊断程序组与运动平板组比较,平均住院时间长（P〈0.05）;但双源CT诊断程序组接受冠状动脉造影的患者总数显著少于运动平板组（P〈0.001）。结论：双源CT诊断程序与普通诊断程序对于胸痛的诊断具有相似的经济学效益,但显著减少了患者接受选择性冠状动脉造影的比例。     

A randomized controlled trial of paroxetine for noncardiac chest pain

Noncardiac chest pain occurs frequently in medical practice and is often difficult to treat.We conducted a randomized double-blind, placebo-controlled, 8-week trial of paroxetine in 50 patients with noncardiac chest pain. None of the patients met criteria for panic disorder or major depression. Paroxetine-treated patients showed greater (P < .05) improvements than placebo-treated patients on the Clinical Global Impressions (CGI) scale. Both paroxetine and placebo-treated patients improved to a similar extent on selfrated pain measures, although baseline differences limited the interpretation of this outcome variable. There were no differences on other outcome ratings. Treatment was well tolerated. These preliminary findings extend other data on the potential of selective serotonin reuptake inhibitors for the acute treatment of noncardiac chest pain. Some recommendations for future studies to definitively test this potential are presented.     

以胸痛就诊的肺血栓栓塞患者临床特点分析

目的研究以胸痛就诊肺血栓栓塞(PTE)患者临床特点,希望对降低肺血栓栓塞患者的死亡率提供帮助。方法选取南阳市中心医院院2008年1月—2009年12月就诊的晕厥患者856例作为观察对象,按照核素肺通气灌注显像检查结果将观察对象分为PTE组和非PTE组。按照胸痛发生原因,将非PE组患者分为心血管性胸痛、肺源性胸痛、胃肠源性胸痛、骨骼肌肉源性胸痛、带状疱疹性胸痛。分析PTE患者与非PTE患者性别、年龄、既往病史、其他伴随症状、体征的差别。结果胸痛患者中,10.2%的患者为PTE所至晕厥;各组患者性别构成、年龄均无显著性差异,PTE组具有3个以上静脉血栓危险因素的患者明显高于其他组;PTE组患者既往单下肢肿胀、气短、咯血、下肢腓肠肌压痛的发生率高于其他各组。结论以胸痛就诊的PTE患者常合并有多个静脉血栓的危险因素,其既往下肢肿胀的发生率高,常合并气短、咯血及腓肠肌挤压痛阳性。     

温胆汤合四君子汤治疗胸痹58例的临床观察

古人将冠心病称为胸痹,为临床中老年人常见疾病,根据《金贵要略》论胸痹,认为阳气虚于上,痰湿等阴邪乘虚干扰而成本病。随着社会的进步,人们饮食及生活习惯的改变发现,临床导致胸痹的病机以脾气亏虚、痰瘀互结多见。笔者跟随导师李洁诊疗多名胸痹患者,运用温胆汤合四君子汤加减治疗胸痹58例,临床效果较满意。     

以胸痛为主要表现的胃食管反流病16例临床分析

目的探讨以胸痛为主要表现的胃食管反流病的病因、临床特点及诊治方法。方法选择本院近年来诊治的16例已排除心源性及食管器质性病变的胸痛患者,对其发病原因、临床特点、诊断、治疗方法及治疗效果进行回顾性分析。结果经抗反流治疗2～4周后,其中9例（56.25%）胸痛及胃食管反流症状完全消失,5例（31.25%）用药后明显缓解,1例（6.25%）无效,总有效率达93.75%。结论胃食管反流病病因复杂、临床表现多样易误诊漏诊,必要的辅助检查结合质子泵抑制剂试验性治疗是确诊本病的关键。     

升督平木汤治疗功能性肛门直肠痛的临床观察

目的分析升督平木汤治疗功能性肛门直肠痛的临床效果。方法随机选择2015年6月~2017年5月、2011年6月~2013年5月在我院接受治疗的肛门直肠痛患者62例、56例作为观察组及对照组,两组均采取生物反馈治疗及黛力新口服;观察组联用升督平木汤口服,分析比较两组患者治疗前后VAS疼痛自评分、焦虑及抑郁(SAS&SDS)自评分、治疗效果。结果观察组治疗总有效率90.32%显著高于对照组的66.07%(P<0.05);观察组治疗后VAS评分显著低于对照组及治疗前(P<0.05);观察组及对照组治疗后SAS及SDS评分均显著低于治疗前,但观察组评分更低(P<0.05)。结论升督平木汤治疗功能性肛门直肠痛能够获得良好的临床效果,有助于尽快恢复,改善预后。