非甾体类药物致急性胃粘膜病变的临床表现与内镜特征

目的：探讨非甾体类药（NSAIDs）致急性胃粘膜病变的临床表现及内镜特点.方法：回顾性分析54例NSAIDs导致急性胃粘膜病变患者的临床资料.结果：服用NSAIDs后临床表现为上腹痛,返酸、嗳气者32例（59.3%）、呕血8例（14.8%）、黑便25例（46.3%）、呕血伴血便10例（18.5%）.内镜下表现为弥漫性胃粘膜充血、水肿及多发性糜烂49例（90.7%）,伴应激性浅表溃疡23例（42.6%）.结论：NSAIDs是急性胃粘膜病变的重要病因,对于需长期服用NSAIDs的高危患者,既往有溃疡病史,年龄＞60岁,同时服用两种以上NSAIDs或与糖皮质激素同服者应给予预防性治疗。     

非甾体抗炎药致急性胃粘膜病变68例临床分析

目的探讨非甾体类抗炎药所致急性胃粘膜病变的临床特点。方法对2009年6月到2010年5月就诊的68例急性胃粘膜病变患者的临床资料进行回顾性分析,并根据出血前10天内是否服用非甾体类抗炎药分为服NSAIDs组20例和非NSAIDs组48例,比较2组患者临床资料和内镜下特点。结果两组患者年龄构成、心脑血管病史、消化道症状、溃疡、Hp感染有显著性差异（P〈0.05）。结论加强对非甾体抗炎药所致急性胃粘膜病变的临床特点认识,采取相应措施,减少非甾体类抗炎药引起急性胃粘膜病变的风险。     

老年人非甾体抗炎药相关性溃疡并发出血的临床研究

目的:研究非甾体抗炎药(NSAIDs)致老年人相关性胃十二指肠溃疡并发出血的临床特点。方法:调查我院2006年1月至2007年12月期间经胃镜检查确诊为胃十二指肠溃疡并出血的60岁以上住院患者,根据入院前1周内有无服用NSAIDs将患者分为NSAIDs组(46例)及非NSAIDs组(38例),对两组病人的临床资料进行分析比较。结果:老年人服用NSAIDs所致的溃疡出血发病率持续上升,其占同期老年人消化性溃疡并出血的30.3%(46/152),与国内2006年文献报道27.17%接近,高于国内2001年文献报道16.51%;其起病隐匿,多以出血为首发症状,就诊时多已存在不同程度的贫血,内镜下复合溃疡、多发溃疡多见,病变损害范围更广泛,导致其病情较非NSAIDs组严重;而NSAIDs组幽门螺杆菌(Hp)阳性者和Hp阴性者的溃疡发生率无明显差异。结论:应加强对老年人NSAIDs相关性胃十二指肠溃疡并发出血临床特点的认识,采取适宜策略降低NSAIDs的不良反应。     

消化性溃疡并发出血危险因素研究

目的 :通过对 36 8例消化性溃疡的分析 ,研究非甾体类消炎药 (NSAIDs)服用史、幽门螺杆菌 (HP)感染、性别、溃疡部位、内镜下溃疡大小、出血病史等因素对溃疡并发出血的影响及其相互关系。方法 :比较年龄、NSAIDs服用史、HP感染、性别、部位、内镜下溃疡大小、出血病史等因素对上消化道出血危险性的影响 ,以及上述因素之间的相互作用关系。结果 :服用NSAIDs患者中 ,出血占 74 % ,未出血占 2 6 % ,与上消化道危险性相关系数为 6 7相比 ,具有显著性差异 (P <0 0 1) ;溃疡出血随年龄增加而增加 ,出血患者中 ,5 0岁以下组为 2 7% ,6 0岁以下组为36 % ,超过 80岁组则为 79% ;对于出血的危险性 ,HP感染阳性率差别不大 (85 %vs 88% ,P >0 0 5 ) ,HP感染并不增加消化道出血的危险性 ,但与服用NSAIDs (OR =6 7)及年龄 (OR =3 6 )因素联合可明显增加出血危险性。其他因素与溃疡并发出血无明显关系。结论 :服用NSAIDs及年龄是Pu患者并发出血的重要原因 ,HP感染并不增加溃疡患者出血危险性 ,但服用NSAIDs及年龄等因素与溃疡出血危险密切相关     

小剂量洛赛克联合前列腺素对NSAIDs胃黏膜损害的预防作用

目的 观察小剂量洛赛克联合前列腺素对服用非甾体类消炎止痛药(NSAIDs)引起的胃黏膜病变的预防作用。方法 以临床诊断为类风湿病、老年性关节炎或老年性骨质增生需服用NSAIDs的患者为入选对象，入选病例分为2组。一组为对照组，为以前门诊随访病例。另一组为预防组。预防组在服用NSAIDs同时予服用小剂量洛赛克加米索前列醇预防性治疗。对照组病例未服用抑酸药或黏膜保护剂。结果 服用洛赛克及米索前列醇后上腹部不适、反酸、烧心、呕血、黑便的发生率明显减少，胃镜检查发生胃黏膜糜烂出血者、发生十二指肠溃疡者、发生胃溃疡者也明显减少。结论 小剂量洛赛克联合前列腺素可有效预防NSAIDs引起的胃黏膜病变。     

非甾体抗炎药相关性溃疡出血临床特点

目的 探讨非甾体抗炎药(NSAIDs)所致相关性溃疡并出血的临床特点.方法 选择因上消化道出血行胃镜检查的126例患者,分为服用NASIDs组(观察组)和未服用NSAIDs组(对照组),比较两组患者临床、内镜下病变特点及幽门螺杆菌(Hp)感染情况.结果 结果显示两组患者的性别、消化性溃疡出血病史比较差异无显著性(P＞0.05);而年龄、出血前消化道症状、心脑血管病史、Hp感染及内镜下溃疡特点两组比较差异有显著性(P＜0.05).结论 非甾体抗炎药相关性溃疡的主要临床特点为:常见于老年人,较多患者有心脑血管病史,内镜下胃溃疡和复合溃疡多见,Hp感染增加发生胃黏膜糜烂、水肿的机会.     

老年人上消化道出血的病因分析

目的:讨论关于老年人出现上消化道出血情况的病因分析。方法:分析研究在我院从2007年1月到2010年12月期间内由胃镜(包括鼻胃镜)诊断的老年人(年龄大于60岁)有上消化道出血情况148例的临床表现,同时和相同时期的非老年病例相对比。结果:老年人出现上消化道出血状况的临床特点中除了黑便和呕血以外,其他表现(例如腹痛等)临床表现不明显,其中为复合性溃疡8例,占5.4%;肝硬化食管胃底静脉曲张破裂出血21例,占14.2%;胃癌23例,占15.5%;急性胃粘膜病变11例,占7.4%;十二指肠溃疡43例,占29.5%;胃溃疡32例,占21.6%,其它(例如食道肿瘤)10例,占6.8%。老年组十二指肠溃疡所占比例明显低于非老年组,但是胃癌、胃溃疡、急性胃粘膜病变高于非老年组。结论:老年人上消化道出血的主要原因是消化性溃疡,其次是胃癌、急性胃粘膜病变、肝硬化食管胃底静脉曲张破裂出血等。     

内镜下观察胃肠黏膜损伤与非甾体抗炎药(NSAIDs)的关系

目的通过内镜观察探讨胃肠黏膜损伤与非甾体抗炎药(NSAIDs)的关系.方法连续观察了200例内镜下胃肠黏膜损伤病例.根据是否服用NSAIDs药物将患者分为NSAIDs组(Ⅰ组)及非NSAIDs组(Ⅱ组).结果Ⅰ、Ⅱ组患者分别占47.5%及52.5%(P＞0.05).与Ⅱ组比较,Ⅰ组中＞60岁者占79.0%(P＜0.001),无症状者占54.3%(P＜0.05),胃溃疡占57.1%(P＜0.05),溃疡并发出血占11.6%(p＜0.01).Ⅰ组合并上消化道出血的相对危险是Ⅱ组的7.04倍(x2=6.217,P＜0.05).结论NSAIDs相关性胃肠黏膜损伤具有较为特异的临床及胃镜下表现,其合并上消化道出血的危险性较高,应引起临床重视.     

脑血管意外致急性胃粘膜病变13例的诊治体会

急性胃粘膜病变是脑血管意外常见的并发症,病情严重,死亡率高。我院自1997年元月至1999年12月共收治脑血管意外致急性胃粘膜病变13例。现将其诊治体会总结如下。临床资料　　1.发病情况　本组病例13例,其中男性10例,女性3例,年龄最小42岁,最大68岁,平均年龄63.7岁。脑出血9例,脑血栓形成3例,脑血管栓塞1例。死亡9例,占本组病例的69.2%。2.出血情况　13例入院时均否认有溃疡病史。入院后出现肤色苍白、解黑便者4例(30.8%),呕血块或咖啡样物6例(46.2%),呕血及血便者2例(15.4%),胃管抽出咖啡样物、腹胀者1例(7.6%)。胃镜检查十二指肠球部溃疡并…     

奥美拉唑对非甾体抗炎药引起的食管炎、消化性溃疡、小肠病变的预防作用

目的:探讨奥美拉唑对非甾体抗炎药(NSAIDs)引起的食管炎、消化性溃疡、小肠病变的预防作用。方法:将138例服用NSAIDs的患者随机分为两组,对照组患者(69例)继续单独服用NSAIDs治疗,治疗组患者(69例)加用奥美拉唑治疗。观察两组患者的消化道黏膜损伤情况、出血发生率及不良反应。结果:治疗组患者消化道溃疡及消化道黏膜损伤率分别为7.2%、11.6%,显著低于对照组21.7%、33.3%(P<0.05);治疗组患者在治疗5⁸周时,消化道出血率及总消化道出血率显著低于对照组(P<0.05);两组患者均未见肝肾功能异常及其他严重不良反应。结论:奥美拉唑对NSAIDs所致患者食管炎、消化性溃疡、小肠病变具有预防作用,可保护胃肠道黏膜,降低消化道出血的发生率。     

NSAIDs胃病51例的内镜特点及临床分析

目的为正确诊治NSAIDs胃病提供临床资料。方法回顾性分析2011年1月～2012年12月我院51例NSAIDs胃病的临床及内镜特点。结果识别NSAIDs胃病的内镜下表现特点，其发生与溃疡危险因素呈正相关，既往有消化性溃疡或出血患者为本病的高危人群。结论消化科医师应准确识别NSAIDs胃病的内镜下表现特点，建议NSAIDs应给予最小的有效治疗量，并及时监测血常规、大便潜血及行胃镜检查，对伴溃疡危险因素患者可同时预防性应用PPI及胃黏膜保护剂．以积极应对该类药物引起的不良反应。     

小儿消化性溃疡46例临床分析

目的:探讨小儿消化性溃疡的临床特征及其与幽门螺杆菌(Hp)的关系.方法:回顾性分析46例消化性溃疡住院患儿的临床资料.结果:十二指肠溃疡(DU)占84.8%(39/46).胃溃疡(GU)占13%(6/46).复合性溃疡占2.2%(1/46);7～16岁占82.6%(38/46);就诊主诉依次为呕血、黑便23例.反复腹痛15例,面色苍白7例,进食后呕吐1例;Hp检出率为41.7%(15/36).结论:小儿消化性溃疡好发于学龄儿童.以DU多见.且与Hp感染密切相关.上消化道出血为就诊首要原因.     

奥曲肽治疗急性胃粘膜病变及应激性溃疡出血疗效观察

目的：探讨生长抑素类似物奥曲肽治疗急性胃粘膜病变及应激性溃疡出血的临床疗效。方法：应用奥曲肽治疗急性胃粘膜病变及应激性溃疡出血１１１例（男性７０例，女性４１例，平均年龄４３．６岁），给予奥曲肽０．１ｍｇ，静脉滴注，１次／８ｈ共维持３ｄ。结果：２４．４８及７２ｈ止血率分别为１８．９％、２８．８％和３７．８％，３ｄ总止血率为８５．６％，无效率为１４．４％。未发现明显的毒副反应。结论：奥曲肽对严重创伤、     

儿童消化性溃疡64例临床分析

目的:总结分析本地区儿童消化性溃疡的临床表现、并发症、胃镜表现,以及其与幽门螺旋杆菌(helicobacter pylori,HP)感染及非甾体类抗炎药(NSAID)的关系。方法:对64例儿童消化性溃疡的资料进行回顾性分析。结果:儿童消化性溃疡临床症状具有不典型性,且个体差异较大,儿童年龄愈大消化性溃疡患病率愈高;并发症以上消化道出血为主,胃镜检查十二指肠溃疡发病率较胃溃疡高,且发病与幽门螺杆菌感染及NSAID关系密切。结论:对临床上原因不明的反复发作性腹痛患儿均应作胃镜和幽门螺杆菌等相关检查,以免误诊或漏诊;根除HP、正确使用NSAID及良好生活习惯是防治儿童PU的重要手段。     

Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease

OBJECTIVE: To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease. DESIGN: Cross-sectional study of peptic ulcer disease in prospectively recruited PATIENTS undergoing gastroscopy. PATIENTS: 277 consecutive patients referred for gastroscopy in 1996-1998. MAIN OUTCOME MEASURES: Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers. RESULTS: 54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups. CONCLUSIONS: Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.     

兰州地区上消化道出血病因及相关因素分析

目的探讨近30年兰州地区上消化道出血（UGIB）的病因及临床特点。方法回顾性分析1982年1月～2011年12月收治的3490例UGIB患者的住院病历资料,按年龄及入院时间顺序分组,并详细记录临床、实验室及内镜检查结果,分析临床特点及病因变化。结果①前、后15年对比,老年组患者增加;且基础病变多（41．43％）,再出血率高（17．6％）,血尿素氮升高（10．3土14．4）,组问差异有显著性（P〈O．05）,而住院时间及最低血红蛋白等组间差异无显著性（P〉O．05）。②消化性溃疡（PU）出血是青年及中年组UGIB的最主要病因,而AGML（25．1％）是老年组的最主要病因。前、后15年相比,PU总体呈下降趋势,其中DU较前明显减少,胃溃疡、复合溃疡及食管胃底静脉曲张出血（EVB）相对稳定。AGML出血较前明显增加。结论老年患者已逐渐成为UGIB的主要发病人群,具有基础病变多、尿素氮升高、再出血率高等特点;消化性溃疡（PU）仍为兰州地区UGIB的主要原因,AGML成为老年患者UGIB的另一重要病因。     

Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers

The ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 272 patients with bleeding or perforated peptic ulcer was compared with 272 age/sex matched controls. A significantly higher proportion of patients with gastric ulcers had received NSAID than those with duodenal ulcers. Twelve of 90 (13%) patients admitted with bleeding duodenal ulcers had received NSAID compared with 11 of 26 (42%) patients with bleeding gastric ulcers (P = 0.003). Sixteen of 132 (12%) patients with perforated duodenal ulcer were taking NSAID compared with 8 of 24 (33%) patients with perforated gastric ulcer. Thirty eight percent of patients with both bleeding and perforated gastric ulcers had received NSAID compared with 13% bleeding and perforated duodenal ulcers (P less than 0.002). This study confirms the association of NSAID and complicated peptic ulcer in patients of over 65 years and highlights the particular susceptibility of the gastric mucosa to their injurious effect.     

Variable use of endoscopic haemostasis in the management of bleeding peptic ulcers

Background: Randomised controlled trials (RCTs) have shown that endoscopic haemostasis is beneficial for patients with a bleeding peptic ulcer. The relevance of such data to management outside of RCTs is unclear. Therefore we examined management of patients with a bleeding peptic ulcer in a UK teaching hospital. Methods: All patients who underwent upper gastrointestinal (UGI) endoscopy for bleeding peptic ulcer between 1997 and 1999 were identified from an endoscopy database and the clinical records reviewed retrospectively. Results: A total of 872 patients underwent UGI endoscopy for presumed acute UGI haemorrhage; 179 (21%) had an endoscopic diagnosis of bleeding peptic ulcer. Seventy nine patients had a peptic ulcer with stigmata of recent haemorrhage (SRH) but only 61 (77%) of these patients received endoscopic haemostasis (77% adrenaline, 23% combination therapy). Re-bleeding occurred in 24 patients with SRH in whom transfusion requirement was the sole predictor of re-bleeding. The re-bleeding rate among patients who received adrenaline was 25% (n=12), compared with 57% (n=8) in the combination group and 31% (n=4) in those who did not receive endoscopic haemostasis. Patients who received combination endoscopic haemostasis had an increased incidence of active bleeding (p=0.007) and an increased transfusion requirement (p=0.002). Eleven of 20 patients who re-bled had repeat endoscopic haemostasis, with 45% eventually requiring surgery. Conclusions: Results of endoscopic management of bleeding peptic ulcers in the unit studied differ markedly from those published by specialised centres. The data reported here suggest that increased standardisation of endoscopic haemostasis is required, especially in units with provision for emergency "out-of-hours" endoscopy, performed by several individuals of different grades.     

骨科手术后并发应激性溃疡大出血

目的 探讨骨科手术并发应激性溃疡大出血临床诊断与治疗。方法 我院1997年9月-2002年8月收治骨科手术后并发应激性溃疡大出血患者11例,其中男7例,女4例。年龄29岁-78岁,平均56.2岁。严重创伤6例,其中3例合并颅脑外伤;脊柱疾病手术2例;骨关节炎、类风湿性关节炎关节置换手术3例。4例患者合并有高血压,5例患者长期服用激索和非甾体类消炎药物(NSAIDs),3例患者抗凝治疗。临床表现为排柏油样大便,呕血,低血容量休克,贫血。急诊胃镜检查显示胃十二指肠粘膜糜烂,弥散性出血。出血1500ml-4000ml,平均2700ml。结果 输血2000ml-4500ml,平均3300ml。9例患者痊愈,死亡2例。结论 骨科手术并发应激性溃疡大出血是一种严重的并发症,治疗在于有效控制出血,补充血容量,同时注意对重要脏器的保护。对长期服用容易引起胃粘膜损害药物的患者,围手术期应使用抑制胃酸分泌的药物,预防应激性溃疡的发生。