奥曲肽结合奥美拉唑治疗消化道出血的临床效果观察

目的:观察奥曲肽结合奥美拉唑治疗消化道出血的临床效果。方法:采取随机分组方式将2017年1月至2017年12月因患消化道出血而至本院接受治疗的100例患者平均分成两组,以50例为一组,其中对照组给予单独奥美拉唑治疗,观察组在对照组基础上采取联用奥曲肽治疗,对比两组患者的治疗效果、平均止血时间、再出血率与不良反应发生率。结果:相比于对照组,观察组的治疗总有效率明显较高,平均止血时间与再出血率明显较低,组间差异具备统计学意义(P<0.05);两组患者的不良反应发生率无明显差异,差异无统计学意义(P> 0.05)。结论:针对消化道出血给予奥曲肽结合奥美拉唑治疗不仅能达到理想的治疗效果,能缩短平均止血时间,降低再出血率,而且还无严重不良反应,兼具安全性与有效性。     

奥曲肽治疗脑出血合并上消化道出血46例疗效观察

目的:观察奥曲肽对脑出血合并上消化道出血的疗效。方法:选定46例脑出血合并上消化道出血的患者采用奥曲肽0.1mg缓慢静脉注射,再以0.025mg/h静脉滴注72～96h,观察止血效果。结果:24h及72h止血率分别为52.2%(24例)和43.5%(20例),3d总有效率为95.7%(44例)。未发现明显不良反应。结论:奥曲肽治疗脑出血合并上消化道出血效果显著,使用安全,可以优先选用。     

奥曲肽治疗消化道出血100例疗效观察

目的 观察奥曲肽治疗上消化道大出血的疗效。方法 对100例上消化道大出血患者采用奥曲肽0．1阴静脉缓慢推注，再以0．025mg/h静脉滴注24～72h。结果 24h及72h止血率分别为56％和40％，3天总有效率为96％。未发现明显毒副作用。结论 奥曲肽治疗上消化道大出血止血效果显著，使用安全。     

奥曲肽治疗急性上消化道出血疗效观察

目的探讨奥曲肽治疗急性上消化道出血的临床疗效。方法 72例急性上消化道出血患者随机分为两组,治疗组应用奥曲肽注射液0.1 mg配氯化钠溶液20 ml缓慢静脉推注,继以0.5 mg加入氯化钠溶液40 ml内,以25μg/h静脉泵入,连用1~3 d;对照组应用去甲肾上腺素8 mg配冰氯化钠溶液100 ml,分次口服,连用1~3 d,比较两组止血效果。结果治疗组总有效率87.5%,明显高于对照组,总有效率62.5%。经统计学处理,两组间总有效率比较差异有统计学意义（P〈0.05）。结论奥曲肽治疗急性上消化道出血疗效好,安全可靠,在基层医院急救中应尽早使用。     

奥曲肽治疗急性消化道出血的效果分析

选取我院急诊接诊的90例急性消化道出血患者,根据治疗方案不同分为对照组40例和研究组50例。对照组采取急诊常规治疗,研究组在对照组基础上加用奥曲肽治疗。观察记录两组患者临床效果、再出血发生率,并对比分析。结果研究组总有效率为98.00%(49/50),对照组则为87.50%(35/40),研究组显著高于对照组(P0.05);研究组再出血率为0,对照组则为10.00%(4/40),研究组显著低于对照组(P0.05)。急性消化道出血患者采取急诊常规治疗联合奥曲肽处理可取得不错的效果,疗效明确,再出血率低,值得借鉴。     

奥曲肽治疗肝硬化上消化道出血疗效观察

我院2005-01～2006-12采用奥曲肽治疗肝炎后肝硬化并发上消化道出血，效果满意，现报告如下。     

奥曲肽治疗肝硬化并上消化道出血疗效观察

本文通过对临床上使用奥曲肽与垂体后叶素治疗上消化道出血 63例的对照观察 ,发现奥曲肽疗效显著 ,总结如下。1　临床资料1 1　一般资料 :入选病例为 1995年 5月～ 2 0 0 0年 5月在我院住院救治者 ,所有病例均有呕血或持续黑便的急性上消化道出血征象。男性 3 9例 ,女性 2 4例     

奥曲肽治疗食管静脉曲张破裂出血的临床研究

奥曲肽治疗食管静脉曲张破裂出血的临床研究福建省三明市第一医院消化内科（３６５０００）黄跃，许鲁宁食管、胃底静脉曲张破裂出血是肝硬化门脉高压的严重并发症，其病死率达９．５％，而再次出血时高达６０％以上［１］。其药物治疗过去一直以垂体后叶素为主。但该药小...     

凝血酶联合奥曲肽治疗急性消化道出血的效果

目的研究凝血酶联合奥曲肽治疗急性消化道出血的效果。方法选取2017年11月至2020年4月河南科技大学第一附院医院收治的86例急性消化道出血患者的临床资料,按随机数字表法分为对照组与研究组,每组43例,对照组采用奥曲肽治疗,研究组采用凝血酶联合奥曲肽治疗。比较两组疗效、输血量、止血时间、住院时间、治疗前后血清炎性因子水平[皮质醇(Cor)、肿瘤坏死因子-α(TNF-α)]。结果研究组总有效率为90.70%(39/43),高于对照组[74.42%(32/43)],差异有统计学意义(P <0.05);研究组输血量低于对照组,止血时间、住院时间短于对照组,差异有统计学意义(P <0.05);治疗后,两组血清Cor、TNF-α水平均较治疗前降低,且研究组血清Cor、TNF-α水平低于对照组,差异有统计学意义(P <0.05)。结论凝血酶联合奥曲肽治疗急性消化道出血患者可提高疗效,加快止血,减少输血量,并能减轻炎性反应,加快患者恢复进程,缩短住院时间。     

综合治疗急性非静脉曲张性上消化道大出血50例

目的探讨综合治疗急性非静脉曲张性上消化道大出血的疗效。方法回顾性分析安庆医院2010年5月至2011年4月50例急性非静脉曲张性上消化道大出血患者的临床资料。结果 33例联合使用奥曲肽和质子泵抑制剂止血成功,4例胃溃疡伴有渗血者分别予3～8枚金属钛夹止血成功,3例胃溃疡,2例球部溃疡,Mallory-Weiss综合征、Dieulafoy溃疡、Mallory-Weiss综合征合并胃溃疡各1例伴有活动性出血者均急转外科手术治疗成功。Dieulafoy溃疡、残胃吻合口溃疡、球部溃疡伴活动性出血者各1例转外科后拒绝手术自动出院,2例胃癌转外科手术,总有效率为94%,住院时间3～36 d,平均11.4 d。结论联合使用奥曲肽及质子泵抑制剂,必要时金属钛夹治疗急性非静脉曲张性上消化道大出血疗效良好。     

不同的生长抑素制剂与垂体后叶素治疗肝硬化性消化管静脉曲张破裂出血的疗效比较--附52例疗效分析

目的：比较不同的生长抑素制剂（施他宁、奥曲肽）与垂体后叶素治疗肝硬化食管、胃底静脉曲张破裂出血的疗效。方法：将５２例出血患者随机分为３组，１５例予施他宁治疗，剂量为首次２５０μｇ静注，再以６０００μｇ／２４ｈ持续静滴；１５例予奥曲肽治疗，剂量为首次０．１ｍｇ静注，再以０．６ｍｇ／２４ｈ持续静滴；２２例予垂体后叶素３０Ｕ／８ｈ持续静滴，３组均连用３天。结果：施他宁组、奥曲肽组、垂体后叶素组平均止血时间分别为（１６±１１）、（２０±７）、（３７±３０）小时，３组间比较均有显著性差异（Ｐ＜０．０５）。施他宁组与奥曲肽组的疗效均优于垂体后叶素组。结论：施他宁、奥曲肽治疗肝硬化食管、胃底静脉曲张破裂出血的疗效较垂体后叶素好     

Octreotide for the treatment of sulfonylurea poisoning

Background. Sulfonylureas are used extensively for treating type-2 diabetes mellitus. Sulfonylurea poisoning can produce sustained and profound hypoglycemia refractory to IV dextrose, particularly in children and the elderly. Objective. To review the use of octreotide, a long-acting somatostatin analog, in the treatment of sulfonylurea-induced hypoglycemia. Methods. A computerized search of U.S. National Academy of Medicine, Embase, PubMed and Toxline databases was undertaken using the keywords “octreotide”, “sulfonylurea”, “poisoning”, “intoxication”, “overdose” and “children”. Textbooks of Clinical Toxicology and Pharmacology and the articles cited in their bibliographies were also searched. Twenty-four publications (19 articles and five conference abstracts) were identified; no publication was excluded. Pharmacology of octreotide. Octreotide, a synthetic peptide analog of somatostatin, binds to G protein-coupled somatostatin-2 receptors in pancreatic beta-cells, resulting in decreased calcium influx and inhibition of insulin secretion. Octreotide markedly inhibited insulin secretion and decreased the number of hypoglycemic events and supplemental dextrose requirements in animal studies. In humans octreotide markedly inhibited insulin release, increased serum glucose concentration, reduced dextrose requirement, prevented recurrent hypoglycemia and was superior to IV dextrose and diazoxide after administration of sulfonylureas. Efficacy of octreotide in pediatric sulfonylurea poisoning. Fourteen pediatric patients were reported; 13 ingested second-generation sulfonylureas, with time to hypoglycemia of 1.5–16 hours. IV dextrose (10–25%) was administered before and after octreotide therapy. Octreotide was given after failure to correct hypoglycemia with IV dextrose in doses of 0.51–2 μg/kg IV or SC; two also required an IV octreotide infusion. Seven patients (50%) had recurrent hypoglycemia and received IV dextrose and additional octreotide. Efficacy of octreotide in adult sulfonylurea poisoning. Fifty-three patients were reported in prospective controlled (n = 22) and retrospective (n = 9) studies, case series (n = 6) and case reports. Fifty-one ingested second-generation sulfonylureas with time to hypoglycemia of 1–13 hours. All received IV dextrose (10–50%) before and after octreotide treatment. Octreotide 40–100 μg SC or IV was administered followed by additional doses in most patients; three patients also required an IV infusion. Octreotide significantly increased serum glucose concentrations, decreased dextrose requirement and recurrent hypoglycemic events compared with IV dextrose. Recurrent hypoglycemia was recorded in 22–50% of the patients treated with octreotide. Therapeutic recommendations. Based on the published clinical and pharmacokinetic data of sulfonylureas and octreotide, we suggest the following dose regimens: in children, octreotide 1–1.5 μg/kg IV or SC, followed by 2–3 more doses 6 hours apart. In adults, octreotide 50 μg SC or IV, followed by three 50 μg doses every 6 hours. During this treatment IV dextrose infusion should be gradually tapered off. Adverse events. Hypertension and apnea were recorded in one pediatric patient 30 minutes after IV octreotide; the relationship to octreotide is unclear. One adult patient with chronic renal failure treated with atenolol developed severe hyperkalemia. Conclusions. Although relatively limited, the available data suggest that octreotide should be considered first-line therapy in both pediatric and adult sulfonylurea poisoning with clinical and laboratory evidence of hypoglycemia. Maintenance doses of octreotide may be required to prevent recurrent hypoglycemia.     

奥曲肽治疗门静脉高压性消化道出血的临床价值分析

目的探讨奥曲肽治疗门静脉高压性消化道出血的临床价值。方法选取2008年7月~2012年9月我院确诊治疗的门静脉高压性消化道出血患者94例,依据随机分配原则分为奥曲肽组和对照组,两组患者均给予常规垂体后叶素治疗,奥曲肽组在此治疗基础上同时给予奥曲肽治疗,对比分析两组患者治疗情况和治疗后不良反应发生情况。结果奥曲肽组患者止血、住院时间均明显短于对照组,胃液pH值明显高于对照组,差异有统计学意义(P0.05);奥曲肽组患者治疗总有效率明显高于对照组,差异有统计学意义(P0.05);奥曲肽组患者治疗后不良反应率明显低于对照组,差异有统计学意义(P0.05)。结论奥曲肽治疗可有效缓解患者出血症状,缩短患者出血时间,有利于加快患者的恢复,提高治疗效果和降低不良反应的发生,值得临床作进一步推广。     

捏脊疗法减轻新生儿高胆红素血症光疗中消化道副作用的效果观察

目的探讨捏脊疗法对减轻新生儿高胆红素血症光疗中消化道副作用的效果。方法188例新生儿高胆红素血症患儿随机分为观察组94例和对照组94例,2组在同时接受常规的药物治疗(鲁米那、白蛋白、纠酸)及光疗的基础上,辅以观察组捏脊疗法,观察患儿的消化道症状和体征,如腹泻、腹胀、呕吐、食欲减退等。结果通过观察发现,观察组的腹泻、腹胀、呕吐、食欲减退等的发生率明显低于对照组,有统计学意义(P<0.05)。结论捏脊疗法能增进消化和吸收作用,减轻新生儿高胆红素血症光疗中消化道副作用。     

足三里按摩联合早期假进食促进老年胃肠患者术后胃肠功能恢复的临床观察

目的 探讨足三里按摩联合早期假进食促进老年胃肠手术后患者胃肠功能恢复的临床护理效果.方法 连续收集2016年9月~2017年12月期间于该院住院年满60周岁的胃肠道手术患者100例,采用完全随机分组的方法随机分为对照组和观察组各50例.对照组接受常规护理,观察组在常规护理基础上增加足三里穴位按摩及早期假进食措施,然后对两组患者的胃肠功能恢复指标、食欲、腹胀程度、术后并发症发生情况、护理满意度进行统计分析.结果 观察组患者的肠鸣音恢复时间、首次肛门排气时间、首次排便时间、进食时间、住院时间均显著短于对照组(均P<0.05),食欲好、中的比率42.0%、32.0%均显著高于对照组24.0%、20.0%(均P<0.05),差的比率26.0%显著低于对照组56.0%(P<0.05),无、轻度的腹胀率54.0%、34.0%均显著高于对照组40.0%、22.0%(均P<0.05),中度、重度腹胀率12.0%、0均显著低于对照组26.0%、12.0%(均P<0.05),术后并发症发生率18.0%显著低于对照组46.0%(P<0.05),护理满意度98.0%显著高于对照组78.0%(P<0.05).结论 足三里按摩联合早期假进食促进老年胃肠手术后患者胃肠功能恢复的临床护理效果良好,值得在临床推广.     

Endoscopic injection of adrenaline for severe peptic ulcer haemorrhage in high surgical risk patients

Endoscopic adrenaline-hypertonic injection was attempted in 40 patients admitted for oesophagogastroduodenal ulcer haemorrhage unresponsive to conventional medical treatment and presenting with severe underlying disease or advanced age (<80 years). The results were compared with our own historical controls (43 patients) treated by conventional therapy, meeting the same inclusion criteria. Permanent haemostasis was achieved in 32 patients in the injection group and 30 in the control group (NS) but emergency surgery was less frequent in the injection group (2 vs 25,p<0.001). Blood transfusion requirements were less in the injection group (8.5±6.2 vs 10.2±5.4,p<0.05) but length of hospital stay was not really different (15.7 days±9.3 vs 20.9±14.4). Unfortunately, mortality was not reduced in the injection group (14/40 vs 17/43). Two lethal complications attributable to injection treatment occurred. This treatment could represent an alternative to conventional haemostatic treatment in high surgical risk patients with severe clinical bleeding, avoiding emergency surgery. In spite of the fact that we selected high-risk patients, endoscopic treatment was not able to lower the mortality (about 37%). Due to severe unpredictable side effects and potential risks of long-term massive rebleeding, this treatment should be performed electively in patients with severe clinical bleeding, as first line treatment when surgical risk factors exist or immediately before surgery in low risk patients.     

指法扩肛对胃肠道手术病人胃肠蠕动功能的影响

目的探讨指法扩肛对胃肠道手术病人胃肠蠕动功能的影响。方法将100例胃肠道手术病人随机分为实验组（n=50）与对照组（n=50）。实验组分别于手术结束时、术后3h、6h、24h各指法扩肛一次,以后每日扩肛一次至自主排气止,对照组按常规方法护理。结果实验组胃肠蠕动恢复时间和腹胀发生率明显少于对照组,P〈0．05。结论指法扩肛可促进胃肠道手术病人胃肠蠕动功能的恢复。     

家庭随访指导老年患者鼻饲护理的效果评价

目的 探讨家庭随访指导对院外家庭老年鼻饲患者管理能力的影响.方法 采用方便取样法,将2006年4月至2008年3月出院的66例实施家庭随访指导的鼻饲患者设为干预组,采用自行设计的调查表、电话随访、上门家访面谈形式进行调查.评价实施家庭随访指导后对院外家庭老年鼻饲患者并发症和照顾者管理能力的影响.2004年3月至2006年3月本院神经内科出院的62例鼻饲患者设为对照组,实施常规护理指导.结果干预组鼻饲并发症明显低于对照组(P＜0.05),管理能力明显高于对照组(P＜0.01).结论 实施家庭随访指导能明显减少鼻饲并发症和提高院外家庭老年鼻饲患者照顾者的管理能力.     

Modern‐day management of upper gastrointestinal haemorrhage

Acute upper gastrointestinal haemorrhage (AUGIH) is a common medical emergency and can present with life threatening haemorrhage. In the UK, there are 70 000 hospital admissions per year. In the majority of cases, the aetiology is non‐variceal in origin, but in other cases it is due to variceal bleeding in patients with cirrhosis. It is also a leading indication for transfusion of blood components. This review explores recent randomised data on the efficacy and safety of red blood cell transfusion for AUGIH. In addition, the evidence base for use of other blood components and pro‐haemostatic pharmacological agents is discussed, including acid suppression, antifibrinolytics and fibrinogen.