盐酸昂丹司琼与甲氧氯普胺联合治疗妇产科肿瘤化疗胃肠反应的疗效分析

目的探讨(盐酸昂丹司琼)或胃复安(甲氧氯普胺)及其联合应用对妇产科肿瘤化疗所致的胃肠不良反应的疗效。方法将我院2007年1月~2010年12月期间120例妇产科肿瘤病人(共240次疗程),随机分为3组(n=40),分别用枢丹、胃复安及联合应用治疗化疗后的胃肠道不良反应。①枢丹组:化疗前30min和化疗后4h、8h静推枢丹8mg;②胃复安组:化疗同时静脉持续(4h)输注胃复安40mg;③联合组:化疗前30min静推枢丹4mg及胃复安20mg持续静滴4h。统计所有病人每次化疗后恶心呕吐的缓解程度,并观察药物的副作用。结果与其它两组相比,联合组的胃肠道症状发生率最低(P<0.05),药物副作用最少(P<0.05)。而枢丹组与胃复安组两者没有显著性差异(P>0.05)。结论联合应用枢丹和胃复安治疗妇产科肿瘤化疗的胃肠反应的效果良好,副作用小,值得临床上广泛推广使用。     

艾灸和针刺胃复安对消化道肿瘤化疗后胃肠道反应的疗效对比

目的探讨艾灸或针刺胃复安及其联合应用对消化道肿瘤化疗所致的胃肠不良反应的疗效。方法将我科2011年4月至9月期间60例各行2周期化疗的消化道肿瘤患者随机分为3组,分别用艾灸、针刺胃复安及联合应用治疗化疗后的胃肠道不良反应。结果与其他两组相比,联合组的胃肠道反应发生率最低(P<0.05),治疗副作用最少(P<0.05),而艾灸组与针刺组两者无显着差异(P>0.05)。结论联合应用艾灸与针刺治疗消化道肿瘤化疗的胃肠道反应的效果较好,副反应小,值得临床广泛推广。     

枢丹预防消化系统肿瘤化疗后恶心呕吐的临床观察

目的 :旨在了解枢丹 (盐酸昂丹司琼 )在消化道肿瘤病人接受化疗期间的止呕疗效及其不良反应。材料和方法 :78例消化道肿瘤并接受化疗的病人 ,连续观察 2个疗程 ,以胃复安 (甲氧氯普胺 )作为对照组 ,化疗方案包括动脉插管化疗、腹腔化疗、静脉化疗 ,恶心呕吐分级采用WHO标准 ,临床有效以完全缓解和部分缓解计算。结果 :3种不同化疗途径枢丹的总有效率为 86 .0 2 % ,与对照组相比有显著差异 (P <0 .0 0 1) ;无论何种化疗途径枢丹A、B两组间无差异 ;化疗过程中呕吐发生率枢丹组明显低于对照组 (P <0 .0 5 ) ;枢丹最常见的不良反应为便秘 ,其次是头痛头晕、腹痛腹泻等 ,大多可自行缓解。结论 :枢丹在消化道肿瘤病人化疗过程中有较强的止呕作用 ,不良反应较小。     

硬膜外腔注射吗啡及其复合液用于消化道肿瘤手术后镇痛的研究

目的 观察硬膜外腔注射吗啡及其复合液对消化道肿瘤手术后的镇痛效果。方法 本研究选消化道肿瘤手术病人120例,手术毕距末次硬膜外注局麻药30min以上,经硬膜外导管注入。A组为对照组,用吗啡2mg计75例;B组用吗啡1mg加胃复安10mg计24例;C组用吗啡2mg加氟哌啶2.5mg计21例。观察注药前后的BP、HR、R和SPO_2,随访48h,并记录镇痛效果、持续时间和副作用。结果 显示B组、C组镇痛效果优良率明显高于A组(P<0.05);镇痛持续时间>16h的A组与B组、A组与C组、B组与C组均无显著差异(P<0.05);不良反应,A组与B、C组比较,都有显著差异(P<0.01)。结论 术后硬膜外镇痛选吗啡加用氟哌啶或胃复安有增强镇痛效果、减少或避免不良反应的功效。     

枢丹注射液控制化疗所致恶心呕吐疗效观察

对70例接受各种化疗的癌症病人，就枢丹与胃复安的止吐效果进行对比研究。结果表明：治疗组枢丹止吐有效率为85.6％Ⅲ～Ⅳ度恶心呕吐发生率分别为11.4％和8.6％;对照组胃复安止吐有效率为257％，Ⅲ～Ⅳ度恶心呕吐发生率分别为54.3％和45.7％。两者比较：枢丹止吐有效率明显高于胃复安组（P＜0.01）。两种药物的不良反应主要有：便秘、腹部不适、腹泻及头晕。其中，以枢丹组较轻。     

枢丹预防消化系统肿瘤化疗后恶尽呕吐？…

目的：旨在了解枢丹（盐酸昂丹司琼）在消化道肿瘤病人接受化疗期间的止呕疗效及其不良反应。材料和方法：７８例消化道肿瘤并接受化疗的病人,连续观察２个疗程,以胃复安（甲氧氯普胺）作为对照组,化疗方案包括动脉插管化疗、腹腔化疗、静脉化疗,恶心呕吐分级采用ＷＨＯ标准,临床有效以完全缓解和部分缓解计算。结果：３种不同化疗途径枢丹的总有效率为８６．０２％,与对照组相比有显著差异（Ｐ〈０．００１）;无论何种化疗途     

中药联合NP方案治疗非小细胞肺癌术后患者的临床观察

目的观察比较ⅠB期~Ⅱ期及部分ⅢA期非小细胞肺癌患者术后单用化疗和中药联合化疗的不良反应及生活质量情况。方法将32例非小细胞肺癌术后患者随机分为两组,18例采用中药联合NP方案化疗(治疗组),14例单纯NP方案化疗(对照组),具体用药:长春瑞滨25mg/m2,静脉注射,第1天、第8天;顺铂25mg/m2静脉滴注2h,第1~3天,21d重复。化疗4个周期,治疗组在化疗同时给予口服中药。结果治疗组骨髓抑制及消化道反应明显轻于对照组,治疗组Karnofsky评分明显高于对照组,生活质量高于对照组,两组比较差异有显著性(P<0.05)。结论中药联合化疗这种中西医结合综合治疗肿瘤的模式有明显优势,值得临床推广应用。     

善得定、凝血酶与洛赛克联合治疗肝硬化并消化道大出血32例

目的对肝硬化并消化道大出血32例患者应用善得定、凝血酶、洛赛克联合治疗,观察治疗后72 h内止血情况。方法患者均采用常规禁食,冷盐水胃管灌洗,补充血容量等对症支持治疗外,应用善得定0．1 mg加入50 g·L-1葡萄糖20 mL中静推(5 min内),继以25～50μg·h-1持续静脉滴注;凝血酶用生理盐水或温开水(不超过37℃)溶解成10～100 U·mL-1的溶液,每次200 U,每4 h口服1次;洛赛克40 mg静推,每日1次。结果本组病人用药后1 h内止血4例, 6 h内止血13例,24 h内止血8例,36 h内止血3例,平均止血时间(16±1．5)h,止血成功率87．5％。结论肝硬化易并发消化道胃底静脉曲张破裂出血,除采用常规禁食,冷盐水胃管灌洗,补充血容量等对症支持治疗外,善得定、凝血酶与洛赛克联合治疗肝硬化并消化道大出血止血成功率高,不良反应小,值得临床推广应用。     

香菇多糖联合化疗治疗中晚期消化道肿瘤疗效观察

目的观察香菇多糖联合化疗治疗中晚期消化道肿瘤患者的临床疗效及不良反应。方法67例患者分为对照组33例单用FOLFOX方案,治疗组34例FOLFOX方案前3d开始加用香菇多糖1mg,疗程2周,4周为1周期,2周期评价疗效。结果治疗组CR2例,PR12例,SD11例,有效率为41.2%;对照组CR1例,PR患者12例,SD10例,有效率为39.4%,两组比较无显著差异(P>0.05),且治疗组CD3+、CD4+细胞活性及CD4/CD8比值较治疗前明显提高(P<0.05)。而对照治疗后各免疫细胞指标与治疗前比较无显著性差异(P>0.05)。结论香菇多糖联合化疗治疗老年消化道肿瘤可以提高患者免疫功能,有较好疗效,且不良反应轻。     

单次与重复静推瑞替普酶治疗急性心肌梗死的临床对比分析

目的对比观察瑞替普酶单次与重复静推应用于急性ST段抬高型心肌梗死(STEMI)静脉溶栓治疗的效果及安全性。方法将82例发病12h内的STEMI患者分为两组,单次静推瑞替普酶组42例,瑞替普酶18mg1次静脉推注;重复静推瑞替普酶组40例,瑞替普酶18mg间隔30min 2次静脉推注。观察两组溶栓再通率、急性期出血并发症发生率。结果溶栓后60、90和120min,单次静推瑞替普酶组临床判断再通率并不低于重复静推瑞替普酶组,两组90和120min两个时间段比较,差异无显著性意义(P>0.01,P>0.05)。48h单次静推瑞替普酶组急性期出血并发症2例(5%),重复静推瑞替普酶组出血并发症12例(30%),死亡2例(5%);两组对比差异具有显著性意义(P<0.01、P<0.05)。结论瑞替普酶静脉溶栓治疗STEMI,单次静推较重复静推,使梗死相关血管开通率无明显差别,并有较高的安全性,较低的急性期病死率。     

Cannabinoids and the digestive tract

In the digestive tract there is evidence for the presence of high levels of endocannabinoids (anandamide and 2-arachidonoylglycerol) and enzymes involved in the synthesis and metabolism of endocannabinoids. Immunohistochemical studies have shown the presence of CB1 receptors on myenteric and submucosal nerve plexuses along the alimentary tract. Pharmacological studies have shown that activation of CB1 receptors produces relaxation of the lower oesophageal sphincter, inhibition of gastric motility and acid secretion, as well as intestinal motility and secretion. In general, CB1-induced inhibition of intestinal motility and secretion is due to reduced acetylcholine release from enteric nerves. Conversely, endocannabinoids stimulate intestinal primary sensory neurons via the vanilloid VR1 receptor, resulting in enteritis and enhanced motility. The endogenous cannabinoid system has been found to be involved in the physiological control of colonic motility and in some pathophysiological states, including paralytic ileus, intestinal inflammation and cholera toxin-induced diarrhoea. Cannabinoids also possess antiemetic effects mediated by activation of central and peripheral CB1 receptors. Pharmacological modulation of the endogenous cannabinoid system could provide a new therapeutic target for the treatment of a number of gastrointestinal diseases, including nausea and vomiting, gastric ulcers, secretory diarrhoea, paralytic ileus, inflammatory bowel disease, colon cancer and gastro-oesophageal reflux conditions.     

Vitamin D and the digestive system

Target tissues of in vivo receptor binding and deposition of 1,25(OH)2 vitamin D3 and its oxygen analog OCT are reviewed in rats, mice, hamsters and zebra finch, identified with high-resolution microscopic autoradiography. Throughout the digestive system numerous sites with nuclear receptor binding of 3H-1,25(OH)2 vitamin D3 and 3H-OCT exist: in the oral region, epithelial cells of the oral cavity, tongue and gingiva, teeth odontoblast and ameloblast precursor pulp and stratum intermedium cells; in the parotid, submandibular and sublingual salivary glands, epithelial cells of striated ducts and granular convoluted tubules, intercalated ducts and acinar cells, as well as myoepithelial cells; in the stomach, neck mucous cells of gastric glands, endocrine cells of the antrum, and muscle cells of the pyloric sphincter; in the small and large intestine, absorptive and crypt epithelial cells; in the pancreas, predominantly islet B-cells. Perisinusoidal stellate (Ito) cells in the liver concentrate and retain variable amounts of radiolabeled compound in regions of their cytoplasm after administration of 3H-I,25(OH)2 vitamin D3 and 3H-25(OH) vitamin D3, probably sites of specific storage, similar to vitamin A. Submucosa in stomach and intestine also retain variable amounts of radiolabel, however unspecific with all compounds studied. In pilot studies with 3H-25(OH)2 vitamin D3 and 3H-24,25(OH)2 vitamin D3, no nuclear concentration was detectable. The reviewed data for vitamin D and its oxygen analogue OCT indicate genomic effects on multiple target tissues of the digestive system that involve cell proliferation and differentiation, endo- and exocrine secretion, digestion and absorption for maintaining optimal functions, with potentials for health prophylaxis and therapies.     

叶酸与消化系统疾病

叶酸是一种生长因子 ,其缺乏会出现机体多系统受损。在消化系统中可发生慢性萎缩性胃炎、结肠炎 ,甚至会增加患消化道肿瘤的危险。而且叶酸缺乏与肝细胞受损及巨幼红细胞性贫血密切相关。本文就叶酸的来源、代谢、生理功能、与消化系统疾病中的关系、实验室检测及其机体需要量的探讨作一综述。     

Element of digestive pathophysiology and fecal analysis

Fecal analysis includes qualitative and quantitative studies which allows quantification and labelling of numerous pathophysiologic phenomenona. Malabsorption and over-absorption of water and electrolytes give rise to six types of watery diarrheas, and two types of constipations; malabsorption of nutriments and maldigestion of food, give rise to two types of fatty and nitrogenous diarrheas with metabolic consequences. Fecal analysis often discriminates organic from non-organic diseases and brings informations on increase or decrease of caloric losses, to the nutritionist. Microscopic observations which requires a high degree of competence and experience, allows the recognition of malabsorption/maldigestion phenomenona, of fortuitous presence of parasites and a good interpretation of a fecal file.     

Alcohol and oropharyngolaryngeal and digestive tract cancer]

Epidemiology has demonstrated that alcoholic beverages are causally related to oropharyngolaryngeal, esophageal, liver, colorectal, and female breast cancer. Among Japanese male alcoholics screened by endoscopy combined with esophageal iodine staining and immunofecal occult blood tests, 4.2% had esophageal squamous cell carcinoma (SCC); 1.2%, oropharyngolaryngeal SCC; 1.4%, stomach adenocarcinoma; 1.9%, colorectal adenocarcinoma. The inactive form of aldehyde dehydrogenase-2 (ALDH2), encoded by the gene ALDH2*1/2*2, which is prevalent in Asians, exposes them to higher levels of acetaldehyde after drinking and was a strong risk factor for these cancers among Japanese heavy drinkers. Inactive ALDH2 was also associated with synchronous and metachronous multiple esophageal cancers. These results suggest a general role of acetaldehyde, an established animal carcinogen, in carcinogenesis of the human alimentary tract. The oropharyngolarynx and esophagus lack ALDH2 activity, suggesting that after exposure to acetaldehyde derived from systemic, mucosal, salivary, or bacterial production or alcoholic beverages, these organs' inefficient degradation of acetaldehyde enhances the chances for local acetaldehyde-associated carcinogenesis. The normal alcohol dehydrogenase-2 (ADH2), encoded by ADH2*1/2*1, is another risk factor for oropharyngolaryngeal and esophageal cancer in Japanese alcoholics. For patients with both normal ADH2 and inactive ALDH2, the risks for oropharyngolaryngeal and esophageal cancer are enhanced in a multiplicative fashion. The responses to a simple questionnaire about both current and past facial flushing after drinking a glass of beer can indicate an individual's ALDH2 phenotype fairly well. Use of this questionnaire to obtain information on ALDH2-associated cancer susceptibility could contribute to the prevention of alcohol-related cancer in Asians.     

消化道吻合器及缝合器在上消化道重建术中的临床应用

目的:探讨国产GF-1型管状吻合器及XF缝合器在上消化道重建术中的优越性。方法:研究组采用GF-1型管状吻合器及XF缝合器行上消化道重建术126例,对照组用手法行上消化道重建术123例,两组间作统计学处理。结果:研究组手术时间明显缩短,并发症明显降低。结论:重建术中按规程操作,国产GF-1型管状吻合器及XF缝合器应用于上消化道重建术效果良好,费用明显低于进口一次性吻合器及缝合器,适合在基层医院推广应用。     

消化酶制剂的临床应用

消化不良是消化系统的一种常见病症，常需应用促动力剂和(或)消化酶制剂治疗才能奏效。现仅就消化不良的基本概念和消化酶制剂的临床应用简述如下。