结肠镜检前肠道清洁的准备方法

结肠镜是消化内科展开诊断、治疗的有效手段.结肠镜检查和内镜下治疗前必须先清洁肠道排除结肠内粪便,使结肠黏膜充分暴露,以便于操作和观察结肠黏膜的改变.结肠清洁的方法有多种,笔者对该院常用的3种方法进行了观察比较,以适用于不同类型的患者.报告如下.     

莫沙必利联合聚乙二醇电解质在老年患者结肠镜检肠道准备中的应用

目的 观察聚乙二醇电解质联合莫沙必利用于结肠镜检查前清肠效果和副作用.方法 712例拟行结肠镜检查的老年患者（＞ 60岁）肠道清洁前随机分为A组351例和B组361例,A组口服聚乙二醇电解质,B组口服聚乙二醇电解质和莫沙必利.记录肠道清洁效果及副作用.结果 B组肠道清洁效果满意率（95.3％）高于A组（91.4％）,但差异无统计学意义（P＞0.05）;B组达到Ⅰ级清洁度的比例（39.3％）高于A组（31.3％）,差异有统计学意义（P＜0.05）.B组恶心发生率和副作用总发生率明显低于A组（3.6％ vs 13.4％; 15.7％ vs 23.7％,P均＜0.05）.结论 聚乙二醇电解质联合莫沙必利用于老年人肠道清肠准备效果好、副作用发生率低.     

肠道准备场所对各年龄层患者肠道准备效果的影响

[目的]研究住院及门诊两种场所对各年龄层患者肠道准备效果的影响.[方法回顾性分析住院及门诊行结肠镜检查的患者共158例,评估各患者肠道准备情况,比较各年龄层段,门诊及住院患者肠道准备清洁度的差异.[结果]年龄对患者肠道准备效果无统计学差异.门诊组患者的肠道准备合格率明显高于住院组(85.19％∶66.23％,P＜0.0...     

非X线下结肠镜检查结圈判定及解法

非X线下结肠镜检查时镜身在大肠内的状态目前缺乏简单有效的判定方法，往往因结圈不能及时解除给患者造成很大痛苦(常见剧烈腹痛)，操作者也进镜受阻延时费力。虽借助X线对解圈有帮助，但这样不仅使患者受到放射线照射，而且操作者也长时间暴露在放射线下，产生不良后果。我们探索了非X线下结圈判定及解决方法，报告如下。     

结肠镜检出大肠癌283例分析

本院1992－01／1997－12进行的4871例次结肠镜检查中，检出经病理确诊的结肠癌283例，现结合临床分析如下1临床资料男156例，女127例，平均年龄57．6岁（19岁～86岁），平均病程7．2mo（d一10a），144例（SO．9％）于出现症状3mo内获得确诊就诊时主诉依次为血便113例（39．9％），腹泻58例QO．5o），腹痛37例（13．l％），结肠癌术后复查22例（7．8％），腹部包块16例（5．7％），黑便或大便隐血12例（4．2％）直肠指检触及肿块或（和）指套带血71例（25．1％）2结果检出早期大肠癌25例（8．8％），其余258例为进展期癌．癌的部位分布分别…     

聚乙二醇与磷酸钠在结肠镜检肠道准备前后血清电解质和体重的变化

[目的]观察聚乙二醇与磷酸钠在结肠镜检查肠道准备前后血生化指标、渗透压和体重的变化。[方法]78例结肠镜检查患者，随机分为2组，分别给予聚乙二醇电解质溶液2L、磷酸钠90ml进行肠道准备，检测聚乙二醇与磷酸钠组在肠道准备前后各种血生化指标、渗透压和体重。[结果]聚乙二醇组肠道准备后血尿素氮、肌酐、磷及体重较肠道准备前有所下降，差异有统计学意义，没有特殊的临床意义。磷酸钠组肠道准备后血钙、钾及体重较肠道准备前有所下降（P〈0．05，〈0．01），血磷水平升高（P〈0．01），没有明显的临床症状。[结论]虽然没有明显的临床症状，而磷酸钠肠道准备后易出现高磷、低钙、低钾血症以及体重下降，在老年尤其伴有肾功能不全的患者，应引起注意。     

116例结肠气囊肿病临床及内镜特点分析

目的 探讨结肠气囊肿病的临床及内镜特点。方法 回顾性分析2005年1月至2018年6月期间于首都医科大学附属北京友谊医院诊治的116例结肠气囊肿病患者资料,包括患者年龄、性别、临床表现,病变大小、部位、内镜表现等,总结肠道气囊肿病临床和内镜特点。结果 116例患者中男54例、女62例;年龄（59.11±13.13）岁（17~91）岁;单发病变50例（43.10%）,多发66例（56.90%）。病变检出率0.40‰（1/2 524）~2.03‰（8/3 945）。临床表现无症状体检者占24.14%（28/116）,其次为腹痛（18.97%,22/116）、肿瘤标记物升高（17.24%,20/116）。共发现病变168处,结肠镜下表现为黏膜下单发或多发大小不等的半球形或球形囊性隆起,质软,部分黏膜表面充血糜烂。116例患者中66例明确记录气囊肿大小,病变直径（1.61±0.87）cm（0.3~5.0 cm）,其中1.0~<2.0 cm占45.45%（30/66）。病变部位单发者好发于升结肠（38.00%,19/50）和横结肠（28.00%,14/50）,多发者好发于升结肠（28.81%,34/118）、乙状结肠（22.03%,26/118）和降结肠（17.80%,21/118）。结论 结肠气囊肿病临床相对少见,结肠镜检查是诊段的有效手段;其临床表现无特异性,老年患者居多,好发于升结肠。     

优化肠道再清洁联合白光或窄带成像内镜对结肠镜检查质量的影响

目的 探讨不同肠道再清洁时机下联合白光内镜或窄带成像内镜退镜观察对结肠镜检查质量的影响。方法 采用单中心前瞻性随机对照试验,将2021年8月至2022年2月1083例门诊及住院结肠镜检查患者随机分为对照组(n=386)、WLI组(n=357)及NBI组(n=340)。对照组：常规进镜,退镜时再清洁,主要采用白光内镜(WLI)观察;WLI组：进镜时再清洁,退镜时主要采用白光内镜(WLI)观察;NBI组：进镜时再清洁,退镜时主要采用窄带成像内镜(NBI)观察。记录并比较三组患者的息肉检出率、进退镜时间、总镜检时间及BBPS等指标。同时将各组按末次肠道清洁剂服用时间至镜检开始时间的时间间隔分为短间隔组(3～5小时)和长间隔组(>5小时)两个亚组,进行亚组分析。结果 研究发现试验组息肉检出率(WLI组44.8%、NBI组51.8%)显著高于对照组(38.1%)(P<0.05),试验组进镜时间(WLI组4.25±0.81 min、NBI组4.37±0.95 min)长于对照组(3.22±0.93 min)(P<0.05),试验组退镜时间(WLI组5.21±2.41 min、NB...     

结肠检查受检者耐受性的研究

肠镜是诊断结肠病变最准确的一种方法,但患者有一定的痛苦。我们对临床上常用的结肠检查方法结肠镜检查、钡剂灌肠检查进行了比较,目的在于探讨两种检查方法患者的可接受性、检查过程中受检者的耐受性及重复该检查的意愿,探讨其常见因素,从而采取相应的措施,减轻患者的痛苦,提高内镜检查的质量。 一、资料与方法 1.研究对象:2000年3月～2001年12月间,本院内科门诊疑诊为结肠病变的300例患者纳入研究。根据常规检查得出初步印象并告之后由患者选择结肠镜或钡灌肠检查。选择肠镜检查的124例,男60例,女64例,年龄18～65岁,平均（45.9±7.4）岁,腹痛发生率8.6％,便血37.4％,腹泻35.8％,便秘3.2％,15％为结肠癌或息肉切除术后。选择钡灌肠检查的176例,男134例,女42例,年龄18～57岁,平均（43.6±8.3）岁,腹痛发生率 18.7％,便血 15.9％,腹泻47.3％,便秘14.3％,3.7％为结肠癌或息肉切除术后。两组     

早期肠内营养预防应激性溃疡的临床研究

目的研究早期肠内营养对应激性溃疡的预防作用。方法将2005年2月至2006年2月温州医学院附属第一医院收治的38例危重患者随机分为3组。第1组:抑酸药物加早期肠内营养组(发病24 h内给予肠内营养)13例;第2组:抑酸药物加延迟肠内营养组(发病72 h后给予肠内营养)13例;第3组:单纯应用抑酸药物预防组(鼻饲或静脉应用奥美拉唑)12例。于发病后5 d、2周分别行胃镜检查,观察溃疡的发生情况,同时测定胃黏膜中前列腺素E-2(PGE-2)和丙二醛(MDA)的含量。结果第1组患者的溃疡发生率及溃疡指数较其它2组患者低(P<0.01),而溃疡抑制率较其它2组高(P<0.01),2周后溃疡愈合率亦较其它2组高(P<0.05);第2组患者溃疡发生率、溃疡指数低于对照组,但差异无显著性,而溃疡愈合率高于对照组(P<0.05),第1组患者胃黏膜中的PGE-2浓度较其它2组明显增高,而MDA较其它2组明显降低,差异有显著性。第2组患者胃黏膜中的PGE-2浓度亦较第3组高,而MDA较后者低,差异有显著性。结论应用抑酸药物同时给予早期肠内营养治疗可能对应激性溃疡的发生有一定的预防作用。肠内营养可能通过调节胃黏膜中PGE-2和MDA等物质的含量起作用。     

A novel shape-locking guide for prevention of sigmoid looping during colonoscopy

BACKGROUND: Looping of the endoscope in the sigmoid colon and other colonic segments often represents a significant challenge to the performance of comfortable, complete, and swift colonoscopy. This report describes the design and operation of a new device that addresses this problem, together with preliminary preclinical experience with this use of this shape-locking guide (SG-1). METHODS: The shape-locking guide is an overtube that can be converted from a flexible to a rigid configuration on demand. When in the rigid configuration, the shape-locking guide is designed to protect the colon wall from lateral forces exerted by the colonoscope. The shape-locking guide was evaluated in vitro by using an artificial colon model to learn how to operate it, and to assess feasibility for prevention of colon looping. In addition, safety was assessed in vivo in a pig model. RESULTS: In vitro, the shape-locking guide prevented colonic looping and, thereby, aided completion of "colonoscopy" in the artificial colon model. Subsequent in vivo studies demonstrated that use of the shape-locking guide is safe and feasible; it performed well with respect to ease of insertion and avoidance of sigmoid looping. There was no evidence of significant injury to the colon or adjacent abdominal viscera. CONCLUSIONS: This preliminary study shows that use of the shape-locking guide is safe and that it has performance characteristics that may assist the performance of colonoscopy. Human trials are being undertaken.     

Prediction and prevention of treatment-related inpatient hypoglycemia

Background

Prolonged severe hypoglycemia (SH) in hospitalized patients is associated with increased morbidity and mortality. This study was undertaken to identify risk factors for SH, to apply that knowledge to the development of a prediction algorithm, and to institute a prevention program at a tertiary medical center.

Methods

We analyzed SH events for 172 patients and developed computer algorithms to predict SH that were tested on a population of 3028 inpatients who were found to have blood glucose (BG) <90 mg/dl during their hospital stay. Variables with significant bivariate associations were entered into partition analyses to identify interactions. Logistic regression was performed by calculating parameters related to the odds of hypoglycemia below each cut point. Sensitivity and specificity were determined at various cut points. The cut points resulting in 50% sensitivity for each hypoglycemia level were determined. These algorithms were tested against the initial 172 adjudicated patients.

Results

Variables related to the BG <40 mg/dl cut off point were basal and adjustment scale insulin doses, weight, and creatinine clearance, while variables related to the 60 mg/dl and 70 mg/dl cut points were basal, prandial, and adjustment scale insulin doses, weight, creatinine clearance, and sulfonylurea use. The 50% sensitivity cut point developed using the <70 mg/dl algorithm correctly identified 71% of the adjudicated cases, while the <60 mg/dl and <40 mg/dl algorithms identified 70% and 55% respectively.

Conclusions

A validated prediction algorithm for SH can aid in the identification of patients at risk for SH and may be useful in the development of prevention strategies.     

低血糖后葡萄糖再灌注脑损伤相关机制及预防

糖尿病发病率越来越高,已成为全球性问题,随着强化控糖观念的提出及胰岛素的广泛应用,糖尿病相关的低血糖发生率也逐渐增加.持续低血糖会导致各种急性心脑血管疾病,然而新近研究发现胰岛素诱导低血糖后,给予葡萄糖升高血糖后出现了比低血糖状态时更严重的心脑血管损害,尤其是对脑的损伤尤为显著,类似于缺血再灌注,因此人们提出"葡萄糖再...     

Incidence,risk and protective factors of symptoms after colonoscopy

BackgroundFew studies focused on minor adverse events which may develop after colonoscopy.AimsTo investigate the incidence and factors associated to post-colonoscopy symptoms.MethodsThis is a prospective study conducted in 10 Italian hospitals. The main outcome was a cumulative score combining 10 gastrointestinal (GI) symptoms occurring the week following colonoscopy. The analyses were conducted via multivariate logistic regression.ResultsOf 793 subjects included in the analysis, 361 (45.5%) complained the new onset of at least one GI symptom after the exam; one symptom was reported by 202 (25.5%), two or more symptoms by 159 (20.1%). Newly developed symptoms more frequently reported were epigastric/abdominal bloating (32.2%), pain (17.3%), and dyspeptic symptoms (17.9%). Symptoms were associated with female sex (odds ratio [OR]=2.54), increasing number of symptoms developed during bowel preparation intake (OR=1.35) and somatic symptoms (OR=1.27). An inverse association was observed with better mood (OR=0.74). A high-risk profile was identified, represented by women with bad mood and somatic symptoms (OR=8.81).ConclusionAbout half of the patients develop de novo GI symptoms following colonoscopy. Improving bowel preparation tolerability may reduce the incidence of post-colonoscopy symptoms, especially in more vulnerable patients.     

Incidence and prognostic significance of hypoglycemia in hospitalized non-diabetic elderly patients

BACKGROUND AND AIMS: To assess the incidence and prognostic value of hypoglycemia in hospitalized non-diabetic elderly patients. METHODS: An observational retrospective study, with a 3-year follow-up, was performed in a series of 678 patients aged over 65 years, admitted between January 1 2001 and December 31 2001 to the Units of Gerontology and Geriatrics of the Careggi University Hospital, Florence, Italy. Patients with diabetes mellitus were excluded. To determine the cumulative incidence of hypoglycemia, all measurements of venous or capillary blood glucose during hospital stay were taken into account. In-hospital mortality was determined from hospital discharge records. Information on all-cause, three-year mortality after hospital admission was obtained from the City of Florence Registry Office. RESULTS: Hypoglycemia was observed in 8.6% of patients, and was asymptomatic in about 25% of cases. In-hospital mortality was significantly higher in patients with hypoglycemia (41.4% vs 14.3%; p<0.001), even after adjustment for potential confounders, including comorbidity, indices of malnutrition, and pharmacological treatment (adjusted OR 2.17[1.25;3.85]). 3-year mortality was significantly higher in patients with hypoglycemia during hospital stay, but the difference was not significant after adjustment for confounders. CONCLUSIONS: Hypoglycemia is a prognostic marker of in-hospital mortality in non-diabetic hospitalized patients, even after adjustment for comorbidity and indices of malnutrition. Instead, it does not seem to have any relevant independent prognostic value in the longer term.     

Pneumatic perforation of the colon during colonoscopy

Perforation of the colon by pneumatic injury during colonoscopy is a rare complication. Intraoperative observations of a patient who developed massive cecal distention, pneumatosis coli and severe pneumoperitoneum during colonoscopy suggest that an isolated, air-trapping colonic segment is a factor in the mechanism of such injury. The possibility that a poorly fixed, hypermobile cecum and right colon predispose to such injury by air insufflation during colonoscopy is discussed.     

Reversal of hypoglycemia unawareness in a long-term type 1 diabetic patient by improvement of beta-adrenergic sensitivity after prevention of hypoglycemia

The purpose of this study was to assess the effect of strict avoidance of hypoglycemia on beta-adrenergic sensitivity in a type 1 diabetic patient with hypoglycemia unawareness and a diabetes duration of 55 yr. beta-Adrenergic sensitivity was determined by an isoproterenol test and was expressed as the lowest dose of isoproterenol that increases the heart rate by 25 beats/min (IC25). Plasma epinephrine and symptom responses to hypoglycemia were determined during a 3-h hypoglycemic (3 mmol/L) clamp. Initially, the patient had a near-normal counterregulatory plasma epinephrine response to hypoglycemia but reduced beta-adrenergic sensitivity (IC25, 2 microg) compared to 10 hypoglycemia aware, type 1 diabetic patients (0.65 +/- 0.14 microg) and 10 normal control subjects (1.13 +/- 0.21 microg). After 1 yr of strict avoidance of blood glucose levels below 4 mmol/L, the IC25 decreased to 0.25 microg, reflecting improved beta-adrenergic sensitivity. In conclusion, the reduced beta-adrenergic sensitivity in this patient was probably the reason for hypoglycemia unawareness and was reversed by strict avoidance of hypoglycemia.