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食管癌围术期管胃的胃电图变化特征

Study on the perioperative changes of electrogastrogram of thoracic (tube) stomach in patients with esophageal cancer

摘要:

目的 探讨食管癌围术期管胃胃电图特征及变化趋势.方法 前瞻性分析2013年3-11月初次就诊于四川省肿瘤医院的30例食管癌患者的临床资料.符合入组标准的患者经同一小组医师行Ivor-Lewis手术方式完成食管癌根治术,在术前1d,术后第3、7、11、30天测量其餐前及餐后胃电图,以术前1d胃电图作自身对照.分析胃电图的主频、主频不稳定系数、主功率、餐后/餐前功率比、正常慢波节律百分比、胃动过缓节律百分比、胃动过速节律百分比等指标.正态分布的计量资料以(x)±s表示,偏态分布的计量资料以M(Qn)表示.采用重复测量双因素方差分析对术前与术后、餐前与餐后胃电图参数进行比较,组间比较采用LSD法或秩和检验.结果 30例患者纳入研究,其中男26例,女4例;年龄49 ~ 75岁,平均年龄62岁.患者餐前、餐后的主频参数变化趋势一致,由术前2.83 ±0.13和3.01±0.17变化至术后第30天的2.66 ±0.10和2.82±0.10,与术前比较,术后各时间点主频参数均明显降低,餐后较餐前高,随术后时间的延长呈现回升的趋势(F=285.62,P<0.05);而时间与进餐没有交互作用(F=0.22,P>0.05).患者餐前、餐后的主频不稳定系数变化趋势一致,由术前0.133 ±0.031和0.045 ±0.019变化至术后第30天的0.150±0.043和0.115±0.010,与术前比较,术后各时间点主频不稳定系数均明显升高,餐后较餐前低,随术后时间的延长呈现下降的趋势(F=16.51,P<0.05).患者餐前、餐后主功率变化趋势一致,由术前(85±15)μV和(149±23) μV变化至术后第30天的(74±9) μV和(98±10) μV,与术前比较,术后各时间点餐前、餐后主功率均明显降低,随时间的推移呈现回升的趋势(F=48.45,P<0.05),时间与进餐具有交互作用(F =7.39,P<0.05).患者餐后/餐前功率比由术前3.00±0.35变化至术后第30天的2.52±0.25,与术前比较,术后各时间点餐后/餐前功率比均明显下降,随术后时间的延长呈现上升的趋势(F=26.66,P<0.05).患者餐前、餐后的正常慢波节律百分比变化趋势一致,由术前81%±6%和94%±5%变化至术后第30天的57%±5%和70%±5%,与术前比较,术后各时间点餐前、餐后的正常慢波节律百分比均明显降低,餐后较餐前高,随术后时间的延长呈现回升的趋势(F =49.36,P<0.05);而时间与进餐没有交互作用(F=0.24,P>0.05).患者餐前、餐后的胃动过缓节律百分比变化趋势一致,由术前17%±7%和4%±4%变化至术后第30天的32%±4%和21%±4%,与术前比较,术后各时间点餐前、餐后的胃动过缓节律百分比均明显升高,餐前较餐后高,随术后时间的延长呈现下降的趋势(F=46.54,P<0.05);而时间与进餐具有交互作用(F=18.12,P<0.05).患者餐前、餐后的胃动过速节律百分比变化趋势不完全一致,由术前1.55% (1.04%,2.21%)和1.95% (1.74%,4.22%)变化至术后第30天的8.97% (5.76%,12.02%)和12.41%(8.04%,16.85%),与术前比较,均明显升高,餐后较餐前高;餐前、餐后的胃动过缓节律百分比术前和术后第3天时比较,差异有统计学意义(Z =11.47,13.28,P<0.05),而第7、11、30天比较,差异无统计学意义(Z=1.88,0.31,0.03,P>0.05);而时间与进餐没有交互作用(F=0.85,P<0.05).结论 食管癌术后管胃在进餐前、餐后仍然保留胃的基本电活动特征.术后管胃的主频参数、主频不稳定系数、主功率、餐后/餐前功率比、正常慢波百分比、胃动过缓节律百分比以及胃动过速节律百分比与术前比较均有明显差异,管胃的上述各参数在围术期内处于一个动态变化的过程.

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abstracts:

Objective To investigate the perioperative characteristics and changing trends of gastric electrical activity of thoracic (tube) stomach in patients with esophageal cancer.Methods The clinical data of 30 patients with esophageal cancer who were admitted to the Sichuan Cancer Hospital between March 2013 and November 2013 were prospectively analyzed.All the eligible patients underwent esophageal cancer resection by Ivor-Lewis according to the inclusion criteria.The electrogastrograms of patients were recorded at preoperative day 1 and at postoperative day 3,7, 11 and 30.The electrogastrograms of patients at preoperative day 1 were used as the control.The parameters of electrogastrogram were analyzed including main frequency, coefficient of dominant frequency instablility, main power, postprandial/preprandial power ratio, percentage of normal gastric slow wave,percentage of slow gastric slow wave and percentage of tachycardia gastric slow wave.Measurement data with normal distritution were presented as x ± s, and measurement data with skew distritution were presented as M (Qn).The postoperative time and pre-and post-prandial electrogastrograms were compared by the repeated measures two-way ANOVA.The comparison between groups were evaluated with the LSD test and analysis of variance.Results Thirty patients were screened for eligibility with a mean age of 62 years (range, 49-75 years), including 26 males and 4 females.The pre-and post-prandial main frequencies were changed from 2.83 ± 0.13 and 3.01 ± 0.17 before operation to 2.66 ± 0.10 and 2.82 ± 0.10 at postoperative day 30 with coherent changing trend.The main frequencies at postoperative each time points were significantly lower than those before operation while postprandial above indicators were higher than preprandial those, showing a significant increasing trend with the passage of postoperative time (F =285.62, P < 0.05).There was no interaction between the time and meal (F =0.22, P > 0.05).The pre-and post-prandial coefficients of dominant frequency instablility were changed from 0.133 ±0.031 and 0.045 ±0.019 before operation to 0.150 ±0.043 and 0.115 ±0.010 at postoperative day 30 with coherent changing trend, and coefficients of dominant frequency instablility at postoperative each time points were significantly higher than those before operation while postprandial above indicators were lower than preprandial those, showing a significant reducing trend with the passage of postoperative time (F =16.51, P < 0.05).The pre-and post-prandial main powers were changed from (85 ± 15) μV and (149 ± 23) μV before operation to (74 ± 9) μμV and (98 ± 10) μV at postoperative day 30, and main powers at postoperative each time points were significantly lower than those before operation, showing a significant increasing trend with the passage of postoperative time (F =48.45, P < 0.05).There was interaction between the time and meal (F =7.39, P < 0.05).The postprandial/preprandial power ratio was changed from 3.00 ± 0.35 before operation to 2.52 ± 0.25 at postoperative day 30, and postprandial/preprandial power ratios at postoperative each time points were significantly lower than those before operation, showing a significant increasing trend with the passage of postoperative time (F =26.66, P < 0.05).The pre-and post-prandial percentages of normal gastric slow wave were changed from 81% ± 6% and 94% ± 5% before operation to 57% ± 5% and 70% ± 5% at postoperative day 30 with coherent changing trend, and percentages of normal gastric slow wave at postoperative each time points were significantly lower than those before operation while postprandial above indicators was lower than preprandial those, showing a significant increasing trend with the passage of postoperative time (F =49.36,P <0.05).There was no interaction between the time and meal (F =0.24, P > 0.05).The pre-and postprandial percentages of slow gastric slow wave were changed from 17% ± 7% and 4% ± 4% before operation to 32%±4% and 21%±4% at postoperative day 30 with coherent changing trend, and percentages of slow gastric slow wave at postoperative each time points were significantly higher than those before operation while preprandial above indicators were higher than postprandial those, showing a significant reducing trend with the passage of postoperative time (F =46.54, P < 0.05).There was interaction between the time and meal (F =18.12, P < 0.05).The pre-and post-prandial tachycardia gastric slow wave percentages were changed from 1.55% (1.04%,2.21%) and 1.95% (1.74%, 4.22%) before operation to 8.97% (5.76%, 12.02%) and 12.41% (8.04%,16.85%) at postoperative day 30 without completely coherent changing trend, and percentages of tachycardia gastric slow wave at postoperative each time points were significantly higher than those before operation while postprandial above indicators were higher than preprandial those, showing a significant difference between before operation and postoperative day 3 (Z =11.47, 13.28, P < 0.05) and no significant difference among the postoperative day 7, 11, 30 (Z =1.88, 0.31, 0.03, P > 0.05).There was no interaction between the time and meal (F=0.85, P<0.05).Conclusions After the esophagectomy, gastric electrical activity of thoracic (tube) stomach is also retained before and after the meal.There are significant differences among the main frequency, main power, coefficients of dominant frequency instablility, postprandial/preprandial power ratio,percentage of normal gastric slow wave, percentage of slow gastric slow wave, percentage of tachycardia gastric slow wave of thoracis (tube) stomach, they have changed dynamically in the perioperative period.

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