昆山地区1419例胆汁反流性胃炎回顾性分析

选取2013年1月~2015年12月昆山中医医院行胃镜检查检出1419例胆汁反流性胃炎患者,回顾性分析患者基本资料及体重指数。1419例患者男性占比显著低于女性;患者年龄分布中21~30岁年龄段占比相对最高,显著高于其他年龄组,胆汁反流性胃炎在女性中发病率较高,在21~~30岁人群中发病率较高。     

吞咽言语诊治仪防治无创通气食道返流的护理观察

目的:观察吞咽言语诊治仪对无创通气食道返流的护理作用。方法:84例采用治疗前后对照方法观察吞咽言语诊治仪护理后的进食时间、呛咳次数、食物反流次数、吸入性肺炎发生。结果:治疗组43例患者经吞咽言语诊治仪电刺激治疗后,进食时间平均为23分钟,较治疗前缩短,呛咳次数和食物反流减少,未发生吸入性肺炎,而对照组41例患者中有3例发生吸入性肺炎。结论:吞咽言语诊治仪护理可有效防治无创通气食道反流的发生。     

喉部分切除术后预防误吸的护理

总结喉部分切除术后预防误吸的护理.认为术后要认真做好鼻饲护理,注意鼻饲时患者体位及鼻饲量、速度,防止反流;术后10 d,对试进食发生误吸的患者继续鼻饲高能量流质的同时予进食训练,注意食物的选择,能经口进食后拔除鼻胃管.     

31例颈椎骨折伴高位截瘫患者食物反流的原因分析与护理干预

探讨31例颈椎骨折伴高位截瘫患者出现食物反流的原因与护理干预方法.对浙江大学医学院附属第二医院急诊科收治的79例颈椎骨折伴高位截瘫患者的临床资料进行数据分析,发现有31例患者发生了食物反流.不合适的体位、胃肠功能紊乱、意识障碍、不正确的鼻饲、药物不良反应、术后进食时间过早等因素致发生食物反流率远高于没有这些因素的截瘫患者.对颈椎骨折伴高住截瘫的患者,采取适宜的体位,进行肠道功能的评估与护理、正确的鼻饲护理,严密观察病情,及时发现反流情况,重视家属和陪护的健康教育.可减少食物反流和并发症的发生.     

非糜烂性反流病和糜烂性食管炎患者心理状况及生活质量调查

目的 比较非糜烂性反流病(NERD)和糜烂性食管炎(EE)患者的反流症状、心理状况和生活质量等情况,为更好的诊治胃食管反流病提供帮助.方法 对274例胃食管反流病(GERD)患者及75例正常对照者进行问卷调查,包括一般资料、反流症状、食管外症状、精神心理状况及生活质量评价.结果 274例GERD患者中EE患者97例(35.4%),NERD患者143例(52.2%),Barrett食管患者34例(12.4%);与EE比较NERD患者中女性多见(62.2%VS 47.4%,P＜0.05).EE组与NERD组患者年龄、体质量指数(BMI)及食管外症状发病率差异无统计学意义.GERD患者的反流症状评分、焦虑抑郁评分及食管外症状发病率均明显高于正常对照者(P＜0.01),且生活质量评分低于正常对照者;与EE组比较,NERD患者反流症状、精神心理异常更明显,生活质量下降也更严重(P＜0.01).结论 与EE患者相比,NERD患者有更明显的反流症状、更突出的精神心理因素,及更严重的生活质量损害,对NERD患者应重视包括心理治疗在内的综合治疗.     

胃食管反流性咳嗽18例

2004年10月～2005年12月收治的胃食管反流性咳嗽(gastro-esophageal reflux induced cough,GERC)患者18例,男13例,女5例,年龄30～68岁,中位年龄42岁,咳嗽病程2个月～3年,中位病程6.7个月.15例符合文献[1]的诊断标准,3例症状不典型者经诊断性抗反流治疗有效而确诊.18例均以咳嗽为首发或主要症状,其中15例有明显的进食时咳嗽及餐后咳嗽,并伴有反酸、嗳气、胸骨后烧灼感;1例仅有进食时咳嗽及餐后咳嗽,无反酸、嗳气、胸骨后烧灼感等反流症状;2例以咳嗽为唯一症状、完全无反流症状且咳嗽与进食无关.     

心内直视手术后行无创机械通气患者误吸的护理干预

目的总结预防心内直视手术后无创机械通气患者误吸的护理经验。方法回顾性分析138例心内直视手术后出现低氧血症行无创机械通气患者的临床资料。结果 138例患者中3例发生了误吸,其中2例为胃内容物反流,1例为进食过程中食物呛咳至呼吸道内。结论专业的术后护理可以降低此类患者发生误吸的概率。     

气管切开患者3种鼻饲方法食物反流发生情况比较

目的 探讨气管切开患者较安全的鼻饲方法,有效地控制食物反流,预防吸入性肺炎.方法 将90例气管切开鼻饲患者随机分为3组各30例,分别采用分次灌注法、持续滴注法、输注泵控制滴注法进行鼻饲.观察1周内3种鼻饲方法食物反流的发生情况.结果 输液泵控制组食物反流发生率明显低于分次灌注组、持续滴注组,差异有统计学意义(P<0.01).结论 输液泵控制鼻饲方法能有效降低气管切开患者食物反流的发生,是3种鼻饲方法中较安全的方法.     

颈椎骨折伴高位截瘫患者食物反流的原因分析及护理对策

目的:探讨颈椎骨折伴高位截瘫患者出现食物反流的原因以及针对其进行有效护理干预的方法。方法:选择我院收治的44例颈椎骨折伴高位截瘫并发生食物反流的患者作为研究对象,对其食物反流原因进行深入分析,包括体位因素、胃肠因素、意识障碍、胃管因素、气切吸痰、术后进食、药物反应、陪护因素等,并针对患者的实际情况进行综合护理,观察和分析临床效果。结果:本组44例患者有38例在2 d内得到有效控制,其余6例在7 d内得到有效控制,有效率高达100%。结论:帮助颈椎骨折伴高位截瘫并出现食物反流患者采取适宜的体位,加强肠道功能护理以及鼻饲护理,强化健康教育,可以有效降低食物反流和并发症发生率。     

胃多原发癌1例

患者男,55岁,住院号17172。因上腹痛5年余,反复黑便,于1981年2月20日入院。患者于5年前起腹部反复胀痛,可因进食刺激性食物而加重,间有空腹痛, 无暖气和反酸。每次解黑便期问,均出现心慌、头昏、乏力等症状,经治疗后好转,此次发作症状较重,要求手术治疗。体查:体温37.3℃,脉搏96次/分,呼吸20次/分,     

老年非糜烂性返流病的综合护理干预

目的观察综合护理治疗与心理因素密切相关的老年非糜烂性返流病(NERD)的疗效。方法将46例老年非糜烂性返流病住院患者随机分为护理干预组和随机对照组,两组患者均采用质子泵抑制剂等药物治疗,干预组在药物治疗的同时行综合护理干预,然后对两组治疗效果进行比较研究。结果23例综合护理干预组患者临床症状缓解及汉密顿焦虑量表(HAMA)评分明显优于对照组(P0.01)。结论对老年非糜烂性返流病进行综合护理干预,能显著改善NERD患者的焦虑状态,并提高NERD的疗效。     

查安生养阴柔肝法治疗老年性胃食管反流病经验

胃食管反流病是一种常见的消化系统疾患,研究表明老年患者的发病率逐年增加,并且老年患者大多病程久,病情迁延反复,更容易受疾病的影响。查安生教授临证结合老年人肝阴不足的特点,主张以养阴柔肝之法治疗老年性胃食管反流病,遣方时多加减一贯煎化裁成方,养肝之阴,柔肝之体,复肝之用,临床使用中疗效显著。     

胃食管反流病合并食管裂孔疝患者的临床特点分析

目的分析胃食管反流病(GERD)合并食管裂孔疝(HH)患者的临床特点及其危险因素。方法回顾性分析2018年1月-2019年3月在宁夏回族自治区人民医院消化内科诊断为GERD合并HH的40例患者并作为研究组,另外40例GERD未合并HH的患者为对照组,比较两组患者的基本临床资料、内镜分级、Barrett食管发生率。结果研究组患者的年龄、体重、吸烟史、糖尿病与对照组比较,差异均有统计学意义(P<0.05),两组性别、饮酒史和冠心病比较,差异均无统计学意义(P>0.05);研究组食管外症状较多见,内镜下分级仅有C级与对照组比较差异有统计学意义(P<0.05);A级、B级、D级两组差异无统计学意义(P>0.05);两组Barrett食管发生率比较,差异有统计学意义(P<0.05)。结论GERD合并HH与年龄、体重、吸烟史、糖尿病有关,且其会使Barrett食管发生率升高,积极防控可改变的因素对该类患者可能有一定的好处。     

Is the macroscopic aspect of the esophagus at endoscopy indicative of reflux esophagitis?

Gastroesophageal reflux was looked for in 51 children with chronic obstructive respiratory disease (CORD) using prolonged pH monitoring. An index of reflux aggressivity dependent on both duration and acidity of refluxed material was calculated. This index was significantly related to the macroscopic endoscopic findings, patients with an elevated acidity index having more severe "endoscopic esophagitis" than patients with a normal acidity index. We conclude that the finding of normal, erythematous or destructive esophagitis at endoscopy has at least some clinical relevance.     

Gastroesophageal reflux and asthma

Gastroesophageal reflux provokes asthma in many patients. Conversely, asthma predisposes to gastroesophageal reflux. In many patients, reflux therapy will ameliorate asthma. Recognition of this relationship is facilitated by physician awareness, clinical history, selected laboratory tests, and ultimately, a careful monitoring of the response to antireflux therapy. With the introduction of effective medical antireflux therapy, the opportunity to benefit these patients has increased. Surgical management of reflux-provoked asthma remains an effective and useful alternative in selected patients.     

Applying clinical practice guidelines to a patient with complicated gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a complex, often misunderstood disease that requires comprehensive medical and nursing care. Recently published clinical practice guidelines provide new direction with regard to the causes, diagnosis, treatment, and nursing care of patients with GERD. Using a case study approach, this article outlines the most recent evidence-based treatment options and patient education guidelines for a patient suffering from a complicated case of GERD.     

Pathogenesis of GERD--peculiarity of NERD

Gastroesophageal reflux disease can be divided into two groups, reflux esophagitis and non-erosive reflux disease, according to the presence of esophageal mucosal breaks. Almost all the reflux esophagitis with mucosal breaks are caused by the pathological reflux of acidic gastric contents to esophagus. Therefore, drugs that suppress gastric acid secretion effectively control reflux symptoms. On the other hand, almost 40% of nonerosive reflux disease are not caused by the reflux of gastric acid but by acid-unrelated mechanisms. Therefore, administration of proton pump inhibitors cures reflux symptom of only 50% of cases with non-erosive reflux diseases. The multi-pathogenesis of nonerosive reflux disease should be considered for the treatment of patients with reflux symptoms.     

Gastroesophageal reflux disease: current treatment approaches.

Gastroesophageal reflux disease is a common, usually lifelong, disorder resulting from chronic abnormal exposure of the lower esophagus to gastric contents. Motor dysfunction of the lower esophageal sphincter is the primary cause of this disease. At this writing, no medical therapies can completely resolve abnormal lower esophageal sphincter function; therefore, the treatment of gastroesophageal reflux disease centers on suppression of intragastric acid secretion. Available acid-suppressant medications include proton pump inhibitors, H2-receptor antagonists, and antacids. Of these, the proton pump inhibitors are recognized generally as the mainstays of both short-term and long-term therapy for gastroesophageal reflux disease. All have a low incidence of side effects and are well tolerated by most patients. Five proton pump inhibitors are available currently for patients with gastroesophageal reflux disease. Of these, esomeprazole has shown greater efficacy in controlling intragastric acidity than the others. For patients with erosive esophagitis, esomeprazole has demonstrated higher healing rates and more rapid sustained resolution of heartburn than omeprazole or lansoprazole after up to 8 weeks of once-daily treatment. Because new therapies for gastroesophageal reflux disease are highly effective, patients can be reassured that their disease will be well controlled and their symptoms resolved with a safe and appropriate treatment.     

Use of proton pump inhibitors in the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a wide spread disease characterized by distinct clinical polymorphism manifesting with various symptoms and/or inflammatory changes of a distal portion of the esophagus. Current first-line therapy in GERD consists in administration of proton pump inhibitors (PPI) which promote faster relief of the symptoms and healing of erosive-ulcerous lesions of esophageal mucosa in GERD patients. Clinical efficacy of standard and novel PPI is compared. Wide use of PPI and their long-term courses require further study of PPI side effects which now lack attention from the clinical researchers.     

GERD guideline

GERD guideline 2002 was defined by the experts in Japan after GERD Guideline Workshop 2002, based on the increased incidence of GERD in clinical practice in Japan and concentration of articles from Japanese patients. In the workshop, GERD was defined as follows; Gastroesophageal reflux disease (GERD) indicates those who have physical complications due to gastro-esophageal reflux and/or those who have impairment in their healthy life due to symptoms related to gastroesophageal reflux. In the diagnostic arm, evaluation of subjective symptom was placed as the most important. In the therapeutic arm, proton pump inhibitor (PPI) was named as the first line choice of medicine.