胃癌术后胃肠道排空障碍临床分析

目的 探讨胃癌手术后胃肠道排空障碍 (GED)病人的临床特点、发病机制和治疗效果。方法 回顾性分析了 3 2 4例胃癌手术病人中 ,2 7例GED病人的临床资料。结果 本组GED的发生率为8.0 %。可能的高危因素包括 ,合并脏器切除、手术时间延长、出血量多以及合并糖尿病史等。结论 手术后GED发病原因不明 ,目前尚无明确有效的治疗方法 ,多数患者手术后 6个月内可自行缓解。

腹部按摩联合枯草杆菌二联活菌对重型创伤性脑损伤病人胃肠道排空作用的分析

目的:研究腹部按摩联合枯草杆菌二联活菌对重型创伤性脑损伤(sTBI)患者胃肠道排空功能的影响。方法:采用随机数字表法,将纳入的sTBI患者分为实验组(腹部按摩联合枯草杆菌二联活菌)与对照组(仅腹部按摩)。收集患者的基线资料及胃肠道排空相关指标,干预两周后运用光冈法计数两组患者新鲜大便中的肠道菌群数,并比较两组间的差异。结果:共112例患者完成了研究,其中实验组55例,对照组57例。两组基线资料比较,差异无统计学意义(P>0.05)。和对照组比较,实验组首次排便时间短、排便量多及便秘、腹泻、呕吐发生率低,差异均具有统计学意义(均P<0.05)。和对照组比较,实验组双歧杆菌(7.41±1.12 vs. 6.36±0.87)及乳酸杆菌(6.48±0.74 vs. 5.23±0.61)明显增多,而大肠杆菌(7.63±0.74 vs. 8.84±1.20)及葡萄球菌(2.41±0.36 vs. 3.20±0.39)减少,差异均有统计学意义(均P<0.001)。结论:腹部按摩联合枯草杆菌二联活菌是调节sTBI患者肠道微生态和促进胃肠道排空的有效方案。

雷贝拉唑联合双歧杆菌四联活菌片治疗老年功能性消化不良效果观察

目的 观察雷贝拉唑联合双歧杆菌四联活菌片治疗老年功能性消化不良(FD)的效果。方法 选择该院2020年2月至2023年1月收治的老年FD患者122例,随机分为A组与B组各61例。两组均予雷贝拉唑钠肠溶片治疗,B组联合双歧杆菌四联活菌片治疗,比较两组治疗前后症状评分(餐后饱胀、上腹痛、嗳气)、胃肠道排空率(胃排空率、肠排空率)、胃功能指标(胃泌素-17、胃泌素、胃动素)及疗效。结果 B组总有效率(95.1%,58/61)高于A组(78.7%,49/61),治疗后餐后饱胀、上腹痛、嗳气评分明显低于A组,胃排空率、肠排空率及胃泌素-17、胃泌素、胃动素水平高于A组,差异均有统计学意义(P <0.05)。结论 雷贝拉唑联合双歧杆菌四联活菌片治疗老年FD的效果优于单用雷贝拉唑,可有效减轻患者临床症状,提高胃肠道排空率,改善胃功能指标。

国内177例肠系膜上动脉血栓疾病诊治特点分析

目的总结肠系膜上动脉血栓疾病的临床特点及治疗概况。方法通过检索2000年1月至2006年12月万方数据资源系统中文数字化核心期刊群关于肠系膜上动脉血栓疾病的论文及案例报道进行总结分析。结果177例肠系膜上动脉血栓疾病中动脉栓塞和动脉血栓形成两者比例为6.70:1;男女比例为5.32:1。心脏疾病、心律失常和下肢动静脉血管病变是引起肠系膜上动脉血栓疾病的常见疾病诱发因素。肠系膜上动脉造影的确诊率为75.44%,明显高于彩色多普勒超声(36.56%)和腹部CT检查(41.38%)。有记录误诊率为35.59%,总病死率为52.54%。结论肠系膜上动脉血栓疾病预后较差,临床医师应提高对该病的认识,对合并各种心脏疾病和心律失常的高龄患者,出现腹痛严重程度与腹部体征不成比例及异常胃肠道排空症状的应考虑此病发生的可能。综合运用多种辅助检查以提高早期诊断,采取及时合理的治疗手段是改善肠系膜上动脉血栓疾病预后的有效手段。

Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume （GRV） measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and en/thromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.

Ghrelin improves delayed gastrointestinal transit in alloxan-induced diabetic mice

AIM: To investigate the effects of ghrelin on delayed gastrointestinal transit in alloxan-induced diabetic mice. METHODS: A diabetic mouse model was established by intraperitoneal injection with alloxan. Mice were randomized into two main groups: normal mice group and diabetic mice group treated with ghrelin at doses of 0, 20, 50, 100 and 200 μg/kg ip. Gastric emptying (GE), intestinal transit (IT), and colonic transit (CT) were studied in mice after they had a phenol red meal following injection of ghrelin. Based on the most effective ghrelin dosage, atropine was given at 1 mg/kg 15 min before the ghrelin injection for each measurement. The mice in each group were sacrificed 20 min later and their stomachs, intestines, and colons were harvested immediately. The amount of phenol red was measured. Percentages of GE, IT, and CT were calculated. RESULTS: Percentages of GE, IT, and CT were significantly decreased in diabetic mice as compared to control mice (22.9 ± 1.4 vs 28.1 ± 1.3, 33.5 ± 1.2 vs 43.2 ± 1.9, 29.5 ± 1.9 vs 36.3 ± 1.6, P < 0.05). In the diabetic mice, ghrelin improved both GE and IT, but not CT. The most effective dose of ghrelin was 100 μg/kg and atropine blocked the prokinetic effects of ghrelin on GE and IT.CONCLUSION: Ghrelin accelerates delayed GE and IT but has no effect on CT in diabetic mice. Ghrelin may exert its prokinetic effects via the cholinergic pathway in the enteric nervous system, and therefore has therapeutic potential for diabetic patients with delayed upper gastrointestinal transit.