216例老年人上消化道出血临床特点分析

目的:探讨老年人上消化道出血的临床特征.方法:对216例老年人上消化道出血患者(老年组)的临床表现、病因、并发症及治疗效果进行回顾性分析,并与同期非老年组比较.结果:老年组上消化道出血以黑便为主要的症状,其上消化道出血的原因依次为消化性溃疡(43.10%)、胃黏膜病变(26.95%)、恶性肿瘤(19.90%)和食管胃底静脉曲张破裂(8.30%),其中消化性溃疡和恶性肿瘤发病率明显高于非老年组(P＜0.01).老年组并发症多于非老年组.老年组保守治疗治愈率为88.43%,非老年组为99.18%(P＜0.01).结论:老年人上消化道出血病情凶险,预后较差,应予以高度重视.     

上消化道出血对消化性溃疡患者14碳呼气试验的影响

[目的]探讨上消化道出血对消化性溃疡患者14碳呼气试验结果的影响.[方法]比较消化性溃疡并出血组与消化性溃疡无出血的对照组的14碳呼气试验检测结果.[结果]出血组14碳呼气试验的阳性率明显低于对照组,差异有统计学意义( P <0.05).[结论]上消化道出血对消化性溃疡患者的14碳呼气试验的阳性率有影响.     

消化性溃疡所致反复上消化道出血27例分析

笔者选择延庆县医院1994-01至今确诊的上消化道出血的住院患者资料,将符合下列条件的病例资料纳人研究：（1）上消化道出血2次或2次以上;（2）接受急诊内镜检查明确为消化性溃疡出血;（3）经病理学检查排除恶性病变。共入选27例,分析如下。     

上消化道出血与季节变化及气象因素的相关性研究

目的探讨吉林省上消化道出血(UGIB)的季节性发病规律及其与气象因素的相关性。方法对吉林大学第一医院2011年1月至2012年12月确诊为UGIB的681例住院患者的临床资料、入院时的月份和季度归属及同期的气象资料进行统计分析,比较各个月份、季度之间UGIB发病的差异,并分析各气象因素与UGIB发病之间的关系。结果 UGIB的发病例数在不同季节有统计学差异(χ2=25.11,P<0.01)。秋、冬季出血发生率明显高于春、夏季(58.30%vs.41.70%,P<0.01),且在10月达高峰,在4月达低谷。Spearman双变量相关分析显示UGIB发病与平均大气压关联最显著(rho=0.738,P=0.000),其次是平均气温(rho=-0.533,P=0.007),再次是人体舒适度指数(rho=-0.462,P=0.023),而平均风速(rho=-0.359,P=0.085)、平均相对湿度(rho=0.168,P=0.431)和平均气温日较差(rho=-0.005,P=0.98)与UGIB发病无明显关联。将平均大气压和平均气温代入多元线性回归分析,可建立回归方程:UGIB月发病数=-1 211.401+0.349×月平均气温+1.254×月平均大气压。结论吉林省UGIB的发病存在显著的季节差异,且与月平均大气压呈正相关,与月平均气温呈负相关。通过多元线性回归分析,可以建立预测方程,进行医疗气象预报。     

老年人消化性溃疡并上消化道出血误诊26例分析

将我院 1999- 0 1～ 2 0 0 3- 0 4收治的老年人消化性溃疡并出血误诊 2 6例分析如下。1　临床资料本组男 2 1例 ,女 5例 ,年龄 6 0～ 80岁 ,平均 6 5 .17岁。上腹轻微不适者 12例 ,胸骨后疼痛者 5例 ,吞咽时咽部阻塞感 6例 ,头晕、胸闷、乏力 3例。有明确溃疡病史者 19例 ,病史时间 0 .5～ 5 0 a,平均 12 .7a;有明显合并症者 2 3例 ,其中冠心病 8例 ,高血压病 12例 ,肺气肿、肺心病 8例 ,糖尿病 4例 ,胆道系统疾病 5例 ,风湿性关节炎 2例 ,无明显合并症者 3例。入院时心电图检查 8例有明显缺血表现 ,其中 2例伴房性早搏 ;6例血红蛋白为 9～ …     

钩虫病致上消化道出血九例分析

钩虫病是十二指肠钩虫或者美洲钩虫寄生于人体胃肠黏膜肠所致的血吸虫病[1],可损伤胃肠黏膜并引起腹痛、出血、贫血,易与胃十二指肠炎、溃疡等相混淆导致误诊[2].现对我院2004～2010年收治的以消化道出血为主要表现的钩虫病9例诊治情况报告如下.     

大黄治疗急性上消化道出血

上消化道出血系指 Treitz韧带以上的消化道 ,包括食管、胃、十二指肠或胰胆等病变引起出血。以呕血、黑便以及由于大出血导致的一系列全身症状 ,以表情淡漠、头昏、心悸、血压下降、尿量减少为主要临床表现。我们用大黄 (片 )治疗急性上消化道出血 137例取得满意疗效。1　资料与方法1.1　研究对象　 137例均为急性非静脉曲张性上消化道出血住院患者 ,因呕血和 (或 )黑便入院。均经胃镜检查诊断。其中男 81例 ,女 5 6例 ;年龄 18～ 79岁。病因 :胃溃疡 2 9例、十二指肠溃疡 83例、急性胃黏膜损害 17例、贲门黏膜撕裂综合征 1例、胃癌 4例、…     

消化性溃疡出血的FORREST分级及其与预后关系

本文采用Ｆｏｒｒｅｓｔ分级前瞻性的调查国人消化性溃疡出血与再出血的关系。结果２６３例中Ⅰａ、Ⅰｂ、Ⅱａ、Ⅱｂ和Ⅲ级各占２．７、１４．４、８．０、１２．９和６２．０％；其再出血率分别是１００、４７、５７、１４和１．８％。认为消化溃疡出血的内镜下征象可提供预后信息；Ｆｏｒｒｅｓｔ分极在实践上是可行的。     

老年人上消化道出血临床特征分析

目的 分析老年人上消化道出血临床特征,为临床及时合理的治疗提供依据.方法 回顾性分析确诊的上消化道出血病例201例,其中老年组患者100例,非老年组患者101例的临床资料.结果 老年组以消化性溃疡为首要病因(39.00%),但胃溃疡出血发生率(24.00%)高于十二指肠溃疡发生率(15.00%);而非老年组以十二指肠溃疡为主.老年组合并疾病多(70.00%),显著高于非老年组(24.75%),2组比较差异有统计学意义(x2=41.27,P<0.01).老年组临床表现以呕血多见(28.00%),相比非老年组(7.92%)差异有统计学意义(x2=13.78,P<0.01).老年组多接受非甾体抗炎药(NSAIDs)或抗凝剂治疗合并疾病.结论 老年人上消化道出血的首要病因是消化性溃疡并出血,其中胃溃疡出血发生率较高,多有呕血表现,且合并疾病明显增多.老年人宜选择应用质子泵抑制剂.

Abstract：

Objective To study the clinical features of upper gastro-intestinal hemorrhage in aged patients and provide information for timely and reasonable treatment for these patients. Methods The clinical data of 100 aged patients with upper gastro-intestinal hemorrhage (group A) were analyzed retrospectively. As control, 101 cases of non-aged patients with the same condition were selected for comparison ( Group B). Results The main cause of upper gastro-intestinal hemorrhage in aged patients was peptic ulcer(39% ) ,but the rate of hemorrhagein gastric ulcer(24. 00% ) was higher than that of duodenal ulcer(15. 00% ). However, in the non-aged patients,duodenal ulcer caused higher chance of upper gastro-intestinal hemorrhage than gastric ulcer. Aged group has higher complications ( 70.00% ) , which was significantly higher than that in non-aged group ( 24.75% ) ( x2 = 41. 27, P < 0. 01). Haematemesis occurred more frequently in aged group ( 28.00% ) thanthat of 7.92% in the non-aged group(x2 = 13.78 ,P <0.01). Most patients in aged group received NSAIDs and anticoagulant to treat complications. Conclusion The primary cause of upper gastrointestinal haemorrhage in aged patients was peptic ulcer,with relatively high incidence in gastric ulcer patients,and frequent incidence of haematemesis and complications. Aged patients were recommended to receive PPI therapy.     

胰十二指肠切除术后消化道出血原因及治疗

目的 探讨胰十二指肠切除术(PD)术后消化道出血的原因及治疗.方法 对我院1996年1月至2011年12月213例PD患者和2例由外院转入的PD术后消化道出血患者的临床资料进行回顾性分析.结果 213例PD共出现术后消化道出血18例,发生率8.5％ (18/213).18例患者中4例死亡,病死率22.2％ (4/18).在20例消化道出血病例(我院的18例和外院转入的2例)中,应激性溃疡为最常见的出血原因(11例,55％).轻度出血8例,均通过内科药物治疗止血;重度出血12例,其中7例接受了再次手术.单因素分析显示手术时间≥420 min(x2 =3.976,P=0.046)和术中出血量≥1200 ml(x2=6.753,P=0.009)与术后应激性溃疡出血有关,多因素分析显示只有术中出血量为独立危险因素(OR=5.677,P=0.035).结论 消化道出血是PD术后的常见并发症之一.术中熟练操作,减少出血量,有助于减少术后应激性溃疡出血的发生.在内科治疗效果不佳时,应及时再手术止血,根据出血的原因和部位采取适当的手术方式.     

脑出血并发上消化道出血的相关性分析

目的为早期胃肠功能保护、预防消化道出血并发症的发生及判断预后提供临床资料。方法采用回顾性分析的方法,对82例脑出血的患者是否并发上消化道出血的相关性进行分析,根据脑出血病例在急性期有无合并上消化道出血分成观察组和对照组,比较两组间的脑出血病变特点。结果观察组和对照组在脑出血病变部位、脑出血量大小、是否破入脑室、意识状况及发病时血压、病死率等方面比较差异有统计学意义。结论脑出血病变的部位及出血量大小以及是否破入脑室与是否并发上消化道出血关系密切,并发消化道出血的患者脑出血病变更重,死亡率明显升高,预后不良,应在积极治疗原发病的同时早期进行胃肠功能保护。     

Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage

Objectives

To determine the association between delayed (>24?h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH).

CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease

Computed tomographic (CT) scans of 11 patients with perforations of the stomach or duodenum were reviewed to determine the variety and relative conspicuity of findings. Five patients had de novo presentation due to perforation of peptic ulcers, two had perforations at ulcer repair sites, and the remaining four patients had ulcer perforations following unrelated surgery. CT allowed recognition of at least one component of bowel perforation, such as extragastroinestinal gas and/or contrast, in most patients. In only three patients (27%), however, could these findings be specifically related to a perforation of the stomach or duodenum from the CT scans alone.Presented in part at The Society of Gastrointestinal Radiologists 20th Annual Meeting, February 1991.     

Fatal gastrointestinal hemorrhage after a single dose of dabigatran

Introduction. Dabigatran (Pradaxa) is a new oral anticoagulant approved by the Food and Drug Administration (FDA), available internationally and indicated as an alternative to warfarin for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Dabigatran does not require laboratory monitoring and its kinetics allow for a more rapid onset of action with a time to peak concentration of 1.25–1.5 h. We are reporting a fatality resulting from gastrointestinal bleeding after the ingestion of a single dose of dabigatran 150 mg. Case details. A 92-year-old man with a medical history of chronic obstructive pulmonary disease, hypothyroidism, and atrial flutter presented to the emergency department with complaints of weakness and rectal bleeding. He was seen by his Cardiologist the day before and was found to be in new atrial fibrillation. He was prescribed dabigatran 150 mg twice daily for anticoagulation therapy. He took one dose of dabigatran 150 mg at 2200 and woke up the following morning before 0900 with profuse rectal bleeding. The initial vital signs in the emergency department, approximately 11 h after ingestion, were heart rate 72 beats/min, blood pressure 62/30 mmHg, and lab work showed hemoglobin 9.9 g/dL, international normalization ratio (INR) 1.99, blood urea nitrogen (BUN) 66 mg/dL, and creatinine (SCr) 1.4 mg/dL (creatinine clearance (CrCl) 24.2 mL/min). He was resuscitated with intravenous fluids, two units of packed red blood cells, two units of fresh frozen plasma, platelets, and vitamin K 10 mg intravenously. He was also given an unknown dose of erythromycin early in his hospital stay. An actively bleeding gastric ulcer was discovered and treated with local epinephrine injections. Approximately 48 h after his exposure, he received an additional two units of blood to treat his decreasing blood pressure (98/41 mmHg). On day three, his hemoglobin and hematocrit were stable at 10 g/dL and 30%, INR 1.6, he was extubated and off vasoactive medications. Day six of hospitalization, he began having maroon stools, his hemoglobin decreased to 8.1 g/dL and his platelets to 81 × 1000/mcL. On day seven, the hemoglobin decreased to 6.4 mg/dL. Despite aggressive resuscitative efforts and supportive care, he died. Discussion. This case demonstrates the potential of a single dose of dabigatran 150 mg to result in a fatal gastrointestinal hemorrhage. This patient was started on the maximum dose with a CrCl 33.9 mL/min and on admission CrCl 24.2 mL/min, suggesting underlying renal insufficiency.     

Value of CT in localizing site of gastrointestinal hemorrhage following negative angiography

This case report of severe gastrointestinal (GI) bleeding demonstrates the utility of computed tomography (CT) in localizing such hemorrhages when all other diagnostic modalities have been exhausted. All previous studies in this case were nondiagnostic. However, abdominal CT performed without the benefit of oral contrast but immediately following negative angiography was useful in directing the surgeon to the region of hemorrhage by documenting the presence of focally dense intraluminal contrast within the small bowel loops.     

重症监护病房内上消化道出血的临床分析

目的探讨重症监护患者上消化道出血的主要因素,以及并发上消化道出血与病死率的关系。方法回顾分析重症监护病房(ICU)并发上消化道出血(急性非静脉曲张性上消化道出血)急危重病患者252例,按发病后上消化道出血发生时间与病死率的关系进行比较分析,并根据治疗超过3 d后继发感染和上消化道出血与病死率的关系进行比较分析。结果发生上消化道出血的主要疾病为脑血管意外和重度颅脑损伤;上消化道出血出现时间愈早(分别为<1 d、1~3 d、>3 d)死亡率愈高(P<0.05);治疗超过3 d后出现继发感染者上消化道出血发生率增加(P<0.05),其中呼吸机相关性肺炎35例,占83.33%,且继发感染伴上消化道出血患者病死率增加(P<0.05)。结论ICU患者出现上消化道出血提示预后不良;及时发现上消化道出血,防治感染尤其是呼吸机相关性肺炎等对ICU患者预后有重要意义。     

脓毒症患者血胆固醇的变化及其与预后的关系

目的探讨脓毒症患者血胆固醇的变化及其与预后的关系。方法回顾性分析2014年2月至2018年12月南京医科大学附属南京医院收治236例脓毒症患者(观察组)的临床资料,并与同期住院的236例非脓毒症患者作为对照组,比较两组患者一般临床资料、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)以及其他生化指标;将脓毒症患者按预后分成存活组和死亡组,以多因素Logistic回归分析影响预后的相关因素。结果脓毒症患者存活率为60.6%(143/236),病死率为39.4%(93/236),生存组为143例,死亡组为93例。观察组和对照组患者TC[(2.51±1.20)mmo/L与(3.42±1.33)mmo/L,t=6.385、P<0.05]、HDL-C[(1.62±0.91)mmo/L与(2.53±0.79)mmo/L,t=5.526、P<0.05]比较差异均有统计学意义,而两组患者LDL-C[(1.95±0.93)mmo/L与(2.11±0.84)mmo/L,t=0.958、P>0.05]比较差异无统计学意义。脓毒症患者死亡组年龄较存活组增大[(75.4±10.3)岁与(64.3±16.0)岁,t=4.984、P<0.05]、血肌酐较存活组升高[(252.3±65.2)μmol/L与(168.3±47.8)μmol/L,t=5.604、P<0.05],而死亡组与存活组TC[(2.20±1.46)mmo/L与(2.91±1.12)mmo/L,t=6.157、P<0.05]、HDL-C[(1.41±0.51)mmo/L与(1.95±0.65)mmo/L,t=5.090、P<0.05]、LDL-C[(1.71±0.67)mmo/L与(2.02±0.84)mmo/L,t=4.525、P<0.05]比较差异均有统计学意义。经Logistic回归分析显示,年龄是影响脓毒症患者预后的独立危险因素(OR=1.035,95%CI 1.012~1.049,P=0.008),而TC则是保护因素(OR=0.748,95%CI 0.693~0.822,P=0.015)。结论TC、HDL-C在脓毒症患者中呈显著下降特征,而死亡者较存活者TC、HDL-C、LDL-C均进一步下降;其中TC作为保护因素可以成为评估脓毒症患者预后的有效生化指标。