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.     

非酒精性脂肪肝的诊断与治疗

肝内脂质沉积含量超过肝湿重的5％，或组织学上每单位面积见1/3以上肝细胞脂变时，称为脂肪肝，系一种病理学概念。临床上脂肪肝被分为酒精性脂肪肝(alcoholic fatty liver，AFI，)和非酒精性脂肪肝(non-alcoholic fatty liver，NAFL)。非酒精性脂肪肝是一种无过量饮酒史肝实质细胞脂肪变性和脂肪贮积为特征的临床病理综合征。     

益生菌在自发性细菌性腹膜炎中的应用

目的:探讨微生态制剂益生菌在预防肝硬化自发性细菌性腹膜炎中的临床效果。方法:随机选择广东省惠州市中心人民医院2008年1月～2009年12月收治的肝硬化自发性细菌性腹膜炎患者93例,随机分为两组,治疗组(抗生素联合益生菌治疗)52例,在常规抗生素治疗的基础上给予益生菌治疗,疗程14d;对照组(抗生素治疗)41例进行对比治疗,仅用常规抗生素治疗。分别观察治疗后即时疗效和追踪观察半年的远期效果。结果:治疗后即时查对照组肠球菌[(8.21±1.39)lgCFUg-1)]较治疗前[(8.63±1.51)lgCFUg-1]减少(P<0.05),双歧杆菌[(10.58±1.46)lgCFUg-1]较治疗前[(9.81±1.13)lgCFUg-1]增加(P<0.05);随访3个月,对照组有18例再发腹膜炎,再发率为43.9%(18/41),而治疗组有16例,再发率为30.8%(16/52),治疗组再发率低于对照组(P<0.05);9例(治疗组5例,对照组4例)患者出现肝功能衰竭、上消化道大出血、肝性脑病等原因死亡,病死率分别为对照组9.8%(4/41),治疗组9.6%(5/52),差异无统计学意义(P>0.05)。结论:抗...     

胃良恶性溃疡组织中幽门螺杆菌感染与端粒酶的关系

端粒酶的激活是恶性肿瘤细胞获得永生性的重要条件。但其激活机制未明。幽门螺杆菌与胃癌的发生关系密切。ＷＨＯ已将Ｈｐ感染作为胃癌的第一类致癌因子。我们的研究试图表明二者之间的关系。资料与方法一、组织标本来源73例胃粘膜组织标本来自我院胃镜下胃粘膜活检标本。每例患者在胃粘膜相邻部位取 7块粘膜组织 ,2块立即放入经处理的试管中后置入液氮罐 ,然后送 - 80°Ｃ低温冰箱保存待检 ;4块做病理检查 ;1块做速尿素酶试验。其中 5 4例胃镜下为溃疡病变 ,经病理组织学检查证实胃良性溃疡 2 5例、恶性溃疡 2 9例。正常胃粘膜 19例。二、…     

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.     

断流术与分流术对门静脉高压性胃病的不同影响

目的　探讨断流术与分流术对门静脉高压性胃病 (PHG)的影响。方法　实验分对照组 9例、断流术组 14例和分流术组 12例 ,采用术前及术后 3个月胃镜检查 ,原位末端标记(TUNEL)染色测凋亡指数 (AI)和逆转录 聚合酶链反应 (RT PCR)法测定Caspase 3mRNA表达量。结果　对照组AI值为 (2 .3 1± 0 .11) % ,Caspase 3mRNA表达量为0 .5 1± 0 .0 3 ,其他组与对照组比较 ,AI值增加差异有统计学意义 (P <0 .0 1) ,Caspase 3mRNA表达量显著增加 (P <0 .0 5 )。断流术后AI值由术前的 (12 .83± 1.5 4) %增加到 (16.2 4± 1.68) % (P <0 .0 5 ) ,PHG患者 2例由轻转重 ,PHG病变程度加重 (P <0 .0 5 ) ;相反 ,分流术后AI值从术前的 (12 .18± 1.3 2 ) %回降至 (8.5 8±0 .72 ) % (P <0 .0 5 ) ,术后PHG患者 1例由重转轻 ,4例痊愈 ,PHG病变程度得到缓解 (P <0 .0 5 )。Caspcse 3mRNA表达量与AI值有类似改变两者间呈正相关(r =0 .86,P <0 .0 5 )。结论　PHG胃黏膜细胞凋亡增加 ,断流术后凋亡加剧 ,PHG病变程度加重 ;分流术后凋亡改善 ,PHG病变程度缓解。     

广东省糜烂性食管炎内镜检出情况调查

目的通过分析13家医院内镜诊断的糜烂性食管炎病例,探讨广东省糜烂性食管炎的患病情况。方法回顾性分析广东省13家大医院2003年全年上消化道内镜检查的所有病例共63 459例,以洛杉矶标准收集符合糜烂性食管炎诊断病例的内镜资料及相关信息进行分析。结果共检出糜烂性食管炎1263例,糜烂性食管炎A、B、C、D级的检出率分别为0.94%(599/63459)、0.69%(440/63459)、0.21%(132/63459)和0.14%(92/63459),总检出率为1.99%(1263/63459), 其中A、B级患者占82.3%(1039/1263)。糜烂性食管炎的严重程度随着患者的年龄的增加而增加(F=22.932,P<0.001)。男性病例明显多于女性病例,男:女=2.3:1。食管裂孔疝见于6.7%(85/ 1263)的病例,其平均年龄明显大于无食管裂孔疝患者(60.0±17.1 vs 49.5±16.8,P<0.001),但两组病变的严重程度情况相似。Barrett食管及食管狭窄等并发症发生率不高,分别为0.71%和0.63%。结论广东省糜烂性食管炎的内镜检出率为1.99%,以轻中度的A、B级为主,并多见于男性、年长患者,病变严重程度随患者年龄的增加而增加。     

无导向下置入螺旋型鼻肠管在急性重症胰腺炎肠内营养中的应用护理

目的探讨急性重症胰腺炎病人无导向下置入螺旋型鼻肠营养管进行肠内营养的置管方法和护理.方法将15例急性重症胰腺炎病人随机分成二组,即研究组10例和对照组5例,实验组行无导向下盲插置管,对照组行内镜引导下置管.观察两种置管方法的成功率、胃肠道刺激反应如恶心呕吐、病人舒适度如耐受或抗拒等、操作所发生的费用、并发症发生率(出血、穿孔).结果无导向下置管方法一次置管成功率90%,出现恶心4例,无呕吐,到达屈氏韧带以下空肠的时间6～12小时.对照组置管成功率100%,出现恶心呕吐4例,均有抗拒反应和退镜后咽喉部疼痛,导管前端到达预定位置所需时间20～45min,所需费用为无导向下操作的3倍,两组均无消化道出血、穿孔等并发症.结论螺旋型鼻肠管可以在无导向下快速准确进入空肠.操作简单易行,对病人刺激少,反应轻,耐受性好,费用低廉,适合基层医院推广使用.     

小剂量阿司匹林诱发消化性溃疡出血的回顾分析

我们对1996年至1997年11月间55岁以上消化性溃疡患者的临床资料作一回顾,分析阿司匹林有无影响消化性溃疡患者出血的作用。临床资料　连续胃镜检查2632例,其中55岁以上消化性溃疡179例,根据是否因缺血性心、脑血管病正在服用小剂量阿司匹林情况(50mg/d)分为2组。A组42例服用阿司匹林,男39例,女3例,年龄55～76(63±5)岁。B组137例未服用阿司匹林,男114例,女23例,年龄55～83(63±7)岁。两组的年龄无显著性差异。且均无服用其它非甾体类抗炎药及皮质激素,具有可比性。根据胃镜检查有出血及呕血或便血判断消化性溃疡出血。结　果1.两组临床资料…     

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.