内镜套扎治疗食管静脉曲张出血的疗效

目的 评价内镜套钆治疗肝硬化门脉高压食管静脉曲张出血的远期效果。方法 内镜低位密集套扎，首次套扎6－12点，后隔2周重复套扎直至食管静脉曲张完全闭塞和缩小至I度以下。追踪时间，第1次于治后3个月，第2交于治后6－12个月，以后每年1次。追踪发现复发者动员再次套扎。结果 21例中套扎1次3例，2次10例，3次8例。近期止血效果好。随访1－3年，再出血8例，死于再出血4例。死亡病例中肝功能按Child's分级属C级为主。结论 套扎治疗食管静脉曲张出血远期疗效，以反复多次套扎使食管静脉曲张呈根治状态的病例效果好，出血复发率亦低。远期存活率与肝功能损害程度有关。     

巴曲酶联合加压素治疗食管曲张静脉破裂出血效果观察

目的 观察巴曲酶联合加压素治疗食管曲张静脉破裂出血的止血效果。方法 70例肝硬化食管曲张静脉出血病人(男62例,女8例,平均年龄46±9岁),随机分成2组,治疗组36例用巴曲酶2kuiv后,随后三天每日静注lku,并给加压素以0.2u/min的速度持续静滴72h。对照组34例,予用加压素1Ou iv后,以相同的速度维持静滴72h。结果 治疗组止血有效率为86.1％(31/36),显著高于对照组(52.9％,18╱34);治疗组病死率19.4％(71/36)明显低于对照组(58.8％,20/34,P相似文献   

食道曲张静脉套扎术对肝硬化患者门静脉血流动力学的影响

目的：了解食道曲张静脉套扎术（ＥＶＬ）后门静脉血流动力学改变与临床的关系。方法：采用彩色多普勒对２５例肝硬化患者内镜下ＥＶＬ前后的门静脉血流动力学改变进行测定。结果：ＥＶＬ治疗２周后肝硬化患者门静脉、脾静脉内径（ＰＤ、ＳＤ）、门静脉血流速度及血流量（ＰＶ、ＰＱ．ＳＱ）较治疗前明显增加（Ｐ值＜０．０１），脾静脉血流速度（ＳＶ）明显减慢（Ｐ值＜０．０１）。结论：ＥＶＬ能短时间升高门静脉压，部分地加重ＰＨＧ和ＬＦ。     

奥曲肽治疗晚期血吸虫病食管胃静脉曲张大出血的疗效

目的对奥曲肽（Octreotide）治疗晚期血吸虫病食管、胃静脉曲张大出血的疗效作出评价。方法将96例病人分为3组,A组32例,用垂体后叶素0．2u／min静脉持续注射,24h后减半剂量连续用3d。B组34例,垂体后叶素的用法同A组,同时加用硝酸甘油10～40μg／min持续静脉注射4d。C组30例,用奥曲肽100μg静脉注射后,以25μg／h的速度持续静脉注射,24h后减半剂量维持1d。结果3组止血率,分别为56．2％（18／32）、50．0％（17／34）及86．7％（26／30）,C组明显优于A组与B组（P＜0．05）。3组止血有效的病例停药后1周内的再出血率,分别为2／18、2／17及5／26,无显著差异（P＞0．05）。结论奥曲肽的疗效明显优于垂体后叶素及硝酸甘油。     

ESOPHAGEAL VARICEAL BLEEDING CAUSED BY HYPOPLASIA OF THE PORTAL VEIN IN A PATIENT WITH THE KLIPPEL-TRENAUNAY SYNDROME

The case of a patient affected by Klippel-Trenaunay syndrome presenting with esophageal variceal bleeding caused by hypoplasia of the vena porta is reported. Hemostasis was achieved by performing a proximal spleno-renal shunt. We discuss the likely association of this mesodermal development abnormality and vascular disorders of the portal vein.     

PREDICTORS OF THE LONG-TERM OUTCOME OF EARLY SYNOVITIS: A 5-YEAR FOLLOW-UP STUDY

One hundred patients who presented to an Early Synovitis Clinicin 1979–81 were called for review after a minimum of 5years. Sufficient data for analysis were obtained in 88 cases,of whom 36 had a final diagnosis of rheumatoid arthritis (19seropositive, 17 seronegative) and 16 human parvovirus B19 arthropathy.Outcome was assessed by persistence of symptoms greater than24 months and functional disability by Health Assessment Questionnaire.Sixty-two patients had persistent disease, with 26 showing somefunctional impairment (positive HAQ FDI). A number of presentingfeatures were assessed for their ability to predict outcomeat 5 years. Polyarticular onset of disease was associated witha poor prognosis but lacked both specificity and sensitivity.Certain laboratory tests at presentation, including positiverheumatoid factor and low serum sulphydryl levels, also indicateda poor outcome. Combining these serological abnormalities gave100% specificity for detecting persistent, disabling diseasebut with rather low sensitivity. Thus, other test systems arerequired to increase further the successful prediction of clinicaloutcome in patients with early synovitis. KEY WORDS: Prognosis, Rheumatoid factor, Serum sulphydryl, Laboratory tests, Rheumatoid arthritis     

NEUROIMAGING PREDICTORS OF DEMENTIAIN STROKE PATIENTS

The risk of dementia is increased in stroke patients. Dementia syndromes associated with cerebrovascular diseases were commonly recognized as an immediate consequence of stroke. However, more and more data suggest that degenerative pathology and white matter changes (WMC) may play a role in the development of dementia in stroke patients. The aim of this paper was to review the literature concerning the neuroimaging predictors of dementia in stroke patients. From the literature data, it appears that although vascular lesions alone may lead to dementia, in stroke patients, no clear association between stroke location and size has yet been identified, even if the role of the left hemisphere has been suggested. The influence of silent infarcts remains undetermined while more and more data suggest that global cerebral atrophy and WMC are predictive factors of post-stroke dementia (PSD). The influence of medial temporal lobe atrophy on the risk of PSD has until now never been evaluated.     

内镜下食管静脉曲张套扎术的护理

内镜下食管静脉曲张套扎术 ( EVL)是近年来开展的治疗食管静脉出血和再出血的新方法 [1 ]。我院自 1999年以来共收治 EVL 患者 2 2例。现报告如下。1　临床资料1.1　一般资料　本组 2 2例中 ,血吸虫性肝纤维化 8例 ,血吸虫性并肝炎性肝硬化 7例 ,肝炎性肝硬化 7例。男 15例 ,女 7例 ,年龄 2 9- 65岁 ,平均 43 .8岁。急性出血患者 3例 ,其中 1例在 6h内行 EVL,2例在 6- 2 4h内行 EVL。出血停止期患者 19例。1.2　治疗方法1.2 .1　术前准备　术前 3 0 m in常规肌注 Atropine0 .5 mg及 Valium5 - 10 mg,备 1- 2单位同型血。1.2 .2　器械…     

乙氧硬化醇治疗严重食管和胃底静脉曲张出血的疗效观察

本文报告我院对４５例严重食管和胃底静脉曲张破裂出血的患者，用１％乙氧硬化醇血管内注射治疗即硬化疗法（Ａ组），并与内科药物组（Ｂ组）和手术治疗组（Ｃ组）的疗效进行对比。结果Ａ组止血率达９８％，而再出血率Ａ组为１５％，Ｂ组６９％，Ｃ组３２％，三组比较：Ａ组明显低于Ｂ组（Ｐ＜０．０１），与Ｃ组无明显差别（Ｐ＞０．０５）。随访追踪观察：Ａ组５年存活率为７９％，Ｂ组为１９％，Ｃ组为７３％，Ａ组明显高于Ｂ组（Ｐ＜０．０１），与Ｃ组无明显差异（Ｐ＞０．０５）。     

施他宁对食管胃底静脉曲张破裂出血的疗效

目的 探讨施他宁对食管胃底静脉曲张破裂出血(EVB)的疗效。方法 142例EVB患者随机分为两组:施他宁(SS)组72例,先以250μg静注,随后以250μg·h~(-1)持续静滴共3d;对照组70例,用垂体后叶素20单位加入5％葡萄糖,以0.2u·min~(-1)静滴,1次/8h,共3d。结果 SS组3d天内的止血率明显优于对照组(P<0.01),再出血率(P<0.05)、病死率(P<0.01)及副作用发生率(P<0.01)明显低于对照组。结论 SS是治疗EVB的安全有效药物。     

食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。     

奥曲肽联合丙氟沙星治疗食管曲张静脉破裂出血

目的 探讨抗生素对奥曲肽治疗食管曲张静脉破裂出血(EVB)的影响。方法 60例EVB患者,随机分为2组,分别给予奥曲肽、奥曲肽联合抗生素治疗。结果 EVB患者6小时、12小时、24小时止血率奥曲肽组分别为27％、40％、63％。治疗前后血清一氧化氮(NO)含量分别为6.9±0.82μmol/L、5.6±0.95μmol/L;奥曲肽联合抗生素组止血率分别为50％、70％(P<0.05)、93％(P<0.05)。治疗前后NO含量分别为7.3±0.66μmol/L、4.3±0.79μmol/L(P<0.05)。结论 抗生素能明显提高奥曲肽治疗EVB的疗效,其机理可能与降低血清NO含量有关。