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肝硬化上消化道出血和幽门螺杆菌感染的相关性研究 总被引:7,自引:0,他引:7
目的研究肝硬化患者幽门螺杆菌感染和上消化道出血之间的关系.方法肝硬化患者160例,内镜检查了解食管静脉曲张和消化性溃疡的发生情况及出血的原因,同时胃粘膜活检作尿素酶试验,检测幽门螺杆菌(Hp).结果Hp阳性组消化性溃疡发生率(64.1%)明显高于阴性组(37.8%,P<0.01).出血率在Hp阳性组(38.5%)也明显高于阴性组(22%,P<0.05).结论Hp感染和肝源性溃疡发生有关,Hp感染者的肝源性溃疡发生率增高及胃粘膜活动性炎症可能导致出血率升高,根除Hp有可能降低肝硬化上消化道出血. 相似文献
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Svoboda P Ehrmann J Klvana P Machytka E Rydlo M Hrabovský V 《Vnitr?ní lékar?ství》2007,53(12):1274-1277
108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4%) followed by peptic gastric ulcer (13.9%) and peptic ulcer of duodenum (11.1%), then portal hypertension gastropathy (5.6%), gastric varices (4.6%), reflux oesophagitis (2.8%), Mallory-Weiss syndrom (2.8%) and erosive gastropathy (0.9%). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69% of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist's attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6% of patients the bleeding was a direct consequence of portal hypertension, in 62% it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy. 相似文献
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普萘洛尔预防肝硬化初次上消化道出血的meta分析 总被引:1,自引:0,他引:1
对普萘洛尔能否预防肝硬化上消化道出血进行系统评价。检索1980年1月至2000年12月期间发表的有关普萘洛尔预防肝硬化初次上消化道出血的随机对照临床试验。按照入选标准,有9项临床试验纳入本研究,由两名作者各自独立地对入选研究中有关试验设计、研究对象的特征、干预措施、研究结果等内容进行摘录,并用RevMan3.1软件进行分析。上消化道出血、死亡及因出血死亡的合并优势比(OR)分别为0.45[95%CI0.34,0.60]、0.73[95%CI0.55,0.96]、0.44[95%CI0.28,0.69]。肝功能越差,预防效果越差;腹水患者的预防效果亦较差。普萘洛尔可以预防肝硬化上消化道出血,并可降低总死亡率以及出血所致的死亡率。肝功能的状况和腹水的有无是影响普萘洛尔的预防效果的重要因素。 相似文献
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《实用肝脏病杂志》2015,(3)
目的探讨肝硬化上消化道出血的预后因素。方法对260例肝硬化初次上消化道出血患者的临床资料进行多因素分析。结果本组呕血113例(43.5%),柏油样黑便51例(19.6%),呕血和柏油样黑便96例(36.9%);轻度出血107例(41.2%),中度出血126例(48.5%),重度出血27例(10.4%);192例行急诊胃镜检查发现食管静脉曲张破裂出血99例(51.6%),胃底静脉曲张破裂出血14例(7.3%),食管胃底静脉曲张破裂出血7例(3.6%),胃溃疡25例(13.2%),十二指肠球部溃疡16例(8.3%),胃十二指肠球部溃疡4例(2.1%),胃粘膜病变27例(14.1%);多因素分析显示Child-Pugh分级、肝性脑病、肾功能不全、再出血和原发性肝癌是独立的预后预测因素。结论胃镜检查结果、凝血酶原时间、有无并发症可能是影响肝硬化UGH预后的独立高危因素,临床中对具有这些高危因素的患者应加以重视。 相似文献
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Vlachogiannakos J Montalto P Burroughs AK 《Minerva gastroenterologica e dietologica》2000,46(2):87-98
Variceal bleeding due to portal hypertension, is a major complication of hepatic cirrhosis. There is a high mortality rate after first bleeding so that primary prophylaxis to prevent bleeding from varices and portal hypertensive gastropathy is the current optimal therapeutic approach. The difficulty in identifying individual patients with varices who will bleed before they do so, can justify a strategy of prophylactic treatment for all patients with varices. We have evaluated the different therapies that have been assessed in randomized controlled trials for prevention of first bleeding, using meta-analysis where applicable. The current treatment of first choice is non-selective beta-blockers; it is cheap, easy to administer, and is effective in preventing the first variceal hemorrhage and bleeding from gastric mucosa. Combination drug therapy of beta-blockers and nitrates probably gives little added advantage. Injection sclerotherapy is contraindicated. The conflicting results of the randomized studies of endoscopic banding ligation, as well as its cost, do not warrant its use at present. However, endoscopic banding ligation may be a reasonable alternative for patients who cannot tolerate, or have contraindications to beta-blockers or no haemodynamic response to the drug therapy, but this must be proved in randomized trials. 相似文献
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目的探讨食管胃底静脉栓塞术(percutaneous transsplenic variceal embolization PTVE)治疗肝硬化门静脉高压性上消化道出血,对患者肝功能的影响。方法通过经肝经门静脉食管胃底静脉栓塞断流术治疗有食管胃底静脉曲张出血的肝硬化患者36例,对照组30例采用内科保守治疗,随访6个月的肝功能指标、Child-Pugh分级变化和出血复发率,进行对比。结果观察组的肝功能指标:ALB、TBil、PTA和NH3,与对照组对比P值分别为〈0.05、〈0.01、〈0.01和〈0.001;Chind-Pugh分级与对照组对比,P〈0.01,有显著性差异;观察组出血再发率也明显低于对照组,8.33%对26.7%,P〈0.05,两组对比显著性差异。结论食管胃底静脉栓塞断流术不仅能减少门静脉高压性上消化道出血复发率降低,同时能改善肝硬化患者的肝功能状况。 相似文献
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目的 探讨应用美罗培南(MEM)治疗肝硬化(LC)并发上消化道出血(UGB)患者对感染预防和再出血的影响。方法 2016年11月~2018年10月期间我院重症医学科收治的92例LC并发UGB患者被随机分为对照组46例和观察组46例,在内科止血等综合治疗的基础上,分别在确定感染时再给予头孢曲松或在入院时即给予预防性应用MEM治疗。结果 在治疗10 d,观察组死亡1例,对照组死亡2例;观察组WBC计数为(5.6±1.9)×109/L,血清降钙素原(PCT)水平为(0.25±0.03) ng/mL,显著低于对照组的(9.8±1.2)×109/L和(0.42±0.06) ng/mL,而血小板计数为(106.2±15.7)×109/L,显著高于对照组的(93.6±20.1)×109/L(P<0.05);观察组患者再出血率和感染发生率分别为8.9%和11.1%,均显著低于对照组的25.0%和43.2%,差异有统计学意义(P<0.05);观察组共检出8株菌株,对照组检出24株。两组感染患者均以大肠埃希菌感染为主,其次为肺炎克雷伯菌。结论 预防性使用抗生素MEM治疗LC伴UGB患者能显著降低感染发生率,并对防止再出血有帮助,值得临床进一步验证。 相似文献
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目的为了对肝硬变腹水合并上消化道出血有进一步认识,总结了近3a157例肝硬变腹水合并上消化道出血者57例及其并发症.方法根据诊断标准,经统计学卡方验证,将出血者(57例)与无出血者(100例)合并脾功能亢进、消化性溃疡、自发性腹膜炎、肝昏迷及肾功能减退进行对照.结果出血组的肾功能减退(68.4%)及肝昏迷(26.3%)发生率明显高于未出血者(19.0%和7.0%,P<0.01).结论肝硬变腹水出现上消化道出血者,再合并其他并发症的发生率较未出血者高为明确出血原因及部位采取相应的治疗措施,应及时进行急诊内镜检查. 相似文献
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目的探讨老年非静脉曲张性上消化道出血患者并发医院感染发生的危险因素,以利于合理防治。方法回顾性调查老年非静脉曲张性上消化道出血住院患者210例,对69例并发医院感染病例(感染组)与141例未并发医院感染病例(非感染组)进行logistic回归分析。结果210例老年患者中,发生院内感染69例,感染率32.9%。患者营养状况、体力状况、住院时间、侵入性操作与发生医院感染呈显著正相关(P〈0.05),与性别、贫血程度无明显相关性。医院感染部位以下呼吸道和泌尿道、导管相关血源性感染为主,分别占55.1%、40.6%和4.3%。菌群组成以革兰阴性杆菌为主,占64.6%。结论老年上消化道出血患者住院期间易发生医院感染,感染发生与患者营养状况、体力状况、住院时间、侵入性操作有关,应重视危险因素,采取积极应对措施,减少医院感染的发生: 相似文献
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Michael J. Williams 《Expert Review of Gastroenterology & Hepatology》2016,10(4):505-515
Gastrointestinal bleeding remains a major cause of mortality in patients with cirrhosis. The most common source of bleeding is from gastroesophageal varices but non-variceal bleeding from peptic ulcer disease also carries a significant risk in patients with liver disease. The prognosis is related to the severity of the underlying liver disease, and deaths often occur due to liver failure, infection or renal failure. Optimal management should therefore not only achieve haemostasis but address these complications as well. The management of gastrointestinal bleeding in patients with cirrhosis includes a range of medical, endoscopic and radiological interventions. This article updates the recent developments in this area and highlights topics where further research is still required. 相似文献
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Eleftheriadis N Makri S Aggouridaki C Pithara E Makris P 《European Journal of Internal Medicine》2002,13(8):480-484
BACKGROUND: In patients with hereditary bleeding disorders, upper gastrointestinal bleeding presents a life-threatening complication, while the role of Helicobacter pylori (H. pylori) infection in this group of patients has not been fully clarified in the literature. The aim of the present study was to evaluate the role of H. pylori infection and of dental status in upper gastrointestinal bleeding in patients with hereditary hemorrhagic disorders (HHD). METHODS: Thirty-seven patients with HHD (18 patients with and 19 without a history of upper gastrointestinal bleeding) and 26 control patients without HHD, who were admitted to our hospital for elective gastroscopy due to dyspeptic symptoms, were included in the study. Endoscopy was performed on all patients with gastrointestinal bleeding and on controls. ELISA was used to detect IgG, anti-CagA, and IgA antibodies to H. pylori in the serum and saliva of patients and controls. Moreover, dental status was examined using the decayed/missing/filled teeth index (DMFT) in all subjects. The chi(2)-test was used for statistical analysis. RESULTS: Some 64.8% of the patients and 65.4% of the controls had H. pylori IgG antibodies in serum (P>0.1, NS) while 54.05% of the patients and 34.6% of controls were anti-CagA-positive in serum (P=NS). However, 83 and 26.3% of the HHD patients with and without gastrointestinal bleeding, respectively, were serum anti-CagA-positive (P<0.01) while 72 and 58%, respectively, were serum IgG-positive (P=NS). H. pylori antibodies in saliva and the DMFT calculated index did not differ between the two subgroups. Subsequently, all serum anti-CagA-positive HHD patients received 1-week of triple H. pylori eradication therapy with omeprazole, clarithromycin, and amoxicillin orally. During a 2-year follow-up, none of these patients reported upper gastrointestinal bleeding. CONCLUSIONS: Although no statistically significant difference in H. pylori infection was found between HHD and controls, the CagA strain appeared more frequently in those HHD patients with a history of upper gastrointestinal bleeding. Given our results and the limited data available in the literature, we would recommend anti-CagA screening and therapy to all patients with HHD. However, further studies with a longer follow-up and a greater number of patients are necessary. 相似文献
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