关键词： 肛肠疾病   直肠出血   影响因素   防治方法  

摘要： 目的分析肛肠疾病患者术后发生直肠出血的影响因素,探讨可行的临床防治方法。方法随机选取2014年4月至2017年1月在我院行肛肠手术治疗并发生出血现象的肛肠疾病患者120例,搜集并统计全部患者的临床资料,分析肛肠患者术后发生直肠出血的影响因素,并探讨可行的临床防治方法。结果所有患者均经适当的处理后有效止血,没有发生1例死亡;患者的平均出血时间是在术后的(7.52±1.29)d,患者的平均住院时间是(27.81±5.34)d,平均出血量是(146.35±39.87)mL。7例(5.83%)患者由于在术后没有遵医嘱即进行剧烈的活动而出血,11例(9.17%)患者在术后由于大便干燥而过度费力,6例(5.00%)患者由于在术后即行排便而出血,17例(14.17%)患者由于在术前没有详细调查近期用抗凝药而出血,20例(16.67%)患者合并原发性高血压,13例(10.83%)患者伴有腹部肿瘤,13例(10.83%)患者的凝血功能存在异常,8例(6.67%)患者在术中的切口不当,19例(15.83%)患者在术中的止血操作不规范,6例(5.00%)患者的结扎线发生滑脱。结论肛肠手术术后发生出血的影响因素较多,在临床中应针对高发因素采取有效地预防和治疗措施,降低直肠出血的风险。

关键词： 肛肠疾病   工作因素   职业  

摘要： 目的了解工作相关因素对肛肠疾病患病的影响,为针对性防治肛肠疾病提供科学依据。方法2013年3—12月,采用多阶段分层整群抽样方法,在全国31个省、自治区和直辖市(港澳台地区除外)随机抽取城镇社区和农村县或郊区中≥18岁常住居民(在当地居住≥6月)68 906人,入户进行问卷调查和专科体检,分析不同工作环境、负重状况、职业与肛肠疾病患病的关系。结果共调查≥18岁常住居民68 906人,肛肠疾病患病率为50.10%,其中城市地区患病率(51.14%)高于农村(48.39%)。不同类型肛肠疾病患病率从大到小依次为:痔疮、肛裂、肛门湿疹、肛瘘和脱肛,患病率分别为49.14%、0.18%、0.14%、0.10%和0.02%,其中痔疮患病人数占所有患病人数的98.09%。在高温高湿环境下工作的人群,肛肠疾病患病率明显高于工作环境一般或舒适的人群。从事负重越大的工作,患病率越高。城市地区肛肠疾病患病率居前3位的职业是司机(69.49%)、教师(57.17%)和商业/服务业员工(56.65%);农村地区为司机(62.81%)、专业技术人员(61.96%)和教师(55.56%)。结论中国肛肠疾病患病率仍处于较高水平,在高温高湿环境下工作、从事负重工作和久坐、久站职业的人群为高发人群,应针对这些高危人群采取相应的防治措施。

关键词： 肛肠疾病   中医外治综合疗法   换药疼痛   创面愈合时间  

摘要： 目的观察中医外治综合疗法对肛肠疾病术后创面愈合效果和换药疼痛的效果。方法选取医院收治的肛肠疾病手术治疗的患者78例为研究对象,随机分为观察组和对照组,每组39例。对照组采用口服盐酸曲马多治疗,观察组采用中医外治综合疗法治疗,观察比较2组不同时段VAS评分,创面愈合时间、住院时间,VEGF、EGF指标情况。结果术后第1天、第4天、第7天观察组VAS评分均低于对照组(P<0.01);观察组创面愈合时间、住院时间均短于对照组(P<0.01);出院时,观察组VEGF、EGF指标均优于对照组(P<0.01)。结论在肛肠疾病手术治疗后使用中医外治综合疗法能够缩短创面愈合时间,缓解患者的换药疼痛,提高患者的舒适度,值得临床推广使用。

关键词： 耳穴埋豆   穴位贴敷   肛肠疾病术后   疼痛缓解   护理满意度  

摘要： 目的探讨耳穴埋豆联合穴位贴敷护理干预在肛肠疾病术后患者疼痛缓解中的应用价值。方法选择2015年1月~2017年2月因肛肠疾病于我院行手术治疗的患者86例,采用随机数字表法将其分为对照组、观察组,每组43例。则联合耳穴埋豆及穴位贴敷护理干预,7 d为1个疗程。比较两组护理前后疼痛情况,比较两组护理满意度及临床疗效差异。结果两组患者治疗前疼痛评分差异无统计学意义(P>0.05),具有可比性。护理后观察组疼痛评分低于对照组,差异有统计学意义(P<0.05);观察组总有效率97.67%,高于对照组的81.40%,差异有统计学意义(χ2=6.081,P<0.05)。观察组患者的总满意率95.35%,高于对照组的76.74%,差异有统计学意义(P<0.05)。结论对于肛肠疾病术后患者而言行耳穴埋豆联合穴位贴敷护理干预具有重要意义,可有效缓解疼痛,提高护理满意度,值得推广。

关键词： adrenal insufficiency   clinical pharmacology   Crohn's disease   immunosuppression   inflammatory bowel disease   ulcerative colitis  

摘要： Background: Adrenal insufficiency (AI) secondary to treatment with glucocorticoids (GCs) is common in patients with inflammatory bowel disease (IBD), but little is known about the relationship between AI and the clinical course in IBD. The aim of the study was to compare the clinical course in IBD patients with normal adrenal function versus patients with subnormal adrenal function. Methods: A retrospective observational study on 63 patients with IBD who had performed a low-dose short Synacthen test (LDSST) (1 g) immediately (1-7 days) after a standard course of GCs. A subnormal LDSST was defined as serum cortisol <550 nmol/L. Outcomes were time to next flare and fecal calprotectin levels. Results: Sixty-three percent (n = 40) of the IBD patients had a subnormal LDSST. Patients who were steroid-free (n = 41) after the LDSST were observed for 3 years. Patients with a peak serum cortisol <400 nmol/L immediately after GC treatment had significantly longer time until the next flare-up of their IBD and tended to use a lower cumulative prednisolone dose during the study period in comparison to the other subgroups. Fecal calprotectin levels were significantly lower in patients with a peak s-cortisol <550 nmol/L versus patients with peak s-cortisol >= 550 nmol/L (median 336 mu g/g (IQR 521) versus 955 mu g/g (IQR 1867);p = 0.012). Conclusions: GC-induced AI is common in patients with IBD and is associated with lower disease activity. This suggests a link between responsiveness to GC treatment and suppression of the hypothalamic-pituitary-adrenal axis in IBD.

关键词： Drug targeting   Inflammatory bowel disease (IBD)   Molecular dynamics   Phospholipase A(2) (PLA(2))   Prodrug   Thermodynamic integration   Umbrella sampling/WHAM  

摘要： Targeting drugs to the inflamed intestinal tissue(s) represents a major advancement in the treatment of inflammatory bowel disease (IBD). In this work we present a powerful in-silico modeling approach to guide the molecular design of novel prodrugs targeting the enzyme PLA(2), which is overexpressed in the inflamed tissues of IBD patients. The prodrug consists of the drug moiety bound to the sn-2 position of phospholipid (PL) through a carbonic linker, aiming to allow PLA(2) to release the free drug. The linker length dictates the affinity of the PL-drug conjugate to PLA(2), and the optimal linker will enable maximal PLA(2)-mediated activation. Thermodynamic integration and Weighted Histogram Analysis Method (WHAM)/Umbrella Sampling method were used to compute the changes in PLA(2) transition state binding free energy of the prodrug molecule (a dagger a dagger G(tr)) associated with decreasing/increasing linker length. The simulations revealed that 6-carbons linker is the optimal one, whereas shorter or longer linkers resulted in decreased PLA(2)-mediated activation. These in-silico results were shown to be in excellent correlation with experimental in-vitro data. Overall, this modern computational approach enables optimization of the molecular design of novel prodrugs, which may allow targeting the free drug specifically to the diseased intestinal tissue of IBD patients.

关键词： quality of care   inflammatory bowel disease   Focus group interview  

摘要： Aims and objectives. The aim of this study was to explore the perceptions of health care among persons living with inflammatory bowel disease.& para;& para;Background. The quality of care plays an important role in the life of persons with a chronic disease. To define what persons with inflammatory bowel disease perceive as high-quality care, greater focus must be placed on the individual's own perspective of living with the condition.& para;& para;Design. A qualitative exploratory study was conducted based on focus groups.& para;& para;Methods. Five focus groups were conducted with adult persons living with inflammatory bowel disease, 14 men and 12 women aged 19-76 years. The interviews were performed between January-June 2014.& para;& para;Results. The perceptions of health care from the perspective of persons living with inflammatory bowel disease were summarised in two categories: 'professional attitudes of healthcare staff' and 'structure of the healthcare organisation'. Persons with inflammatory bowel disease want to be encountered with respect, experience trust and obtain information at the right time. They also expect shared decision-making, communication and to encounter competent healthcare professionals. Furthermore, the expectations on and perceptions of the structure of the healthcare organisation comprise access to care, accommodation, continuity of care, as well as the pros and cons of specialised care.& para;& para;Conclusion. The findings show the importance of establishing a respectful and trusting relationship, facilitating healthcare staff and persons with inflammatory bowel disease to work as a team in fulfilling individual care needs - but there is room for improvement in terms of quality of care.& para;& para;Relevance to clinical practice. A person-centred approach, which places the individual and her/his family at the centre, considering them experts on their own health and enabling them to collaborate with healthcare staff, seems important

关键词： inflammatory bowel diseases   Crohn disease   NOD2   CARD15   single nucleotide polymorphism   TLR4   ulcerative colitis  

摘要： OBJECTIVEThe common association between NOD2/CARD15 and TLR4 gene variants with inflammatory bowel disease (IBD) has not been replicated in all studies. We studied the polymorphism of these two genes in Tunisian patients with IBD. METHODSPolymorphisms of NOD2 (R702W, G908R and L1007fs) and TLR4 (Asp299Gly and Thr399Ile) genes were analyzed in 106 patients with IBD (68 with ulcerative colitis [UC], 38 with Crohn's disease [CD]) and 160 healthy controls using polymerase chain reaction-restriction fragment length polymorphism. Genotypes and phenotypes were correlated. RESULTSThe mutated allele of TLR4-Thr399Ile was strongly associated with IBD (9.4% in IBD, 7.4% in UC and 13.2% in CD vs 2.5% in controls;P = 0.0004, 0.014 and 0.00006, respectively). Heterozygous genotypes were significantly more frequent in patients with IBD (17.0%), UC (14.7%) and CD (21.1%) than in controls (5.0%) (P = 0.0012, 0.012 and 0.001, respectively). Interestingly, the wild genotype was found to be protective (odds ratio 0.24). The mutated allele of TLR4-Asp299Gly was more frequent in controls (6.8%) than in patients with IBD (2.9%). A phenotypic correlation of Asp299Gly-AG genotype with arthritis in UC patients was detected (P = 0.003). Regarding the NOD2 gene, the common variations studied were not polymorphic and there was no genetic association with IBD. CONCLUSIONThe TLR4-Thr399Ile variant was strongly associated with susceptibility to IBD, whereas TLR4-Asp299Gly seems to play a role in the clinical expression of UC. The rarity and non-association of NOD2 mutations with IBD may reveal a genetic characteristic of the population in our region.

关键词： Crohn's disease   disability   functioning   inflammatory bowel disease   multiple sclerosis   rheumatoid arthritis   ulcerative colitis  

摘要： Disability is a common worldwide health challenge and it has been increasing over the past 3 decades. The treatment paradigm has changed dramatically in inflammatory bowel diseases (IBDs) from control of symptoms towards full control of disease (clinical and endoscopic remission) with the goal of preventing organ damage and disability. These aims are broadly similar to rheumatoid arthritis and multiple sclerosis. Since the 1990s, our attention has focused on quality of life in IBD, which is a subjective measure. However, as an objective end-point in clinical trials and population studies, measures of disability in IBD have been proposed. Disability is defined as ... any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.' Recently, after 10 years of an international collaborative effort with the World Health Organization (WHO), a disability index was developed and validated. This index ideally would assist with the assessment of disease progression in IBD. In this review, we will provide the evidence to support the use of disability in IBD patients, including experience from rheumatoid arthritis and multiple sclerosis. New treatment strategies, and validation studies that have underpinned the interest and quantification of disability in IBD, will be discussed.