影响创伤后应激性溃疡出血的因素

目的：探讨影响创伤（含手术）后应激性溃疡出血的因素。方法：回顾性分析近5年来收治的1986例创伤和手术后患者的临床资料,将其中发生应激性溃疡出血病例与未发生病例对比分析。结果：严重创伤后应激性溃疡出血发生率明显高于创伤较轻者（P〈0．01）,合并糖尿病、心肺病及年龄≥60岁患者应激性溃疡出血发生率明显高于无糖尿病、心肺病及年龄〈60岁者（P〈0．05）。结论：创伤后应激性溃疡出血的发生,决定于创伤程度、伤者年龄、基础疾病及救治措施情况等综合因素。     

心肺复苏后患者住院期间下肢深静脉血栓形成的危险因素分析

目的 探讨心肺复苏后患者住院期间发生下肢深静脉血栓形成的危险因素。方法 收集2021年7月至2022年7月于首都医科大学附属北京友谊医院进行心肺复苏的115例患者的临床资料,根据住院期间是否发生下肢深静脉血栓形成将患者分为血栓组（n=33）和对照组（n=82）。比较两组患者的临床特征、住院检查及治疗情况,分析心肺复苏后患者住院期间发生下肢深静脉血栓形成的危险因素。结果 血栓组患者的年龄大于对照组患者,高血压、糖尿病、创伤和心力衰竭的患者比例均高于对照组,差异均有统计学意义（P﹤0.05）。多因素分析结果显示,年龄≥60岁、高血压、糖尿病、心力衰竭及创伤均是心肺复苏后患者住院期间发生下肢深静脉血栓形成的独立危险因素（P﹤0.05）。结论 年龄、高血压、糖尿病、心力衰竭及创伤均与心肺复苏后患者住院期间发生下肢深静脉血栓形成密切相关,在临床实践中应针对有这些危险因素的患者进行筛查及针对性预防。     

重型颅脑外伤后肺部感染患者的临床分析

目的:探讨重型颅脑外伤患者肺部感染率及与其相关危险因素的关系,了解肺部感染的病原菌和耐药情况,为临床治疗提供依据.方法:对135例重型颅脑外伤合并肺部感染患者的临床资料进行回顾性调查,分析与气管切开、机械通气、基础疾病和年龄等相关危险因素的关系,统计病原菌及其耐药率.结果:重型颅脑外伤后行气管切开、机械通气和年龄＞60岁、有糖尿病、心肺疾病等因素的患者肺部感染率明显高于自然正常通气、年龄＜60岁和无基础疾病的患者,差异具有统计学意义(P＜0.001);肺部感染的病原菌以革兰氏阴性杆菌为主占70.6％.结论:气管切开、机械通气和年龄＞60岁、并发有糖尿病、心肺疾病的患者是肺部感染的主要原因,减少和缩短气管切开、机械通气时间,合理应用抗菌药物,加强消毒隔离是控制重型颅脑外伤肺部感染的有效措施.     

直肠癌患者术后应激性溃疡出血的相关因素

收集468例直肠癌手术治疗患者的临床资料,采用Logistic回归分析法,对直肠癌患者术后发生应激性溃疡出血的相关因素进行分析。术后应激性溃疡出血的发生率为3.85％（18,468）,经单因素分析后,术后发生应激性溃疡出血症状与年龄、性别、饮酒、淋巴结转移、手术时间、术后并发症以及白蛋白下降等因素显著有关（P〈0.05）;经Logistic回归分析后,年龄、术后严重并发症、术前慢性疾病、饮酒史、术中出血量、术前应用非甾体类抗炎药物以及术后应用糖皮质激素等因素是导致术后发生应激性溃疡出血症状的独立危险因素（P〈0.05）。直肠癌患者术后容易发生应激性溃疡出血的症状,与年龄、术后严重并发症、术前慢性疾病、饮酒史、术中出血量、术前应用非甾体类抗炎药物以及术后应用糖皮质激素等因素密切关联,值得临床进一步研究与探讨。     

直肠癌患者术后发生应激性溃疡出血的影响因素分析

目的探讨直肠癌患者术后发生应激性溃疡出血的影响因素。方法回顾性分析2002年1月～2012年3月于我院诊治并行手术治疗的468例直肠癌患者病历资料。结果术后发生应激性溃疡出血病例18例,发生率为3.85%;单因素分析显示高龄、男性、饮酒史、肿瘤发生淋巴结转移、手术时间长、术后发生其他并发症、术后前白蛋白下降等因素与直肠癌患者术后发生应激性溃疡出血明显相关(P<0.05);非条件多因素Logistic分析结果显示高龄、淋巴结转移、手术时间长、术后并发症发生、术后血清前白蛋白下降是直肠癌患者术后发生应激性溃疡出血的独立危险因素(P<0.05)。结论直肠癌患者术后发生应激性溃疡出血较为常见,男性饮酒患者直肠癌患者术后发生应激性溃疡出血的可能性明显增加,高龄、肿瘤淋巴结转移、手术时间长、术后并发症发生、术后血清前白蛋白下降等因素可作为直肠癌患者术后应激性溃疡出血发生的独立危险因素。     

消化性溃疡合并上消化道出血影响因素分析

目的探讨消化性溃疡合并上消化道出血的影响因素。方法收集笔者所在医院315例消化性溃疡合并上消化道出血患者为研究组;同期门诊选取656例消化性溃疡无上消化道出血并发症的患者为对照组。再根据研究组中HP阳性者根除HP后随访2年,观察上消化道再出血情况。所有入选患者均统计幽门螺杆菌检测结果、NSAIDs服用、性别、年龄、饮酒史、血小板计数等情况。结果 NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）;年龄对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.01）;合用不同种类NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）。结论 NSAIDs增加消化性溃疡合并上消化道出血的风险;年龄与消化性溃疡合并上消化道出血相关,大于60岁的老龄消化性溃疡患者更易合并上消化道出血;合用不同种类NSAIDs较单用NSAIDs者消化性溃疡更易合并上消化道出血。     

高渗性葡萄糖预防约束大鼠发生的应激性溃疡

因烧伤、多发性创伤和败血症而处于应激状态下的外科患者,可合併急性胃粘膜糜烂。自从对应激性溃疡常规采用预防措施以后,应激性溃疡出血发生率虽有所减少,但其大出血仍是临床上的一个难题,死亡率仍高于40%,而不出血的溃疡的发病率是有明显出血者的10倍。临床观察到在同等的应激状态下,接受鼻饲营养的患者的应激性溃疡发病率较未接受肠道营养者为低。数个实验证实,胃内注入25%葡萄糖液     

颅脑外伤患者应激性溃疡的护理体会

应激性溃疡是机体在应激状态下发生的应激性反应。特别是在严重创伤、大手术后等情况下发生的急性上消化道黏膜的损害，它是颅脑创伤后较常见的并发症。颅脑创伤合并的应激性溃疡与颅脑损伤的严重程度相关。其主要症状是消化道出血，严重时可造成胃肠大出血，致使机体血容量不足，造成失血性休克，直接威胁患者的生命。因此对颅脑创伤应严密细致地观察及护理，预防及有效地控制出血，对挽救患者的生命起着至关重要的作用。     

浅表超声观察右颈内静脉与颈总动脉的解剖关系及影响因素

目的 利用超声技术探讨右侧颈内静脉与颈总动脉间的解剖关系以及影响因素.方法 随机选择306例成年患者,男171例,女135例,年龄18～86岁,BMI 16～36 kg/m2.超声探测右颈部高位(甲状软骨上缘水平)、中位(环状软骨水平)和低位(环状软骨水平下至2 cm)三处位点颈内静脉与颈总动脉覆盖情况.比较不同性别、年龄及BMI的患者高、中、低位颈内静脉与颈总动脉覆盖情况差异.结果 中、低位未覆盖率明显低于高位(P＜0.05),而部分覆盖、完全覆盖率明显高于高位(P＜0.05).女性中位未覆盖率明显低于男性(P＜0.05).≥60岁患者低位未覆盖率明显低于其他年龄患者(P＜0.05),完全覆盖率明显高于其他年龄患者(P＜0.05).BMI≥25 kg/m2患者中、低位未覆盖率明显降低(P＜0.05),而完全覆盖率明显升高(P＜0.05).影响覆盖程度的因素依次为:位点＞BMI＞性别＞年龄,判别符合率为71.24％.结论 高位右颈内静脉与颈总动脉覆盖程度低,行静脉穿刺时能减少损伤动脉概率.     

骨折与骨折术后并发应激性溃疡死亡3例临床分析暨文献复习

目的探讨创伤骨折并发胃肠道应激性溃疡的机制及诊治方法。方法报道3例因严重骨折并发胃肠道应激性溃疡死亡的病例资料。结果 3例患者均予积极止血、输血、抗休克治疗,但终因抢救无效死亡。结论胃肠道应激性溃疡是严重创伤骨折不可忽视的并发症,一旦发生,死亡率相当高,因此创伤早期应该采取措施积极预防,对出现胃肠道应激性溃疡临床表现的患者积极治疗。     

重症急性胰腺炎并发应激性溃疡大出血14例临床分析

目的　探讨重症急性胰腺炎(SAP)并发应激性溃疡大出血的影响因素及防治措施。　方法　回顾性分析1993年1月～1998年12月我院收治的14例SAP并发应激性溃疡大出血的临床资料,总结其发生率、影响因素及防治效果。　结果　本组SAP并发应激性溃疡大出血的发生率为11.6%,与患者的年龄、病情严重程度、合并胆道结石梗阻、胰腺脓肿、假性胰腺囊肿及是否接受清创引流手术等因素明显有关。本组14例大出血患者中行保守治疗6例,死亡5例;手术治疗8例,死亡1例,两者差异有显著意义(P<0.01)。　结论　老年SAP患者,尤其是胆源性SAP合并胰腺脓肿或假性囊肿者容易并发应激性溃疡大出血;预防性应用生长抑素类药物可降低出血发生率;对经保守治疗后出血仍不能停止者,行手术止血可提高抢救的成功率。     

Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

Objective： To evaluate the local risk factors of traumatic brain injury （TBI） patients developing gastrointestinal （GI） bleeding during the early hospitalization in neurosurgery intensive care unit （NICU）. Method： From September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone （ACTH）, total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5. Results： Within 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group （P〈0.05）. The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, （F=1.413, P=0.253） for ACTH and （F=9.371, P=0.006） for gastrin. GI bleeding had a positive correlation with gastrin concentration （r=0. 312, P〈0.05） and a negative correlation with serum hemoglobin （Hb） （r=-0.420, P〈0.01）. The clinical incidence of GI bleeding was 24.39% （10/41） in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration （OR=26.643, P〈0.05） and hematocrit （Hct） （OR=5.385, P〈0.05）. High ACTH concentration （〉100 pg/ml） increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% （9/22） and the mortality rate was 20%（2/10）. Conclusions： Low Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH （〉 100 pg/ml） are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.     

胃癌并发出血的危险因素分析

目的分析胃癌合并出血病人的危险因素。方法回顾收集2000~2012年期间就诊于河北医科大学第四医院的胃癌病人。根据病人发病过程中是否并发出血,将病人分为出血组和非出血组。比较两组的临床基线资料、入院时辅助检查资料、手术相关资料和住院期间的主要情况。使用Logistic回归分析胃癌合并出血的危险因素。结果累计入选病人7 919例,其中合并出血病例316例,未并发出血的胃癌病人7 603例。出血组病人男性比例高于非出血组(69.3%比60.3%,P=0.001)。与非出血组相比,出血组病人高血压、糖尿病比例高(均P0.001)。出血组病人吸烟比例较非出血组低(32.0%比39.8%,P=0.005)。与非出血组相比,出血组病人并发梗阻的比例较高(P=0.002),两组病人合并消化道穿孔的比例相似。出血组病人入院时便潜血比例较高(P0.001),血红蛋白、总蛋白和白蛋白水平低于对照组(均P0.001),两组病人天冬氨酸转氨酶和丙氨酸转氨酶水平相似(均P0.05)。两组病人在肿瘤浸润深度和肿瘤TNM分期方面存在明显差异(均P0.05),两组病人M分期情况和术后并发症无明显差异。Logistic回归分析发现,男性、高血压、糖尿病、合并消化道穿孔、肿瘤浸润深度、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性是胃癌合并出血的危险因素(均P0.05)。结论胃癌合并出血的危险因素包括:男性、高血压、糖尿病、合并消化道穿孔、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性。     

Clinical characteristics and prognosis of ANCA-associated vasculitis in patients with renal injury

Objective To investigate the characteristics and outcome of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in patients with renal injury. Methods AAV patients with renal injury diagnosed in the Department of Nephrology, Renmin Hospital of Wuhan University, from January 2012 to January 2017 were included into this study. Patients were divided into MPO-ANCA positive and PR3-ANCA positive groups for further study. The clinical characteristics, pathological and laboratory indexes, treatment and prognosis were retrospectively analyzed. Results A total of 68 cases were enrolled, among which 52 cases (76.5%) were MPO-ANCA positive and 16 cases (23.5%) were PR3-ANCA positive, and 41 patients (60.3%) were over 65 years old. The incidences of interstitial lung disease, digestive and nervous system damage in PR3-ANCA positive group were significantly higher than those MPO-ANCA positive group (P＜0.05). There were significant differences of hemoglobin, complement C3, complement C1q, IgE, 24 h urinary protein, erythrocyte sedimentation rate, procalcitonin, BVAS score and eGFR in two groups (P＜0.05). 19 cases had done renal biopsy,among them 14 cases were MPO-ANCA positive and 5 cases were PR3-ANCA positive. Incidence of crescentic necrotizing glomerulonephritis in PR3-ANCA positive group was significantly higher than that in MPO-ANCA positive group, and incidence of diffuse global glomerulosclerosis in MPO-ANCA positive group was significantly higher than that in PR3-ANCA positive group (all P＜0.05). At the median follow-up time of 32 months, the relapse rate at 6 month of MPO-ANCA-positive and PR3-ANCA-positive patients were 46.2% and 75.0%, respectively (P＜0.05). Multivariate logistic regression analysis showed that PR3-ANCA positive, age≥65 years old, baseline eGFR＜30 ml?min-1?(1.73 m2)-1, and combined with pulmonary interstitial lesions were all independent risk factors for relapse. And the incidence of ESRD were 42.3% and 75.0% during the follow-up period and 10 patients (14.7%) died. COX regression analysis showed that patients older than 65 years old, BVAS score≥18 points, eGFR＜30 ml?min-1?(1.73 m2)-1 and complicated with pulmonary interstitial disorders at the onset were independent risk factors causing ESRD or death. Conclusion The PR3-ANCA-positive patients had more severe renal injury than those with MPO-ANCA-positive patients, and the injury of extrarenal organs was more serious, recurrence rate was higher, and the prognosis was worse.     

老年肾移植受者贫血的特征及危险因素分析

目的 研究老年肾移植受者贫血的特征及其危险因素.方法 回顾性分析168例首次肾移植的老年肾移植受者的临床资料,采用多因素Logistic回归方法筛选老年肾移植受者发生贫血的危险因素.结果 168例老年首次肾移植受者,贫血的总发生率为45.2％( 76/168).40例为正细胞正色素性贫血;26例为小细胞低色素性贫血;10例为溶血性贫血.76例贫血受者中,51例为红细胞生成素(EPO)缺乏;25例为EPO抵抗.贫血受者营养不良,心、脑血管病变的发生率显著高于非贫血受者(P＜0.01).环孢素、硫唑嘌呤、泼尼松方案( CsA+Aza+Pred)贫血发生率为57.1％,显著高于其他方案(P＜0.01).多因素非条件Logistic回归分析表明,男性、肌酐水平、急性排斥反应、移植肾功能延迟恢复(DGF)是老年肾移植受者贫血发生的独立危险因素,OR值分别为1.089、5.156、6.345、1.876.结论 贫血是老年肾移植受者严重并发症.男性、肌酐水平、急性排斥反应、DGF是老年肾移植受者贫血发生的独立危险因素.     

老年患者肝移植的临床分析

目的 探讨年龄≥60岁的老年患者肝移植的临床特点,总结临床诊治经验.方法 36例年龄≥60岁者接受肝移植治疗(老年组),术前其Child-Pugh评分为(7.86±2.06)分,其中34例采用非转流原位经典肝移植,2例为背驮式肝移植.术后采用他克莫司与糖皮质激素联用预防排斥反应,并辅以达利珠单抗诱导治疗.以同期施行肝移植、年龄小于60岁的214例患者作为对照.结果 老年组女性比例以及术前合并丙型肝炎、糖尿病的患者比例明显高于对照组,差异有统计学意义(P＜0.05,P＜0.05,P＜0.01),而合并乙型肝炎的患者比例则明显低于对照组(P＜0.01).两组在手术方式、供肝缺血时间以及术中情况等方面的差异均无统计学意义.老年患者术后气管插管时间为(9.0±12.1)h,明显长于对照组的(5.8±6.8)h(P＜0.05),36.1%的患者术后插管超过12 h,明显高于对照组的17.8%(P＜0.05).老年组术后心血管并发症和细菌感染的发生率分别为13.9%和77.8%,明显高于对照组的1.9%(P＜0.01)和59.3%(P＜0.05),而急性排斥反应发生率为5.6%,明显低于对照组的19.6%(P＜0.05).老年组患者术后1、2及3年存活率分别为77.8%、71.8 %和61.6 %,对照组分别为85.5 %、72.2 %和65.5 %,两组间各存活率的差异均无统计学意义;老年组中超出米兰标准者肝移植后的1、2及3年存活率分别为56.3%、56.3%和36.5%,对照组分别为78.0%、62.8%和62.8%,两组比较,各存活率的差异均有统计学意义(P<0.05).老年组患者的死亡原因,肺部感染占第一位(41.7%),明显高于对照组的14.9%(P＜0.05).结论 老年患者肝移植术后易并发感染和心血管疾病,肺部感染是老年患者术后死亡的主要原因;超出米兰标准的老年肝癌患者行肝移植需慎重.     

伤口呈色显影用于预测重症肢体缺血患者血管腔内治疗后溃疡愈合的价值初探

目的 探讨伤口呈色显影预测重症肢体缺血患者血运重建术后溃疡愈合的价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2011年6月1日-2014年6月30日收治成功实施Angiosome概念指导腔内血运重建的重症肢体缺血的缺血性溃疡患者临床资料.根据血管腔内血运重建术后伤口呈色显影情况分组,其中伤口呈色(+)组109例,伤口呈色(-)组64例,分别比较患者保肢率,溃疡愈合时间的差异,试分析其作为重症肢体缺血的缺血性溃疡愈合预测因子的价值.采用SPSS 19.0软件进行统计学分析.正态分布计量资料以均数±标准差(x±s)表示,两组比较采用t检验.计数资料以频数和百分比表示,两组比较采用Pearson x2检验或Fisher确切概率法.结果 纳入研究患者共173例(173条患肢),两组患者年龄、性别比例、吸烟史、冠心病、糖尿病、慢性肾功能不全、术前踝肱指数、术后踝肱指数差异均无统计学意义,溃疡愈合时间:伤口呈色(+)组(3.9±1.9)个月低于伤口呈色(-)组(7.9±2.6)个月,差异有统计学意义(P＜0.05).累积保肢率:伤口呈色(+)组(90.2％)高于伤口呈色(-)组(78.0％),差异有统计学意义(P＜0.05).通过Logistic回归分析,校正年龄、性别、吸烟史、高血压异常等因素后,伤口呈色(-)(OR=4.5,P＜0.05)、IRc(间接血供有侧支)血运重建(OR =2.6,P＜0.05)均是溃疡难愈合的独立危险因素.结论 伤口呈色显影阳性显示足部循环较好,可以作为重症肢体缺血的缺血性溃疡愈合的预测因子,而伤口呈色显影阴性是溃疡难愈合的独立危险因素.     

Taking rivaroxaban is a risk factor for acute kidney disease and disorders in patients with coronary heart disease or non-valvular atrial fibrillation

Objective To observe the risk of acute kidney disease and disorders (AKD) in patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time in our hospital. Methods A retrospective case-control analysis was performed using the hospital database to screen for patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time for more than 3 months during January 1, 2018 to June 30, 2019. A total of 279 patients with serum creatinine reviewed within 3 months were as the rivaroxaban group, and 317 patients with coronary heart disease or non-valvular atrial fibrillation who did not take rivaroxaban during the same period in our hospital were selected as the control group. The general condition and the incidence of AKD were compared between the two groups, and the influencing factors of AKD were analyzed by logistic regression analysis. Results The prothrombin time and international normalized ratio were higher in the rivaroxaban group than those in the control group (both P＜0.01). There was no significant difference in age, gender, serum creatinine and urea level between the two groups. The incidence of AKD in the rivaroxaban group was 4.30%(12/279), and the incidence of AKD in the control group was 1.26%(4/317). The relative risk (RR) of the two groups of patients was 3.409. Logistic regression analysis showed that older age (≥75 years old, OR=1.166, 95%CI 1.012-1.343, P=0.033) and diabetes (OR=34.261, 95%CI 1.639-716.326, P=0.023) were risk factors for AKD in patients taking rivaroxaban. Rivaroxaban was a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation (OR=3.500, 95%CI 1.115-10.988, P=0.032). Conclusions The incidence of AKD in patients taking rivaroxaban for the first time due to coronary heart disease or non-valvular atrial fibrillation was 4.30%. Taking rivaroxaban is a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation. Older age and diabetes are the risk factors for AKD in the rivaroxaban group.     

胃间质瘤内镜下黏膜剥离术后出血的危险因素分析

目的:探讨胃间质瘤内镜下黏膜剥离术(ESD)后出血的危险因素。方法:回顾性分析武汉大学人民医院2011年2月—2017年5月124例胃间质瘤行ESD治疗患者的临床资料,采用单因素及多因素非条件Logistic回归分析胃间质瘤ESD术后出血的危险因素。结果:纳入的124例患者中,10例(8.06%)发生术后出血。单因素Logistic回归分析结果显示,肝硬化、冠心病、陈旧性脑梗塞、房颤病史与胃间质瘤ESD术后出血明显有关(均OR1,P0.05)。进一步多因素Logistic回归分析表明,与肝硬化、冠心病、陈旧性脑梗塞、房颤病史是胃间质瘤ESD术后的独立危险因素(均OR1,P0.05)。结论:肝硬化、冠心病、陈旧性脑梗塞、房颤病史为胃间质瘤ESD术后出血的危险因素,对于这些危险因素的患者应优化术前评估,加强术前准备与术后管理,以降低术后出血率。