高血压脑出血甲状腺功能异常患者再出血及预后的观察

目的探讨高血压脑出血(HICH)甲状腺功能异常患者再出血的发生与预后情况。方法纳入盐城市亭湖区人民医院2014年5月至2019年5月收治的HICH甲状腺功能异常患者80例。根据患者是否发生再出血,分成再出血组14例、未再出血组66例。比较两组甲状腺功能指标,包括促甲状腺激素(TSH)、总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)。记录患者再出血后血肿量,分析各甲状腺功能指标与血肿量的相关性。观察患者的预后情况,比较生存组、死亡组的甲状腺功能指标,绘制受试者工作特征曲线分析相关血清指标对患者预后的预测价值。结果在80例患者中,有14例(17.50%)发生再出血,66例(82.50%)未发生再出血。再出血组的血清TT3、FT3含量显著低于未再出血组,血清TSH显著高于未再出血组(t=2.249、6.713、3.099,P <0.05)。在14例再出血患者中,患者的平均血肿量为(41.39±7.53)mL。经Pearson线性相关提示,血肿量与血清TT3、FT3含量呈负相关(r=-0.487、-0.589,P <0.05),其与血清TSH呈正相关(r=0.495,P <0.05)。在80例患者中,有10例(12.50%)死亡,70例(87.50%)生存。死亡组血清TT3、FT3含量显著低于生存组,血清TSH显著高于生存组(t=2.185、2.969、3.463,P <0.05)。血清TSH、TT3、FT3预测患者预后的曲线下面积分别为0.916、0.605、0.937;P值分别为<0.05、> 0.05、<0.05。结论血清TT3、FT3下调,血清TSH上调可能与HICH甲状腺功能异常患者再出血的发生有关,且血清TSH、FT3对其预后具有一定预测价值。     

聚集解决护理模式预防肝硬化食管胃底静脉曲张患者再次出血的效果观察

目的：观察聚集解决护理模式对肝硬化食管胃底静脉曲张患者再次出血的预防作用。方法将120例肝硬化食管胃底静脉曲张患者按照奇偶数字法随机均分为对照组与观察组各60例,分别采用常规护理与聚集解决护理模式。比较两组预防再出血效果、护理干预前后焦虑自评量表(SAS)及抑郁自评量表(SDS)评分、游离肝静脉压(FHVP)、肝静脉楔压(WHVP)及肝静脉压力梯度(HVPG)的变化、静脉主干血流动力学及脾静脉血流动力学变化情况。结果观察组预防再出血效果显著优于对照组(P<0.05);观察组护理干预后SAS及SDS评分显著低于干预前及对照组护理干预后(P<0.05);观察组护理干预后WHVP及HVPG水平较护理干预前显著降低(P<0.05);两组护理干预后血流动力学指标均较护理干预前显著降低(P<0.05);两组护理干预前后脾静脉内径(Dpv)差异均无统计学意义(P>0.05),但两组护理干预前后脾静脉流速(Vpv)及流量(Qpv)差异均具有统计学意义(P<0.05)。结论聚集解决护理模式能够更好地预防肝硬化食管胃底静脉曲张患者再出血,应在临床上加以推广应用。     

Platelet-albumin-bilirubin score-a predictor of outcome of acute variceal bleeding in patients with cirrhosis

BACKGROUND The albumin-bilirubin(ALBI) score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma. Incorporating platelet count in the platelet-albumin-bilirubin(PALBI) score improved validity in predicting outcome of patients undergoing resection and ablation.AIM To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.METHODS The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed. Child Turcotte Pugh(CTP) class, Model of End-stage Liver Disease(MELD), ALBI and PALBI scores were calculated on admission, and were correlated to the outcome of variceal bleeding. Areas under the receivingoperator characteristic curve(AUROC) were calculated for survival and rebleeding.RESULTS Mean age was 52.6 years; 1176 were male(77.5%), 69 CTP-A(4.5%), 434 CTP-B(29.2%), 1014 CTP-C(66.8%); 306 PALBI-1(20.2%), 285 PALBI-2(18.8%), and 926 PALBI-3(61.1%). Three hundred and thirty-two patients died during hospitalization(21.9%). Bleeding-related mortality occurred in 11% of CTP-B,28% of CTP-C, in 21.8% of PALBI-2 and 34.4% of PALBI-3 patients. The AUROC for predicting survival of acute variceal bleeding was 0.668, 0.689, 0.803 and 0.871 for CTP, MELD, ALBI and PALBI scores, respectively. For predicting rebleeding the AUROC was 0.681, 0.74, 0.766 and 0.794 for CTP, MELD, ALBI and PALBI scores, respectively.CONCLUSION PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.     

高血压性脑出血患者小骨窗手术术后 再出血的影响因素分析

目的 探讨高血压性脑出血（hypertensive intracerebral hemorrhage,HICH）患者小骨窗手术术后再出血的影响因素。方法 选取2019年1月至2021年12月于台州市第一人民医院进行小骨窗手术的HICH患者150例为研究对象,通过自制调查问卷收集患者相关临床资料,统计HICH患者小骨窗手术术后再出血的发生率,采用多因素Logistic回归分析探究HICH患者小骨窗手术术后再出血的危险因素。结果 在收回问卷的145例HICH患者中,35例发生术后再出血,再出血率24.14%。单因素分析结果显示,发病至手术时间<6h、术前收缩压≥200mmHg（1mmHg=0.133kPa）、术前舒张压≥120mmHg、高血压病程≥10年、凝血功能异常、血肿形状不规则、合并糖尿病、出血破入脑室的HICH患者小骨窗手术术后再出血的发生率较高,差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,发病至手术时间<6h、术前收缩压≥200mmHg、术前舒张压≥120mmHg、高血压病程≥10年、凝血功能异常、血肿形状不规则、合并糖尿病、出血破入脑室均为影响HICH患者小骨窗手术术后发生再出血的主要危险因素（P<0.05）。结论 手术时机、术前血压、高血压病程、凝血功能、血肿形状、合并糖尿病、出血破入脑室均是HICH患者小骨窗手术术后再出血的危险因素,应把握手术时机,严密监测患者的血压、凝血功能等,对改善患者预后意义深远。     

高血压脑出血微创术后再出血的临床多因素分析

目的探讨影响高血压脑出血微创术后再出血的因素及防治策略。方法回顾性分析213例使用微创穿刺血肿清除技术治疗的高血压脑出血病例,对8个可能影响术后再出血的因素进行统计,使用Logistic回归分析选出影响术后再出血的危险因素。结果27例出现术后再出血,血肿形状（β=2．236,P=0．002）、入院时收缩压（β=1．877,P=0．001）、手术时机（β=-1．589,P=0．004）、术中抽吸血肿量（β=1．280,P=0．010）是影响微创术后再出血的主要因素。结论重视血肿形状、入院时收缩压、手术时机、术中抽吸血肿量对微创术后再出血的影响,针对不同患者作个性化的防治策略,有助于减少高血压脑出血微创术后再出血的发生率。     

立体定向软通道颅内血肿清除术与内科保 守治疗高血压性脑出血疗效的Meta分析

目的 系统评价立体定向软通道颅内血肿清除术治疗高血压性脑出血的效果。
方法 计算机检索国内外数据库中关于立体定向软通道颅内血肿清除术与内科保守治疗高血压
性脑出血的随机对照试验（randomized controlled trial,RCT）,同时追索纳入文献的参考文献。检
索时限均从建库至2012年12月。根据卫生系统中证据推荐分级的评估、制订与评价（grading of
recommendations assessment,development and evaluation,GRADE）系统推荐分级方法,对纳入研究的质
量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan 5.2软件
和GRADE profiler 4.0.3软件。
结果 共纳入11个RCT。Meta分析主要结局结果显示,定向软通道颅内血肿清除术治疗高血压性
脑出血3个月内的临床疗效、病死率、发生感染、发生再出血四个方面,与传统的内科保守治疗方法
相比,其差异有显著性,优势比（odds ratio,OR）和95%可信区间（confidence interval,CI）分别为3.34
（2.13～5.22）、0.42（0.29～0.60）、0.42（0.27～0.64）、0.47（0.28～0.77）。每个结局的GRADE系统
推荐分级均为低等级。
结论 现有研究显示立体定向软通道颅内血肿清除术治疗高血压性脑出血疗效确切,3个月病死率、
发生感染及再出血并发症较传统内科保守治疗更低,临床医师在治疗高血压性脑出血时,可以把立
体定向软通道颅内血肿清除术作为一般推荐。     

Rebleeding and survival after acute lower gastrointestinal bleeding

BACKGROUND: Previous studies of acute lower gastrointestinal bleeding (LGIB) have focused on evaluation and therapy. Measurement of long-term outcome has been rare. The purpose of this study was to document rebleeding and survival rates in patients with acute LGIB. METHODS: A retrospective review of all patients undergoing technetium-labeled red blood cell scans for LGIB from January of 1997 to December of 2002 was performed. Rebleeding was defined as identification of enteric bleeding requiring a transfusion 2 or more weeks after the initial bleeding episode. RESULTS: A total of 119 patients met inclusion criteria. Rebleeding was documented in 14 of 102 patients surviving for more than 2 weeks. The actuarial rebleeding rate was 15% at 2 years. No factors were identified that portended a higher likelihood of rebleeding. The 30-day mortality was 18% and the median survival was 60 months for the entire cohort. Of the 36 patients in whom cause of death was documented, 4 died of surgical complications and a single patient died as a direct result of hemorrhage. CONCLUSIONS: Rebleeding after an initial episode of LGIB occurs in a small percentage of individuals. Although survival is poor for patients with LGIB, few patients die as a direct consequence of hemorrhage.     

Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.     

蛛网膜下腔出血再出血临床特点和危险因素分析

目的探讨引起蛛网膜下腔出血（SAH）再出血的临床特点和危险因素及预防措施。方法回顾分析普内科及神经内科7年收治的127例SAH患者和28例SAH再出血患者的临床表现和可能的危险因素。结果再出血发生率18.06%,高峰在发病后2周内,再出血多发生在冬季;再出血组平均年龄比SAH组低9.01岁,男性多于女性,为2.1∶1;再出血组病死率高达71.43%,比SAH组21.26%明显增高（P〈0.01）;高血压病、激动、长期的烟酒史和感染等均是再出血间接危险因素。结论 SAH急性期和恢复期,需对再出血可控危险因素及时干预。     

Predictive factors for colonic diverticular rebleeding: a retrospective analysis of the clinical and colonoscopic features of 111 patients

Background/Aims

Colonic diverticular bleeding can stop spontaneously or be stopped by endoscopic hemostasis. We analyzed the clinical and colonoscopic features of patients with colonic diverticular bleeding to establish the predictive factors for rebleeding.

Methods

A total of 111 patients (median age, 72 years) with colonic diverticular bleeding in Aso Iizuka Hospital between April 2007 and July 2010 were enrolled. Age, sex, body mass index (BMI), comorbidity, medication, location of bleeding, colonoscopic findings and hemostatic methods were analyzed retrospectively from the hospital records.

Results

The most common sites of bleeding were the ascending (39.6%) and sigmoid (29.7%) colon. Overt rebleeding occurred in 30 patients (27.0%). Spontaneous hemostasis was seen in 81 patients (73.0%), and endoscopic hemostatic treatment was performed in 30 patients. The BMI in the patients with colonic diverticular rebleeding was significantly higher than in patients without rebleeding. Colonoscopic findings of actively bleeding or nonbleeding visible vessels in the responsible diverticula were more frequent in the group with rebleeding.

Conclusions

A higher BMI and colonoscopic findings of actively bleeding or nonbleeding visible vessels can be used as predictive factors for colonic diverticular rebleeding. Patients with such findings should be carefully followed up after hemostasis of the initial colonic diverticular bleeding.