谷氨酰胺双肽保护肠粘膜屏障

传统的肠外营养和化疗药应激可导致肠粘膜形态及屏障功能障碍。为研究腹腔注射５－ＦＵ后谷氨酰胺双肽对肠粘膜形态及屏障功能的影响，作者将大鼠随机分成两组。对照组（ｎ＝１０）接受传统肠外营养液。双肽组（ｎ＝１０）接受传统肠外营养液加３％谷氨酰胺双肽，胃肠外营养维持７天；第４天腹腔注射５－ＦＵ，第３、７天测定肠粘膜通透性，第８天处死，测氨基酸谱、肠粘膜形态及细菌移位。结果：双肽组较对照组体重丢失少（Ｐ＜０．０５）。双肽组血浆谷氨酰胺浓度、空肠粘膜厚度和绒毛高度均高于对照组（Ｐ＜０．０５）。双肽组肠系膜淋巴结细菌移位率低于对照组（分别为３０％和９０％，Ｐ＜０．０５）。对照组和双肽组术后第３天（即化疗前）肠粘膜通透性无差异。乳果糖／甘露醇（Ｌ／Ｍ）分别为０．０２６±０．００６和０．０２２±０．００３。用５－ＦＵ后第３天（即第７天）对照组肠粘膜通透性明显升高。Ｌ／Ｍ为０．０４２±０．００５（Ｐ＜０．０５）。但双肽组Ｌ／Ｍ基本维持不变０．０２９±０．００２。作者认为：谷氨酰胺双肽强化的肠外营养对腹腔注射５－ＦＵ的大鼠，可维持小肠粘膜形态及屏障功能，减轻肠道细菌移位和肠粘膜通透性的升高。     

腹腔感染实验大鼠肠粘膜屏障功能的变化及机理

目的探讨实验大鼠腹腔感染时肠粘膜屏障功能变化及其发病机理。方法在盲肠结扎加穿孔（ＣＬＰ）模型上,观察肠粘膜通透性、肠粘膜血流量、血浆内毒素、肠道荧光标记菌示踪以及肠组织血小板活化因子（ＰＡＦ）、磷脂酶Ａ２（ＰＬＡ２）和丙二醛（ＭＤＡ）的变化。结果腹腔感染组比对照组肠粘膜通透性和血浆内毒素水平明显升高;肠道荧光标记菌大量移位于肠外器官。肠粘膜血流量明显降低。肠组织ＰＡＦ、ＰＬＡ２和ＭＤＡ水平明显升高。应用ＰＡＦ拮抗剂ＷＥＢ２１７０治疗能明显减轻肠粘膜损害,有效降低肠道细菌移位率和血浆内毒素水平。结论腹腔感染时有肠粘膜屏障功能严重受损和肠源性感染发生,而ＰＡＦ是导致这一病理生理改变的重要因素之一     

一氧化氮,内皮素在急性坏死性胰腺炎肠道损伤中的作用

目的探讨一氧化氮（ＮＯ）,内皮素１（ＥＴ１）在急性坏死性胰腺炎（ＡＮＰ）肠道损伤中的作用。方法制成犬ＡＮＰ模型。分别于术后第１,２,４,７ｄ测定血浆ＮＯ,ＥＴ１水平和二胺氧化酶（ＤＡＯ）活性,并对肠粘膜超微结构和肠道细菌移位情况进行观察。结果ＡＮＰ组犬血浆ＮＯ和ＥＴ１水平显著高于对照组,均以发病后第１,２ｄ最为明显（Ｐ＜０．０１～Ｐ＜０．０５）;血中细菌移位率为１００％,亦以发病后第１,２ｄ为最高（６／８,５／８）;肠粘膜微绒毛出现破损和部分脱落,面积减少。结论ＮＯ和ＥＴ１是导致ＡＮＰ时肠道损伤的重要因素,抑制ＥＴ１的产生和减少早期ＮＯ的超量释放,可减轻ＡＮＰ对肠道的损伤作用。     

血清LDH和同功酶在小儿胆道梗阻和感染中的诊断意义与预后关系

本研究分为两部分：１．实验研究：测定胆道梗阻和感染的家兔，模型（实验组）的血清ＬＤＨ与同功酶，并取肝组织活检进行研究。结果表明实验组ＬＤＨ与ＬＤＨ４均较正常对照组增高（Ｐ＜０．００５、Ｐ＜０．０２）。肝组织学检查示肝细胞损害。２．临床研究：将３７例患儿分为３组，血清ＬＤＨ与同功酶的测定结果表明：①胆道感染与梗阻组的ＬＤＨ高于胆道疾病未合并感染或梗阻组（Ｐ＜０．００１）及对照组（ｐ＜０．００１）；②胆道感染与梗阻组ＬＤＨ５亦高于正常。以上结果表明血清ＬＤＨ与ＬＤＨ４或ＬＤＨ５的升高有助于小儿胆道感染与梗阻的诊断与预后判断。     

MODS时肠道细菌移位及承气方剂对其影响的病理形？…

目的 观察承气 方剂对ＭＯＤＳ时肠道细菌移位的影响。方法 利用ＭＯＤＳ动物模型,采用Ｄｉｇ－ｐｒｏｂｅ在肠杆菌原位杂交的方法,观察ＭＯＤＳ时肠道细菌移位及承气方剂和抗生素对其影响。结果 ＭＯＤＳ时肠源性大肠杆菌可以移位到肠壁的粘膜下层甚至肌层,经淋巴系统和门静脉到达全身。与模型组比较,承气方剂治疗可以明显地抑制ＭＯＤＳ大鼠肠道细菌移位（Ｐ〈０．０５）;抗生素治疗不能抑制ＭＯＤＳ大鼠肠道细菌移位。结     

丙氨酰－谷氨酰胺对机体创伤后肠道屏障功能的保护作用

作者采用ＳＰＦ大鼠以ＴＰＮ、ＴＰＮ液中添加丙氨酰－谷氨酰胺（Ａｌａ－Ｇｌｎ）和经肠饮食（ＥＮ）三种营养方式支持一周后，造成创伤性休克，观察了大鼠在接受不同营养方式支持一周后，肠道屏障功能对严重创伤应激状态的影响，以及Ａｌａ－Ｇｌｎ是否具有维持肠道屏障功能的作用。结果显示，标准ＴＰＮ组与ＥＮ组相比，血浆二胺氧化酶（ＤＡＯ）水平明显低下；肠固有层（ＬＰ）淋巴细胞和浆细胞、肠上皮内淋巴细胞（ＩＥＬ）及肠腔细菌分泌型ＩｇＡ（Ｓ－ＩｇＡ）包被率明显下降；盲肠粘膜菌群Ｅ．ｃｏｌｉ优势增殖，双歧杆菌／大肠杆菌（Ｂ／Ｅ）比值倒置，肠上皮细菌粘附增多；肠道细菌移位率升高；死亡率（４／ｌ２）高。而Ａｌａ－Ｇｌｎ组因添加肠道必需氨基酸Ｇｌｎ前体Ａｌａ－Ｇｌｎ，各参数接近ＥＮ组，肠屏障储备增加，死亡率下降。提示：标准ＴＰＮ由于缺乏肠粘膜必需氨基酸（Ｇｌｎ）和肠道刺激，严重损伤肠屏障功能，创伤性休克可加重损害，促发脓毒症和多器官功能不全（ＭＯＤＳ）。对标准ＴＰＮ进行改良，添加肠粘膜保护剂Ａｌａ－Ｇｌｎ对肠屏障有较好维持作用。这对临床创伤和围手术期患者进行营养支持有一定指导意义。     

肠外营养时肠道细菌移位及其治疗的动物研究

消化道粘膜是阻止肠道细菌侵入循环系统及身体其它组织的重要屏障。但是，在某些疾病状态下，如化疗、骨髓移植、烧伤、多器官功能衰竭时，机体免疫功能受到抑制，肠道细菌过度生长，肠粘膜屏障发生物理损伤，则可能发生肠道细菌移位。在动物和人体的研究均证明了来自肠道细菌的感染。肠外营养是复杂胃肠道疾病外科治疗中不可缺少的重要手段，但是长期肠外营养可引起肠道粘膜及肠道相关淋巴组织（gut－asso－ciatedlympho饲tissue，GALT）的明显萎缩，肠道局部免疫功能的下降，导致肠道细菌移位。因此，弄清细菌移位发生的机制，找到一种…     

肠源性内毒素血症对组织脂多糖结合蛋白mRNA表达的影响

目的探讨烫伤后肠源性内毒素血症对不同组织脂多糖结合蛋白（ＬＢＰ）ｍＲＮＡ表达的影响。方法采用大鼠３５％体表面积Ⅲ度烫伤模型，观察门、体循环内毒素含量及肝、肺、肠、肾等组织ＬＢＰｍＲＮＡ表达的改变。结果烫伤后血浆内毒素水平（门、体循环均值分别为０．７０７ＥＵ／ｍｌ与０．３４２ＥＵ／ｍｌ）及细菌移位率（３７．１％）较伤前值均有显著升高（Ｐ＜０．０１）。同时，肝、肺、肠、肾等组织ＬＢＰｍＲＮＡ表达亦显著增多（Ｐ＜０．０１）。给予杀菌／通透性增加蛋白（ＢＰＩ）治疗后可明显降低门、体循环血浆内毒素水平及肺、肠、肾等组织ＬＢＰｍＲＮＡ表达（Ｐ＜０．０５～０．０１），其中以肠道改变最为显著（治疗组与烫伤组均值分别为０．９９０与１．７２９，Ｐ＜０．０１）。相关分析显示，肺组织ＬＢＰｍＲＮＡ表达与血浆内毒素水平呈显著正相关（ｒ＝０．５９４，Ｐ＜０．０５）。结论创伤后肠源性内毒素血症可显著影响不同组织ＬＢＰｍＲＮＡ的表达，ＬＢＰｍＲＮＡ在局部组织表达增多可能与增敏内毒素血症的组织器官损伤有关。     

丁哌卡因与芬太尼骶管注入用于小儿术后镇痛的比较

目的：比较小儿骶管注入不同浓度丁哌卡因（Ｂ）及芬太尼（Ｆ）的镇痛效果和安全性。方法：１５０例在骶麻下行斜疝修补术小儿随机分为五组：Ａ组骶管注入１％利多卡因（Ｌ），Ｂ组注１％Ｌ＋０．１５％Ｂ，Ｃ组注１％Ｌ＋０．２５％Ｂ，Ｄ组注Ｂ组药及２μｇ．ｋｇ＾－１Ｆ，Ｅ组注Ｃ组及２μｇ／ｋｇ＾－１Ｆ。术后４、８、１２、２４随访并记录肌力、疼痛评分（ＬＰＳ）及副作用。结果：ＬＰＳ〈３级；Ｂ、Ｃ、Ｄ、Ｅ组各点明显多     

老年男性甲状旁腺激素与骨密度的关系

本文的目的在于探讨在健康老年人中，甲状旁腺素（ＰＴＨ），钙（Ｃａ）、磷（Ｐ）、镁（Ｍｇ）、碱性磷酸酶（ＡＫＰ）、肌酐（Ｃｒ）与骨密度（ＢＭＤ）之间的关系。选择７０名健康老人，抽血查Ｃ－ＰＴＨ、Ｃａ、Ｐ、Ｍｇ、ＡＫＰ和Ｃｒ的水平。并在左侧桡骨远端１／３处，用单能光子骨密度测定仪测定ＢＭＤ。以正常参考值为标准（０．６２９７～０．７６９５ｇ／ｃｍ２），将对象分为ＢＭＤ降低组和ＢＭＤ正常组。结果显示：（１）在ＢＭＤ正常组（ＢＭＤ值为０．７３±０．０７ｇ／ｃｍ２）中，ＰＴＨ的水平为１５５．３６±９３．４５（ｎｇ／Ｌ），在ＢＭＤ降低组（ＢＭＤ值为０．５７±０．０４ｇ／ｃｍ２）中，ＰＴＨ的水平为２１４．１１±９１．９３（ｎｇ／Ｌ）。二组间差异有统计学意义。（２）在ＢＭＤ正常组中，血清钙的水平为２．１２±０．２２（ｍｍｏｌ／Ｌ），在ＢＭＤ降低组中，血清钙的水平为２．２３±０．１９（ｍｍｏｌ／Ｌ）。两组相比，差别有统计学意义（Ｐ＜０．０５）。实验结果提示：在老年男性与年龄有关的骨密度降低中，ＰＴＨ的分泌起到重要作用。     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency. In the developed world approximately 20% of patients with acute abdominal pain admitted to surgical units have intestinal obstruction and 80% of these will have small bowel obstruction. In the western world, adhesional obstruction is by far the most common cause of small bowel obstruction, reflecting the increasing number of abdominal surgical procedures being performed. Malignancy is the leading cause of obstruction of the large intestine. The cardinal clinical features are vomiting, abdominal pain, distension and gross constipation which differ in predominance depending on the site of the obstruction. Management of bowel obstruction requires prompt identification, meticulous attention to fluid and electrolyte balance and timely surgical intervention.     

Intestinal stomas

The formation of an intestinal stoma (usually ileostomy or colostomy) is an integral part of the surgical management of several pathologies of the gastrointestinal tract – in both emergency and elective patients. The basic underlying principle is that faecal flow is diverted from the site of the pathology by bringing the end or a loop of bowel through the anterior abdominal wall. A stoma may be created in a temporary or permanent role to reduce morbidity and mortality associated with several conditions of the gastrointestinal including perforation, inflammatory bowel disease, bowel obstruction and elective cancer operations. Early complications of stoma formation include ischaemic necrosis of the stoma, stomal retraction and obstruction with later potential complications of parastomal hernia formation, stomal prolapse and peristomal skin changes.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (tachycardia, tenderness, fever and leukocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal duplication

Gastrointestinal duplications are rare but interesting clinical entities. They have a varied presentation, with most of them showing up in paediatric population. Clinical features may vary from asymptomatic abdominal masses to bowel obstruction or perforation. This review traces the embryological origin and describes the anatomical types of duplications. An outline of the principles of management is described.     

Intestinal stomas

The formation of an intestinal stoma (usually ileostomy or colostomy) is an integral part of the surgical management of several pathologies of the gastrointestinal tract – in both emergency and elective patients. The basic underlying principle is that faecal flow is diverted from the site of the pathology by bringing the end or a loop of bowel through the anterior abdominal wall. A stoma may be created in a temporary or permanent role to reduce morbidity and mortality associated with several conditions of the gastrointestinal including perforation, inflammatory bowel disease, bowel obstruction and elective cancer operations. Early complications of stoma formation include ischaemic necrosis of the stoma, stomal retraction and obstruction with later potential complications of parastomal hernia formation, stomal prolapse and peristomal skin changes.     

Intestinal hemangiopericytoma

A case of intestinal hemangiopericytoma is described. This localization is extremely rare. Clinical presentation consisted of upper digestive hemorrhage and abdominal mass; 9 months after surgical removal, the patient presented a single liver metastasis located in the left lobe, which was resected. Twenty-one months after the first surgical procedure the patient shows a favorable outcome. We review the literature and discuss this exceptional form of hemangiopericytoma, as well as its outcome.     

Intestinal stomas

The formation of an intestinal stoma (usually ileostomy or colostomy) is an integral part of the surgical management of several pathologies of the gastrointestinal tract – in both emergency and elective patients. The basic underlying principle is that faecal flow is diverted from the site of the pathology by bringing the end or a loop of bowel through the anterior abdominal wall. A stoma may be created in a temporary or permanent role to reduce morbidity and mortality associated with several conditions of the gastrointestinal tract including perforation, inflammatory bowel disease, bowel obstruction and elective cancer operations. Early complications of stoma formation include ischaemic necrosis of the stoma, stomal retraction and obstruction with later potential complications of parastomal hernia formation, stomal prolapse and peristomal skin changes.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.