注水结肠镜与注气结肠镜检查240例临床对照研究

目的探讨注气结肠镜与注水结肠镜检查的舒适度及操作性。方法选取2016年6-9月在北部战区总医院内窥镜科接受结肠镜检查的240例患者,将其随机分为注气结肠镜检查组和注水结肠镜检查组,比较两组患者一般情况,记录检查的达盲率、时间、腹痛评分,随访腹痛、腹胀及再次检查是否选择无痛结肠镜意愿。结果注气组与注水组在一般情况、进镜成功率、进镜深度、检查后腹痛情况、再次检查选择无痛结肠镜等方面差异无统计学意义(P0.05);注气组疼痛评分明显高于注水组(P=0.001),注水组的进镜时间、退镜时间及操作总时间明显高于注气组(P0.001,P=0.013,P0.001),检查后1 h腹胀程度注气组明显高于注水组(P0.001),检查后6 h腹胀程度两组间差异无统计学意义(P0.05)。结论注水结肠镜检查可明显减轻患者腹痛和检查后腹胀不适感,但其操作时间较注气法延长。     

注水结肠镜检查对老年患者腹痛和炎症反应的影响

背景:老年患者行结肠镜检査的难度相对较大,检查过程中腹痛和组织损伤的发生率增加。目的:探讨注水结肠镜检查对老年患者腹痛和炎症反应的影响。方法:纳入2014年1月—2016年6月在南阳市第二人民医院择期接受结肠镜检查的老年患者40例,随机分入注水结肠镜检查组(注水组)和常规结肠镜检查组(注气组)。记录两组进镜、退镜时间,以视觉模拟评分法(VAS)评估腹痛程度,以ELISA法检测检查前后血清炎症反应指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平。结果:注水组检查过程中的腹痛VAS评分显著低于注气组(P0.05),两组间进镜、退镜时间则无明显差异(P0.05)。检查前,两组间各血清炎症反应指标差异均无统计学意义(P0.05);检查结束即刻以及检查后6 h和24 h,注气组血清TNF-α、IL-6、CRP水平均显著高于检查前(P0.05),且高于同时间点注水组(P0.05)。注水组炎症反应指标的恢复快于注气组。结论:注水结肠镜检查可减轻老年患者检查过程中的腹痛感受,同时有效抑制机体炎症反应。     

注水式结肠镜检查的优势

注水结肠镜检查与传统的注气结肠镜相比,能够显著减轻腹痛,提高盲肠插管成功率,提高腺瘤检出率,有利于困难肠镜的肠镜检查,提高成功率,且有利于初学者进行肠镜学习。本文就注水肠镜的特点作一概述。     

比较注水肠镜与传统注气肠镜检查对老年患者结肠息肉检出率的影响

目的比较注水肠镜与传统注气肠镜检查对老年患者结肠息肉检出率的影响,探讨注水肠镜的优势。方法选择因下消化道症状就诊并行非麻醉肠镜的老年患者102例,随机分为注水肠镜组(A组)53例和注气肠镜组(B组)49例,比较患者结直肠息肉检出率、疼痛评分、肠镜达盲肠时间、插镜深度、全结肠检查率、进镜与退镜时肠道清洁度、操作者主观难易度及相关并发症等。结果注水肠镜组患者结肠息肉检出率显著高于注气肠镜组(P=0.021);术中腹痛评分明显低于注气肠镜组(P=0.001);注水肠镜组患者的退镜清洁度评分高于注气肠镜组(P=0.030);插镜深度明显小于注气肠镜组(P=0.003);注水肠镜组操作者主观评价得分显著高于注气肠镜组(P=0.007)。结论注水肠镜显著提高了老年患者的结直肠息肉检出率,减轻了老年患者肠镜检查中的腹部疼痛与不适感,操作更为简便,同时显著提高了退镜时的肠道清洁度。     

注水法行结肠镜检查在便秘患者中的应用

背景:内镜医师普遍认为便秘患者行结肠镜检查的操作难度较非便秘患者相对增加。目的:分析注水法行结肠镜检查在便秘患者中的效果。方法:选择2010年11月~2011年11月江苏省苏北人民医院便秘患者200例,随机分为注水组和注气组。比较两组进镜时间、退镜时间、疼痛程度、满意度以及操作过程中是否需外界辅助。结果:与注气组相比,注水组患者平均进镜时间、退镜时间均无明显差异,疼痛程度明显降低(3.5±2.3对9.5±4.3,P0.05),满意率显著升高(90.8%对17.6%,P0.05),需外界辅助的发生率明显降低(体位变化:33.7%对73.5%、腹部压迫:16.3%对62.7%、调节镜身硬度:8.2%对21.6%,P0.05)。结论:对于便秘患者,注水法行结肠镜检查可明显减轻患者的疼痛不适,对顺利完成结肠镜检查有切实可行的应用价值。     

注水法在婴幼儿结肠镜检查中的应用

目的比较注气法和注水法在婴幼儿结肠镜检查中的达盲时间、麻醉药物剂量等，探索注水法结肠镜检查在婴幼儿中的应用价值。 方法收集2019年1月至2020年9月经吉林大学第一医院小儿消化科行无痛结肠镜检查的71例患儿，年龄为月龄≤72个月，其中，观察组为注水法35例，对照组为同期行传统注气法36例。应用SPSS统计学软件分析比较两组患者的达盲率、达盲时间、达盲时丙泊酚用量等差异，并探讨注水法中注水量的影响因素。 结果观察组的达盲率为100%，对照组的达盲率为94.4%，差异无统计学意义；观察组的达盲时间(8.66±4.20)min，显著少于对照组达盲时间(16.69±9.22)min(P<0.05)；观察组达盲时丙泊酚用量(64.00±18.50)mg显著少于对照组丙泊酚用量(83.33±25.72)mg(P<0.05)。对注水法结肠镜注水量的相关因素分析中，发现肠道准备程度与注水量之间具有显著相关性(P<0.05)。 结论注水法在婴幼儿结肠镜中安全、可靠，适合在临床推广、应用。     

注水式结肠镜检查法的研究进展

1984年,FMchuk和Griffin发表了针对肠道多发憩室的患者,应用传统的注气式结肠镜检查失败时,改用注水的方式帮助寻找肠腔走行,顺利通过憩室段的报道,由此,开启了注水式结肠镜检查法的发展之路。注水式结肠镜检查方法是指进镜过程中应用注水法代替传统注气法,注水提供视野,到达回盲部后,改为注气,退镜过程中注气提供视野进行肠道病变检查的一种方法。近年来,国内外许多学者对注水式结肠镜检查法进行了大量的研究。本文从以下几个方面对注水式结肠镜进行综述。     

左半结肠水交换结肠镜检查比较常规注气结肠镜检查的临床效果分析

背景常规注气结肠镜检查最为困难的部分在左半结肠,插镜过程中患者可有明显不适,有研究报道水交换技术可明显减轻内镜检查过程中患者的疼痛和不适感,然而,左半结肠水交换技术与常规注气比较效果如何,目前与之相关的研究尚少.目的比较左半结肠水交换(water exchange, WE)结肠镜与常规注气(air insufflation, AI)结肠镜检查的临床应用效果.方法2020-06/2020-12,至我院消化内镜中心行结肠镜检查的连续患者,符合纳入标准的患者,按照随机数字表以(1:1)进行随机分为左半结肠WE组与常规AI组,记录两组的盲肠插镜成功率,到达盲肠的进镜时间,退镜时间,腺瘤检出率(adenoma detection rate, ADR),疼痛视觉模拟评分(visual analogue scale, VAS),穿孔等检查相关并发症.结果根据纳入与排除标准,共筛选出276例患者,其中左半结肠WE组139例,常规AI组137例,两组盲肠插镜成功率、退镜时间以及腺瘤检出率差异无统计学意义,但左半结肠WE组较常规AI组进镜时间明显缩短(4.6 min vs 5.3 min; P0.05), VAS评分更低(2.7 min vs 3.3 min;P0.05),两组间均无穿孔等检查相关并发症发生.结论左半结肠水交换结肠镜较常规注气结肠镜检查明显缩短进镜时间,减轻患者的疼痛和不适,值得临床选择使用.     

二氧化碳注入联合水交换在肠镜检查中的应用效果分析

目的探究二氧化碳注入联合水交换在肠镜检查中的应用效果。方法选择2018年2至11月新疆军区总医院北京路临床部拟行结肠镜检查的患者190例,随机分为空气组(63例)、水交换组(63例)和联合组(64例)。空气组患者采用常规注气结肠镜检查;水交换组患者采用注水结肠镜检查;联合组患者采用二氧化碳气泵联合注水结肠镜检查。比较三组的结肠镜检查情况、检查后不适症状间的差异。结果水交换组和联合组的退镜时间和麻醉需求率均显著低于空气组,两组的盲插成功率和Boston评分均明显高于空气组(P 0. 05);联合组的退镜时间明显低于水交换组,差异均有统计学意义(P 0. 05)。三组的进镜时间和检出率间均无统计学差异(P0. 05)。水交换组、联合组检查中及检查后1 h的VAS评分和腹胀评分显著低于空气组(P 0. 05)。检查中,联合组的VAS评分低于水交换组(P 0. 05),两组的腹胀评分比较无统计学差异(P 0. 05);检查后1 h,联合组的VAS评分和腹胀评分均显著低于水交换组(P 0. 05)。结论二氧化碳注入联合水交换可明显减少退镜时间和麻醉需求,有效改善清洁度,减轻患者的疼痛和腹胀程度。     

注水结肠镜在消化道疾病治疗中的临床应用

注水结肠镜是诊断结直肠疾病的一种新型的检查方法,与传统的注气结肠镜相比较能够明显降低检查时的腹痛程度,提高检查成功率和结直肠腺瘤检出率。近年来的研究表明,注水结肠镜在下消化道止血、乙状结肠扭转的治疗、肠道病变的内镜下黏膜切除等方面展现了其独特的优势。     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

Pulmonary sporotrichosis in Oklahoma in susceptibilities in vitro

Six cases of pulmonary sporotichosis were observed in 2 institutions in Oklahoma City, Okla. Three of the patients were treated with iodides with or without surgery. Although one patient required a second course of iodides, the patients have remained well after at least 34 months of follow-up. Three patients treated with amphotericin B, single course as well as multiple courses, and other antifungal agents (hydroxystilbamidine and miconazole) have all relapsed. These cases and a reviewed of more than 40 cases of pulmonary sporotrichosis susceptibilities of Sporothrix schenckii that we observed in vitro suggest that amphotericin B is not an effective agent for the treatment of pulmonary sporotrichosis. It is our opinion that the treatment of choice for pulmonary sporotrichosis is a supersaturated solution of potassium iodide. If the patient is allergic to the medication or fails to respond, then a combination of amphotericin B plus flucytosine may be tried.     

Differences in outcome in primary angioplasty in women.

BACKGROUND: In acute myocardial infarction (AMI), primary percutaneous transluminal coronary angioplasty (PTCA) has proved to be the best therapeutic approach. Several factors have been associated with worse outcome in AMI in females. Are there differences in outcome in women undergoing PTCA for AMI? AIM: To evaluate gender influence on clinical outcome and in-hospital mortality in patients with AMI who undergo primary percutaneous interventions. METHODS: We studied 245 consecutive patients (72 women, 29.4 %), who underwent primary PTCA between January 2000 and December 2001. The following parameters were analyzed: risk factors for coronary artery disease including hypertension, diabetes, smoking, hypercholesterolemia and family history, previous AMI, PTCA or angina, pain-to-balloon time, extent of coronary disease and outcome. RESULTS: Female patients were older (67.9+/-11.6 vs. 59.6+/-13; p < 0.001) with a higher prevalence of hypertension (65.3 % vs. 47.4 %; p < 0.05) and angina (29.0 % vs. 16.0 %; p < 0.05) and lower prevalence of smoking (27.8 % vs. 54.3 %; p < 0.001). Pain-to-balloon time was longer in women (6.8+/-4.1 vs. 5.4+/-3.7 hours; p < 0.05). Extent of coronary disease was similar in both groups. Glycoprotein IIb/IIIa inhibitors were used in 84.7 % of women and 90.8 % of men. The frequency of hemorrhagic complications (5.6 % vs. 5.2 %) and arrhythmias (15.3 % vs. 10.4%) and in-hospital mortality (9.7 6.4 %) were higher in females, although without statistical significance (p = NS). Hospitalization time was similar in both groups. CONCLUSIONS: Despite the growing awareness of a gender bias in therapeutic approaches to AMI, there are still some differences in outcome, with a trend towards higher mortality rates in women. Older age and longer pain-to-balloon time could account for this.