以单纯咳嗽为表现的胃食管反流病1例并文献复习

目的探讨高分辨率食管测压(HRM)联合24hpH测定在以食管外症状为表现的胃食管反流病(GERD)的诊断价值。方法回顾分析1例以咳嗽为主诉的GERD患者的临床资料,并复习相关文献。结果 HRM显示食管下括约肌压力正常,湿咽时40%食管体部小缺损弱蠕动,食管上括约肌静息压力偏低,诊断为食管体部弱蠕动;24hpH测定诊断为食管病理性酸反流。予以质子泵抑制剂及促动力药物治疗2周后随访,患者自觉咳嗽症状有所缓解,服药4周后患者咳嗽症状完全消失。结论以食管外症状为表现的GERD易被误诊,HRM联合24hpH阻抗测定可对其进行确诊,并可为疗效判定提供客观依据。 更多还原     

围绝经期胃食管反流病患者食管动力学检测及其临床特点

目的探讨围绝经期女性胃食管反流病(GERD)的食管动力学特点和临床特点。方法选取110例GERD女性患者作为研究对象,根据月经情况将患者分为围绝经期组45例和非围绝经组65例。分析并比较2组GERD患者的食管动力学特点、典型症状发生率和非典型症状发生率。结果围绝经期组反酸症状发生率为44. 45%,显著低于非围绝经组的52. 31%(P 0. 05); 2组反食症状和胃灼热症状发生率比较,差异无统计学意义(P 0. 05)。非典型症状中,2组患者咽喉炎和咽部异物感发生率均较高;围绝经期组嗳气发生率为53. 33%显著高于非围绝经组的29. 23%,睡眠障碍发生率为55. 56%显著高于非围绝经组的27. 69%(P 0. 05)。围绝经期组、非围绝经组GERD患者的胃食管反流病问卷(Gerd Q)积分分别为(9. 57±1. 82)、(9. 87±2. 25)分,差异无统计学意义(P 0. 05)。2组GERD患者的总反流次数、酸反流次数及非酸反流次数无显著差异(P 0. 05)。围绝经期组与非围绝经组的弱酸反流次数有显著差异(P 0. 05)。结论围绝经期女性GERD大多表现为非典型症状,主要是咽喉炎和咽部异物感,食管动力学检测可以作为诊断围绝经期女性GERD的重要选择。     

食管动力指标联合食管pH值检测在胃食管反流病合并抑郁患者病情评估中的临床价值

目的 研究食管动力指标联合食管pH值检测在胃食管反流病(GERD)合并抑郁患者病情评估中的临床价值。方法 以回顾性分析为法,观察对象为2020年1月至2022年1月入海南医学院第一附属医院的80例GERD患者,参考是否合并抑郁分为研究组(合并抑郁,37例)与对照组(无抑郁,43例)。比较两组患者食管动力指标、食管pH值;同时,比较不同类型GERD[反流性食管炎(RE),非糜烂性反流病(NERD)]合并抑郁患者的食管动力指标、食管pH值及抑郁自评量表(SDS)评分,并分析SDS评分与食管动力指标、食管pH值的相关性。结果 研究组远端收缩积分(DCI)、食管下括约肌压力(LESP)均明显低于对照组,DeMeester评分、pH<4大于5 min反流次数、pH<4反流次数、立位pH<4的时间比率、pH<4的总时间比率、收缩前沿速度(CFV)均明显高于对照组,差异均有统计学意义(P<0.05)。研究组GERD合并抑郁患者中,RE患者的LESP明显低于NERD患者,SDS评分、DeMeester评分、pH<4大于5 min反流次数、pH<4的总时间比率明...     

24小时食管PH监测对诊断胃食管反流的临床研究

目的:探索24h食管pH检测对胃食管反流和胃食管反流性疾病的诊断价值。 方法:采用携带式24h食管pH分析仪对37例具有胃食管反流症状患者作为疾病组在常态下进行24h食管pH监测,并以20名健康成人作为对照组进行比较。 结果:20名正常成人中平均97.7％的时间食管pH>4,观察6项食管pH测定指标,得出95％的正常值范围:pH<4的总时间百分率为4.97％;pH<4的立位时间百分率为3.82％;pH<4的卧位总时间百分率2.34％,反流持续≥5min的次数<2.57;最长反流持续时间<18.62min,pH<4的反流次数为25.69次。疾病组与对照组相比有显著差异(P<0.01),24h食管pH监测的阳性检出率为94.59％,明显高于食管钡餐X线检查(27.02％)、内镜检查(40.54％)及食管粘膜活检(51.35％)等方法。 结论:24h食管pH监测的指标对鉴别生理性与病理性GER,深入了解GER与食管炎的关系,特别对GERD的诊断和疗效判定,提供了可靠的依据。其诊断价值明显优于食管钡餐X线检查和内镜检查。     

胃食管反流病酸碱度24小时监测的临床意义

196 9年Spencer首先应用 pH电极进行食管pH值动态监测 ,Johnson和DeMeester分别对正常人和具有反流症状的患者做 2 4小时 pH动态监测 ,定量分析食管酸暴露程度的临床意义。目前 ,食管的 2 4小时 pH动态监测已被广泛应用于临床 ,并成为胃食管反流病 (GERD)诊断的“金标准”。 2 4小时pH动态监测的可重复性 (84 %～ 93% )、敏感性和特异性(96 % )均好。 2 4小时 pH动态监测可用来评价症状与 (酸 )反流的相关性 ,对于判断内镜检查无食管炎 ,但有典型胃食管反流症状者 (NERD)及可疑症状 (如非心源性胸痛、慢性声嘶等 )是否由反流引起…     

幽门螺杆菌与胃食管反流病的关系

目的本文研究了Hp阴性和Hp阳性的胃食管反流病(GERD)患者食管动力学和食管酸暴露情况,以阐明Hp感染和GERD两者之间的关系。方法纳入GERD患者64例,按Hp感染情况分为Hp阳性组37例,Hp阴性组27例。检测前1周停用抑酸药和胃肠动力药。对2组进行食管动力学检测和食管24 h pH监测。结果①Hp阳性和Hp阴性组性别、年龄和体质量指数无显著性差异(P>0.05)。②Hp阳性和Hp阴性组食管动力学检测:LES压力、长度及食管体部的各项动力学指标均无显著差异(P>0.05)。③Hp阳性和Hp阴性组24 h食管pH监测DeMeester评分、食管pH<4时间百分比、pH<4反流次数、pH<4大于5min反流次数、pH<4最长反流持续时间均无显著性差异(P>0.05)。④本研究中GERD患者食管下端括约肌压力(LESP)为(9.1±1.9)mm Hg,明显低于正常人,但它和DeMeester评分无相关性(r=0.130,P=0.304)。结论①Hp感染对胃食管反流病患者的LESP和食管体部的运动功能无明显影响;②Hp感染对胃食管反流病患者的食管酸暴露也没有显著影响;③Hp感染与胃食管反流病的发生没有明显关系。     

胃食管反流性疾病误诊调查

胃食管反流病 (GERD)临床常见 ,对胃镜阴性的 GERD用较新的雷贝拉唑 4周后烧心消失率亦只有 5 9% [1 ] ,因此临床上易否定本病 ,本研究调查 GERD的误诊原因如下。1　对象和方法1.1　对象　 2 0 0 1- 0 8～ 2 0 0 3- 0 2川北医学院附属医院门诊以烧心、胸痛就诊 ,或伴有反酸、反胃拟诊为胃食管反流病 ,进一步选择胃镜、2 4 h食管 p H检测或食管动力检测。 GERD确诊标准 :食管有充血、糜烂者诊断反流性食管炎 ;2 4 h p H检测如 p H<4的时间占总时间的百分比 >4 %或 De Meester Score>14 .72 ;食管动力检测下食管括约肌 L ES<10 mm …     

幽门螺杆菌感染对胃食管反流病患者食管酸暴露及食管动力的影响

目的分析幽门螺杆菌（helicobacterpylor,Hp）感染胃食管反流病（gastroesophagealrefluxdisease,GERD）患者食管远端酸暴露及食管动力变化特点,探讨Hp感染与GERD的关系。方法GERD患者80例,分为Hp阳性组30例,Hp阴性组50例,同期20例慢性浅表性胃炎患者为对照组,对3组进行食管动力学检测和食管24hpH监测。结果Hp阳性组与Hp阴性组DeMeester评分、食管下括约肌压力、24hpH监测各项指标及食管动力学各项指标比较差异均无统计学意义（P〉O．05）;2组DeMeester评分均高于对照组（P〈0．05）,食管下括约肌压力低于对照组（P〈0．05）。结论GERD患者食管下括约肌压力较正常人群低,且存在过量酸反流;Hp感染与GERD发生可能无明显关系。     

食管pH监测对内镜阴性胃食管反流病的诊断价值探讨

目的观察食管pH监测在内镜阴性胃食管反流病中的诊断价值。方法选择临床诊断胃食管反流病（GERD）而内镜检查阴性的42例患者作为研究组，选择无上消化道症状的10例体检者作为对照组．分别行食管24h pH监测检查，分析比较其结果。结果42例内镜阴性者经食管24h pH值监测检出36例（85.71％）符合GERD诊断标准，有反流症状患者酸反流次数、酸长反流次数、最长酸反流时间、pH值〈4 总百分比、pH值〈4 立位百分比、pH值〈 4卧住百分比均显著高于正常对照组，各指标比较有统计学意义（t分别=7.95、6.38、6.12、7.34、7.86、6.06，P均〈0.05）。老年患者24h pH监测GERD栓出率显著高于非老年患者（X^2=6.36，P〈0.05）。结论食管24h pH值监测是诊断内镜检查阴性的胃食管反流病的理想方法。     

24小时食管pH监测和内镜检查在胃食管反流病的诊断价值

目的:本文旨在探讨食管pH监测和内镜检查在GERD中的诊断价值。方法:临床诊断GERD患者121例行内镜及pH检查,对照组18例行内镜和pH检查。结果:内镜食管炎检出率51.2％(74/121),pH检测,阳性率87.6％(106/121)。对74例内镜诊断的食管炎与pH检测进一步分析显示食管酸暴露时间越长,内镜下炎症程度及症状越重。而32例内镜阴性的症状性反流性食管炎,症状多为轻中度,pH<4的总时间％的值亦偏低,但其数值与食管酸暴露数值有重叠。故不能以内镜阳性作为诊断GERD的客观依据,必须结合使用其他方法才能回答有否反流。结论:24h pH确实是诊断GERD的比较理想的方法。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.