Effects of Xiangsha Liujunzi decoction drug serum on gastric antrum smooth muscle cells from rats with functional dyspepsia by regulating gastrointestinal hormones

Objective:To observe the effect and mechanism of Xiangsha Liujunzi decoction(XSLJZD)drug serum on gastric antrum smooth muscle cells(SMCs)in rats with functional dyspepsia(FD).Methods:Gastric antrum SMCs from rats with FD were isolated,cultured,and then divided into six groups as follows:control,model,domperidone,low-dose XSLJZD(LXSLJZD),medium-dose XSLJZD(MXSLJZD),and high-dose XSLJZD(HXSLJZD).Each group was administered the corresponding drug serum for intervention.Drug serum intervention conditions and proliferative activity of SMCs were tested by cholecystokinin octapeptide.Ghrelin,gastrin,somatostatin,and substance P(SP)levels were measured by ELISA.Somatostatin and SP mRNA expression was measured by real-time PCR.Results:A concentration of 10%drug serum for 24 h was decided to be the best intervention condition for later study.The mean optical density value in the model group was lower than that in the control group(P紏.001).Optical density values in the domperidone and HXSLJZD groups were higher than those in the model group(P?.025,P?.032,respectively).Gastrin,SP,and ghrelin levels in the model group were lower(P?.007,P?.037,P?.005,respectively),but somatostatin levels were higher,compared with those in the control group(P?.031).Gastrin,SP,and ghrelin levels in the domperidone,MXSLJZD,and HXSLJZD groups were higher than those in the model group(all P<.05).Somatostatin levels in the four drug-treated groups were lower than those in the model group(P?.002,P?.007,P?.001,P?.009,respectively).SP mRNA levels in the model group were lower than those in the control,domperidone,MXSLJZD,and HXSLJZD groups(P?.037 P?.016,P?.025,P?.002,respectively).Somatostatin mRNA levels in the model group were higher than those in the control and MXSLJZD groups(P紏.042,P紏.035).Conclusions:XSLJZD and domperidone drug serum effectively promote proliferative activity of gastric antrum SMCs in an FD model.The mechanism of this activity may be regulated by gastrointestinal hormones.

Xiangbinfang granules enhance gastric antrum motility via intramuscular interstitial cells of Cajal in mice

BACKGROUND Interdigestive migrating motor complexes(MMC)produce periodic contractions in the gastrointestinal tract,but the exact mechanism of action still remains unclear.Intramuscular interstitial cells of Cajal(ICC-IM)participate in gastrointestinal hormone and neuromodulation,but the correlation between ICCIM and MMC is also unclear.We found that xiangbinfang granules(XBF)mediated the phase III contraction of MMC.Here,the effects of XBF on gastric antrum motility in W/Wv mice and the effects of ICC-IM on gastric antrum MMC are reported.AIM To observe the effects of ICC-IM on gastric antrum motility and to establish the mechanism of XBF in promoting gastric antrum motility.METHODS The density of c-kit-positive ICC myenteric plexus(ICC-MP)and ICC-IM in the antral muscularis of W/Wv and wild-type(WT)mice was examined by confocal microscopy.The effects of XBF on gastric antrum slow waves in W/Wv and WT mice were recorded by intracellular amplification recording.Micro-strain-gauge force transducers were implanted into the gastric antrum to monitor the MMC and the effect of XBF on gastric antrum motility in conscious W/Wv and WT mice.RESULTS In the gastric antrum of W/Wv mice,c-kit immunoreactivity was significantly reduced,and no ICC-IM network was observed.Spontaneous rhythmic slow waves also appeared in the antrum of W/Wv mice,but the amplitude of the antrum slow wave decreased significantly in W/Wv mice(22.62±2.23 mV vs 2.92±0.52 mV,P<0.0001).MMCs were found in 7 of the 8 WT mice but no complete MMC cycle was found in W/Wv mice.The contractile frequency and amplitude index of the gastric antrum were significantly increased in conscious WT compared to W/Wv mice(frequency,3.53±0.18 cpm vs 1.28±0.12 cpm;amplitude index,23014.26±1798.65 mV·20 min vs 3782.16±407.13 mV·20 min;P<0.0001).XBF depolarized smooth muscle cells of the gastric antrum in WT and W/Wv mice in a dose-dependent manner.Similarly,the gastric antrum motility in WT mice was significantly increased after treatment with XBF 5 mg(P<0.05).Atropine(0.1 mg/kg)blocked the enhancement of XBF in WT and W/Wv mice completely,while tetrodotoxin(0.05 mg/kg)partially inhibited the enhancement by XBF.CONCLUSION ICC-IM participates in the regulation of gastric antrum MMC in mice.XBF induces MMC III-like contractions that enhance gastric antrum motility via ICCIM in mice.

Effects of erythromycin on pressure in pyloric antrum and plasma motilin and somatostatin content in dogs

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Complete resection of the gastric antrum decreased incidence and severity of delayed gastric emptying after pancreaticoduodenectomy

Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still unclear.The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD.Methods:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric antrum.The tension(g)of remnant stomach contraction was observed.We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy.Moreover,patients underwent PD at our department between January 2012 and May 2016 were included in the study.These cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively analyzed.Results:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(P<0.05).The contraction tension of the remnant stomach increased with increasing acetylcholine concentration,while remained stable at the concentration of 10×10^(-5 )mol/L.Furthermore,174 consecutive patients were included and retrospectively analyzed in the study.The incidence of DGE was significantly lower(3.5%vs.21.3%,P<0.01)in CR group than in IR group.In addition,hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,P<0.05).Conclusions:The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD.Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.

Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success

BACKGROUND Helicobacter pylori(H.pylori)causes chronic gastritis,peptic ulcer disease,gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma.Eradication rates have fallen,mainly due to antimicrobial resistance.Consensus guidelines recommend that first-line treatment is based on the local prevalence of antimicrobial resistance and that rescue therapies are guided by antimicrobial susceptibility testing(AST).However,H.pylori culture is challenging and culture-based AST is not routinely performed in the majority of hospitals.Optimisation of H.pylori culture from clinical specimens will enable more widespread AST to determine the most appropriate antimicrobials for H.pylori eradication.AIM To determine whether dual antrum and corpus biopsy sampling is superior to single antrum biopsy sampling for H.pylori culture.METHODS The study received ethical approval from the joint research ethics committee of Tallaght University Hospital and St.James’s Hospital.Patients referred for upper gastrointestinal endoscopy were invited to participate.Biopsies were collected in tubes containing Dent’s transport medium and patient demographics were recorded.Biopsies were used to inoculate Colombia blood agar plates.Plates were incubated under microaerobic conditions and evaluated for the presence of H.pylori.Statistical analyses were performed using Graphpad PRISM.Continuous variables were compared using the two-tailed independent t-test.Categorical variables were compared using the two-tailed Fisher exact test.In all cases,a P value less than 0.05 was considered significant.RESULTS In all,samples from 219 H.pylori-infected patients were analysed in the study.The mean age of recruited patients was 48±14.9 years and 50.7%(n=111)were male.The most common endoscopic finding was gastritis(58.9%;n=129).Gastric ulcer was diagnosed in 4.6%(n=10)of patients,while duodenal ulcer was diagnosed in 2.7%(n=6).Single antrum biopsies were collected from 73 patients,whereas combined antrum and corpus biopsies were collected from 146 patients.There was no significant difference in age,sex or endoscopic findings between the two groups.H.pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsies were used compared to a single antrum biopsy[64.4%(n=94/146)vs 49.3%(36/73);P=0.04)].CONCLUSION Combined corpus and antrum biopsy sampling improves H.pylori culture success compared to single antrum biopsy sampling.

Chronic Stress Induced Proliferation and Activation of Mast Cells of Gastric Antrum in Rats

To explore chronic eration and activation of mast heterotypic stressors induced prolifcells in gastric antrum mucosa by ultrastructure alterations of mast cells, chronic unpredictable heterotypic stressors were used as a study model. The mean immunofluorescence magnitude of mast cell protease 1 （MCP-1） taken from chronic stress rats were 37.4±7.7, significantly higher （p〈0.05） than the value of normal control group （24.8±5.6）. Chronic unpredictable haterotypic stressors appeared also to induce ultrastructure alterations of mast cells. It indicated that mast cells were proliferated and activated, while mast cell granules were hyperplasiaed. Most granules had obvious intragranular changes with loss of electron-dense material. The morphologic evidence showed that macrophages and leukocytes infiltrated in chronic stress rats. Some granules of leukocytes adhered to the surface of mast cell, and formed a bridge. Macrophages phagocytized the mast cell granules.

Effects of extract F of red-rooted Salvia on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock-reperfusion in rats

AIM To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats.``METHODS The rats were subject to hemorrhagic shock and followed by reperfusion, and were divided randomly into two groups. Group 1 received saline, and group 2received EFRRS intravenously. The index of gastric mucosal lesions (IGML) was expressed as the percentage of lesional area in the corpus or antrum. The degree of gastric mucosal lesions (DGML) was catalogued grade 0,1. 2 and 3. The concentrations of prostaglandins (lags)were measured by radioimmunoassay. The concentration of MDA was measured according to the procedures of Asakawa. The activity of SOD was measured by the biochemical way. The growth rates or inhibitory rates of above-mentioned parametes were calculated.``RESULTS As compared with IGML (%), grade 3 damage (%) and MDA content (nmol/g tissue) of gastric antrum which were respectively 7.96 ± 0.59, 34.86± 4.96 and 156.98± 16.12. those of gastric corpus which were respectively 23.18 ± 6.82, 58.44 ± 9.07 and 230.56 ± 19.37increased markedly (P<0.01), whereas the grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2(pg/ mg tissue), the ratio of PGI2/ TXA2 and the activity of SOD (U/ g tissue) of corpus which were respectively 3.01 _- 1.01, 8.35 + 1.95, 540.48 _+ 182.78,714.38 ± 123.74, 17.38 ± 5.93 and 134.29 ± 13.35 were markedly lower than those of antrum which were respectively 13.92 ± 2.25, 26.78 ± 6.06, 2218.56 ± 433.12,2531.76 ± 492.35, 43.46 ± 8.51 and 187.45 ± 17.67( P<0.01 ) after hemorrhagic shock and reperfusion. After intravenous EFRRS, the growth rates (%) of grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2, the ratio of PGI2/TXA2 and the activity of SOD of corpus which were respectively 632.56, 308.62, 40.75,74.75, 92.29 and 122.25 were higher than those in antrum which were respectively 104,89, 58.40, 11.12, 56.58,30.65 and 82.64, whereas the inhibitory rates (%) ofIGML, grade 3 damage and MDA content of gastric corpus were 82.93, 65.32 and 59.09, being higher than those of gastric antrum which were 76.64, 53.18 and 42.37.``CONCLUSION After hemorrhagic shock-reperfusion, the gastric mucosal lesions in the corpus were more severe than those in the antrum, which were related not only to the different distribution of endogenous PGs in the mucosa, but also to the different ability of anti-oxidation of the mucosa. The protective effect of EFRRS on the gastric mucosa in the corpus was more evident than that in the antrum, which was related to higher growth degree of PGs contents and anti-oxitative ability in gastric corpus after administration of EFRRS.

Effects of fluoxetine on mast cell morphology and protease-1 expression in gastric antrum in a rat model of depression

AIM: To investigate the effects of fluoxetine on depression-induced changes of mast cell morphology and protease-1 (rMCP-1) expression in rats. METHODS: A Sprague-Dawley rat model of chronic stress-induced depression was established. Fifty experimental rats were randomly divided into the following groups: normal control group, fluoxetine + normal control group, depressed model group, saline + depressed model group, and fluoxetine + depressed model group. Laser scanning confocal microscopy (LSCM) immunofluorecence and RT-PCR techniques were used to investigate rMCP-1 expression in gastric antrum. Mast cell morphology was observed under transmission electron microscopy. ANOVA was used for statistical analysis among groups.RESULTS: Morphologic observation indicated that depression induced mast cell proliferation, activation, and granule hyperplasia. Compared with the normal control group, the average immunofluorescence intensity of gastric antrum rMCP-1 significantly increased in depressed model group (37.4 ± 7.7 vs 24.5 ± 5.6, P < 0.01) or saline + depressed model group (39.9 ± 5.0 vs 24.5 ± 5.6, P < 0.01), while there was no significant difference between fluoxetine + normal control group (23.1 ± 3.4) or fluoxetine + depressed model group (26.1 ± 3.6) and normal control group.The average level of rMCP-1mRNA of gastric antrum significantly increased in depressed model group (0.759 ± 0.357 vs 0.476 ± 0.029, P < 0.01) or saline + depressed model group (0.781 ± 0.451 vs 0.476 ± 0.029, P < 0.01 ), while no significant difference was found between fluoxetine + normal control group (0.460 ± 0.027) or fluoxetine + depressed model group (0.488 ± 0.030) and normal control group. Fluoxetine showed partial inhibitive effects on mast cell ultrastructural alterations and de-regulated rMCP-1 expression in gastric antrum of the depressed rat model.CONCLUSION: Chronic stress can induce mast cell proliferation, activation, and granule hyperplasia in gastric antrum. Fluoxetine counteracts such changes in the depressed rat model.

胃窦部幽门螺杆菌活检检测情况的临床分析

目的分析胃窦部不同部位幽门螺杆菌(Hp)检测情况,为寻找Hp最佳活检部位提供临床指导依据。方法回顾性分析2020年1月-2022年12月承德市中心医院行13C尿素呼气试验并行电子胃镜检查,于胃窦部位取活检的患者的临床资料,按超基准值(DOB)分为:13C尿素呼气试验阳性组(DOB≥4)和13C尿素呼气试验阴性组(DOB<4),收集患者的胃镜报告和病理资料。根据患者胃窦部不同活检部位,分为:常规活检部位组、隆起糜烂部位组和平坦糜烂部位组,比较不同活检部位Hp的检出率。将13C尿素呼气试验阳性组按DOB值的情况,分为:A组(4<DOB≤16)、B组(16<DOB≤35)和C组(DOB>35),并分类统计每组患者胃窦部活检及病理情况。结合患者内镜报告和病理资料,分为:萎缩性胃炎组和非萎缩性胃炎组,分类统计胃窦部活检及病理情况。结果13C尿素呼气试验阳性组中,隆起糜烂部位组Hp检出率(96.4%)高于常规活检部位组(92.7%)和平坦糜烂部位组(93.9%),差异有统计学意义(P=0.036);DOB值方面,A组中,隆起糜烂部位组Hp检出率最高,常规活检部位组Hp检出率最低,3个活检部位Hp检出率比较,差异有统计学意义(P=0.016);B组和C组3个活检部位Hp检出率比较,差异均无统计学意义(P=0.622;P=0.721);非萎缩性胃炎组中,隆起糜烂部位组Hp检出率(96.5%)高于常规活检部位组(91.2%)和平坦糜烂部位组(92.0%),3个活检部位组Hp检出率比较,差异有统计学意义(P=0.043);萎缩性胃炎组中,3个活检部位组Hp检出率比较,差异无统计学意义(P=0.614)。13C尿素呼气试验阴性组中,3个活检部位Hp检出率比较,差异无统计学意义(P=0.255)。结论对于13C尿素呼气试验阳性但DOB值较低的患者,隆起糜烂部位Hp的阳性率更高。对于非萎缩性胃炎患者而言,与常规活检部位相比,隆起糜烂部位Hp的检出率更高;但对于萎缩性胃炎患者而言,胃窦部不同部位的Hp检出率差异不大。对于13C尿素呼气试验阴性患者而言,3个活检部位Hp检出率无明显差异。临床工作中,对于类似的患者,可以精准活检,以提高Hp的检出率。

Pulmonary vein antrum isolation of pre-excited atrial fibrillation

Background Pulmonary vein antrum isolation （PVAI） of pre-excited atrial fibrillation （AF） is controversial. This study aimed to observe the therapeutic effects of PVAI on pre-excited AF. Methods Twenty-nine patients with pre-excited AF were prospectively divided into a PVAI group （group I, 19 cases） and a control group （group II, 10 cases）. To each case in group I, PVAI was performed, and then electroanatomical mapping of accessory pathways （AP） and ablation were constructed on a three-dimensional （3D） map of the valve annulus. Only AP ablation was performed in each case of group II. Results Of the 29 cases, three were found to have dual APs, two had intermittent APs, and the remaining 24 had single APs. All APs were successfully ablated after the procedure. There were no significant statistical differences in the AP procedure duration （（77.4±21.3） minutes vs. （85.3±13.1） minutes）, the AP ablation time （（204±34） seconds vs. （223±62） seconds） and the AP X-ray exposure time （（18.6±4.4） minutes vs. （19.1±4.5） minutes） respectively between groups I and II. As compared with the control group （5 of 10 cases, 50%）, the PVAI group had a significantly lower AF recurrence rate （2 of 19 cases, 11%; P 〈0.05） during follow-up of （20.5±10.0） months. All seven patients who recurred were successfully abolished by a second ablation. Conclusions In patients with pre-excited AF, PVAI is an effective therapeutic approach with a low AF recurrence rate. 3D electroanatomical maps of AP contributed to the high success rate of ablation without significantly prolonging of operational duration and X-ray exposure time.

胃窦超声、AGIUS评分联合注射器回抽法指导老年重症病人肠内营养的疗效研究

目的:探究胃窦超声、胃肠损伤超声(AGIUS)检查评分联合注射器回抽法指导老年重症病人肠内营养(EN)的疗效。方法:随机选取于2022年7月1日至2023年7月1日入住大连市友谊医院重症医学科的老年病人为样本,随机分为实验组及对照组各30例病人,实验组通过每日两次床旁胃窦超声、AGIUS检查评分及每日两次注射器回抽法来指导EN喂养,对照组通过日四次注射器回抽法来指导EN喂养。比较两组鼻饲开始时间和鼻饲7、10、14日达到目标热量情况,鼻饲期间EN并发症发生情况、营养指标改善情况、淋巴细胞总数的差异,比较两组住院天数及28d死亡率的差异。结果:实验组开始鼻饲时间(1.47±0.82)d早于对照组(2.00±0.64)d,具有统计学差异(P<0.05)。实验组EN时的腹泻、腹胀及中断营养发生例数低于对照组(P<0.05),具有统计学差异,但两组误吸例数无明显差异(P>0.05)。鼻饲7、10、14达到目标热量例数实验组均高于对照组,具有统计学差异(P<0.05)。实验组病人在实验10日后检测前白蛋白、白蛋白及转铁蛋白含量均高于对照组,具有统计学差异(均P<0.05)。但两组淋巴细胞总数、住院天数及28d死亡率无统计学差异(P>0.05)。结论:胃窦超声、AGIUS检查评分联合注射器回抽法可使EN开始时间提前,更快达到目标热量,并减少EN并发症发生。

床旁胃窦超声评估门诊无痛消化内镜诊疗患者胃内容物的应用价值研究

目的研究床旁胃窦超声用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险的应用价值。方法选择2021年11月至2022年3月在桂林医学院第二附属医院择期行无痛消化内镜诊疗患者616例,在无痛消化内镜检查前10 min行床旁胃窦超声检查。观察并记录胃内容物性质、Perlas胃窦分级、右侧卧位胃窦横截面积(RLD CSA)、预测胃容积等超声检查结果及麻醉方案改变情况,记录胃镜实际胃容积及胃镜发现饱胃情况。通过Pearson相关分析评估RLD CSA、预测胃容积与实际胃容积的相关性,通过受试者工作特征(ROC)曲线分析评估RLD CSA对饱胃的预测价值。结果19例患者未获得典型胃窦超声图像,最终597例患者纳入统计分析。所有患者超声检查时间为(2.9±0.9)min;超声诊断饱胃患者42例(7.0%)。超声诊断饱胃患者均改变麻醉方案,其中4例患者延期,38例患者行普通胃镜检查。胃镜下发现实际饱胃患者31例,其中液体28例,固体3例。所有患者未发生反流误吸。Pearson相关分析显示,RLD CSA、预测胃容积与实际胃容积呈正相关(P<0.05)。ROC曲线分析结果显示,RLD CSA具有预测饱胃的应用价值[AUC(95%CI)=0.926(0.864~0.987),P<0.001],最佳截断值为7.87 cm^(2),对应的灵敏度和特异度分别为96.4%、78.6%。结论床旁胃窦超声可用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险,可行性强、准确性高,具有良好的临床应用价值。

胃窦横截面积指导老年重症患者肠内营养治疗的临床价值

目的探讨应用胃窦横截面积指导老年重症患者肠内营养治疗的临床价值。方法选取2020年1月至2022年12月在兰州市第一人民医院重症医学科住院的236例老年(年龄≥65岁)重症患者作为研究对象,根据住院先后顺序设置研究对象序号,采用奇偶数方法进行分组,以奇数作为超声组(118例),以偶数作为常规组(118例)。超声组通过胃窦横截面积来指导肠内营养支持治疗,当胃窦横截面积≥709.2 mm2时,停止肠内营养4 h,再进行胃窦横截面积测量,若<709.2 mm2,再进行肠内营养。常规组通过胃残余量来指导肠内营养支持治疗,当胃残量≥200 ml时,停止肠内营养4 h,再进行胃残量测定,若明显减少,再进行肠内营养。比较两组患者的血清白蛋白、肠内营养量、肠内营养达标时间、住ICU时间、住院总费用、死亡率,并比较两组患者在治疗过程中发生喂养中断率、返流、误吸、腹泻、肝功能不全、消化道出血、肠梗阻的发生率。结果两组患者治疗前的血清白蛋白、肠内营养量比较,差异无统计学意义(P>0.05)。两组患者治疗第7天的血清白蛋白高于本组第5天,第5天的血清白蛋白高于本组第3天,第3天的血清白蛋白高于本组第1天,差异有统计学意义(P<0.05);超声组治疗第1、3、5、7天的血清白蛋白高于常规组,差异有统计学意义(P<0.05)。两组患者治疗第7天的肠内营养量高于本组第5天,第5天的肠内营养量高于第3天,第3天的肠内营养量高于第2天,第2天的肠内营养量高于第1天,差异有统计学意义(P<0.05);超声组治疗第1、2、3、5、7天的肠内营养量高于常规组,差异有统计学意义(P<0.05)。超声组的喂养中断率、肠梗阻发生率、病死率、住院总费用低于常规组,肠内营养量达标时间短于常规组,差异有统计学意义(P<0.05)。两组患者反流、误吸、腹泻、肝功能不全、消化道出血的发生率比较,差异无统计学意义(P>0.05);超声组的并发症总发生率低于常规组,差异有统计学意义(P<0.05)。结论通过胃窦横截面积指导老年重症患者肠内营养支持治疗具有重要的临床价值,可更快达到喂养目标,更早改善低蛋白血症,减少喂养中断率,减少各种并发症的发生,减少住院总费用及病死率,为老年重症患者肠内营养支持治疗提供一定的临床理论依据。

胃窦区超声测定在急腹症腹腔镜手术麻醉中的临床应用

目的:分析胃窦区超声测定在急腹症腹腔镜手术麻醉中的临床应用效果。方法:回顾性分析2022年8月—2023年8月广州市花都区第二人民医院120例急腹症腹腔镜手术麻醉患者的临床资料。根据检测方法不同分为两组,各60例。A组常规禁食禁饮,行急诊腹腔镜手术麻醉。B组同时采用胃窦区超声测定。采用超声测量胃窦横截面(CSA)指导是否采取干预措施,并根据Perlas半定量的3级分级得到3种测量结果将B组分为空胃组、中间胃内容物组、饱胃组。比较两组呕吐发生情况,以及B组中不同患者处理率、延迟手术率、呕吐发生情况。结果:两组麻醉诱导时呕吐发生率比较,差异无统计学意义(P>0.05);B组麻醉苏醒过程、术后2 h呕吐发生率及总发生率比A组低,差异有统计学意义(P<0.05)。空胃组饱胃患者处理率、术后2 h呕吐率低于中间胃内容物组,差异有统计学意义(P<0.05)。空胃组饱胃患者处理率、延迟手术率、术后2 h呕吐发生率低于饱胃组,差异有统计学意义(P<0.05)。结论:采用胃窦区超声测定可减少急腹症腹腔镜手术麻醉患者的呕吐发生率,降低反流误吸风险,提高麻醉的安全性和可控性。

肺静脉前庭扩大冷冻消融治疗阵发性心房颤动早期疗效分析

目的:探索肺静脉前庭扩大冷冻消融治疗阵发性心房颤动(房颤)的早期疗效及安全性。方法:回顾性分析2018年1月至2019年12月于福建省立医院行第二代冷冻球囊导管消融(CBA)治疗阵发性房颤患者249例。根据术式不同分为肺静脉前庭扩大冷冻消融组(PVIPLUS组,n=106例)和单纯肺静脉电隔离组(PVI组,n=143例)。观察两组并发症及12个月成功率以评估肺静脉前庭扩大冷冻消融的安全性及早期疗效。结果:249例阵发性房颤患者随访中位数15(6~31)个月,有209例(83.94%)维持窦性心律。PVIPLUS组CBA术后的成功率明显高于PVI组[89.62%(95/106)vs.79.72%(114/143),P=0.035],生存分析同样显示PVIPLUS组CBA术后12个月的成功率高于PVI组(HR=0.402,95%CI:0.202~0.875,log-rank P=0.035)。应用Logistic回归分析显示,与单纯肺静脉电隔离相比,采用肺静脉前庭扩大冷冻消融方法(OR=0.455,95%CI:0.216~0.959,log-rank P=0.039)与提高阵发性房颤CBA成功率独立相关,同时左心房内径增大(OR=2.077,95%CI:1.143~3.777,log-rank P=0.017)与术后复发率独立相关,术后复发的患者左心房内径大于术后成功患者。两组共出现10例(4.02%)并发症[PVIPLUS组4例(3.77%),PVI组6例(4.20%)];其中主要并发症为短暂性膈神经麻痹6例(2.41%),PVIPLUS组2例(1.89%),PVI组4例(2.80%);PVIPLUS组1例发生迷走反射,3例(PVIPLUS组1例,PVI组2例)出现术后右侧股静脉穿刺部位血肿。PVIPLUS组与PVI组并发症发生率差异无统计学意义(P=1.000)。结论:肺静脉前庭扩大冷冻消融治疗阵发性房颤是安全、有效的,可降低阵发性房颤CBA术后早期复发风险,提高成功率。左心房内径增大是阵发性房颤患者CBA术后复发的独立危险因素。

腹腔镜胃袖状切除术中保留胃窦部及His角完整性对术后恶心呕吐的影响

目的探讨腹腔镜胃袖状切除术中保留胃窦部及His角完整性对术后恶心呕吐(postoperative nausea and vomiting,PONV)及止吐药物使用的影响。方法回顾性分析首都医科大学附属北京潞河医院内分泌与代谢病科2022年1月至2023年7月行腹腔镜胃袖状切除手术的肥胖症病人80例,根据术中是否保留胃窦部及His角周围组织完整性分为保留胃窦部及His角完整性组(A组,36例)和常规手术组(B组,44例)。对比分析两组术后24 h内恶心呕吐、止吐药物使用、术后肠道功能恢复情况及术后出院时间的差异性。结果A组与B组病人PONV发生率比较[术后12 h:27.8%(10/36)比59.1%(26/44),术后24 h:33.3%(12/36)比65.9%(29/44)],差异均有统计学意义(均P<0.05);A组、B组术后24 h止吐药物使用次数分别为(0.7±1.2)次、(1.4±1.1)次,差异有统计学意义(P<0.05);A组比B组术后首次肛门排气时间更早(P<0.05);两组病人术后首次饮水和住院时间差异均无统计学意义(均P>0.05)。结论保留胃窦部及His角完整性有利于降低胃袖状切除术PONV的发生率,减少术后止吐药物的使用及促进术后胃肠道功能的恢复。

根治性远端胃切除术治疗急诊胃窦癌并穿孔患者临床疗效及对凝血功能的影响

目的 探讨根治性远端胃切除术治疗急诊胃窦癌并穿孔患者的临床疗效及患者凝血功能的影响。方法 选取2019年8月—2021年2月江门市新会区人民医院急诊收治的72例胃窦癌并穿孔患者作为研究对象,根据治疗方法分为开腹组和腹腔镜组,开腹组(n=38)接受开腹根治性远端胃切除术,腹腔镜组(n=34)接受腹腔镜根治性远端胃切除术,比较2组患者的临床疗效及凝血功能水平。结果 腹腔镜组患者手术出血量比开腹组少,术后排气时间、术后离床活动时间、住院时间均比开腹组短,手术时间比开腹组长,差异均有统计学意义(P<0.05)。腹腔镜组患者术后并发症发生率比开腹组低,差异有统计学意义(P<0.05)。术后12 h、术后24 h 2组活化部分凝血酶原时间均明显降低,但腹腔镜组变化幅度更大,差异均有统计学意义(P<0.05);术后12 h、术后24 h 2组纤维蛋白原、D-二聚体水平均明显升高,但腹腔镜组变化幅度更大,差异均有统计学意义(P<0.05)。结论 在根治性远端胃切除术对急诊胃窦癌并穿孔患者的治疗中,与开腹手术相比,腹腔镜手术能有效减少对患者造成的创伤,患者术后并发症少,康复更快,但对患者凝血功能有一定影响,需引起重视。

床旁胃窦超声评估特殊人群胃排空及预防反流误吸的研究进展

孕产妇、患儿、肥胖、高龄、终末期肾功能衰竭、糖尿病胃轻瘫、危重患者以及急诊手术患者等特殊人群按目前的禁饮食指南不能保证麻醉诱导时胃排空。床旁胃窦超声便携、快速、准确、无创,可用于上述特殊人群胃内容物性质和容量的评估,指导麻醉科医师制定个体化的麻醉诱导方案,预防反流误吸。本文对床旁胃窦超声评估胃内容物的实施、方法、预防反流误吸的策略及评估特殊人群胃内容物的临床应用进展进行综述。

基于列线图模型对进展期胃窦癌术前低蛋白高危患者的识别

目的:探讨胃窦癌根治术前低白蛋白血症发生的高危因素以及对预后的影响。方法:选择2008年6月至2015年6月福建省肿瘤医院收治的行手术治疗胃窦癌患者共497例,按术前血清白蛋白水平分为低白蛋白组(<35 g/L,194例)与正常白蛋白组(≥35 g/L,303例),分析根治术前低白蛋白血症发生的高危因素及对预后的影响。结果:影响根治术前低白蛋白血症的单因素研究发现,在年龄、肿瘤大小、分化程度、肿瘤T分期、TNM分期上,低白蛋白组与正常白蛋白组存在统计学差异(P<0.05);多因素研究发现,年龄、肿瘤大小、肿瘤TNM分期是术前低白蛋白血症发生的独立危险因素,并据此建立列线图风险预测模型;低白蛋白组1年、3年、5年生存率分别为96.3%、85.7%、78.7%,正常白蛋白组1年、3年、5年生存率分别为94.1%、76.0%、62.9%,差异有统计学意义(P<0.001)。胃窦癌患者预后单因素及多因素分析结果显示,年龄、T分期、TNM分期、术前白蛋白是患者的独立预后因素(P<0.05)。结论:对于胃窦癌患者,年龄、肿瘤大小及肿瘤TNM分期是术前低白蛋白血症发生的独立危险因素,术前低白蛋白血症是胃窦癌患者不良预后的提示,对该类患者应加强识别及干预措施。

健脾消痞方联合推拿对厌食症胃肠动力、Cajal间质细胞自噬的影响

目的:基于促分裂原活化的蛋白激酶(MAPK/MEK)/胞外信号调节激酶1/2(ERK1/2)信号通路分析健脾消痞方联合推拿疗法对厌食症幼鼠胃肠动力及胃窦Cajal间质细胞自噬的作用机制。方法:无特定病原体(SPF)级SD健康幼鼠50只随机分为健康组、模型组(小儿厌食症模型)、中药组(模型+健脾消痞方干预)、联合组(模型+健脾消痞方+推拿疗法干预),每组10只。另10只大鼠建立小儿厌食症模型给予MEK/ERK信号通路抑制剂PD98059进行注射作为抑制剂组。每2周测量幼鼠体质量和摄食量;比色法测血清淀粉酶水平;放射免疫法测血清胃泌素水平;苏木精-伊红(HE)染色观察病理形态;实时PCR检测Cajal间质细胞标志物氨酸蛋白激酶生长因子受体(c-kit)、微管相关蛋白轻链3(LC3)、自噬基因苄氯素1(Beclin1)基因表达。蛋白印迹检测MEK、ERK1/2、p-MEK、p-ERK1/2蛋白表达。结果:与健康组比较,模型组幼鼠体质量、体质量增长率、摄食量、c-Kit、小肠推进比、血清淀粉酶、血清胃泌素降低,MEK、ERK1/2、LC3、Beclin1、胃内残留水平升高(P<0.05)。在经过中药组及联合组干预后,幼鼠体质量、体质量增长率、摄食量、c-Kit、小肠推进比、血清淀粉酶、血清胃泌素升高,MEK、ERK1/2、LC3、Beclin1、胃内残留水平降低(P<0.05),且联合组较中药组效果更佳(P<0.05)。联合组与抑制剂组幼鼠蛋白表达比较,差异无统计学意义(P>0.05).结论:健脾消痞方联合推拿可能是通过抑制MEK-ERK1/2信号通路激活,从而抑制胃窦Cajal间质细胞自噬,改善胃肠道功能。