保护早产儿胃肠道黏膜功能的研究进展

近年来，随着对胃肠道黏膜屏障功能不断深入的研究，肠内营养尤其是早期肠内营养越来越受到医学界的普遍关注。对于早产儿，由于各系统发育尚不完善，胃肠道功能不健全的特点，如何更好的保护胃肠道黏膜功能，更科学的营养支持已成为临床研究的重要课题。本文就此方面的研究进展综述如下。     

谷氨酰胺联合益生菌肠内营养对胃肠术后患者肠道屏障功能的影响

胃肠道手术引起的应激反应会使循环系统血液重新分布,优先供应心脑等重要器官,减少肠道血供,术后不可避免的禁食及抗生素使用又会加剧肠道缺血和菌群改变,破坏肠道黏膜屏障,严重时可继发肠道菌群失调,引起局部肠道感染乃至全身炎症反应[1]。创伤应激后给予机体提供一定量的免疫增强型肠内营养制剂有助于肠道功能恢复,且益生菌的应用可一定程度改善手术和抗生素导致的菌群失调,有助于肠道屏障功能恢复[2]。本次研究观     

益生菌对肠黏膜屏障损伤的保护及修复机制研究进展

胃肠道益生菌是定植于人体胃肠道内,通过保持微生态平衡,能产生确切对于胃肠道功能改善的有益非致病性特定活性的微生物的总称.益生菌能平衡肠道菌群比例、转化肠内有害物质、减轻炎症反应、保护肠道黏膜屏障等.手术、创伤、严重感染、重症胰腺炎等因素可导致肠黏膜屏障功能下降,如不能及时修复,极可能会发展至肠衰竭甚至危及生命.近年来的研究表明,益生菌对于肠黏膜屏障损伤的修复及保护具有重要的临床意义.     

肠内营养的护理及进展

当前临床营养学的迅猛发展,推动了临床营养护理学的进步。营养护理学 已成为当代跨学科、跨专业的新兴学科。肠内营养(enteral nutrition , EN) 支持治疗在国际上已被普遍使用,在临床营养支持中所占的比例越来越高,临床上成为“肠道有功能,且能安全使用”时的首选[1]。近年来,随着对胃肠道在创伤休克和多器官功能障碍中作用的深人研究,发现早期EN可较好维持和改善患者的营养状况,更重要的是可维持肠道的完整性,保护肠道黏膜,维持肠道功能,促进肠功能的恢复[2,3],已引起护理人员的极大关注。本文就近年来临床肠内营养的相关护理及研究工作综述如下     

胃癌术后早期应用肠内营养130例临床护理

肠内营养与肠外营养相比,有助于维持肠道黏膜细胞结构与功能的完整,维护肠道黏膜屏障功能、刺激消化液和胃肠道激素的分泌,增加内脏血流,使代谢更符合生理需要,可减少肝、胆并发症的发生[1].2005年1月～2006年1月,我们对130例胃癌患者术后早期应用肠内营养,并给予精心护理,取得满意效果.现报告如下.     

肠内营养在肝硬化治疗中的临床研究进展

随着对肠内营养研究的深入,尤其是肠内营养在维护和增强肠道黏膜免疫屏障功能,防止肠道菌群移位上的特殊价值,使其成为肝硬化患者营养支持治疗的首选方式.为了评价肠内营养在肝硬化患者中临床应用的必要性和可行性,我们搜集近年来的国内、外医学文献,阐述肠内营养的概念、肝硬化患者肠内营养的临床应用、主要并发症及其处理.     

合理应用大黄及其复方开启危重患者肠道功能的研究

已有充分的研究证实,大黄具有肯定的保护胃肠道功能,促进胃肠蠕动,减轻肠源性内毒素血症,保持肠道菌群平衡,改善肠道黏膜血液灌流,降低血管通透性,缓解肠道缺血状态,保护胃肠黏膜屏障,防止细菌移位,进而降低多器官功能障碍综合征(M ODS)发生的作用〔1〕,但有关危重患者合理应用     

益生菌联合肠内营养在重症患者疾病治疗中的应用

肠内营养是目前重症患者常用的营养支持方式。重症患者应激状态下的肠道微环境发生变化,出现肠道菌群失调,致病菌增多。益生菌联合肠内营养能够保护肠黏膜屏障,减少腹泻、腹胀以及感染的发生,增强免疫功能,促进疾病的康复,目前已被应用于多种重症疾病。     

早期肠内营养和肠道水疗在重症胰腺炎中的应用

营养支持是治疗重症急性胰腺炎（SAP）的重要组成部分,长期完全胃肠外营养（TPN）可以引起肠黏膜萎缩,肠黏膜屏障功能损害,发生肠道细菌移位,致使肠源性感染增加。为减少感染性并发症的发生,早期肠内营养（EN）已越来越受到重视,EN对肠黏膜屏障功能的保护作用已得到临床实验证实。临床实验也证实肠道水疗可促进肠蠕动及功能恢复,加速内毒素排除,防止胰腺炎的重症转化。本研究选择42例SAP患者,对其早期EN和肠道水疗的安全性、有效性进行初步研究。     

危重病人肠内营养支持常见并发症的护理

在疾病治疗的同时,营养支持治疗被视为基础治疗方法之一。临床营养支持有肠内与肠外两大类,肠内营养的最大优点是有食物通过肠道,有助于改善门静脉系统循环,改进腔肠的功能,特别是肠道的血液灌注与氧的供给,促进肠蠕动,促进肠道激素与免疫蛋白的释放,利于肠黏膜的渗透性,维护肠黏膜屏障功能,减少多器官功能障碍综合征(MODS)的发生。但是肠内营养治疗过程中的并发症虽然相对于肠外营养较少,但也是护理人员应注意的。现对我院2001年5月—2004年6月实施肠内营养治疗的危重病人并发症护理总结如下。1临床资料本组病例共56例,其中男26例,女30例…     

Prolapsed gastric mucosa: Roentgenologic demonstration of ulcer crater in prolapsed polypoid mucosa

The American Journal of Digestive Diseases - A case of prolapsed polypoid gastric mucosa, visualized by roentgen examination and verified by surgery, is presented. Severe melena arising from two...     

Precancerous lesions of oral mucosa

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.     

Functional lymphangiectasia of the duodenal mucosa

Tiny millet-like prominent villi with dilated lymphatics may be part of a food-induced functional lymphangiectasia. Peroral olive oil load causes diffuse transient lymphangiectasia, the gross aspect, histological findings and electron-microscopy of which is described in detail.     

Adenylate cyclase of human gastric mucosa

It has been shown that human gastric mucosa contains a prostaglandin-sensitive adenylate cyclase system. Of the prostaglandins tested the E-type induced an about 3--3.5-fold increase of enzyme activity. The prostaglandin A2 by causing an about 2.5-fold enhancement of cAMP formation and the F-prostaglandins (1.4--2.0-fold stimulation) were less effective in activating the enzyme system. Maximally effective concentrations of histamine and prostaglandin E2 were additive with respect to enzyme activity indicating that both hormones act via individual adenylate cyclases.     

Precancerous lesions of the gallbladder mucosa

To elucidate the morphological characteristics and the incidence of precancerous lesions of the gallbladder, 200 gallbladders removed for presumed benign diseases were examined histopathologically. Dysplastic epithelia with distinct cellular and structural atypia were graded into either mild or moderate to severe degree. Twenty-nine (14.5%) of 200 cases showed dysplasia; 5 (2.5%) was to moderate to severe degree and 24 (12%) to mild degree. Carcinoma in situ was found in 4 cases (2%) and occult invasive carcinoma in 2 cases (1%). Simple hyperplasia was seen in 54 cases (27%). Abnormal epithelia showed a male preponderance in consistent with the previous report on cancer epidemiology in Japan. Dysplasia and hyperplasia were found to have close association with chronic cholecystitis, but not with gallstones per se. It was postulated that the progression of dysplasia or carcinoma in situ into invasive carcinoma may occur in the sixties to seventies.     

Heterotopic gastric mucosa of the esophagus

We have described three patients with heterotopic gastric mucosa of the proximal esophagus, which has been recognized by pathologists since the early 19th century. In contrast to Barrett's esophagus, which is now known as an acquired metaplastic lesion of the esophagus, this mucosa is believed to be a remnant of incomplete epithelialization of the esophagus during fetal life. It has little clinical significance because of the small size of the mucosal patch and the neutralization of the acid by saliva.