上消化道出血急诊胃镜检查的经济学分析

Objective To value of economic with emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage. Methods I00 patients with upper gastrointestinal hemorrhage were ran-domly divided into emergency endoscopy group (group A) 48 cases and non emergency endoscopy group (group B) 52 cases. Then the correct diagnosis rates, rebleeding rates, complication rates, mean hospitalization days, the en-doscopy costs, the blood transfusion costs, the drugs costs and the total hospitalization costs of two groups were evalu-ated and the cost effect ratio (C/E) was calculated. Results Thecorrect diagnosis rates in A group (100. 0%) were higher than the B group(90. 2%)(x2 =4.01,P <0. 05) ;The endoscopy costs of group A (714. 78±263.54) yuan were higher than the group B (383.57 ±251.72) yuan(t = 2. 778, P < 0. 01) ; Rebleeding A group (6. 7%) were sig-nificantly lower than B group(26. 8%) (x2 = 4. 13 ,P < 0. 05) ; The total hospitalization costs in group A (2785.76 ± 353.26) yuan were lower than group B (3527. 76 ± 555.62) yuan (t = 2. 898, P < 0. 01) ; The C/E of group A (2785.76) yuan per patient were lower than the group B(3527.76) yuan per patient (t = 2. 239 ,P < 0. 01). Con-dusion Emergency endoscopy is economical in the diagnosis and treatment of massive upper gastrointestinal hereof-rhea.     

恩替卡韦联合益生菌治疗失代偿期乙肝肝硬化疗效观察

目的：探讨核苷类联合益生菌治疗失代偿期乙肝肝硬化患者的疗效。方法：将70例失代偿期乙肝肝硬化患者随机分治疗组及对照组,在综合治疗基础上,治疗组应用恩替卡韦及益生菌,对照组仅用恩替卡韦,疗程1年。治疗前后观察两组生化指标、病毒指标、自发性细菌性腹膜炎发生率及预后指标。结果：治疗组生化指标、血清内毒素指标、自发性细菌性腹膜炎发生率优于对照组,而病毒复制及死亡率情况,两组无差异。结论：恩替卡韦联合益生菌在治疗乙型肝炎失代偿期肝硬化方面有较好疗效。     

乙型肝炎病毒核心启动子的T1762A1764变异与干扰素疗效的关系

目的为探讨乙型肝炎病毒(HBV)核心启动子(CP)区域T1762A1764变异对干扰素治疗疗效的影响。方法41例HBeAg阳性、HBVDNA阳性及ALT升高的慢性乙型肝炎(CHB)患者给予干扰素治疗,在治疗前后均应用聚合酶链反应(PCR)技术并对其产物直接测序分析,并定期检测肝功能及HBVDNA。结果治疗前41例CHB患者中有22例存在T1762A1764变异,占54%。干扰素治疗6个月后,HBVDNA阴转率在T1762A1764变异株感染患者中显著高于野生株感染的患者(64%vs37%,P<0.01);HBeAg阴转率在变异株感染患者中显著高于野生株感染的患者(55%vs42%,P<0.05);两组ALT复常率差异无显著性(54%vs46%,P>0.05)。在野生株治疗有效的6例患者中有1例患者出现T1762A1764变异株。结论CP区域T1762A1764变异可提高干扰素治疗疗效,干扰素治疗可能会增加T1762A1764变异的机会。     

内毒素、一氧化氮、白细胞介素-6在肝硬化并原发性腹膜炎中的临床意义

目的探讨内毒素(LPS)、一氧化氮(NO)、白细胞介素-6(IL-6)对肝损伤、肝硬化并原发性腹膜炎(SBP)的致病作用.方法检测34例SBP患者、30例腹水患者、33例无腹水患者的LPS、N0、IL-6水平,对比治疗前后的变化,并相互之间进行相关分析.结果 SBP患者的血清和腹水中上述三项指标水平显著高于腹水患者(P＜0.01),治疗后二组的血清水平均显著下降(P＜0.01),腹水患者血清中上述指标显著高于无腹水患者(P＜0.05),各组三项指标之间呈正相关(P＜0.01).结论 LPS、NO、IL-6参与了SBP的发生和发展.     

体位改变对胃复安在胶囊内镜消化道转运的影响

目的讨论分析患者接受肌注胃复安后不同体位对胶囊胃内停留时间的影响。方法对83例患者进行回顾性分析,所有患者均吞服胶囊并且1h后胶囊仍然停留在患者胃中,按照随机数字表法将所有患者分成三组,分成A组(n=27)、B组(n=28)、C组(n=28),参与本研究所有患者在服用胶囊之后均接受肌注胃复安,医护人员帮助不同组患者采取不同体位,其中A组患者为仰卧位、B组患者为右侧卧位、C组患者为坐立位,医护人员对不同组患者的胶囊胃停留时间情况进行观察并对比分析。结果相比于C组,A组和B组患者胶囊胃内停留时间均更短(P<0.05),但是A组和B组患者胶囊胃内停留时间和三组患者的小肠通过时间指标数据比较,差异无统计学意义(P>0.05)。结论对于吞服胶囊1h后仍然存在于胃中的患者,为了达到预期临床效果可以对其采取肌注胃复安用药,同时帮助患者采取右侧卧位休息或者仰卧位休息,能够从根本上缩短胶囊胃中停留时间,促进患者消化道运转,以此达到预期临床效果。     

清醒镇静胃镜胃息肉电切术的围手术期护理

目的:探讨清醒镇静胃镜胃息肉电切术的围手术期的护理措施。方法:对40例应用清醒镇静胃镜技术行胃息肉电切术的病人,术前进行有针对性的心理护理,严格做好术前准备,术中密切配合内镜医师诊疗,严密观察心率、呼吸、血氧饱和度变化,做好应急抢救的准备及术后的护理健康指导。结果:40例患者均能耐受诊疗,切除息肉45颗,手术成功率100%,手术过程遗忘率100%,满意度100%,无呼吸抑制、循环衰竭、出血等并发症。结论:清醒镇静胃镜胃息肉电切术,对医护配合要求高,做好围手术期病人的护理,是提高手术安全性和成功率的关键。     

动脉栓塞治疗上消化道动脉性大出血

临床上惯用的处理上消化道非静脉曲张出血的模式是药物治疗-内镜治疗-手术治疗。但经药物及内镜治疗后仍不能止血的患者病情均较严重，快速止血是迫切的问题。我们将19例经药物治疗、内镜治疗无效的上消化道动脉性大出血患者行经股动脉插管腹腔动脉造影和栓塞治疗的结果报告如下。     

长期脓血便68例肠镜检查结果分析

对91年至95年因长期脓血便来我院行纤维结肠镜检查者68例,分析结果如下: 一、资料、方法与结果 1.临床资料:68例病人中男33例,女35例,年龄20—77岁。病程1月至1年47人,1年以上21人。临床表现为:①反复脓血便1月以上。②反复用抗生素治疗症状反复或无效。 2.方法与结果 68例均作纤维结肠镜检查及病理检查,部分病例作大便细菌培养。结果如下:大肠癌19     

上消化道出血急诊胃镜检查的经济学分析

Objective To value of economic with emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage. Methods I00 patients with upper gastrointestinal hemorrhage were ran-domly divided into emergency endoscopy group (group A) 48 cases and non emergency endoscopy group (group B) 52 cases. Then the correct diagnosis rates, rebleeding rates, complication rates, mean hospitalization days, the en-doscopy costs, the blood transfusion costs, the drugs costs and the total hospitalization costs of two groups were evalu-ated and the cost effect ratio (C/E) was calculated. Results Thecorrect diagnosis rates in A group (100. 0%) were higher than the B group(90. 2%)(x2 =4.01,P <0. 05) ;The endoscopy costs of group A (714. 78±263.54) yuan were higher than the group B (383.57 ±251.72) yuan(t = 2. 778, P < 0. 01) ; Rebleeding A group (6. 7%) were sig-nificantly lower than B group(26. 8%) (x2 = 4. 13 ,P < 0. 05) ; The total hospitalization costs in group A (2785.76 ± 353.26) yuan were lower than group B (3527. 76 ± 555.62) yuan (t = 2. 898, P < 0. 01) ; The C/E of group A (2785.76) yuan per patient were lower than the group B(3527.76) yuan per patient (t = 2. 239 ,P < 0. 01). Con-dusion Emergency endoscopy is economical in the diagnosis and treatment of massive upper gastrointestinal hereof-rhea.