应激性溃疡时幽门区局部一氧化氮含量变化对胆汁返流的影响及机理探讨

目的探讨胆汁返流与幽门区局部神经递质一氧化氮的变化对应激性溃疡发病的影响及可能的机理。方法采用冷束缚应激方法复制应激性溃疡的动物模型，将60只成年SD大鼠分为两部分，第1部分：对照组10只，溃疡组30只，用于观测影响应激性溃疡发生的相关因素；第2部分：左旋硝基精氨酸甲酯（L—NAME）预处理组10只（L—NAME组），生理盐水预处理组10只（生理盐水组），用于观测幽门区局部一氧化氮含量变化对其他因素的影响。分别检测各组胃内胆汁酸浓度、胃黏膜溃疡指数（Guth评分）以及胃内pH值，用生化试剂盒检测幽门区一氧化氮的含量。结果溃疡组应激结束后1h幽门区一氧化氮含量达到峰值（P〈0．01），应激结束后2h胃内胆汁酸浓度和pH值均达到峰值（P〈0．01），应激结束后4h胃内溃疡指数达到峰值（P〈0．01）。L-NAME组的胃内胆汁酸浓度、溃疡指数及一氧化氮含量较生理盐水组显著降低（P〈0．01，P〈0．05），而胃内pH值的差异无统计学意义（P〉0．05）。幽门区一氧化氮含量与胆汁酸浓度呈正相关（r=0．715，F=12．55，P=0．017）。结论幽门区一氧化氮含量变化与胆汁的返流量之间存在正相关关系，而L—NAME的幽门区局部干预使幽门区一氧化氮含量减少，幽门松弛程度降低，胆汁返流量也随之减少，进而降低溃疡指数，起到保护胃黏膜的作用。     

Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer

Background and aims The aim of this study is to evaluate the predictive accuracy of different scoring systems on surgery for perforated peptic ulcer referred to an academic department of general surgery in a tertiary reference center. Patients and methods Seventy-five consecutive patients (Male/female ratio = 64:11; mean age, 44 years; range, 16–85) with perforated peptic ulcer disease were investigated. Disease severity scores and mortality predictions were calculated using the collected data during admission. Discrimination and calibration characteristics of each system, namely, the acute physiology and chronic health evaluation II and III, the simplified acute physiology score II, and the mortality probability models (MPM) II, were determined by using the area under receiver operating characteristics curve and the Hosmer–Lemeshow goodness-of-fit test, respectively. Results Among the 75 patients included, there were eight (10.6%) mortalities. All systems had a reliable power of discrimination and calibration. Among the systems tested, MPM II was the best performing as far as discrimination and calibration characteristics were considered. The parameters of MPM II system that were related to systemic perfusion of the patient were significantly positive in patients who died compared to those who survived. Conclusions MPM II that predicted mortality at admission is better than the other systems in predicting mortality. Results also indicate the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation.     

龙血竭散在肛瘘术后的临床应用

目的：探讨龙血竭散在肛瘘术后促进创面愈合的疗效和机理。方法：选用50例肛瘘手术病人，分为治疗组（用龙血竭散）和对照组（用雷夫奴尔纱条）各25例，分别观察术后创面换药疼痛和愈合时间。结果：治疗组在减轻创面疼痛，促进肉芽组织生长，加速创面愈合等方面明显优于对照组（P〈0．01）。结论：龙血竭散可明显缩短创面愈合时间，且无瘢痕过度生长，具有临床应用价值。     

板蓝根磷脂对内毒素血症小鼠巨噬细胞膜脂流动性的影响

目的　以小鼠内毒素血症为模型 ,观察板蓝根磷脂对内毒素血症小鼠巨噬细胞膜脂流动性的保护作用。方法　小鼠分为板蓝根氯仿提取物预处理组、磷脂脂质体预处理组、板蓝根磷脂脂质体预处理组和内毒素血症对照组。各组按照上述次序分别给予腹腔注射 5ml/kg相应药物 ,预处理 18h后腹腔注射内毒素 6mg/kg。 6h后处死小鼠 ,观察细胞膜脂流动性的变化。结果　板蓝根氯仿提取物对内毒素血症小鼠巨噬细胞膜脂流动性的保护作用没有达到具有统计学意义的程度 (P >0 .0 5 ) ,磷脂脂质体对膜脂流动性具有保护作用 (P <0 .0 5 ) ,但两者之间并没有统计学上的差别 (P >0 .0 5 ) ;板蓝根磷脂对内毒素血症小鼠细胞膜脂流动性具有明显的保护作用 (P <0 .0 1) ,优于单独使用板蓝根氯仿提取物 (P <0 .0 5 )或磷脂脂质体 (P =0 .0 5 )。结论　板蓝根磷脂脂质体对内毒素血症小鼠巨噬细胞膜脂流动性的保护作用优于单独使用板蓝根氯仿提取物或磷脂脂质体     

附子理中丸方药的药物动力学研究

附子理中丸是中医治疗脾胃虚寒、脘腹冷痛、呕吐泄泻、手足不温的常用成药。本文通过小白鼠急性死亡实验,测得ip LD_(50)=42.4870g/kg;运用药物累积法对该复方方药进行了药物动力学研究。结果表明:附子理中丸在小鼠体内按一级动力学消除,呈二房室开放式模型分布。测得其t_(1/2)α=0.1922h,t_(1/2)β=11.2888h等动力学参数。阐明了该药的体内动态过程,为评价该药的内在质量及临床安全合理应用提供了参考依据。     

十二指肠溃疡生活事件及社会支持的对照研究

目的 探讨十二指肠溃疡与生活事件及社会支持的关系。方法 采用生活事件量表（LES），社会支持评定量表（SSRS）对十二指肠溃疡患者（58例）与健康对照（67例）进行问卷测试与评价分析。结果 十二指肠溃疡患者在生活事件里正性刺激量，负性刺激量和总刺激量都明显高于健康对照组，十二指肠溃疡患者受到的主观支持比一般人群多；而客观支持比一般人群少，但十二指肠溃疡患者受到的总支持量并不比一般人多，而且，十二指肠溃疡患者对支持的利用度也不比一般人高。结论 十二指肠溃疡患者有明显的生活事件和不足的社会支持，对生活事件的刺激尤为敏感。     

A nonspecific colonic ulcer occurring after hepatectomy: Report of a Case

We herein report the case of a 53-year-old man with a nonspecific acute colonic ulcer whose liver function deteriorated after he had undergone hepatectomy. He was referred to our hospital for a hepatoma caused by hepatitis B virus and a right hemihepatectomy was performed. His liver function was poor after the operation, and minor complications such as pleural effusion and biliary fistula developed. A large amount of melena was seen 29 days after the hepatectomy and he developed hemorrhagic shock. Superior mesenteric arteriography revealed pooling of blood in both the hepatic flexure of the ascending colon and the cecum. An emergency right hemicolectomy was performed. There was a 5 x 1-mm ulcer 18 cm distal to the ileocecal valve. Numerous erosions were observed to be scattered throughout the colonic mucosa. The patient recovered slowly and was discharged 6 months after the hepatectomy. This is the first report of an acute colonic ulcer that could have been caused by liver dysfunction.     

豆番粉与玉米粉对人体血糖胰岛素胰升血糖素的影响

目的探讨豆番粉和玉米粉对人体餐后血糖、胰岛素、胰升血糖素的影响。方法选择Ⅱ型糖尿病人、肥胖人、健康人，ｄ１均进食面粉，ｄ２随机进食豆番粉或玉米粉，测量２ｄ的空腹血糖及餐后３０、６０、１２０、１８０ｍｉｎ各５个时点的血糖、胰岛素、胰升血糖素值。结果糖尿病人进食豆番粉后６０、１２０、１８０ｍｉｎ的血糖值低于进食面粉，Ｐ分别＜０．０１、０．０１、０．０５；进食玉米粉后１２０、１８０ｍｉｎ血糖值低于面粉，Ｐ＜０．０５。２种实验食物的血糖增值面积均低于面粉，Ｐ＜０．０５；进食豆番粉后各时点胰岛素值、胰升血糖素值明显低于进食面粉，Ｐ＜０．０５或＜０．０１；进食玉米粉后同时点胰岛素值与面粉相比无显著性差异，胰升糖素值３０、１２０ｍｉｎ有显著性差异。肥胖人进食豆番粉后血糖值与面粉相比无显著性差异，但胰岛素值、胰升血糖素值有明显下降，各时点值Ｐ均＜０．０５。结论①豆番粉血糖指数低，可控制餐后高血糖状态，不增加胰岛素、胰升血糖素分泌，可减轻胰岛素抵抗。②玉米粉血糖曲线增值面积、低于面粉，可作为糖尿病人选择的食品，对改善胰岛素抵抗也有较好的作用。     

Comparison of acid reduction in antiulcer operations

Background: Three acid-reducing operations have recently been described for the laparoscopic treatment of peptic ulcer disease. These consist of a posterior truncal vagotomy combined with either (1) an anterior seromyotomy (SERO), (2) an anterior highly selective vagotomy (AHSV), or (3) a linear stapled lesser curvature excision (STAP). The purpose of this study was to investigate the physiologic effects of these procedures in terms of basal and maximal acid outputs. Methods: Fifty New Zealand rabbits were prospectively randomized into five open laparotomy groups (n= 10): a control group without vagal manipulation (CON), a bilateral truncal vagotomy with pyloromyotomy group (VP), a SERO group, an AHSV group, and a STAP group. All animals underwent placement of a gastrostomy tube for subsequent gastric secretory analysis. On postoperative day 6, basal acid outputs (BAO) and maximal acid outputs (MAO) following IV pentagastrin stimulation (30 μg/kg/h) were measured. Results were compared statistically using the ANOVA method. Results: Pentagastrin stimulation was associated with a significant increase in MAO in the CON group (p < 0.05 vs BAO); however, this response was effectively blunted in all the experimental groups. There were no differences in BAO or MAO between any of the vagotomized groups (SERO, HSV, STAP, VP). Conclusions: We conclude that the three acid-reducing procedures modified for laparoscopy are equally efficacious in reducing gastric acid secretion and that they compare favorably with VP. To our knowledge, this is the first report comparing basal and stimulated gastric acid secretion between these new acid-reducing techniques. Received: 27 March 1996/Accepted: 17 July 1996