间歇和连续静脉输注法莫替丁对消化性溃疡患者胃酸的影响

胃十二指肠出血通常由慢性消化性溃疡、应激性溃疡或局部胃黏膜因素导致的急性胃黏膜损伤 (ＡＧＭＬ)引起。对良性疾病导致的胃十二指肠出血的治疗分为保守疗法和手术疗法。但是 ,内镜下止血的进展以及有效的Ｈ2 受体拮抗剂 (Ｈ2 ＲＡ)和某些胃肠激素的应用使手术疗法在治疗胃十二指肠出血中的地位明显下降。Ｈ2 ＲＡ对上消化道出血的止血作用主要基于其抑酸作用 ,但此类药物控制应激性溃疡或ＡＧＭＬ时大出血的价值有限。因此将某些胃肠激素如生长抑素和促胰液素用于治疗这种大出血受到关注 ,且文献报道疗效很好。我们推测疗效的差异可能是…     

法莫替丁治疗消化性溃疡近期疗效观察

法莫替丁治疗消化性溃疡近期疗效观察邹晓平，许国铭，李兆申法莫替丁（Ｆａｍｏｔｉｄｉｎｅ）是第三代Ｈ２受体拮抗剂，对治疗消化性溃疡（ＰＵ）有显著效果［１］。我院自１９９１年７月至１９９３年３月应用上海信谊药业有限公司生产的法莫替丁（信法丁片剂）治疗ＰＵ...     

内镜下注射结合静注法莫替丁治疗消化性溃疡活动性出血疗效观察

20 0 0年 1～ 1 2月 ,我们采用随即对照的研究方法 ,对内镜注射结合静注抑酸药法莫替丁与单用法莫替丁治疗溃疡活动性出血进行疗效对照观察。现报告如下。1　资料与方法1 . 1　一般资料　同期收治 48例消化性溃疡活动性出血患者 ,均经急症胃镜检查确诊。胃镜下可见动脉喷血、活动性渗血和血管暴露等表现 ,合并有严重并发症如心力衰竭、呼吸衰竭、脑血管意外、尿毒症及肝性脑病者除外。随机分为两组 :1 组 :2 4例。男1 8例 ,女 6例 ;年龄 2 8～ 62岁。 2 组 :2 4例。男 1 9例 ,女 5例 ,年龄 2 4～ 65岁。两组患者的病情、伴随病及内镜表现…     

静脉注射潘托拉唑与法莫替丁治疗消化性溃疡出血疗效观察

潘托拉唑是第三代质子泵抑制剂，对胃酸分泌具有强而持久的抑制作用，是治疗消化性溃疡的理想药物。我们200l～2003年50例消化性溃疡并出血病人分别用潘托拉唑和法莫替丁做对照，结果潘托拉唑对溃疡止血效果明显优于法莫替丁，现总结报道如下。     

法莫替丁与奥美拉唑治疗消化性溃疡疗效比较

消化性溃疡(Peptic ulcer，PU)系指胃溃疡、十二指肠溃疡，因其病因复杂且易复发，治疗比较困难。我们分别用组胺H2受体拮抗剂法莫替丁和质子泵抑制剂奥美拉唑治疗40例，均取得较好疗效。     

法莫替丁治疗消化性溃疡25例

法莫替丁是一种新型的组胺H2-受体阻滞剂，我们应用国产法莫替丁治疗消化性溃疡（PU）25例，现报告如下。1对象和方法1．l对象男19例，女6例，共25例．年龄19岁～万岁，其中十二指肠球部溃疡15例、复合性溃疡3例25例pU患者均有典型的周期性、节律性、上腹部疼痛病史及上腹部剑突下压痛等症状体征、治疗前均经纤维内镜和X线钡餐检查确诊1．2方法法莫替丁20ms，早餐后、睡前各服回次．治疗期间辅以抗酸或抗胆碱能药物．治疗lino为工疗程．治疗前后均检查血、尿、大便常规，肝肾功能和心电图，一个疗程结束后均由同一医师行纤维内镜或钡餐复…     

康复新液联合法莫替丁治疗消化性溃疡82例

目的 :探讨康复新液联合法莫替丁对消化性溃疡的治疗作用。方法 :16 1例经内镜确诊的消化性溃疡患者均予 1 3C尿素呼气试验 ,随机分为 2组 ,治疗组 82例 ,予康复新液与法莫替丁联用 ;对照组 79例 ,予法莫替丁与丽珠得乐联用 ,疗程均为 4周。对幽门螺杆菌 (Hp)阳性者加用阿莫西林和甲硝唑 1周。结果 :治疗组溃疡痊愈率为 87.80 % (72 / 82 ) ,1年内复发率 11.11% (8/ 72 ) ;对照组分别为 73.4 2 % (5 8/ 79)及 2 5 .86 % (15 / 5 8)。两组比较差异有显著性意义 (P <0 .0 5 )。而对 Hp根除率两组差异无显著性意义 (P >0 .0 5 )。在治疗过程中 ,两组均未见明显不良反应。结论 :康复新液联用法莫替丁治疗消化性溃疡的疗效确切 ,副作用少 ,可广泛用于临床。     

法莫替丁预防急性心肌梗死后应激性溃疡出血

目的 观察法莫替丁对急性心肌梗死后应激性溃疡出血的预防作用。方法 65例急性心肌梗死患者随机分为两组,基础治疗相同。治疗组34例,加用法莫替丁20mg入壶,一日两次,持续5－7天。对照组31例,未用法莫替丁。结果 治疗组34例中未发生应激性溃疡出血,对照组31例中5例发生应激性溃疡出血,统计学处理有显著差异（X^2=3.91,P＜0．05）。结论 法莫替丁能预防急性心肌梗死后应激性溃疡出血。     

消化性溃疡出血的内镜治疗

内镜能有效地治疗消化性溃疡出血,降低病人的急诊手术率、再出血率和输血量,并可能降低其死亡率。内镜下止血方法较多,但以热凝疗法和注射疗法为佳。     

内镜下注射治疗消化性溃疡并出血的临床应用评价

目的探讨内镜下注射止血的临床意义。方法2001年7月至2002年8月因呕血和(或)黑便入院，经紧急内镜检查确诊为消化性溃疡并出血患81例．分成内科保守治疗和内镜注射止血治疗二组，内镜组在内科保守治疗的基础上，内镜下于出血灶注射HLGE液。结果内镜组42例，止血成功率95．24％，对照组39例，止血成功率79．49％，二组有显性差异。结论内镜注射止血治疗简单有效，降低手术率和再出血率。     

内镜下注射结合静脉注射奥美拉唑对消化性溃疡活动性出血的疗效

目的观察内镜注射治疗联用不同剂量的奥美拉唑(OME)及单用OME对消化性溃疡活动性出血患者的疗效。方法采用随机对照的方法。把101例内镜下有活动性出血的消化性溃疡出血患者,随机分为3组,分别接受①内镜注射止血治疗联用每天2次静脉注射OME40mg,疗程5d;②内镜注射止血治疗联用每天1次静脉注射OME40mg,疗程5d;③单用每天2次静脉注射OME40mg,疗程5d。治疗期间观察患者的止血时间、输血量、再出血情况及住院时间。结果3组患者的再出血率为3/35(8.6％),9/32(28.1％),15/34(44.1％),差异有显著性(P＜0.05);手术率1/35(2.9％),2/32(6.3％),7/34(20.6％),差异有显著性(P＜0.05);死亡率0/34(0％),1/32(3.1％),1/34(2.9％),差异无显著性(P＞0.05);输血量(3.7±2.7)单位(每单位=200m1),(5±2.5)单位,(2.5±2.4)单位,差异无显著性(P＞0.05);止血时间分别为(1.8±1.5)d,(3.8±1.9)d,(5.5±2.1)d,差异有显著性(P＜0.05);住院时间(8.7±2.5)d,(15.7±6.9)d,(17.1±8.3)d,差异有显著性(P＜0.05)。结论内镜注射治疗联用每天2次静脉注射40mgOME疗效最好o     

联合应用内镜注射和热凝治疗消化性溃疡出血

目的观察评价内镜注射肾上腺素、热探头热凝治疗和联合上述两种方法治疗消化性溃疡出血的疗效。方法１０２例消化性溃疡出血患者分为三组,其中内镜注射组３７例,热凝治疗组３１例,内镜注射联合热凝治疗组３４例。结果４８小时止血率在三组分别为８６．５％、８７．１％和９７．１％。一周内再出血率分别为１３．５％、９．７％和８．８％,手术率为１６．２％、１６．１％和８．８％。观察期间未发生严重并发症,无一例死亡。联合治疗组的４８小时止血率高于其他二组（Ｐ＜０．０５）;一周内再出血率低于内镜注射组（Ｐ＜０．０５）,与热凝治疗组没有明显差别（Ｐ＞０．０５）;手术率低于其他二组（Ｐ＜０．０５）。结论联合应用内镜注射和热探头热凝治疗可以提高消化性溃疡出血的止血率、降低近期再出血率和外科手术率。     

不同Forrest分级溃疡出血患者内镜下注射治疗的疗效观察

目的　探讨不同Forrest分级溃疡出血患者内镜下注射治疗的疗效 ,评估不同Forrest分级溃疡出血患者内镜下注射治疗的必要性。方法　选自 2 0 0 1年 7月至 2 0 0 2年 8月因呕血和 (或 )黑便入院 ,经紧急内镜检查确诊为溃疡性出血患者 81例 ,溃疡出血按Forrest镜下表现分级 ,内镜注射止血治疗组 4 1例 ,内科治疗组 4 0例。结果　内镜组 4 1例 ,止血成功率 95 1% ,对照组 4 0例 ,止血成功率 80 0 % ,两组差异有显著性意义 (P <0 0 5 )。其中ForrestⅠ级、Ⅱa级内镜组止血成功率 (8/ 9、5 / 6 )均高于对照组(3/ 7、3/ 5 ) ,Ⅱb级、Ⅱc级与Ⅲ级两组无明显差异。结论　内镜注射止血治疗简单有效 ,优于单纯药物治疗 ,镜下表现为ForrestI级和Ⅱa级的溃疡出血患者 ,内镜下注射治疗是有效和必要的     

Effect of intragastric pH on control of peptic ulcer bleeding

BACKGROUND: We have performed series studies to investigate the effect of intragastric pH on control of peptic ulcer bleeding. In laboratory and animal studies, both platelet aggregation and gastric mucosal bleeding time were shown to be extremely sensitive to different pH levels. Platelet aggregation decreased significantly at pH > or = 6.8 and gastric mucosal bleeding time fell significantly at pH > or = 6.4. In a prospective clinical trial, primed infusions of different dosages of omeprazole (8 or 4 mg/h) after a bolus (40 mg) produced consistently high intragastric pH values in patients with bleeding duodenal ulcer. These results were not significantly different from that obtained from omeprazole 40 mg bolus treatment every 12 h (P > 0.05). However, primed injection with cimetidine (800 mg/12 h) was less effective (P < 0.05). METHODS: In a retrospective analysis, 303 patients with bleeding peptic ulcer who were treated with cimetidine and 326 patients who were treated with omeprazole were compared. RESULTS: The emergency surgery (4.91%) and mortality rates (1.84%) in the omeprazole group were not significantly different (P > 0.05) from those (7.28 and 1.99%) in the cimetidine group. However, the standardized emergency surgery rate of the omeprazole group (3.28%) was significantly lower than that (9.28%) of the cimetidine group (P < 0.05). CONCLUSION: We conclude that increased intragastric pH to at least 6.4 with omeprazole is helpful in controlling peptic ulcer bleeding. Chinese patients require a lower dose of omeprazole than their Western counterparts to control ulcer bleeding.     

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

One hundred and nine patients presenting with severe haemorrhage from benign peptic ulcers were randomised to either endoscopic injection sclerotherapy using a combination of 1:100,000 adrenaline and 5% ethanolamine or to conservative treatment. Only high risk patients with active bleeding or endoscopic stigmata of recent haemorrhage and accessible ulcers were considered. The two groups were well matched for age, shock, haemoglobin concentration, endoscopic findings, and consumption of non-steroidal anti-inflammatory drugs. The group treated endoscopically had a significantly reduced rebleeding rate (12.5% v 47%, p less than 0.001). Rebleeding was successfully treated in some patients by injection sclerotherapy, other patients underwent urgent surgery. While there was a tendency towards a lower operation rate and lower transfusion requirements in the treated group, this failed to achieve statistical significance. The use of injection sclerotherapy in the conservatively treated group after rebleeding undoubtedly reduced the number of surgical operations. Endoscopic injection sclerotherapy is effective in the prevention of rebleeding in these patients.     

不同pH值对消化性溃疡并出血疗效的影响

目的：探讨不同ｐＨ值对消化性溃疡并出血疗效的影响，方法和结果：１临床和动物实验富血小板血浆（ＰＲＰ）中加入不同剂量的ＨＣｌ以改变其ｐＨ环境并测定其血小板聚集率。结果显示，随着ＨＣｌ量的增加，ｐＨ下降，血小板聚集率也降低，当ｐＨ＜６８时，血小板聚集率显著下降，用不同ｐＨ值的缓冲液冲洗大白鼠胃内活检伤口，测定其胃粘膜出血时间（ＧＭＢＴ），结果显示，当ｐＨ≥６０时，ＧＭＢＴ明显减少，约５７６±１８６秒。２胃内ｐＨ值监测连续４８小时监测胃内ｐＨ值，结果显示，甲氰米胍１６００ｍｇ静脉注射与奥美拉唑４０ｍｇ静脉注射，胃内ｐＨ值相仿，分别为５４±１３和５８±１３，逐步降低甲氰米胍用量，其ｐＨ值亦逐步下降，至８００ｍｇ时，胃内ｐＨ值为１５，基本无作用。３临床疗效观察回顾性分析３０３例应用雷尼替丁与３２６例应用奥美拉唑的溃疡出血病人，前者手术率与死亡率为７２８％和１９９％，后者为４９１％和１８４％。结论：ｐＨ值与血小板聚集率及ＧＭＢＴ密切相关，药物治疗溃疡出血成功的关键在于有效提高胃内ｐＨ值。     

Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding

AIM: To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS: This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers (spurting or oozing) were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1:10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS: There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups (P < 0.05). The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group (20.3%) than in the 30 (5.3%) and 40 mL (2.8%) epinephrine groups (P < 0.01). There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group (51/76) than in the 20 (2/76) and 30 mL (5/76) epinephrine groups (P < 0.001). Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group (P < 0.01). Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups (P < 0.01). CONCLUSION: Injection of 30 mL diluted epinephrine (1:10000) can effectively prevent recurrent bleeding with a low rate of complications. The optimal injection volume of epinephrine for endoscopic treatment of an actively bleeding ulcer (spurting or oozing) is 30 mL.     

The hemostatic effect of endoscopic sodium hyaluronate injection in peptic ulcer bleeding

BACKGROUND/AIMS: Endoscopic injection therapy is a well-established method of controlling peptic ulcer bleeding but it is not clear which agent would be the best choice for injection material. In this study, we evaluated the effect of Sodium Hyaluronate for control of ulcer bleeding. METHODOLOGY: The subjects consisted of 26 patients with major peptic ulcer hemorrhage from June 2000 to August 2001. There were 17 gastric ulcers, 7 duodenal ulcers and 2 ulcers at anastomosis site. According to modified Forrest classifications, there were 7 active bleeding (spurting, 3; oozing, 4) and 19 stigmata of recent hemorrhage (visible vessel, 14; fresh blood clots, 5). Sodium Hyaluronate-saline solution was injected to control the bleeding. The initial and permanent hemostatic rate, rebleeding rate, and other complications were retrospectively evaluated. RESULTS: The initial hemostatic rate was 25/26 (96.2%) and re-bleeding rate 3/26 (11.5%). The success rate of the second trial of Sodium Hyaluronate injection was 3/3 (100%). Overall, the permanent hemostatic rate was 25/26 (96.2%) and there were no complications related to Sodium Hyaluronate injection. CONCLUSIONS: Sodium Hyaluronate is an excellent candidate agent for endoscopic injection therapy because of its convenience and safety. Further prospective randomized trials with other hemostatic methods are needed.