中国实用医刊杂志   部级期刊

摘要：目的 分析自愿接受胃旁路手术(GBP)的46例患者于术后并发胃瘫、吻合口出血病例的临床表现和特点.方法 通过临床观察胃管的引流量、上腹饱胀、呃逆、呕吐及禁食时间和近端胃腔经造影观察蠕动等情况.评价患者术后胃瘫、吻合口出血的发生情况和程度.结果 术后并发胃瘫6例,占13.04%(6/46),轻度胃瘫1例(禁食1周左右),中度胃瘫3例(禁食2周左右),重度胃瘫2例(禁食3周左右);吻合口出血2例,均有Ⅱ期高血压病史.结论 GBP治疗2型糖尿病术后并发胃瘫比一般胃大部切除术后胃瘫发生率高,且临床症状持续较长、程度较重,其机制与糖尿病患者胃底硝基能神经失支配使容受性松弛和适应性松弛受损所致. Abstract： Objective To analyze clinical manifestations and characteristics of gastroparesis developed in 46 patients with type 2 diabetes mellitus received GBP voluntarily. Methods The study evaluated gastroparesis and anastomotic bleeding condition of postoperative patients by observing tube drainage, swollen feeling in the upper abdomen, hiccups, fasting time, and evaluating gastric peristalsis function with proximal gastric angiography. Results There were 6 patients with gastroparesis after surgery, which accounting for 13.04%, including 1 case of mild gastroparesis (fasting 1 week), 3 cases of moderate gastroparesis (fasting 2 weeks), 2 cases of severe gastroparesis (fasting 3 weeks). And there were 2 cases of amastomotic bleeding. And all of the 2 cases with hepertention. Conclusions The incidence of postoperative gastroparesis is higher in type 2 diabetic treated by GBP than the average incidence after subtotal gastrectomy with other diseases, and there are longer and more serious clinical symptoms. The above mentioned are related to the mechanism of diabetic patients with the damage of gastric receptive expansion and adaptive relaxation caused by gastric nitro-innervation.

摘要：目的 探讨胃癌穿孔的临床特点、诊断与处理方法.方法 回顾性分析16例胃癌合并急性胃穿孔患者的临床资料以及手术方式.结果 16例行手术治疗患者中,5例行胃癌根治术,其中2例为D2根治术,3例为D1根治术;4例行姑息性胃切除术;6例行穿孔修补术;胃造瘘1例.手术早期死亡2例,其中1例为穿孔修补术,1例为姑息性胃大部分切除术,均死于感染性休克伴多器官功能衰竭.随访11例,1年内死亡5例,2年内死亡3例,3例存活3年以上.结论 术中常规取标本活检可避免胃癌漏诊.早期诊断及正确术式选择是降低病死率、提高生存质量的重要因素.姑息性切除术或根治性切除术可明显延长患者的生存期并改善预后. Abstract： Objective To investigate the principles of diagnosis and treatment of perforated gastric carcinoma. Methods Sixteen cases with perforated gastric cancer were analyzed retrospectively in the clinical data and operative manners. Results In 16 cases underwent operation, 5 cases were perfomed radical gastrectomy, 2 cases underwent D2 operation, 3 cases underwent D1 operation; 4 cases were perfomed palliativel gastrectomy. Six cases underwent perforation repair operation. 1 case underwent gastrotomy. Early death 2 cases, 1 case underwent local repair operation, 1 case was palliativel distal subtotal gastrectomy. Two cases died from septic shock accompanied with multiple organ dysfunction syndrome. Eleven cases were followed up, 5 cases died within 1 year, 3 cases within 2 years and 3 cases survived more than 3 years. Conclusions If intraoperative biopsy was taken, the missed diagnosis of gastric cancer can be avoided,and early diagnois and correct choice of surgical procedure may be important in reducing the mortality and improve the quality of life. The surgical methods of palliative resection and radical exision can prolong survival of patients with acute perforation of gastric carcinomas and improve their prognosis.

摘要：目的 观察培美曲塞二钠联合顺铂治疗晚期非鳞非小细胞肺癌患者的近期临床疗效和毒性反应.方法 20例Ⅲb～Ⅳ期非鳞非小细胞肺癌患者均经病理组织学和(或)细胞学检查确诊.培美曲塞二钠联合顺铂治疗2个周期后评价疗效.结果 20例患者均可评价,获得完全缓解(CR)0例,部分缓解(PR)9例,有效率为45.0%(9/20).最主要的不良反应为骨髓抑制,但均可耐受.结论 培美曲塞二钠联合顺铂治疗晚期非鳞非小细胞肺癌有较好疗效,不良反应轻,易于耐受. Abstract： Objective To observe the clinical efficacy and adverse effect of pemetrexed disodium combined with cisplatin in treating advanced non-small cell lung cancer of nonsquamous cell histology. Methods A total of 20 patients with advanced non-small cell lung cancer of nonsquamous cell histology diagnosed by pathology or cytology were enrolled into the study.The patients were treated with pemetrexed disodium and cisplatin. Each patient was received 2 cycles chemotherapy at least. The short-term effect,side effects were evaluated after chemotherapy. Results Complete remission (CR)was observed in 0 case and PR in 9 cases.The response rate(RR) was 45.5% (9/20).The main side effects were bone marrow suppression,but that was tolerable. Conclusions The regimen of pemetrexed disodium combined with cisplatin is effective,safe and well tolerable in the treatment of non-small cell lung cancer of nonsquamous cell histology.

摘要：目的 观察冠状动脉介入手术前禁食时间的长短对并发症的影响.方法 采用随机分组的方法,将656例择期介入手术的患者分为A、B两组,A组上午手术者术前晚正常进食,次日早餐进半流质饮食,下午手术者早餐正常进食水,午餐进半流质饮食,进食量为平日食量的80%左右,术后再让患者进食水.B组上午手术者术前晚正常进食,次日早餐禁食水,下午手术者术前早餐正常进食,中午禁食水,术后均正常进食水.结果 A组术前平均禁食时间为(2.0±1.2)h,B组术前平均禁食时间(14.0±1.5)h,B组禁食时间明显长于A组,且B组并发症的发生明显高于A组.结论 行冠状动脉介入手术的患者,术前尽可能缩短禁食水时间,能有效减少并发症的发生. Abstract： Objective To obsereve the impact of the time of pre-operative non-fasting on its complicaions in cardiac catheterization. Methods Dividing 656 cases into group A and group B at random.In group A, the operative patients in the morning eat normal food the night before last, semifluid food at the second day breakfast. The operative patients in the afternoon eat normal food at amount.In group B, the operative patients in the morning eat normal food the night before last, non-fasting at the second day breakfast, the operative patients in the afternoon eat normal food at breakfast,non-fasting at lunch. Results The average time of non-fasting was (2.0±1.2) hours in group A, (14.0±1.5) hours in group B;the time of non-fasting in group B was longer than that in group A,and the complications increased obviously in group B. Conclusions Shortening the time of pre-operative non-fasting can reduce its complications in cardiac catheterization.

摘要：目的 观察开胸手术后吗啡复合氯诺昔康静脉镇痛与单独应用吗啡效果比较.方法 将ASAⅠ～Ⅱ级60例择期开胸手术患者随机分为吗啡(A)组(n=30)和吗啡+氯诺昔康(B)组(n=30),A组采用吗啡60 mg+恩丹西酮4 mg,B组采用吗啡40 mg+氯诺昔康32 mg+恩丹西酮4 mg,均以生理盐水稀释至100 ml,给予吗啡2.5 mg+恩丹西酮4 mg作为负荷量后连接PCIA泵进行自控镇痛.术后第1、2、3天静息及咳嗽时行VAS评分,监测用药量及不良反应发生情况.结果 两组VAS评分比较差异无统计学意义,用药量、不良反应A组明显高于B组.结论 吗啡与氯诺昔康联合应用于开胸手术后镇痛与吗啡单独应用效果相当,但吗啡用量及不良反应发生率明显降低,是一种更安全、有效的镇痛方法. Abstract： Objective To compare the effect of morphine combined with lornoxicam and morphine alone for postoperative thoracotomy patients. Methods All 60 postoperative thoracotomy patients with ASAⅠ-Ⅱ stage were randomly divided into group A(30 cases)and group B(30 cases).All patients were given morphine and ondansetron as loading dose and then connected PCIA pump for controlled intravenous analgesia,but lornoxicam were added to the patients in group B. VAS score,drug consumption and adverse reactions were marked after operation. Results VAS score had no significant difference between the two groups,but the drug consumption and adverse reactions of group A were significant higher than that in group B. Conclusions For postoperative thoracotomy patients,taking morphine combined with lornoxicam can relieve pain effectively and meanwhile cut down drug consumption and adverse reactions.