内镜检查下消化道出血304例次临床分析

结肠镜检查对于下消化道出血的诊断是有效方法之一,自１９９５年１月至１９９９年１月,我们对急性下消化道出血患者３０４例次行结肠镜检查,现将结果分析如下。１．临床资料：本组３０４例次结肠镜检查的下消化道出血患者,均因排出鲜血便、血块、暗红色或果酱色血便来我院就诊的患者行结肠镜检查。其中男性１９９例次,女性１０５例次,年龄１８～８７岁,平均５８．５岁,超过５５岁的１８７例次（６１．５％）。２．结果：３０４例次结肠镜检查病灶明确者有２９６例次,其出血病因见表１,出血部位见表２。其中原因不明的８例次中５例…     

消化道出血的病因分析

目的分析消化道出血的原因,更好地指导临床诊治。方法分析127例消化道出血患者的病例资料,对其病因进行分析总结。结果 78例(61.4%)位于上消化道;49例(38.6%)位于下消化道;上消化道出血的最常见原因是消化性溃疡,占48.7%,其次是急性胃黏膜病变(16.7%)和食管胃底静脉曲张破裂(12.8%);下消化道出血的主要原因是肿瘤和炎症性病变,分别占55.1%和16.3%。结论消化道出血的部位以上消化道多见,上消化道出血原因以消化性溃疡占首位,而下消化道出血则以肿瘤多见。     

下消化道出血病因分析

目的探讨下消化道出血的病因。方法对71例下消化道出血的患者（男40例,女31例）常规行电子结肠镜检查,部分患者行小肠气钡双重造影、肠系膜上或下动脉造影检查、及手术探查。结果71例病例中,溃疡性结肠炎5例（7％）,结肠息肉9例（12．7％）,结肠新生物10例（14％）,缺血性肠病4例（5．6％）,感染性结肠炎9例（12．7％）,肛周疾患3例（4．22％）,空肠憩室4例（5．6％）,血管畸形或血管瘤6例（8．45％）,小肠平滑肌瘤2例（2．8％）,另有19例未明确诊断（26．77％）。结论下消化道出血的病因主要以恶性肿瘤、肠息肉、肠道炎症性病变最多见;其次是痔、肛裂、肠血管畸形、肠憩室等。注重电子结肠镜等相关检查,可提高确诊率及治愈率。     

重症肝炎并发消化道出血31例临床分析

本文对1985～1987年收治的重肝并发消化道出血31例进行临床分析,发现普遍存在凝血障碍。本症发生率高,来势凶猛、病死率高。本文着重讨论了出血机理与胃粘膜糜烂的关系,并就其防治作了一些探讨。     

消化道出血诊断与治疗研究近况

消化道出血是消化内科的常见急症之一，其诊断与治疗手段进展十分迅速，本就近年来消化道出血的病因、诊断、治疗等方面的研究作一综述。     

小儿消化道出血52例病因分析

小儿消化道出血病因较多,不易定位,而明确病因对治疗帮助更大.我院自1990年1月至1995年6月共收住小儿消化道出血52例,现总结报告如下.1 临床资料1.1 诊断依据 ①呕血或由鼻胃管吸出血性咖啡色液者:②排黑色柏油样便或鲜红色血便及潜血试验阳性者.具上述之一,同时排除吞入母亲血液和上呼吸道出血吞入胃内者.凡肠套、菌痢及临终前消化道出血不予列入.1.2 一般资料 男35例,女17例.呕鲜血或咖啡色液11例,黑便32例,暗红色大便5例,鲜红色大     

不同年龄层不明原因消化道出血患者胶囊内镜诊断结果分析

目的 对不明原因消化道出血患者的胶囊内镜(CE)检查结果进行分析,总结不同年龄层患者的病变特点.方法 收集我院2006年12月～2010年2月间符合纳入标准的患者163例,采集患者信息并分析病变特点.结果 163例患者中,老年组患者检出率高于青年组和中年组,差异有统计学意义(P＜0.01);不同年龄组患者检出病变类型分布比较,差异有统计学意义(P＜0.05),青年组以肿物为主;中年组以溃疡、血管畸形为主;老年组以血管畸形为主.结论 各年龄组间的检出率和诊断率比较差异有统计学意义(P＜0.05),提示CE检查对老年组患者的不明原因消化道出血有更好的检出率.     

小儿消化道出血116例病因分析

小儿消化道出血病因较多，不易定位，而明确病因对治疗有重要意义。我科自1995～2001年共收治小儿消化道出血116例，现总结报告如下。     

消化道溃疡出血急诊内镜检查220例分析

１９９０年１月￣１９９５年２月，对２２０例消化性溃疡出血病人进行了急诊内镜检查。急诊内镜检查在２４￣４８ｈ内完成。内镜所见的出血类型参照Ｆｏｒｒｅｓｔ所建议的分类标准，其中ＦⅠａ４例（１．８％），ＦⅠｂ２８型（１２．７％），ＦⅡａ２８例（１２．７％），ＦⅡｂ１２０例（５４．５％）和ＦⅢ４０例（１８．２％）。结果显示，球部溃疡出血明显多于胃溃疡（６１．８％比２９．１％，Ｐ〈０．００５）；出血发生率与     

消化内镜诊断消化道憩室316例临床分析

消化道憩室的发生与消化道局部解剖结构、年龄、人种及膳食结构等诸多因素相关。国内外流行病学的研究多为有消化道症状的消化道憩室患者的患病情况,存在地域差异,且诊断多依靠钡餐、CT等影像学检查。本文回顾我院消化内镜中心近年来的内镜检查资料,分析消化道憩室病的内镜下特点,现报道如下。1．研究对象：2007年9月至2009年12月间于我院消化内镜中心行内镜检查者27579例,其中憩室患者316例,共326处憩室病灶。     

高血压脑出血并发消化道出血51例临床分析

目的分析高血压脑出血（HICH）并发消化道出血的临床特点。方法对2008年1月至2012年6月在我院就诊的197例HICH患者的临床资料行回顾性分析,其中51例（25.9%）合并消化道出血。依据HICH合并消化道出血与否分组,分析性别、年龄、就诊时血压、GCS评分（意识状态）、脑部出血位置、破入脑室与否、中线结构移位与否、出血量、病死率等因素与并发消化道出血的关系。结果 HICH并发消化道出血与其脑部出血位置、出血破入脑室与否、中线结构移位与否及意识状态（昏迷）等因素有关（P〈0.05）;出血位于脑干、丘脑部位、并破入脑室或有中线结构移位、出血量大、昏迷程度重者,消化道出血发生率明显升高（P〈0.05）;HICH并发消化道出血的独立危险因素有GCS评分≤8分,单纯基底节区出血,基底节出血且破入脑室,出血破入脑室（或中线结构移位,或有意识丧失）,脑出血量≥30 mL。本组197例HICH患者,死亡40例（20.3%）,其中合并消化道出血组,死亡23例（45.1%）;HICH合并消化道出血患者的预后明显比未合并出血的患者差,且消化道出血发生时间越早,患者病死率越高（P〈0.05）;瞳孔散大,GCS评分≤8分,并发消化道出血及3 d内发生消化道出血,均是HICH死亡的独立危险因素。结论掌握HICH并发消化道出血相关危险因素后,针对原发病行积极防治,可保护胃黏膜,有效降低消化道出血并发率。     

急性非静脉曲张性上消化道出血临床分析

目的分析非静脉曲张性上消化道出血的临床特征。方法回顾分析我院消化内科2009年1月-2011年12月期间收治的经胃镜证实的301例非静脉曲张性上消化道出血病例,分析总结非静脉曲张性上消化道出血的常见病因及临床诊治情况。结果非静脉曲张性上消化道出血的常见病因依次为消化性溃疡、消化道肿瘤、急性胃黏膜病变,内科保守治疗的有效率为96.35%(290/301),内镜下止血成功率93.55%(58/62)。结论消化性溃疡是非静脉曲张性上消化道出血最常见的病因。在消化道出血的救治中,急诊内镜、选择性血管造影以及内外科的紧密配合与协作发挥着重要作用。     

Under-diagnosing and under-treating iron deficiency in hospitalized patients with gastrointestinal bleeding

AIM: To determine whether patients hospitalized with gastrointestinal(GI) blood loss anemia are being checked and treated for iron deficiency. METHODS: Retrospective chart review was conducted for all patients admitted to a single tertiary care hospital between 11/1/2011 and 1/31/2012 for any type of GI bleeding. The primary endpoint was the percentage of patients who had their iron studies checked during a hospitalization for GI blood loss anemia. Secondary outcomes included percentage of anemic GI bleeders who had adequate documentation of anemia and iron deficiency, and those who were treated for their iron deficiency. Then we tried to identify possible predictors of checking iron studies in an attempt to understand the thought process that physicians go through when managing these patients. Iron deficiency was defined as Iron saturation less than 15% or ferritin level less than 45 μg/L. Anemia was defined as hemoglobin level less than 13 g/dL for males and 12 g/dL for females.RESULTS: Three hundred and seven GI bleeders were hospitalized during the study period, and 282 of those(91.9%) had anemia during their hospital stay. Ninetyfive patients(30.9%) had iron studies performed during hospitalization, and 45 of those(47.4%) were actually found to be iron deficient. Only 29 of those 45 iron deficient patients were discharged home on iron supplements. Of the 282 patients that had anemia during hospitalization, 50(17.7%) had no documentation of the anemia in their hospital chart. Of the 45 patients that had lab proven iron deficiency anemia(IDA), only 22(48.5%) had documentation of IDA in at least one note in their chart. Predictors of checking iron studies in anemic GI bleeders were lower mean corpuscular volume, documentation of anemia, having fecal occult blood testing, not having hematemesis or past history of GI bleeding. There were no significant differences between the teaching and non-teaching services in any patient characteristics or outcomes. CONCLUSION: Iron deficiency is under-diagnosed, under-recognized even when iron studies were checked, and under-treated in hospitalized patients with GI bleeding.     

影响消化道出血患者预后的多因素分析

目的探讨影响消化道出血患者预后的危险因素。方法回顾性分析大庆油田总医院2006年1月1日～2006年12月31日消化道出血住院患者临床资料。结果消化道出血患者死亡率（15．8％）高于全院患者死亡率（1．8％）。老年组和中年组死亡率（19．9％和15．0％）高于青少年组（5．8％）。单纯呕血组和呕血伴便血组死亡率（19．0％和22．9％）高于单纯便血组（8．2％），呕血量〉500mL组死亡率（34．6％）高于≤500mL组（15．5％），出血后第一次血常规检查血红蛋白≤90．0g／L组死亡率（20．9％）高于血红蛋白〉90．0g／L组（12．4％）．恶性肿瘤患者北亡率最高（57．9％），其次是食管胃底静脉曲张（36．4％），消化性溃疡患者死亡率为1．5％。多因素非条件Logistic回归分析显示年龄、出血临床表现形式、呕血量、血红蛋白水平是影响患者预后的独立危险因素；病因学方面恶性肿瘤、食管胃底静脉曲张和消化性溃疡也是影响预后的独赢危险因素。结论消化道出血仍是住院患者死亡的重要原因，患者年龄、呕血量〉500mL、血红蛋白水平、原发病（恶性肿瘤、食管胃底静脉曲张等）均为影响其预后的独立危险因素。     

生长抑素联合乌司他丁治疗消化道出血的Meta分析

目的 系统评价生长抑素联合乌司他丁治疗消化道出血的有效性和安全性。方法 计算机检索中国知网、维普、万方、CBM、PubMed、Cochorane library、Embase数据库,搜集有关生长抑素联合乌司他丁治疗消化道出血的随机对照试验。使用Revman 5.3软件进行Mete分析。结果 共纳入16项研究,1466例患者。结果显示,在总有效率[RR=1.24,95%CI(1.19～1.31),P <0.000 01]、白细胞介素-2[SMD=1.10,95%CI(0.38～1.81),P=0.003]、白细胞介素-6[SMD=-3.40,95%CI(-4.69～-2.12),P <0.000 01]、白细胞介素-10[SMD=2.77,95%CI(1.66～3.87),P <0.000 01]、肿瘤坏死因子-α[SMD=-2.56,95%CI(-3.26～-1.87),P<0.000 01]、住院时间[SMD=-1.75,95%CI(-2.24～-1.26),P<0.000 01]、消化道出血时间[SMD=-3.55,95%CI(-4.11～-2.99)...     

Venous thromboprophylaxis in gastrointestinal bleeding

OBJECTIVE:

To study the use of venous thromboembolism (VTE) prophylaxis and the incidence of thrombotic events in patients with acute gastrointestinal (GI) bleeding.

METHODS:

Individuals admitted with a primary diagnosis of a GI bleed along with any endoscopically confirmed source (over a two-year period) were included. Patient comorbidity and data regarding anticoagulation or antiplatelet agent use before hospitalization were collected, in addition to type of VTE prophylaxis and duration of treatment. The primary end point was the development of VTE (deep vein thrombosis or pulmonary embolism) within one year of presentation.

RESULTS:

Data from 504 patients admitted with GI bleeding were eligible for review. The total number of VTE events was 20 (4%) while the mortality rate during hospitalization was 4.6%; 397 patients were not given VTE prophylaxis during their hospitalization. Of the patients who were given VTE prophylaxis, 68 received prophylactic heparin or heparin derivatives during their admission. One hundred sixty-five patients had at least one other significant risk factor for VTE including recent or subsequent surgery, past thrombotic event or malignancy. The incidence of thrombosis in those with significant risk factors for VTE was significantly higher than those without (8.5% versus 1.8%; P=0.0009). Overall, there was no significant difference in thrombotic events between individuals receiving pharmacological prophylaxis (1.2%) and those who did not (2.8%) (P=0.4).

CONCLUSION:

Overall, VTE prophylaxis did not significantly affect thrombotic events in patients admitted for an active GI bleed.     

Prognostic factors in patients with active non-variceal upper gastrointestinal bleeding

Background and study aims

Acute upper gastrointestinal bleeding is one of the main causes of hospitalisation. The purpose of this study was to determine the prognostic factors in non-variceal upper gastrointestinal bleeding.

Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

AIM:To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS:We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult,overt),CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS:Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE.In 222 patients (...     

Applicability of the Rockall score in patients undergoing endoscopic therapy for upper gastrointestinal bleeding

BACKGROUND: The Rockall score is used to assess the prognosis of patients with upper gastrointestinal bleeding. AIM: To assess the applicability of the Rockall score in patients undergoing endoscopic therapy for upper gastrointestinal bleeding. METHODS: Retrospective evaluation of the Rockall score in the period 1995-2001. To evaluate the applicability of the Rockall system, two groups were created: group I (Rockallor=6 points). RESULTS: Two hundred and twenty-two patients were included. The median age of patients was 65 +/ -17 years. Hypotension and associated diseases were present in 20 and 50% of patients, respectively. Re-bleeding occurred in 50 patients (23%) whose median score was 7, whereas the median score of patients without re-bleeding was 6 (p=0.14). There were 20 deaths (9%) with a median score of 8, whilst the median score of surviving patients was 6 (p<0.001). Sixteen patients in group I (18.4%) and 34 in group II (25.2%) re-bled (p=0.25). All the patients who died belong to group II with a Rockall score>or=6 (15% versus 0% in groups II and I, respectively, p<0.001). CONCLUSION: The Rockall score can be used in patients who undergo therapeutic endoscopy for upper gastrointestinal bleeding to identify those with high risk for mortality.