白芍总苷对肠缺血再灌注大鼠Cajal 间质细胞线粒体的保护作用研究

目的探究白芍总苷对肠缺血再灌注(IIRI)大鼠Cajal 间质细胞线粒体的保护作用。方法:将45 只大鼠随机分成假手术组、模型组和白芍总苷组,每组15 只。造模前7 d,白芍总苷组给予白芍总苷溶液灌胃,假手术组和模型组给予同剂量生理盐水灌胃,1 次/d。手术完成后12、24 h,测定小肠推进率;HE 染色观察小肠病理学变化,醋酸双氧铀和枸橼铅双重电子染色观察Cajal 间质细胞超微结构;Western blotting 检测小肠组织中C-kit、SCF 及Cx43 蛋白水平。结果:与假手术组比较,术后12、24 h 时模型组大鼠的小肠推进率明显降低,差异有统计学意义(P ＜ 0.01),与模型组比较,术后12、24 h 时白芍总苷组大鼠的小肠推进率明显升高,差异有统计学意义(P ＜ 0.01);光学显微镜下,白芍总苷组大鼠肠道损伤较模型组明显减轻,黏膜间水肿、充血明显改善;透镜下,白芍总苷组大鼠肠Cajal 间质细胞明显改善,线粒体肿胀减少,自噬体减少,可见缝隙连接体。与假手术组比较,模型组的大鼠小肠中SCF、C-kit 以及Cx43 蛋白表达水平均明显降低,差异有统计学意义(P ＜ 0.01)。与模型组比较,白芍总苷组大鼠的SCF、C-kit 及Cx43 蛋白表达水平明显升高,差异有统计学意义(P ＜ 0.01)。结论:白芍总苷预处理改善了IIRI,对Cajal 间质细胞线粒体结构和功能稳定性具有保护作用,其机制可能与C-kit/SCF 信号通路有关。     

诱导型一氧化氮合成酶对同系大鼠移植肠运动功能的作用

目的 观察诱导型一氧化氮合成酶(iNOS)对同系原位全小肠移植术后早期移植肠运动功能的影响.方法 分为对照组、移植组、L-NIL治疗组,每组12只大鼠.对照组行十二指肠造瘘术,另两组均行同系原位全小肠移植及十二指肠造瘘术,术后分别给予生理盐水、L-N6-(1-亚氨乙基)-赖氨酸(L-NIL).于术后2 d,各组取6只获取肠段行病理组织学检查,观察炎性损伤程度,并采用RT-PCR和免疫组织化学方法检测iNOS mRNA及蛋白表达水平.各组另6只行小肠传输实验,观测小肠传输功能.结果 移植组呈明显炎性损伤改变,iNOS mRNA及蛋白表达水平(1.278±0.142)%,(56.33±5.16)%较对照组(0.066±0.016)%,(9.17±3.17%)上调(P＜0.01),较对照组小肠传输延迟(P＜0.01).L-NIL治疗组炎性损伤程度较移植组减轻,iNOS mRNA及蛋白表达水平(0.588±0.096)%,(26.17±4.14)%较移植组下调(P＜0.01),且小肠传输延迟有改善(P＜0.01).结论 iNOS在术后早期移植肠炎症损伤及其引发的肠运动功能障碍中可能起重要作用.     

耳穴贴压配合穴位贴敷在上消化道肿瘤术后的应用

目的：探究耳穴贴压配合穴位贴敷在上消化道肿瘤术后的应用效果。方法：选取前期行常规干预的上消化道肿瘤手术患者 51 例作为对照组,另选取近期行耳穴贴压配合穴位贴敷干预的 51 例作为观察组,对比两组不良反应发生率、疼痛改善率及康复指标。结果：观察组不良反应总发生率为 2%,低于对照组的 16%（P ＜ 0.05）,观察组术后第 6 d 疼痛改善有效率为 88%,高于对照组的 63%（P ＜ 0.05）,观察组术后排气时间为（33.17±11.24） h、排便时间为（46.21±5.38） h,肠鸣音康复时间为（23.41±11.18） h,均优于对照组的（42.05±10.18） h、（61.64±5.87） h 及（41.16±10.52） h（P ＜ 0.05）。结论：对上消化道肿瘤术后患者行耳穴贴压配合穴位贴敷干预,可有效降低不良反应发生率,提高疼痛改善率,改善术后康复指标。     

一氧化氮合成酶在大鼠小肠移植急性排斥反应中的作用

目的 观察神经型(nNOS)和诱导型一氧化氮合成酶(iNOS)在大鼠小肠移植急性排斥反应(AR)中作用.方法 行大鼠原位小肠移植.实验分为2组.1组:同系移植组(Lewis→Lewis,12例);2组:同种移植组(DA→Lewis,12例).观察术后生存时间.再灌注30 min、术后1、3、5、7d检测血清一氧化氮(NO)浓度;开腹行麦芽糖吸收实验;切取移植肠管,苏木素-伊红(HE)染色后光镜检查.免疫组织化学法观察移植肠nNOS和iNOS的活性.逆转录-聚合酶链反应(RT-PCR)法检测移植肠nNOS mRNA和iNOS mRNA的表达.结果 A组生存时间＞30 d.B组生存时间为(6.83±0.75)d.再灌注后A组nNOS染色与mRNA表达明显减弱,此后nNOS染色和mRNA表达分别于术后3、7d恢复正常.再灌注后A组iNOS染色与mRNA表达增强,此后逐渐减弱.与A组比较,术后3～7 d,B组nNOS染色减弱,iNOS染色增强,血清NO水平明显升高(P＜0.05),血糖吸收值显著降低(P＜0.01);术后5、7d,B组nNOS mRNA表达显著下降(P＜0.001),iNOS mRNA表达明显增强(P＜0.01).结论 在AR过程中,nNOS可能调节了iNOS的表达;nNOS的活性和表达与移植肠管的结构和吸收功能密切相关;iNOS的激活是加重组织损伤的重要因素之一.     

耳穴贴压法对围术期患者焦虑及心率、血压的影响

目的 寻找减轻或改善围术期患者焦虑、保证患者生命体征稳定的方法.方法 将200例住院择期手术患者随机分为常规护理组(A组)和耳穴贴压护理组(B组).两组均予常规围术期护理;B组在此基础上加用耳穴贴压法,即在耳穴板上将带有王不留行籽的小方块胶布贴于耳穴位,使用时间为术前3 d至术后3 d;采用焦虑自评量表(SAS)和心电监护仪对患者焦虑程度和心率、血压进行评定与监测.结果 两组术前1 d、术后3 d焦虑程度变化比较,差异有显著性意义(P＜0.01);入手术室后20 minA组心率、收缩压较术前1 d显著增加(均P＜0.01),B组差异无显著性意义(均P＞0.05);两组入手术室后20 min心率、收缩压比较,差异有显著性意义(均P＜0.01).结论 围术期行耳穴贴压法配合常规护理可缓解患者焦虑情绪,稳定心率和血压,利于手术的顺利进行.     

激光照射配合耳穴贴压治疗带状疱疹后遗神经痛

目的 现察半导体激光照射配合耳穴贴压治疗带状疱疹后遗神经痛(PHN)的疗效.方法 将符合条件的70例PHN患者随机分为两组各35例.治疗组运用半导体激光照射配合耳穴贴压治疗,对照组口服复合维生素B、吲哚美辛肠溶片.均治疗2个疗程.结果 两组治疗效果随疗程延长而提高,治疗组治疗10 d、20 d的疗效显著优于对照组(P＜0.01,P＜0.05);两组治疗后VAS评分均显著下降,治疗组下降更显著(P＜0.05,P＜0.01);治疗后1个月,两组复发率比较差异有统计学意义(P＜0.05).结论 半导体激光照射配合耳穴贴压治疗PHN疗效确切,能迅速缓解症状,效果持久,且复发率低.     

有氧运动联合耳穴指压对卵巢癌化疗患者癌因性疲乏的影响

目的 探讨有氧运动联合耳穴贴压对卵巢癌化疗间隙期患者癌因性疲乏的影响.方法 将72例出现癌因性疲乏的卵巢癌化疗患者随机分为两组,对照组(36例)接受常规出院护理指导,观察组(36例)在此基础上给予30 d的耳穴贴压及有氧运动干预.应用简短疲乏评估表和生活质量指数量表进行效果评估.结果 干预30 d后,观察组疲乏程度显著轻于对照组,生活质量评分显著高于对照组(P＜0.05,P＜0.01).结论 有氧运动联合耳穴贴压能有效缓解卵巢癌患者的疲乏程度,提高患者的生活质量.     

耳穴贴压对髋膝关节置换术后患者疼痛影响的系统评价

目的评价髋膝关节置换术后行耳穴贴压的镇痛效果,为中医临床护理提供参考。方法检索国内外相关数据库自建库至2018年2月发表的关于耳穴贴压缓解髋膝关节置换术后疼痛文献。依据Cochrane手册进行质量评价及提取文献,使用Review Manager5.3.3软件进行统计学分析。结果共纳入14篇RCT,共计974例患者(耳穴贴压组490例,对照组484例)。膝关节置换术后6、12及24hVAS评分耳穴贴压组显著低于对照组,髋关节置换术后24、48及72hVAS评分耳穴贴压组显著低于对照组(P0.05,P0.01);术后48h内镇痛药物使用量耳穴贴压组显著少于对照组(均P0.01)。结论在常规护理的基础上增加耳穴贴压可显著减轻髋膝关节置换术后疼痛,减少镇痛药物用量。     

情绪释放疗法联合耳穴贴压对混合痔术后疼痛及焦虑状态的疗效观察

目的探讨情绪释放疗法联合耳穴贴压对混合痔术后患者疼痛、焦虑状态的影响。方法:将99 例混合痔术后患者采用随机数字表法分为对照组( 常规护理,33 例)、耳穴组( 在常规护理基础上增加耳穴贴压干预,33 例) 和联合组( 在常规护理和耳穴贴压基础上增加情绪释放疗法干预,33 例)。观察三组干预后不同时间点的疼痛视觉模拟量表(VAS)、状态焦虑量表(S-AI) 的变化,并于干预结束后评估患者对护理的满意度。结果:联合组患者干预后48 h、72 h、7 d 的VAS评分较耳穴组、对照组更低,差异有统计学意义(P ＜ 0.05) ;联合组患者干预后72 h 的S-AI 评分较耳穴组、对照组更低,差异有统计学意义(P ＜ 0.05) ;干预结束后,联合组、耳穴组满意度评分高于对照组,差异有统计学意义(P ＜ 0.05)。结论:情绪释放疗法联合耳穴贴压能够有效降低混合痔术后患者疼痛程度,改善焦虑情绪,提高其护理满意度。     

泌尿系肿瘤术后肠功能障碍患者的综合干预

目的 促进泌尿系肿瘤患者术后肠功能恢复。 方法 将141例泌尿系肿瘤术后胃肠功能障碍患者按时间段分为对照组71例、观察组70例。对胃肠功能障碍，对照组实施术后常规护理；观察组采取腹式呼吸训练，盆底肌训练，腹部按摩，肛门直肠刺激，肛门注入液体石蜡5项措施综合应用的方法。连续干预3 d后评价效果。 结果 观察组肠鸣音恢复时间、排气及排便时间显著短于对照组（均P＜0.01）。 结论 对泌尿系肿瘤术后肠功能障碍患者实施综合护理措施效果更显著。     

Die Wirkung einer antiperistaltischen Dünndarminterposition in Abhängigkeit von ihrer Lokalisation

Zusammenfassung Bei kolektomierten Ratten wurden antiperistaltische Dünndarminterpositionen von 2 bis 3 cm Länge ausgeführt, entweder im untersten Ileum oder in Dünndarmmitte. Die Verzögerung der Darmpassage war in beiden Gruppen gleich stark, ein Hinweis darauf, daß sie sich nur in einem begrenzten Abschnitt oral des Interponates auswirkt.

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The efficiency of an antiperistalticly interposed small bowel loop in relation to its localization

Summary An antiperistaltic interposition of approximately 1 in. of small bowel was performed in colectomized rats. This was done either in the lowest ileum or in the middle of the small intestine. In both groups there resulted the same degree of bowel transit retardation. This proves, that the braking effect is limited only to a portion of the bowel close above the interposed segment.

     

Abstracts

Abstract

The efficacies of four bowel care regimens (bisacodyl suppositories, glycerin suppositories, mineral oil enemas and docusate sodium mini-enemas) were compared in seven subjects with traumatic spinal cord injury. Efficacy was assessed in terms of colonic transit time, bowel evacuation time and subjective responses to a questionnaire. Both docusate sodium mini-enemas and mineral oil enemas decreased total and left-sided colonic transit time. However, docusate sodium mini-enemas were superior to mineral oil enemas in terms of the decrease in bowel evacuation time and symptom reduction. Results in this small group of subjects suggest that docusate sodium mini-enemas may have advantages in the management of bowel evacuation in individuals with spinal cord injury. (J Spinal Cord Med 1998;21 -24)     

Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus

Background/Purpose

In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments.

Methods

Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature.

Results

Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF).

Conclusions

In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.     

Small bowel reversal procedure for treatment of the "short gut" baby

An increasing number of infants have undergone massive intestinal resection for various reasons: uncontrollable diarrhea, malabsorption, and failure to thrive makes these babies a difficult management problem and threatens their survival and later "quality of life." Five short gut babies have had a 3-cm small bowel reversal operation as part of the total salvage effort. It is recognized that very skilled care by dedicated personnel and parents, utilizing i.v. nutrition and special feeding techniques, is probably the most significant factor in achieving success with these babies. It is believed small bowel reversal helps in keeping these infants alive while their intestinal tract is making the adjustments necessary for long-term survival.     

Pneumatosis Intestinalis Caused by Ischaemic Bowel: Report of Three Cases

Pneumatosis intestinalis is a rare condition in which gas is found in the bowel wall. It exists in a primary form or can be secondary to an underlying pathology.

We present three cases of patients in whom pneumatosis intestinalis was caused by ischaemic bowel. In all three cases, the diagnosis was made using CT scan. A partial bowel resection with ileocolic anastomosis was performed in every case. All patients fully recovered after surgery.     

Serial transverse enteroplasty for short bowel syndrome: a case report

The patient is a 2-year-old boy born with gastroschisis and midgut volvulus that left him dependent on total parenteral nutrition (TPN). At 11 months of age, a Bianchi procedure was performed increasing the total length of bowel from 72 cm to 130 cm. Although he appeared to have sufficient bowel length, he continued to have malabsorption and could only tolerate 10% of his caloric requirement enterally. A barium study found significant dilatation of the lengthened small bowel. At 23 months, we performed a novel bowel lengthening procedure that we have reported previously in an animal model. The serial transverse enteroplasty (STEP) operation increased the 83 cm of dilated and previously lengthened bowel to 147 cm, making the total small bowel length 200 cm. The patient tolerated the procedure well and began to have semisolid bowel movements. Small intestinal absorptive capacity measured by D-xylose absorption showed a substantial increase from 5 to 12 mg/dL (normal range, >20), implying improved but not completely normal small bowel function. This case shows that the STEP procedure increases intestinal length, can be used after a prior Bianchi, and may result in improved intestinal absorptive capacity. The STEP procedure should be considered a surgical option for children with short bowel syndrome.     

Limited Survival of Rat Small Bowel Transplants Preserved in University of Wisconsin Solution for 48 Hours

We have previously shown that rat small bowel may successfully be transplanted after preservation for 24 hours. In this study, syngeneic rat small bowel transplants were studied by light microscopy and transmission electron microscopy during and after preservation in University of Wisconsin (UW) solution for 48 hours. A total of 6 transplants were carried out using a previously described, standardized technique. In most cases, the bowel appeared histologically well preserved at the end of the 48 hr storage period (prior to implantation). Upon revascularization, however, reperfusion injury was dramatic, with loss of villi and crypts and inflammatory cells in all layers. The bowel was abnormal grossly as well as microscopically. This injury was irreversible with persistently abnormal histology for up to 1 week in all but 2 cases.

We conclude that UW solution alone may allow satisfactory preservation of intestinal grafts for 48 hours only in isolated cases, and is therefore not adequate for predictable, satisfactory 48 hr preservation. Attempts to prevent reperfusion injury with oxygen-free radical scavengers are in progress.