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难治性消化性溃疡诊断和治疗的现状
难治性消化性溃疡(intractable peptic ulcer)一词,已被众多临床工作者所接受,意即消化性溃疡,经用标准剂量的H2受体拮抗剂治疗,症状未能消失,十二指肠溃疡在8周末和胃溃疡在12周末通过胃镜复查,见溃疡未能愈合,称之为难治性消化性溃疡,有人提出消化性溃疡病人经过正规、严格、充分的内科治疗,疼痛持续存在或短时间缓解,而很快再度出现,有的症状加重、持续时间延长;有的病人在住院期间,经治疗症状消失,但在出院后很快复发,胃肠钡餐检查及胃镜检查见溃疡并未愈合,便可确认为难治性消化性溃疡.
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Peptic ulcer is a common and frequently encountered disease. H2 receptor blocker and several other drugs have been used in treating peptic ulcer (PU) since many years ago, but there still remain a rather large number of intractable ulcer and recurrent ulcer. Recently the discovery of Helicobacter pylori (HP), as well as the relationship between HP and PU relapse was confirmed, but there still lacks of perfect therapeutic program for anti-HP infection(1). From June 1993 to August 1996, we used a pure TCM preparation Moluo Yangping granule (摩罗疡平冲剂, MYG) in treating 64 PU patients, and satisfactory results have been obtained. The report is as follows.METHODSPatient Selection According to the diagnostic standard of PU worked out by Ministry of Health in “Guiding Principles for Clinical Study of New Chinese Drugs”, 126 PU patients with typical symptoms and signs were enrolled, who were confirmed to have PU before treatment with biopsy sample performed urease quick diagnostic method under gastroscopy, and pathological special stain were microscopically examined to verify the HP infection. Basal acid output (BAO), maximal acid output (MAO), peak acid output (PAO) and the amount of parietal cells were measured in all the patients.
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消化性溃疡患者转化生长因子a、表皮生长因子和前列腺素E2的关系
目的:研究转化生长因子a(TGFa)在慢性胃粘膜病变患者血液、胃液中的含量变化及其与表皮生长因子(EGF)和前列腺素E2(PGE2)的关系,初步探讨TGFa在胃粘膜病变发病过程中的作用. 方法:选择经胃镜和病理组织学检查证实的活动期消化性溃疡(PU)患者44例,其中十二指肠球溃疡(DU)22例,胃溃疡(GU)22例;慢性浅表性胃炎(CSG)患者18例;另选择20例胃镜观察胃粘膜基本正常者作为对照组.胃镜下经活检孔抽取胃液,并采集空腹静脉血,用放免分析法检测胃液、血液中TGFa,EGF,PGE2的含量.结果:GU和DU两组的血清TGFa(ng.L-1),EGF(ug.L-1)含量均明显低于对照组和CSG组(3.5±1.1,3.4±1.3 vs 5 9±1.6,5.0±1.7,P<0.01;0.3±0 1,0.3±0.1 vs 0.6±0.2,0.5±0.2 P<0.01).GU和DU血浆PGE2(ng.L-1)含量与对照组和CSG组相比,差异无显著性(24.7±8.4,26.0±8.7vs25.2±8.0,20.9±7.7,P>0.05).GU,DU和CSG三组胃液中TGFa(ng.L-1),EGF(ng.L-1),PGE2(ng.L-1)含量均明显低于对照组(1.7±0.7,1.6±0.7,2.1±0.7vs2.7±0.8,P<0.05;109±47,121±67,113±48vs373±78,P<0.01;15.8±6.6,14.1±7.3,16.4±6.9vs21.9±7.5,P<0.05).GU组胃液中TGFa与PGE2间存在直线正相关(r=0.55,P<0.05),GU组血液中及其余各组血液、胃液中TGFa与PGE,EGF与PGE2,TGFa与EGF间皆无线性相关.血液、胃液间TGFa,GU和DU两组均无线性相关;血液、胃液间EGF,各组皆无线性相关;血液、胃液间PGE2,各组均无线性相关.结论:TGFa、EGF的缺乏与PU的发病有关,TGFa、EGF的粘膜保护作用似与PGE2的介导无关.检测血清和胃液中TGFa、EGF含量,对PU诊断具有指导意义.
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AIM To provide evidence that UBT is the most cost-effective tool for evaluation of H. pylori eradication.METHODS Data on twenty-six consecutive patients at Atlanta VA Hospital who underwent UBT wereretrospectively reviewed. All patients had endoscopic diagnosis of peptic ulcers and biopsy proven H. pyloriinfection. Eight to ten weeks after completion of triple therapy (amoxicillin, biaxin and prilosec), allpatients had C14 UBT (PY test kit, Charlottesville, Virginia). Ten patients had repeated endoscopicexaminations and gastric biopsies. Twelve patients had serology tests for H. pylori.RESULTS UBT was negative in all patients (two patients had indeterminate result on the first time, butshown to be negative on the second UBT). Biopsies from all ten patients who were re-endoscoped werenegative for H. pylori. Serology tests on all the twelve patients were positive. Cure of H. Pylori could notbe determined on the titer change. All patients spent about 30 minutes in nuclear medicine laboratory, theendoscopic patients spent 2 hours to 4 hours in endoscopic laboratory; the cost for a UBT was about 50, thecost for an endoscopy with biopsy was above 200.CONCLUSION The 04 UBT is a rapid, economic and accurate test to monitor H. pylori eradication. Thetest should be considered a gold standard test for evaluating the effectiveness of treatment of H. pyloriinfection, unless patients need repeated endoscopy to rule out gastric cancer.
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Helicobacter pylori (H. pylori ) is a major causativebacterium of chronic gastritis, peptic ulcer and mucosaassociated lymphoid tissue lymphoma in humans, and associated with an increased risk of gastric cancer[1 -8]. An important virulant factor of H. pylori is the vacuolating cytotoxin ( VacA ) encoded by vacA that induces cytoplasmic vacuolation in target cells both in vitro and in vivo[9-11]. VacA is produced as a 140 kDa precursor which contains an N-terminal signal peptide and an approximately 33 kDa C-terminal outer membrance exporter. The precursor is cleaved at both N-terminal and C-terminal and secreted into the extracellular milieu as a 95 kDa mature protein. The mature protein futher undergoes specific cleavage to yield 37 kDa and 58 kDa subunits[12-14] Although vacA is present in all H. pylori strains, only about 50% to 60% of strains can induce vacuolation of epithelial cells as assessed by the HeLa cell assay. vacA shows considerable genetic variation in H. pylori isolated from all over the world and contains at least two variable regions. The s region exists as sl or s2 allelic types. Among type sl strains, subtypes sla and slb have been identified. The m region occurs as ml or m2 allelic types. Specific vacA genotype of H. pylori strains are associated with the production of the cytotoxin in vitro, epithelial damage in vivo, and clinical consequences[15-27]. The other virulant factor is the cytotoxin-associated protein (CagA) encoded by the cytotoxin-associated gene (cagA). The cagA gene is present in about 60% to 70% of strains and all of these strains express the cagA. The presence of cagA is also associated with the production of the cytotoxin in vitro, and clinical outcome[24-30]. The aim of this study was (i) to identify vacA genotypes and cagA status of H. pylori isolated from Chinese patients; (ii) to evaluation the relatioship beween vacA genotypes, cagA status and related gastroenterological disorders.
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非甾体消炎药相关消化道溃疡与溃疡并发症的预防与治疗规范建议
非甾体消炎药( NSAIDs)是一大类不含糖皮质激素而具有抗炎、镇痛、解热作用的药物,其临床应用极为广泛,主要用于多种疼痛的对症治疗,改善风湿性疾病的炎性症状,近年来也用于预防心脑血管疾病等,是仅次于抗感染药物的第二大类药物。然而使用NSAIDs可能导致消化道、心血管、肾脏、肝脏、中枢神经系统和血液系统等的不良反应,其中消化道不良反应常见。 NSAIDs胃肠道副作用不仅危害患者健康,增加病死率,且大大增加了医疗费用。因此提高NSAIDs胃肠道安全性是临床医生需要关注的问题。
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消化内镜清洗消毒常规(试行)
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应用护理路径对消化性溃疡患者实施健康教育
健康教育是整体护理工作中的重要环节,也是消化性溃疡综合治疗的一项重要措施.怎样使健康教育得到佳效果,以满足患者对健康知识的需求,到目前为止还没有一种公认的模式[1].
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消化性溃疡病的护理进展
消化性溃疡(PU)是常见的慢性疾病之一.文献统计约有10%的成人患有本病.主要是指发生在胃和十二指肠球部的慢性溃疡,亦可发生于食管下段、胃空肠吻合口附近及憩室[1].
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中学生消化性溃疡病的诱因分析及护理
消化性溃疡病为全球性常见病、多发病,主要包括胃溃疡及十二指肠溃疡,人群总体患病率10%以上,为常见的心身疾病之一.近年来随着社会的发展,包括消化性溃疡在内的心身疾病在青年人群中的发病率日益升高.各种身心应激因素常常成为溃疡病发病的诱因.本文旨在分析中学生人群中消化性溃疡发病的诱因并制订相应的护理对策.
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经内镜中西医结合治疗消化性溃疡病人的观察与护理
随着内镜技术的发展,国内外已经开始使用内镜对消化性溃疡(peptic ulcer,PU)进行局部治疗.2003年8月-2006年10月我院脾胃科将现代内镜治疗技术及传统的中医祛腐生肌法相结合治疗PU,取得满意疗效.现将护理体会汇报如下.
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小儿消化性溃疡的诊断与治疗
消化性溃疡系指发生于胃和十二指肠粘膜及其深层组织的一种局部缺损.以往认为该病在小儿中少见,近年来随着诊断技术的进步,尤其因消化内镜在儿科的普及应用,该病的检出率明显上升.在小儿,消化性溃疡病可分为两大类:原发性(或特发性)溃疡,好发于学龄儿童及青少年,大多为慢性,以十二指肠溃疡多见,多有家族史,初次治愈后易复发;继发性(或应激性)溃疡,多见于新生儿及婴幼儿,大多为急性,主要在胃部,通常为全身疾病在胃肠道的表现,无复发倾向.
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用兰索拉唑治疗消化性溃疡出血的临床疗效观察
目的:评价用兰索拉唑治疗消化性溃疡出血的临床疗效。方法:将2012年2月至2014年2月我院收治的101例消化性溃疡出血患者随机分为治疗组(50例)和对照组(51例)。为治疗组患者使用兰索拉唑进行治疗,为对照组患者使用奥美拉唑进行治疗,并对比分析其临床疗效。结果:治疗组患者治疗的总有效率为98%(显效42例,有效7例,无效1例)。对照组患者治疗的总有效率为98.04%(显效44例,有效6例,无效1例)。两组患者治疗的总有效率相比较差异不显著(P>0.05),无统计学意义。在治疗的过程中,两组患者均未发生明显的不良反应。结论:在治疗消化性溃疡所致上消化道出血方面,兰索拉唑和奥美拉唑疗效相当,但其引发的不良反应更轻微,值得在临床上推广使用。
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Helicobactor pylori was first isolated by Warren and Marshall in 1983 from clinical patients and was considered to be the etiological agent of peptic ulcer and chronic gastritis[1]. According to the literature 1/3~1/2 of the population in the world and 32~ 75 %population above age 19 in China were reported to be infected with this organism. During the recent years more and more attentions were paid to their close association between H. pylori infection and gastric cancer, since this organism was isolated in 70 9 of the cases of gastric cancer and 160 000 individuals died of gastric carcinoma in China each year[2~3].
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老年人消化性溃疡的临床特点、诊断和治疗原则
老年人消化性溃疡的临床特点和中青年患者有很大不同,其临床表现常不典型,因为常合并心肺和肾功能减退,一旦发生并发症多很严重,死亡率高,应引起临床医生的重视.
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消化性溃疡防治药物的新进展
随着根除幽门螺杆菌治疗的推广以及各种新药的问世,消化性溃疡的治疗取得了飞跃发展.据香港中文大学消化疾病研究所的调查显示,过去10年间全球消化性溃疡的年发病率为0.10%~0.19%(根据医师诊断)以及0.03%~0.17%(根据住院统计).而一年的患病率则为0.12%~1.50%(根据医师诊断)以及0.10%~0.19%(根据住院统计).
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消化性溃疡出血病人健康教育需求的调查及对策
胃十二指肠溃疡出血是上消化道出血的主要病因,约占50%~80%.为了增进病人对健康知识的了解,促使其行为向有利于健康的方向发展,笔者对110例消化性溃疡出血病人进行了健康教育需求的调查.
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胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用
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胃及十二指肠溃疡穿孔的诊断与治疗体会(附165例病历分析)
胃及十二指肠溃疡穿孔是普通外科常见的急腹症之一,其发病率及危险性都相当高.倘若在诊断和治疗上出现失误均可造成病人生命危险.笔者自1970~2001年共收治胃、十二指肠溃疡穿孔患者165例,为了提高对本病的诊治水平,增强今后对该病的认识,现对该组病历进行回顾性分析,并加以探讨和总结.
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乳晕切口作乳腺肿物及区段切除术
乳腺增生性疾病作手术切除,按传统是作放射状切口,目的是避免损伤乳腺管,但术后瘢痕明显.近年来作者把传统放射切口改为乳晕边缘弧形切口,手术42例,效果满意,报告如下.