农村老年人上消化道出血的常见病因和治疗对策的探讨

上消化道出血是老年人消化系统常见病。我院对 15 8例老年人上消化道出血的病因进行分析 ,从而了解老年人上消化道出血的临床特点 ,提出相应对策 ,现探讨如下。1　临床资料1 1　一般资料　本组 15 8例 ,年龄 6 5～ 85岁 ,平均72岁 ;其中男 116例 ,女 4 2例 ,男女比为 2 96∶1。1 2　病因　本组 15 8例均经胃镜检查以及病理组织学检查确诊。发现消化道溃疡 95例 (45 1% ) ,其中十二指肠球部溃疡 30例 (31 5 % ) ,胃溃疡 12例(13% ) ,复合性溃疡 2例 (2 1% ) ,残胃溃疡 1例(0 6 % ) ;胃癌 2 2例 (14% ) ,急性胃粘膜病变 12例(7 5 % ) ,食…     

口服凝血酶治疗上消化道出血的临床疗效观察

上消化道出血是临床上最常见的症状之一 ,占消化科急诊和住院患者首位。主要原因为急性胃粘膜病变、消化性溃疡和肝硬化合并食管胃底静脉曲张等。近年 ,我们应用口服凝血酶(杭州杭康制药公司生产 )治疗上消化道出血 ,并根据不同的疾病口服应用对照药物 ,以观察凝血酶局部止血的疗效。1　资料与方法1.1　一般资料　本组 2 3 96例均为因呕血或 /和黑便入院治疗的住院患者。其中男 2 95例 ,女 10 1例。年龄 19～ 84(平均 5 4.6)岁。肝硬化合并食管胃底静脉曲张破裂出血 62例 ;十二指肠溃疡 15 0例 ;胃溃疡 49例 ;复合溃疡 43例 ;急性胃粘膜病变…     

口服有机磷农药中毒并发上消化道出血原因分析

口服有机磷农药中毒并发上消化道出血者,预后多凶险,抢救成功率与就诊早晚、出血原因、救治措施有密切关系.我院自1981年1月～1990年12月共收治急性有机磷农药中毒112例,并发有上消化道出血23例(占20.5%);23例中有7例(占30.4%)因服毒量大,就诊晚及治疗方法不当死亡.余16例在病人神志清楚,无休克昏迷时行急诊胃镜检查明确了出血原因.其中急性胃粘膜病变5例(31.3%);胃粘膜机械损伤3例(1.7%);食管贲门粘膜撕裂症2例(12.5%).诱发原有肾十二指肠病变出血6例(37.5%).(胃溃疡1例,慢性胃炎3例;十二指肠球部溃疡2例).现举例分析如下.     

非甾体抗炎药致胃十二指肠疾病诊治进展

<正> 非甾体抗炎药(NSAID)致胃十二指肠疾病的机理尚不完全明了,自然史也不清楚,症状隐匿,以致临床诊断和防治困难。本文介绍该病诊治进展。1.NSAID性胃十二指肠病的发生率内镜提示服用NSAID的患者35%～60%发生胃糜烂或粘膜下少量出血,发生胃溃疡者占10%～25%。老年患者可并发严重胃十二指肠溃疡,尤其是出血和穿孔。自从阿斯匹林(ASA)损伤人胃粘膜得到证实以来,NSAID与消化性溃疡的关系已获广泛研究。Cillies等报道ASA致胃溃疡的相     

法莫替丁注射液治疗小儿上消化道出血20例疗效观察

1998年 12月～ 2 0 0 2年 6月 ,我院儿科应用法莫替丁注射液 (商品名立复丁 ,哈尔滨制药三厂生产 )治疗上消化道出血 2 0例并与西米替丁注射液治疗 2 0例对照 ,现报道如下。1　临床资料1 1　病例选择　两组病例均为经胃镜或上消化道钡剂造影确诊的消化性溃疡或急性胃粘膜病变患儿 ,排除了血液病和寄生虫病引起的出血 ,随机分成治疗组和对照组 ,治疗组 2 0例 ,男12例 ,女 8例。胃溃疡 7例 ,十二指肠溃疡 8例 ,急性胃粘膜病变 5例 ;轻度出血 11例 ,中度出血 7例 ,重度出血 2例。对照组2 0例 ,男 11例 ,女 9例。胃溃疡 6例 ,十二指肠溃疡 9例 ,…     

口服洛赛克治疗上消化道出血的疗效观察

洛赛克是一种质子泵抑制剂 ,是治疗消化性溃疡的理想药物。 1995年 8月～ 1998年 10月 ,我们采用口服洛赛克治疗上消化道出血 6 9例 ,疗效良好 ,报告如下。1　资料与方法1.1　病例选择　 138例患者均经胃镜检查确诊上消化道出血 138例 (肿瘤及食管胃底静脉曲张所致出血除外 ) ,随机分为洛赛克治疗组 6 9例 ,男 5 7例 ,女 12例 ;年龄 18～ 78岁 ,平均 42 .3岁 ;其中十二指肠球部溃疡 35例 ,胃溃疡 13例 ,复合性溃疡 3例 ,急性胃粘膜病变 18例 ;大量出血 (>80 0 m l/ 2 4h) 15例 ,中量出血 (40 0～ 80 0 ml/ 2 4h) 4 2例 ,小量出血(<40 0 ml/ …     

老年上消化道疾病内镜检查1993例临床分析

摘要 目的 探讨老年上消化道疾病的发病情况； 方法 以中青年为对照组，回顾性分析1993例老年上消化道疾病的内镜检查结果和临床资料。 结果 老年上消化道疾病结果如下：萎缩性胃炎(49.8%)、浅表性胃炎(48.5%)、十二指肠炎(30.5%)、食管炎(17.8%)、十二指肠溃疡(11.4%)、食管癌(8.1%)、胃溃疡(7.3%)、胃息肉(6.6%)、胃癌(5.6%)、食管溃疡(3.2%)、复合溃疡(2.2%)；食管炎、食管癌、食管溃疡、食管裂孔疝、食管息肉、萎缩性胃炎、胃溃疡、胃息肉、胃癌、贲门癌、出血性胃炎、胃憩室、复合溃疡、十二指肠息肉和十二指肠憩室等病老年组发病率明显高于中青年（P＜0.05） 结论 老年人上消化道病变以炎症为主，但是上消化道肿瘤及溃疡发病率也较高。     

79例老年上消化道出血临床分析

目的 :探讨老年上消化道出血的原因和不同制酸剂对出血的治疗效果。方法 :对我院 1998年 1月至2 0 0 4年 6月共 79例老年上消化道出血患者的临床资料进行回顾性分析。男 4 5例 ,女 34例 ,年龄 6 0～ 85岁 ,平均 6 7 6岁 ,患者被随机分为两组分别接受洛赛克和法莫替丁治疗。统计治疗 3天的总有效率和引起出血的原发疾病百分比。结果 :引起出血的原发疾病中 ,胃、十二指肠溃疡 30例 (38 0 %) ,胃黏膜病变 2 8例 (35 4 %) ,门静脉高压症并发食管静脉曲张破裂出血 14例 (17 7%) ,上消化道肿瘤 5例 (6 3%) ,其他 2例 (2 5 %)。洛赛克组总有效率 95 2 %,法莫替丁组总有效率 78 4 %(P <0 0 5 )。结论 :老年上消化道出血主要由胃、十二指肠溃疡和胃黏膜病变引起。质子泵抑制剂洛赛克治疗老年上消化道出血疗效显著。     

经胃镜局部喷洒凝血酶治疗上消化道大出血临床观察

我们对 48例经常规治疗难以控制的上消化道大出血患者行内镜下局部喷洒凝血酶止血 ,取得满意疗效 ,现报道如下。1　临床资料本组男 31例 ,女 17例 ,年龄 19～ 72岁 ,平均 (4 5± 0 .5 )岁。其中胃溃疡 16例 (33.3% ) ,出血性胃炎 4例 (8.3% ) ,急性胃粘膜病变 7例 (14.6 % ) ,胃癌 3例 (6 .3% ) ,十二指肠球部溃疡 12例 (2 5 % ) ,贲门粘膜撕裂症 1例 (2 % ) ,残胃吻合口溃疡 3例(6 .3% ) ,幽门管溃疡 2例 (4 1% )。其中出血量 >2 0 0 0 ml者 2 9例 ,2 0 0 0 ml以下者 12例 ,失血性休克 7例。2　方法与结果对急性出血患者尽快行胃镜检查 ,明…     

102例上消化道出血病人的护理

上消化道出血是指屈氏韧带以上 ,包括食管、胃、十二指肠以及胆道病变引起的出血 ,它多为消化性疾病中的急症。现将我科自 1995年— 1999年收治的 10 2例上消化道出血病人的发病病因及诱因总结如下。1　临床资料本组 10 2例 ,男 78例 ,女 2 4例 ;年龄最大 78岁 ,最小 19岁 ,平均 48.5岁。吸烟者 2 8例 ,嗜酒者 10例 ,嗜烟又嗜酒者 2 3例 ,喜食辣味饮食者 5例。出血病因 :胃溃疡 3 0例 ,十二指肠球部溃疡 17例 ,急性胃粘膜出血 8例 ,胃癌 10例 ,肝硬化食管静脉破裂出血 6例 ,浅表性萎缩性胃炎 13例 ,其他 18例。诱因 :饮食不当 3 2例 ,过度疲…     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.