目的 研究低浓度N2O清醒镇痛在高龄患者结肠镜检查中的安全性和有效性.方法 将2012年5月至2016年6月行N2O清醒镇痛结肠镜检查的520例≥70岁高龄患者作为观察组,同期常规行结肠镜检查的580例≥70岁高龄患者作为对照组,观察2组患者术前、术中、术后心率(HR)、血氧饱和度(SPO2)、血压(BP)情况,以及检查满意率及不良反应发生情况.结果 观察组术中HR、SPO2、BP与对照组比较差异有统计学意义(P<0.05),且观察组满意率高于对照组,不良反应明显低于对照组,差异有统计学意义(P<0.05).结论 低浓度N2O清醒镇痛用于结肠镜检查提高了老年患者结肠镜检查的舒适度和安全性,临床效果良好.

Objective:To explore the expression and clinical significance of serum homocysteine (Hey),folic acid and vitamin B12 in gastric cancer and precancerous diseases.Methods:100 patients with gastric cancer (gastric cancer group) and 100 patients with benign gastric lesions including 41cases of gastritis,34 cases of gastric ulcer,25 cases of gastric polyps,(precancerous lesions group)who were treated in our hospital were collected from January 2014 to August 2016.At the same time,200 healthy volunteers as control group were randomly selected.The serum Hcy level of three groups were detected by the cyclic enzymatic,and folic acid and vitamin B12 level were detected by the electrochemiluminescence immunoassay.And the associate between Hey,folic acid,vitamin B12 and clinic pathological features in patients with gastric cancer were analyzed.Results:The serum Hey of gastric cancer and precancerous lesions group was higher than that of control group,and folic acid,vitamin B12 were lower than those of precancerous lesions group,the difference was statistically significant (P＜0.05).Moreover,the serum Hcy of gastric group was higher than that of control group,and folic acid,vitamin B12 were lower than those of precancerous lesions group,the difference was statistically significant (P＜0.05).The serum Hcy in patients with Ⅲ+Ⅳ gastric caner was higher than that in Ⅰ+Ⅱ gastric cancer,and the serum Hcy in patients with advanced gastric cancer was higher than that in earlier gastric cancer,and the serum Hcy in patients with lymph node metastasis was higher than that in patients with without metastasis,the difference was statistically significant (P＜0.05).No association between Hcy expression and gender,age,location of lesion,degree of differentiation was found (P＜0.05).The expression of folic acid,vitamin B12 in clinic pathological features in patients with gastric cancer was no statistical significance(P＞0.05).Conclusion:Serum Hcy is expressed at high levels in patients with gastric cancer,and folic acid,vitamin B12 is expressed at low levels.Combing detection of three metrics can help to distinguish early gastric cancer and precancerous lesions.Serum Hcy may also be involved in the development of gastric cancer.Therefore,Hey,folic acid and vitamin B12 can be used as an important indicator for early diagnosis of gastric cancer and precancerous lesions.

Objective To explore the diagnostic value of pepsinogen (PG) combined with homocysteine (Hcy) detection on benign and malignant lesions of gastric tissue. Methods A total of 100 patients with gastric cancer, who admitted to our hospital from January 2014 to August 2016, were selected as the gastric cancer group, and 100 patients with benign lesions (41 cases of gastritis, 25 cases of gastric polyps, 34 cases of gastric ulcer) were selected as the be-nign lesions group. Besides, 200 healthy persons who were inspected in our hospital during the same period were select-ed as the control group. The serum PG (PGⅠ, PGⅡ) levels of three groups were detected by the enzyme-linked immunosor-bent assay (ELISA), and the rate of pepsinogen (PGR) was calculated. The serum levels of Hcy of the three groups were de-termined by cyclic enzyme assay, and the value of serum PG combined with Hcy in the diagnosis of benign and malignant gastric lesions was evaluated. Results The serum PGⅠlevels and PGR levels of the gastric cancer group and benign le-sions group were (59.37 ± 14.16)μg/L, (3.27 ± 1.52), (93.85 ± 14.23)μg/L, (7.65 ± 2.04), respectively, which were significantly lower than (149.92 ± 13.34)μg/L and (11.40 ± 1.95) of the control group (P<0.05). The serum PGⅡlevels and Hcy levels in the gastric cancer group and benign lesion group were (20.18±4.59)μg/L, (26.37±3.85)μmol/L, (16.06±5.87)μg/L, (12.16± 3.91)μmol/L, respectively, which were significantly higher than (10.71±5.15)μg/L and (9.83±3.24)μmol/L in the con-trol group (P<0.05). The levels of serum PGⅠand PGR in the gastric cancer group were significantly lower than those in the benign lesions group, and the levels of serum PGⅡand Hcy in the gastric cancer group were significantly higher than those in the benign lesions group (all P<0.05). AtⅠ,Ⅱ,Ⅲ,Ⅳof tumor, nodes, metastasis (TNM) stage, the serum Hcy levels were (19.64 ± 4.98)μmol/L, (22.00 ± 5.14)μmol/L, (24.38 ± 5.97)μmol/L, (27.07 ± 4.52)μmol/L, respectively, which showed an increased tendency, and the overall difference was statistically significant (P<0.05);PGⅠlevels were respectively (67.63 ± 15.91)μg/L, (55.39 ± 15.18)μg/L, (46.18 ± 14.97)μg/L, (39.72 ± 15.50)μg/L, PGⅡlevels were re-spectively (18.02 ± 3.97)μg/L, (17.25 ± 4.25)μg/L, (16.34 ± 4.50)μg/L, (15.38 ± 4.12)μg/L, and PGR levels were respec-tively (3.87±2.28), (3.38±2.56), (2.76±3.31), (2.02±3.54), which all showed a decreased trendency, with statistically sig-nificant overall differences (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PGⅠ+PGR+Hcy in the diagnosis of gastric cancer were 89.00%, 95.00%, 94.68%, 89.62%, 92.00%, respec-tively, which were significantly higher than those of PGⅠ+PGR (76.00%, 83.00%, 81.72%, 77.57%, 79.50%, respective-ly) and Hcy (71.00%, 86.00%, 83.53%, 74.78%, 78.50%, respectively) (P<0.05). Conclusion Serum PG and Hcy can be used to evaluate the disease state of gastric mucosa. The combination of the two indexes is helpful for the early diagno-sis of benign gastric lesions and gastric cancer, which can be used to improve the diagnostic value of gastric cancer.

Objective:To research the diagnostic value of measuring serum pepsinogen Ⅰ(PGⅠ),pepsinogen Ⅱ(PGⅡ) and gastrin-17 (G-17) for atrophic gastritis and gastric cancer.Methods:A total of 44 patients were diagnosed with non-atrophic gastritis(non-atrophic gastritis group),47 patients were chronic atrophic gastritis(atrophic gastritis group),42 were gastric cancer(gastric cancer group)were enrolled in the hospital February 2015 to December 2015.The serum PGⅠ,PGⅡ and G-17 levels were detected by enzyme-linked immunosorbent assay (ELISA),and PGⅠ/Ⅱ ratio (PGR) was calculated,compared above indexes in different groups,and drew the receiver operating curve (ROC) of above indexes,and analyzed their diagnostic value.Results:The levels of serum PGⅠ and PGR in gastric cancer group and chronic atrophic gastritis group were significantly decreased than that of non-atrophic gastritis group,and gastric cancer group decreased more,the differences were statistically significant (P＜0.05),the level of PGⅡ in atrophic gastritis group was lower than non-atrophic gastritis group,the difference was statistically significant (P＜0.05),the level of serum G-17 in gastric cancer were significantly increased than chronic atrophic gastritis and non-atrophic gastritis group,the differences were statistically significant (P＜0.05).The optimal value of PGⅠ screening for atrophic gastritis was PGⅠ＜90 ng/mL,its sensitivity and specificity were 71.5％ and 51.0％,respectively.The optimal value of PGR screening for atrophic gastritis was PGR＜8,its sensitivity and specificity were 71.9％ and 54.0％,respectively.The optimal value of G-17 screening for atrophic gastritis was G-17＜5 pmol/L,its sensitivity and specificity were 66.1％ and 64.0％,respectively.The optimal value of PGⅠ screening for gastric cancer was PGⅠ＜73 ng/mL,its sensitivity and specificity were 86.0％ and 74.9％,respectively.The optimal value of PGR screening for gastric cancer was PGR＜3,its sensitivity and specificity were 90.2％ and 62.5％,respectively.The optimal value of G-17 screening for gastric cancer was G-17＜4 pmol/L,its sensitivity and specificity were 62.5％ and 61.3％,respectively.Conclusion:The levels of serum PGⅠ and PGR in patients with gastric cancer and atrophic gastritis are significantly decreased,and the serum G-17 of the patients with gastric cancer are abnormally increased,detecting serum PG combined with G-17 can be used to screen early gastric cancer and chronic atrophic gastritis.

Objective To investigate the effectiveness and safety of nitrous oxide for colonoscopy and evaluate its clinical ap-plication value.Methods A total of 532 patients were randomly divided into N2 O group ( inhalation with nitrous oxide ) and O2 group ( inhalation with pure oxygen) .The heart rate( HR) and blood oxygen saturation ( SPO2 ) were observed before, during, and after the colonoscopy.The reaction and feeling of patients and doctors were evaluated by visual analogue scale( VAS) .Results There was not significant difference in HR and SPO2 between the N2O group and O2 group.The satisfaction rate of both doctors and patients in the N2O group was higher than O2 group,withsignificant difference(P<0.01).Conclusions Nitrous oxide for colonoscopy is comfortable and safe, and is worthy of widespread use.