早期肠内营养对晚期胰腺癌患者营养状况的影响

目的 探讨早期肠内营养对晚期胰腺癌患者营养状况和并发症的影响。方法 选择2012年1月-2013年12月海军总医院肿瘤科和消化内科收治的晚期胰腺癌患者68例,将其按照入院后24～72 h是否接受鼻空肠管置管行肠内营养支持分为肠内营养组（33例）和对照组（35例）。肠内营养组患者给予肠内营养粉支持,对照组患者给予普通流质饮食。两组患者在给予营养支持的同时,均给予同类肠道益生菌及镇痛等对症治疗。于治疗第1天和第30天时观察两组营养指标,包括体质指数（BMI）、肱三头肌皮褶厚度、上臂围|生化指标,包括空腹血糖、血清总蛋白、清蛋白、胆固醇、三酰甘油|肝功能指标,包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBiL）|以及两组肠道并发症和感染发生率。结果 治疗前,两组BMI、肱三头肌皮褶厚度、上臂围比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组BMI、肱三头肌皮褶厚度、上臂围均高于对照组（P＜0.05）。治疗前,两组血糖、总蛋白、清蛋白、胆固醇、三酰甘油比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组空腹血糖、总蛋白、清蛋白、胆固醇均高于对照组（P＜0.05）。治疗前,两组ALT、AST、TBiL比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组ALT、AST、TBiL均低于对照组（P＜0.05）。两组腹胀发生率比较,差异无统计学意义（P＞0.05）|肠内营养组腹泻、便秘、感染发生率均低于对照组（P＜0.05）。结论 早期肠内营养支持治疗可有效改善晚期胰腺癌患者的营养状况,降低肝功能受损、腹泻、便秘和感染的发生率。     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

幼猪头颅低剂量螺旋CT扫描参数优化研究

Objective To optimize the scanning parameters for CT with lower radiation dose on the infant pigs' brain which mimic the baby's head of human being. Methods Five pigs underwent CT scan using regular X-ray dose I. E. , 400 mAs, and other dose including 300,250, 200,150 and 100 mAs respectively, and the other parameters were the same. Each pig was scanned 12 times repeatedly with each of the six X-ray doses, which obtained 960 image. Anatomic details and the confidence level in reaching a diagnosis were evaluated by three radiologists respectively in a double-blinded manner using a 4-point scoring system. The CTDI of every group were compared. All Results were analyzed by Chi-square test and analysis of variance. Results The CTDI of 400,300,250,200,150,100 mAs was (55.5±0.1),(41.9±0.0), (34.7±0.0), (27.8±0.0), (20.9±0.0), (12.2±0.0) mGy respectively, there was a significant difference(F = 214872.0,P < 0.05)among the six groups. There was no significant difference in the quality of images obtained from the conventional 400 mAs scanning and low dose group of 300,250,200, 150 mAs scanning images, the total score was (3.7±0.5), (3.7±0.5), (3.6±0.3), (3.6±0.5), (3.6±0.5) respectively,which was more than 3 points, while the 100 mAs group showed low quality (2.1±0.5) which was less than 3 points. In the 100 mAs group, there were 215 in 960 images >3 points, 745 images < 3 points, and regular doses of 400 mAs group (934 image > 3 points). Image quality difference was statistically significant (χ2=3289.9,P <0.05). Conclusion The low-dose scanning (120 kV, 150 mAs, 20.8 mGy)would be practical in diagnosing in normal infant pigs' brain.     

142例内镜下逆行胰胆管造影术并发症的临床分析

目的 分析内窥镜逆行胰胆管造影术的常见并发症.方法 回顾2004年1月～2008年4月间我院行内窥镜逆行胰胆管造影术142例住院患者的术后情况,比较术后常见并发症高淀粉酶血症、急性胰腺炎、急性胆管炎、上消化道出血等的发生率,以及诊断性及治疗性内窥镜逆行胰胆管造影术术后并发症的差异.结果 内窥镜逆行胰胆管造影术术后并发症共计53例;其中,高淀粉酶血症31例(58.5%),急性胰腺炎12例(22.6%),急性胆管炎6例(11.3%),上消化道出血3例(5.7%).诊断性与治疗性内窥镜逆行胰胆管造影术的术后并发症发生率分别为16.7%和37.4%,两者比较有统计学意义(P＜0.05).结论 内窥镜逆行胰胆管造影术操作技术是比较安全的,主要并发症以高淀粉酶血症为主,经内科保守治疗多能缓解.内窥镜下治疗性操作可能增加内窥镜逆行胰胆管造影术术后并发症发生的风险.     

混合型过敏性紫癜1例及诊断分析

报道1例以紫癜、急性胰腺炎、十二指肠降部溃疡和心脏受损为主要临床表现的成年女性病例.复习1990年美国风湿病学会制订的过敏性紫瘢新的诊断标准及在该病例的应用.临床怀疑腹型或混合型过敏性紫癜的患者,对实验室和影像学检查结果要综合分析,多次复查,有助于诊断和疗效的判断.     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

原发于皮革胃的库肯勃瘤1例

1 病例报告 女,29岁.因腹痛、腹胀伴消瘦2mo入院.体检:一般情况差,浅表淋巴结未触及;腹部膨隆,下腹部可触及肿块,其分界不清,腹水征阳性.CEA:54.9ng/mL.B超检查:子宫前上方可探及一大小约11cm×10 cm囊实性肿物,内有大小不等的囊腔,最大直径约为4.2 cm,实性部分回声较强、致密.腹腔内可见游离液体,肝前可见2.0 cm无回声区.上消化道钡餐检查:胃 容积极度缩小,胃壁较僵硬,粘膜皱襞消失,未见明确龛影及充盈缺损.内镜检查:胃腔缩小,壁增厚、僵硬、蠕动差.病理报告:胃粘液细胞癌.妇科手术探查:腹腔内有黄色清亮腹水1000mL,右侧卵巢肿物约17 cm×16 cm×16 cm大小,包膜完整,切面呈囊实性结节状.左侧卵巢大小约6 cm×4 cm×3 cm,其表面光滑,切面呈粉红色囊实性结节状.病理报告:卵巢库肯勃瘤.     

肝硬变患者血浆肽类激素的变化

肝硬变时内源性肽类激素发生明显改变,并对机体产生诸多影响．由于肝硬变患者常出现门脉高压和钠水潴留等并发症,因此研究肝硬变时肽类激素的变化及其对门脉、内脏及全身性血液循环的影响颇受关注．为此我们观察失代偿期肝硬变患者空腹血浆胃动素（ＭＴ）、Ｐ物质（ＳＰ）、精氨酸加压素（ＡＶＰ）、内皮素（ＥＴ）、肾上腺髓质素（ＡＭ）和内源性类洋地黄物质（ＥＤＬＳ）和甘丙素（ＧＡＬ）、降钙素基因相关肽（ＣＧＲＰ）等肽类激素水平变化,探讨其在肝硬变时血流动力学异常中的作用．１　材料和方法１．１　材料　肝硬变组２８３例,…     

血清腹水白蛋白梯度对腹水鉴别诊断的临床价值

目的比较血清腹水白蛋白梯度与渗出液／漏出液概念对腹水鉴别诊断的准确性。方法选择诊断明确患者的51对血清及腹水标本,分为门脉高压组、非门脉高压组,比较两组问白蛋白梯度的差异;51对资料同时被分为渗出液、漏出液组,评价血清腹水白蛋白梯度≥11g／L诊断为门脉高压组,腹水总蛋白≥25g／L、腹水比重≥1．018诊断为渗出液的各自诊断准确率。结果血清腹水白蛋白梯度的诊断准确率为84．3％,腹水总蛋白诊断准确率为70．6％、腹水比重的诊断准确率为58．8％。结论血清腹水白蛋白梯度对腹水鉴别诊断较腹水总蛋白、腹水比重更有价值,腹水分类应以高白蛋白与低白蛋白梯度取代漏出液和渗出液。     

经内镜综合治疗胃石16例

目的探讨内镜下多种方法综合治疗胃石。方法利用套扎器、活检钳,结合口服碳酸氢钠、芝麻油治疗16例胃结石患者。结果16例患者中13例经1次碎石排尽,3例巨大结石经第2次碎石消失。2周后复查胃镜,胃石均消失,无出血、肠梗阻等并发症。结论经内镜综合治疗胃石,一次成功率81％,二次成功率100％;器械简单,操作方便、成本低,患者痛苦少,值得推广。