质子泵抑制剂防治经皮冠状动脉介入治疗术后上消化道出血的疗效观察

目的:评价质子泵抑制剂(PPI)防治冠心病患者行经皮冠状动脉介入治疗(PCI)术后上消化道出血的效果.方法:接受PCI的冠心病患者1 000例,随机分成PPI干预组(A组)和对照组(B组)各500例,所有患者PCI术前负荷量阿司匹林300 mg、氯吡格雷300 mg,术后口服阿司匹林100 mg、氯吡格雷75 mg;A组在此基础上加用PPI.对比观察2组患者服药期间主要上消化道出血的发生率及严重程度.结果:A组患者无消化道出血事件发生;B组患者中35例粪潜血强阳性(其中8例为严重上消化道出血).结论:冠心病患者PCI术后联合应用氯吡格雷及阿司匹林增加了上消化道出血风险,PPI可有效地减少上消化道出血并发症的发生.     

奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的Meta分析

目的系统评价奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的有效性。方法计算机检索Cochrane Library、Pubmed、万方数据库,检索时间从建库至今,收集有关奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的疗效的随机对照试验。由2名评价员独立对所纳入的文献进行资料提取、质量评价并交叉核对,然后采用使用Revman 5.0版软件进行数据统计分析。结果共纳入文献6篇,包括484例患者。Meta分析结果:奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血较单用质子泵抑制剂止血率高。结论奥曲肽联合质子泵抑制剂可有效治疗非静脉曲张上消化道出血,但由于纳入的文献质量不高,可能存在发表性偏倚,因此需要进行更大规模,多中心的随机临床对照研究,从而更客观、全面地评价其疗效。     

不同剂量质子泵抑制剂治疗消化性溃疡出血疗效观察

目的 探讨质子泵抑制剂对消化性溃疡出血的疗效.方法 95例为我科1年来住院的消化性溃疡出血患者,均排除慢性肝病、血液病等影响凝血机制疾患者,随机分为A、B两组,A组为治疗组,48例,B组为对照组,47例,均给予质子泵抑制剂治疗,但不同的是A组给予质子泵抑制剂首次剂量80 mg,并以8 mg/h维持24～48 h;B组给予质子泵抑制剂40 mg,每日2次.结果 A组显效30例,有效17例,无效1例,总有效率97.9%;B组显效18例,有效21例,无效8例,总有效率83%,两组对比P＜0.05.结论 质子泵抑制剂"80+8"剂量治疗消化性溃疡出血有显著疗效,未见明显不良反应.     

口服云南白药和凝血酶联合质子泵抑制剂治疗经皮冠脉介入术后上消化道出血的临床观察

目的:评价口服云南白药和凝血酶联合质子泵抑制剂(PPI)治疗冠心病患者行经皮冠状动脉介入治疗(PCI)术后上消化道出血的临床效果及安全性。方法: 选择PCI治疗术后服用阿司匹林+氯吡格雷行双联抗血小板聚集治疗期间发生上消化道出血的病例77例,随机分成口服云南白药和凝血酶的治疗组39例和口服去甲肾上腺素的对照组38例。两组患者均静脉使用PPI治疗,依据失血量情况给予补液、必要时输注新鲜血液及血浆等救治措施。治疗组给予云南白药1.0 g+凝血酶1 000 U+4℃生理盐水100 ml口服、每6 h 服1次;而对照组给予去甲肾上腺素8 mg+4℃生理盐水100 ml口服、每6 h服1次,对比观察两组患者服药72 h后消化道出血的止血率及120、168 h后的粪便潜血情况。结果: 云南白药治疗组患者72 h后消化道止血率明显好于对照组（92% vs. 74%,P<0.05）、而输血量少于对照组［(1.5±0.3) U vs. (1.8±0.5) U,P<0.01］及120、168 h后的粪便潜血好转率均明显好于对照组(95% vs. 76%,P<0.05;90% vs. 71%,P<0.05),且未见有支架内血栓形成事件发生。结论: 口服云南白药和凝血酶联合PPI治疗PCI术后上消化道出血安全有效,值得在临床应用。     

归脾汤联合西药对上消化道出血的近期疗效观察

[目的]观察归脾汤联合质子泵抑制剂对上消化道出血的近期疗效.[方法]将确诊的上消化道出血患者80例分为观察组与对照组,每组40例.对照组给予休息、饮食和支持疗法,并服用质子泵抑制剂(奥美拉唑)、止血芳酸、止血敏药物；观察组在对照组治疗的基础上加用归脾汤；治疗后观察2组近期疗效.[结果]观察组总有效率97.5％,对照组总有效率90.0％,观察组总有效率明显高于对照组,差异有统计学意义(P＜0.05).[结论]归脾汤联合质子泵抑制剂治疗上消化道出血,可获得较好的近期疗效.     

不同质子泵抑制剂对急性心肌梗死患者直接经皮冠状动脉介入治疗的影响

目的探讨不同机制的质子泵抑制剂对急性心肌梗死患者直接PCI术后临床效果的影响。方法选择在北京安贞医院抢救中心实施直接PCI、术前术后给予氯吡格雷联合阿司匹林抗血小板治疗的患者354例。随机分为奥美拉唑组(116例)、泮托拉唑组(121例),2组术前分别开始静脉滴注40 mg/d,7 d后持续口服1年(20 mg/d),对照组(117例)未用质子泵抑制剂。观察3组主要不良心血管事件发生率和出血并发症发生情况。结果 3组临床基本资料、冠状动脉造影及PCI比较差异无统计学意义,心源性死亡、非致死性心肌梗死、靶血管血运重建、支架内血栓的发生率奥美拉唑组分别为1.7%、3.4%、9.5%、1.7%,泮托拉唑组分别为1.7%、5.0%、10.7%、2.5%,对照组分别为0.9%、3.4%、12.0%、1.7%。3组主要不良心血管事件发生率相近(P>0.05)。总出血事件发生率与对照组(9.4%)比较,奥美拉唑组(2.6%)和泮托拉唑组(3.3%)明显减少(P<0.01),但奥美拉唑组与泮托拉唑组比较,总出血事件发生率差异无统计学意义(P>0.05)。结论奥美拉唑和泮托拉唑的作用相近,不降低冠状动脉支架置入术后氯吡格雷联合阿司匹林治疗对心血管事件的效果,同时可显著降低出血事件的发生率。     

质子泵抑制剂防治老年冠状动脉介入术后上消化道出血并发症的疗效观察

目的评价质子泵抑制剂(PPI)防治老年冠心病患者PCI术后上消化道出血并发症的疗效和安全性。方法接受PCI的老年患者800例,随机分为PPI干预组和对照组,每组400例。2组PCI术前、术后常规双联抗血小板,PPI干预组在PCI术前即服用埃索美拉唑镁40 mg/d,连续4周,随后改为40 mg/2d,直至氯吡格雷停用。随访1 8个月,观察2组患者服药期间上消化道不良反应的发生率;监测血小板聚集率;观察主要心脏不良事件(MACE)。结果 PPI干预组无消化道出血事件发生,仅11例出现轻微消化道症状;对照组79例出现不同程度消化道症状,便隐血强阳性39例,其中7例为严重上消化道出血,2组比较差异有统计学意义(P<0.01)。2组血小扳聚集率和MACE发生率差异无统计学意义(P>0.05)。结论老年患者PCI术后加用PPI可有效防治消化道不良反应,减少上消化道出血并发症发生,且对血小板聚集率无明显影响,未增加心血管事件风险。     

蛇毒血凝酶及云南白药对非静脉曲张上消化道出血治疗效果及并发症的影响

[目的]探讨云南白药联合蛇毒血凝酶对上消化道出血治疗效果及并发症的影响。[方法]将鞍钢集团总医院诊治的248例非静脉曲张上消化道出血患者随机分为4组,对照组63例给予质子泵抑制剂;血凝酶组65例在对照组的基础上加用蛇毒血凝酶治疗;云南白药组60例在对照组基础上给予云南白药口服;联合治疗组60例在对照组基础上给予云南白药联合蛇毒血凝酶。比较4组在上消化道出血24h、48h、72h治疗有效率及总有效率,同时观察4组在消化道出血并发症方面差别,尤其是缺血性脑血管病、冠状动脉粥样硬化性心脏病方面的差别。[结果]联合治疗组在24h治疗有效率方面治疗组优于其他组,在48h、72h治疗有效率及总有效率方面差异无统计学意义。在缺血性脑血管病、冠心病并发症方面4组差异无统计学意义。[结论]在质子泵抑制剂基础上云南白药联合蛇毒血凝酶治疗非静脉曲张上消化道出血可获得满意疗效,不良反应少,云南白药组与对照组差异无统计学意义。     

肝硬化患者合并急性上消化道出血原因分析

肝硬化患者合并上消化道出血，以前考虑食管胃底静脉曲张破裂出血的可能性更多一些，现在随着消化内镜技术的普及，发现其出血原因也是多样的。在2004年5月至2006年5月期间，我院肝病科共有55例确诊肝硬化患者因急性上消化道出血在我院胃镜室做急诊胃镜检查，现将出血原因统计报告如下。     

Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: a meta-analysis

Medical therapy is an attractive adjuvant to endoscopic treatment in upper gastrointestinal (UGI) bleeding. This review aims to assess the treatment effects of proton pump inhibitor (PPI) therapy in acute non-variceal UGI bleeding. Outcome measures evaluated were further bleeding, surgery, all-cause deaths, ulcer deaths and non-ulcer deaths. We searched MEDLINE (1966-2002) and EMBASE (1974-2002) using the terms 'gastrointestinal hemorrhage', 'peptic ulcer hemorrhage', 'proton pump inhibitor', 'omeprazole', 'pantoprazole', 'lansoprazole', 'rabeprazole' and 'esomeprazole'. The search was extended to the Cochrane controlled trials registry database, published abstracts from five international gastroenterology conferences, manufacturers of PPI, known contacts and bibliographies from each full-length published report. We included trials published in English and non-English languages. Eligible studies were randomized controlled trials that compared the treatment effects of PPI therapy with placebo or H2 receptor antagonists in patients with acute non-variceal UGI bleeding. Of the 175 articles screened, 26 controlled trials including 4670 subjects (2317 in treatment arm and 2353 in control arm) were analyzed. The methodology, population, intervention, and outcomes of each selected trial were evaluated using duplicate independent review. Disagreements were resolved by consensus. PPI therapy significantly reduced rates of further bleeding (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40-0.57) and surgery (OR, 0.61; 95% CI, 0.48-0.76). All-cause deaths were unaffected (OR, 1.02; 95% CI, 0.76-1.37). Ulcer deaths showed a significant reduction (OR, 0.58; 95% CI, 0.35-0.96), while non-ulcer deaths showed a significant increase (OR, 1.60; 95% CI, 1.06-2.41) in the PPI therapy group. Sensitivity analysis of 22 trials published in peer-reviewed journals, 10 trials with double-blind design and 19 trials with high quality score and 22 trials using omeprazole in the treatment group showed results similar to those seen in the analysis of all 26 trials, confirming the stability of the conclusions. Subgroup analysis revealed that summary outcome measures were not influenced by control group therapy (placebo vs H2 receptor antagonists) or the use of prior endoscopic treatment to achieve hemostasis (given vs not given). However, the summary treatment effects for further bleeding and need for surgery were significant in only those trials enrolling patients with peptic ulcers having high risk for rebleeding and not in those trials enrolling patients with all causes of UGI bleeding. The summary treatment effects for further bleeding and need for surgery were significant in trials using intravenous as well as oral PPI. However, summary OR for all-cause deaths and non-ulcer deaths in trials using intravenous PPI were higher in the treatment group and not in trials using oral PPI. This raised the possibility of intravenous PPI-therapy-associated non-ulcer deaths in high-risk patients. PPI therapy in acute non-variceal UGI bleeding reduced rates of further bleeding, surgery and deaths caused by ulcer complications. However, non-ulcer deaths were increased. The overall mortality was unaffected. PPI therapy is useful only in a selected group of patients with acute non-variceal UGI bleeding, namely those with peptic ulcers having endoscopic high-risk stigmata for rebleeding.     

The role of proton pump inhibitors in NSAID-associated gastropathy and upper gastrointestinal symptoms

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used drugs in the United States. Ulcers are found with an endoscopy in 15%-30% of patients who are using NSAIDs regularly, and the annual incidence of upper gastrointestinal (GI) clinical events is 2.5%-4.5% among those who use NSAIDs regularly. Upper GI symptoms, such as dyspepsia, also occur in up to 60% of patients taking NSAIDs. H2-receptor antagonists when used at standard doses are not effective at preventing gastric ulcers resulting from the use of NSAIDs. Misoprostol effectively decreases NSAID-induced ulcers and GI complications, but issues of compliance (multiple daily doses) and side effects (eg, diarrhea and dyspepsia) may limit its use. Once-daily therapy with proton pump inhibitors has been documented to significantly decrease the development of NSAID-associated ulcers in endoscopic studies, reduce the rate of NSAID-related ulcer complications, and reduce upper GI symptoms in NSAID users.     

质子泵抑制剂对老年急性呼吸窘迫综合征患者发生应激性溃疡的治疗效果分析

目的:分析质子泵抑制剂(PPI)预防老年急性呼吸窘迫综合征(ARDS)患者发生应激性溃疡(SU)效果及影响短期死亡风险的相关因素。方法:多中心回顾性队列研究。连续性纳入2017年11月至2019年12月在北大国际医院、北京安贞医院和鄂州市中心医院诊治的老年ARDS患者200例,均为入重症监护室后48 h内应用PPI(奥...