术前肢体远隔缺血预处理对食管癌根治性手术患者单肺通气相关性肺损伤的作用及影响

探讨术前肢体远隔缺血处理后对患者单肺通气相关性肺损伤的作用。择期行食管癌根治性手术的患者60例,平均随机分为肢体远隔缺血预处理组(R组)和对照组(C组)。单肺通气前(T_1)、单肺通气后30min(T_2)、60min(T_3)、90min(T_4)、单肺通气结束即刻(T_5)、单肺通气结束后30min(T_6)时行动脉血气分析,计算各组氧合指数、呼吸指数和PaO_2/PAO_2,收集呼出气冷凝液测pH值,ELISA法测血浆TNF-α、IL-1β和IL-10浓度。与C组比较,R组T_2~T_6时刻氧合指数升高,呼吸指数降低,PaO_2/PAO_2升高,T_3~T_6时血浆TNF-α和IL-1β浓度降低,呼出气冷凝液pH值升高,T_2~T_6时血浆IL-10浓度升高(P0.05)。术前肢体远隔缺血处理后可在一定程度上减轻食管癌根治性手术患者单肺通气相关性肺损伤。     

感染性休克患者术前应用盐酸戊乙奎醚的临床疗效

观察盐酸戊乙奎醚在感染性休克患者中作为术前药应用的临床疗效。感染性休克手术患者40例,随机分为2组：实验组术前30min肌注盐酸戊乙奎醚lmg,对照组肌注东莨菪碱0．3mg。于各时间点检测血乳酸值、血气（PaO2、PaCO2）及胃黏膜二氧化碳分压（PgCO2）。结果示实验组血乳酸下降、PaO2上升,PgCO2一PaCO...     

胃黏膜内pH在多脏器功能障碍综合征监测中的应用进展

组织器官微循环灌注障碍是MODS发生的重要机制,胃肠道是机体最早发生缺血的器官。胃PHi能敏感反映MODS发生过程中胃肠黏膜缺氧情况,对MODS具有预警作用。目前测定PHi方法分盐水张力计法和连续气态张力计法,效果较可靠。本文通过大量查阅文献,结合临床经验,较系统地阐述了pHi在MODS监测中的意义、原理、方法、安全性及应用前景,为及早采取措施,防治MODS提供理论依据和临床参考。     

胃黏膜内pH在多脏器功能障碍综合征监测中的应用进展

组织器官微循环灌注障碍是MODS发生的重要机制,胃肠道是机体最早发生缺血的器官.胃PHi能敏感反映MODS发生过程中胃肠黏膜缺氧情况,对MODS具有预警作用.目前测定PHi方法分盐水张力计法和连续气态张力计法,效果较可靠.本文通过大量查阅文献,结合临床经验,较系统地阐述了pHi在MODS监测中的意义、原理、方法、安全性及应用前景,为及早采取措施,防治MODS提供理论依据和临床参考.     

感染性休克患者术前应用盐酸戊乙奎醚的临床疗效

观察盐酸戊乙奎醚在感染性休克患者中作为术前药应用的临床疗效.感染性休克手术患者40例,随机分为2组:实验组术前30min肌注盐酸戊乙奎醚1mg,对照组肌注东莨菪碱0.3mg.于各时间点检测血乳酸值、血气(PaO<,2>、PaCO<,2>)及胃黏膜二氧化碳分压(PgCO<,2>).结果示实验组血乳酸下降、PaO<,2>上升,PgCO<,2>-PaCO<,2>降低幅度均高于对照组(P<0.05).盐酸戊乙奎醚术前应用对感染性休克患者手术有良好的临床疗效.     

机械通气患者肠内营养不同输注方式的比较

探讨机械通气患者肠内营养时最佳输注方式及应用时机.选择30例进行机械通气的患者,采用3种输注方式:间歇泵入输注(90min/次,5次/d)、持续泵入输注20h、持续泵入输注14h;每4h监测1次患者胃液残留量及胃液pH值,每种输注方式观察24h.结果3种输注方式下抽取的胃液残留量及测得的胃液pH值差异均有统计学意义(P＜0.05).间歇泵入输注方式较持续泵入输注14h、持续泵入输注20h测得的胃液pH值低,胃液残留量少,机械通气患者早期肠内营养适应后,更适宜采用此输注方式.     

胃肠道干细胞

胃肠道是人体内各系统细胞更新频率最高的器官,其干细胞的增生分化也很旺盛。尽管胃肠道干细胞本身未分化成熟,其细胞表型无法确认而不利于鉴别,但随着一些干细胞标志物的发现及对细胞信号传导通路的不断了解,我们对胃肠道干细胞的调控机制的认识正在不断加深。胃肠道干细胞的基本特征:(1)胃肠道干细胞的数量、定位和组织起源;(2)胃肠道干细胞的主要功能,包括分化转化成胃肠道各成熟的细胞系及维持组织的动态平衡和稳定;(3)从其他组织的干细胞获得胃肠组织细胞系用以胃肠道疾病的治疗;(4)胃肠道组织癌变的基因变化及形态学观察。     

肝硬化患者中血小板参数联合D-二聚体检测的临床意义

探讨血小板参数联合D-二聚体检测在肝硬化患者中的临床意义。选取73例肝硬化患者按Child-pugh评分分为A、B、C级并进行血清PLT、PDW、MPV及D-二聚体的检测,同时检测肝硬化患者中消化道出血及无消化道出血患者的上述参数。30例健康体检者作为对照组。发现肝硬化患者PI。T显著降低,PDW、MPV、D-二聚体显著升高,肝硬化出血组与非出血组亦有明显差异。表明肝硬化患者血小板参数与联合D-二聚体检测可以间接反映临床出血倾向及肝功能变化。     

重视肠黏膜屏障功能障碍的防治

肠黏膜屏障损伤是严重创伤、感染、手术、休克时常见的病理生理过程,可造成细菌及内毒素移位、肠源性感染,甚至导致全身炎症反应综合征（SIRS）及多器官功能不全（MODS）等。因此对肠黏膜屏障功能障碍的认识与防治尤为重要,积极纠正肠屏障功能障碍将有助于提高疗效、改善患者预后。     

302m氦氧饱和潜水模拟实验中对神经和心理功能的观察

国内首次302m氦氧饱和潜水模拟实验中,用心理学测验和主观感觉询问对3名受试者的神经和心理反应现象进行了观察。加压到200m、250m、302m和302m停留1天后,受试者的简单视觉运动反应时较常压对照值分别延长了7.3%、4.5%、6.5%和6.1%。加压到200m受试者书面心理学测验失分率较常压对照值增加了156.4%。加压到250m受试者滚珠投递数和失误数较常压对照值分别减少12.2%和增加27.6%。302m停留1天后受试者滚珠投递数和失误数较常压对照值分别减少11.3%和增加56.2%,扑克花样分类时间较常压对照值增加8.7%,书面心理学测验失分率较常压对照值增加113.8%。减压后或减压毕,上述各指标的变化均恢复常压对照水平。根据测试结果和受试者的症状和体征,实验中所观察到的高压神经综合症的表现较国外同样深度的实验报道为轻,这可能与实验采用的缓慢加压速度和设置中间驻留站有关。     

功能性消化不良

功能性消化不良（FD）是临床上常见的症候群,其发病机制可能与胃及十二指肠的高敏感、胃肠运动障碍、幽门螺杆菌（H．pylori）感染、精神心理因素等有关。症状为反复发作的上腹部不适、疼痛、早饱、腹胀等。目前FD的诊断以罗马Ⅲ为标准,即无可以解释症状的器质性疾病的证据（包括内镜）,诊断前症状至少出现6个月,近3个月症状符合以下1点或1点以上：餐后饱胀不适、早饱、上腹痛、上腹烧灼感。治疗以去除诱因及对症治疗为主,包括避免劳累及精神紧张,应用抑酸药、促胃肠动力药、根除H．pylori、西甲硅油乳剂、抗抑郁及中药等。     

Thirty years of abdominal pain

In this paper, the author describes a brief psychotherapy with a man who has struggled with abdominal symptoms for most of his adult life. After an unhappy childhood, the patient (Mr A) married and then was witness to the birth of his stillborn child, in a foreign country. Soon after his abdominal symptoms started, and plagued him for the following 30 years. In the therapy, Mr A began to explore areas of guilt, hostility, and shame, together with previously unknown-about unconscious phantasies. By the end of the therapy, he reported a substantial diminution in his symptoms, as well as changes to his relationships, and mode of thinking and feeling. Some aspects of working psychoanalytically with patients with somatic symptoms, especially those pertaining to the gastrointestinal tract, are discussed.     

CXCR4／CXCL12在胃癌及结直肠癌中的研究进展

消化道肿瘤是一种常见的恶性肿瘤,远处转移是其预后不良的主要原因。近年来消化道肿瘤的发病率逐年上升,其相应的研究得到了广泛的重视。趋化因子对肿瘤的侵袭和转移作用也备受关注。 CXCR4及 CXCL12在肿瘤研究中已逐渐成为热点;最近研究表明,其与胃癌、结直肠癌等的转移密切相关,将为消化道肿瘤转移的防治提供新的思路。此文对CXCR4／CXCL12在胃癌及结直肠癌中的研究进展做一简要综述,CXCR4／CXCL12轴的深入研究将有望使其成为消化道肿瘤靶向治疗的特异靶点。     

术前人文关怀对肺癌手术患者全麻诱导心理和生理的影响

为探讨术前进行人文关怀式沟通和健康教育对肺癌手术患者全麻诱导后心理和生理的影响,将83例非同期别的肺癌手术患者（均采用全身麻醉,双腔管气管插管辅助通气）分成两组。观察组进行人文关怀式沟通,对照组采用普通沟通。判定方法采用焦虑自评量表（SAS）,根据焦虑评分反映两组患者入院即刻及手术前的心理变化情况,监测全麻诱导即刻与全麻诱导气管插管后5min患者平均动脉压（MBP）的波动、心率（HR）的变化,用两个时间段两个变量的差值来反映两组患者全麻诱导期发生心理和生理反应的情况。结果显示,两组患者入院即刻焦虑差异无统计学意义（P〉0．05）;手术前SAS评分两组患者较入院即刻降低（P〈0．05）,并且观察组与对照组相比下降更明显（P〈0．01）;观察组患者MBP波动无统计学意义（P〉0．05）、HR波动有统计学意义（P〈0．05）。因此,证实人文关怀式沟通和健康教育能够减轻肺癌患者在心理和生理两个方面对麻醉和手术产生的不良反应。     

Possible involvement of the vagus nerve in monitoring plasma catecholamine levels

In their article Miyashita and Williams (Neurobiology of Learning and Memory 2006, 85, 116-124) describe the effect of peripheral administration of epinephrine on neural discharge in vagal afferent fibers. It seems that described data supports the hypothesis of the vagus nerve participation in monitoring plasma catecholamine levels and consequently modifying brain functions. However, do these results indicate indeed that afferent vagus nerve pathways are activated by circulating epinephrine? Catecholamines influence virtually all tissues and many functions. Vagus nerve participates significantly in monitoring of those effects. Therefore epinephrine-induced increases of afferent vagus nerve activity described by Miyashita and Williams may reflect not only exclusive activation of beta-adrenergic receptors but also an activation of other types of receptors on vagal sensory nerve endings, e.g., mechanosensors, chemoreceptors, and osmosensors. Discussion is focused on the possibility that the increase in afferent vagus nerve activity may reflect activation of mechanoreceptors of the vagus nerve endings in the epinephrine-activated heart.     

Ein dramatischer Verlauf einer Demenz

Delirium and dementia are two of the most common causes of cognitive dysfunction in the elderly. In patients with dementia, there is a high risk that changes in location – and especially being admitted to the hospital – may result in serious deterioration of brain function, e.g., delirium. With this case report, the authors emphasize the importance of a thorough medical history, behavioral observation, and progress monitoring in the diagnosis of dementia, while at the same time also question the sense, responsibility, and resource use in daily hospital routine.     

A psychology of the human brain–gut–microbiome axis

In recent years, we have seen increasing research within neuroscience and biopsychology on the interactions between the brain, the gastrointestinal tract, the bacteria within the gastrointestinal tract, and the bidirectional relationship between these systems: the brain–gut–microbiome axis. Although research has demonstrated that the gut microbiota can impact upon cognition and a variety of stress‐related behaviours, including those relevant to anxiety and depression, we still do not know how this occurs. A deeper understanding of how psychological development as well as social and cultural factors impact upon the brain–gut–microbiome axis will contextualise the role of the axis in humans and inform psychological interventions that improve health within the brain–gut–microbiome axis. Interventions ostensibly aimed at ameliorating disorders in one part of the brain–gut–microbiome axis (e.g., psychotherapy for depression) may nonetheless impact upon other parts of the axis (e.g., microbiome composition and function), and functional gastrointestinal disorders such as irritable bowel syndrome represent a disorder of the axis, rather than an isolated problem either of psychology or of gastrointestinal function. The discipline of psychology needs to be cognisant of these interactions and can help to inform the future research agenda in this emerging field of research. In this review, we outline the role psychology has to play in understanding the brain–gut–microbiome axis, with a focus on human psychology and the use of research in laboratory animals to model human psychology.     

A Survey of the Sources of Noise in fMRI

Functional magnetic resonance imaging (fMRI) is a noninvasive method for measuring brain function by correlating temporal changes in local cerebral blood oxygenation with behavioral measures. fMRI is used to study individuals at single time points, across multiple time points (with or without intervention), as well as to examine the variation of brain function across normal and ill populations. fMRI may be collected at multiple sites and then pooled into a single analysis. This paper describes how fMRI data is analyzed at each of these levels and describes the noise sources introduced at each level.