中青年与老年消化性溃疡患者临床资料对比分析

目的探讨中青年与老年消化性溃疡的临床特点。方法对我院近5年间经胃镜检查或手术病理确诊为消化性溃疡的904例患者临床资料进行统计分析。结果消化性溃疡患者904例，其中中青年患者703例，老年患者201例。中青年患者中症状不典型，以并发症为首发症状者明显少于老年组（P〈0．01）；老年组患者并发症、伴发病发生率、高位溃疡,巨大溃疡发生率、并发症死亡率均明显高于中青年组（均P〈0．01）。结论中青年患者与老年患者消化性溃疡的临床流行病学特点存在较大差异。     

751例老年消化性溃疡患者的致病危险因素与临床特征

目的探讨老年消化性溃疡患者的致病危险因素和临床特征。方法选取徐州市第一人民医院2006年2月-2014年5月收治的老年消化性溃疡患者751例和同期治疗的846例中青年消化性溃疡患者,对两组患者消化性溃疡的影响因素、临床表现、并发症及伴发病症、溃疡发生部位和溃疡大小进行回顾性对比分析。结果两组患者的饮酒、抑郁、非甾体抗炎药使用情况之间相比,差异有统计学意义(P0.05),而抽烟和H.pylori感染差异无统计学意义(P0.05);老年组消化性溃疡并发的上消化道出血、基础性疾病所占比例显著多于中青年组(P0.01);老年组患者典型症状发生率为4.53%,显著低于中青年组,差异有显著统计学意义(P0.01);溃疡主要发生在胃部的老年组患者(63.65%)明显多于中青年组患者(30.26%);溃疡直径≥2 cm的老年患者为11.05%,显著多于中青年组(P0.01)。结论老年消化性溃疡患者有自身特点,临床表现不够典型,发生部位转移向高位,临床治疗应引起重视。     

老年消化性溃疡患者的身心健康状况

消化性溃疡(PU)主要指发生在胃和十二指肠的溃疡,是最常见的老年病,呈世界性分布,全球大约有10%老年人患此病,随之而来的是一系列心理活动异常,如得不到及时的健康指导,会影响患者的治愈率,增加复发率.本文拟回顾分析老年PU患者的心理健康状况,为提高其生活质量提供临床依据.     

消化性溃疡患者血浆内皮素的临床观察

应用特异性放射免疫分析法测定了活动期22例胃溃疡,33例十二指肠球部溃疡患者血浆内皮素水平,结果胃溃疡组为81.2±12.2,球部溃疡组为94.7±28.5,与对照组50.8±7.6比较,均有显著性差异(P<0.001).胃溃疡组与球部溃疡组比较,无明显差异(P<0.05).提示溃疡病患者体内内皮素的合成与分泌增加,内皮素与溃疡病发生有较密切的关系.     

消化性溃疡患者心率变异的临床分析

心率变异性 (ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ ,ＨＲＶ) ,作为反映植物神经系统对心脏和血管调节动态平衡的一项客观的无创指标 ,已引起国内外学者注意[1] ,并在研究其判定心血管疾病的高危事件、药物疗效等方面广泛应用[2 ,3 ] 。这一无创性指标在心血管疾病领域以外的应用报道不多[4 ] 。我们就十二指肠球部溃疡 (ＤＵ)患者的心率变异性作一临床分析。材料和方法一、对象1999年 6月～ 2 0 0 0年 3月住院和门诊患者 6 5例。所有对象心电图检查为窦性心律。按临床表现 ,电子胃镜检查分为 2组 :①正常对照组 2 1例 ,男 11例 ,女 10…     

消化性溃疡患者胃排空功能的研究

胃排空功能异常可能参与了溃疡的发生机制［１］，我们对消化性溃疡患者治疗前后的胃排空功能作了较深入的研究，以期阐明其在溃疡病因学上的意义。一、对象和方法１病人的选择：１５例经内窥镜证实为活动期十二指肠溃疡（ＤＵ）患者，男１２例，女３例，平均年龄（３３...     

消化性溃疡患者血浆胃动素含量的变化

消化性溃疡患者血浆胃动素含量的变化赵英恒沈青燕陈丽英于宪对胃动素（ＭＴＬ）既往的研究多侧重于其与胃肠动力障碍性疾病的关系，在消化性溃疡（ＰＵ）方面的文献报告少见。我们抽测ＰＵ患者消化期及消化间期血浆ＭＴＬ水平，并对其临床意义进行了初步探讨。对象与方法...     

消化性溃疡患者住院情况分析

本文对我院１９５９～１９９１年消化性溃疡患者的住院情况进行了分析。消化性溃疡的发病平均年龄十二指肠溃疡和胃溃疡分别为３７．５岁和４７．７岁，男女性别比二者分别为６．３１：１和４．７：１．老年的溃疡住院率和并发症的发生率均呈上升趋势．溃疡的并发症方面以出血最为多见．穿孔和幽门梗阻次之。症状方面以腹痛为最突出的症状，无症状溃疡约占住院患者３％．溃疡的发病存在着季节分布，十二指肠溃疡与胃溃疡略有不同．     

消化性溃疡患者临床护理体会

消化性溃疡主要指发生于胃和十二指肠的慢性溃疡，是一种多发病、常见病。溃疡的形成有各种因素，其中酸性胃液对黏膜的消化作用是溃疡形成的基本因素，因此得名。酸性胃液接触的任何部位，如食管下段、胃肠吻合术后吻合口、空肠以及具有异位胃黏膜的Meckel憩室。绝大多数的溃疡发生于十二指肠和胃，故又称胃、十二指肠溃疡。     

埃索美拉唑治疗高危老年溃疡性上消化道出血的研究

目的观察大剂量与常规剂量埃索美拉唑治疗高危老年溃疡性上消化道出血的有效性。方法以2010年6月至2013年8月在我院老年医学科住院的96例溃疡性上消化道出血的高危（Rockall评分〉5分）老年患者为研究对象,将其随机分为治疗组和对照组,2组患者均在内镜下成功的止血,2组患者的一般治疗方案相同,治疗组采用1次静滴埃索美拉唑80 mg后（30 min）,接着以8 mg/h的速度持续静脉泵入埃索美拉唑,71.5 h后改为口服埃索美拉唑40 mg（1次/d）,持续观察至第30天;对照组静滴埃索美拉唑80 mg（1次/d）,3 d后改为口服埃索美拉唑40 mg（1次/d）,持续观察至第30天,观察2组的再出血率、死亡率、平均住院日及平均住院费用。结果与对照组相比,治疗组的再出血率、死亡率、平均住院日及平均住院费用均有明显的降低（P均〈0.05）。结论对高危的老年溃疡性上消化道出血患者而言,静脉大剂量使用埃索美拉唑是有效、合理的。     

Peptic ulcer disease in the elderly in Singapore

Of 460 patients with peptic ulcer disease seen over a 30-month period, there were 174 elderly patients (defined as ? 60 years old), constituting 38%. In this group of elderly, gastric ulcers (GU) were observed more frequently than duodenal ulcers (DU) with a ratio of 1.6: 1 and the male to female ratio was 1.7: 1. In patients < 60 years old, there were more DU than GU with a ratio of 2.7: 1, and a higher male to female ratio of 3.7: 1. Seventy-two per cent of the elderly had at least one other medical condition with 20% having three or more medical problems. Hypertension and ischaemic heart disease were the most frequently encountered illnesses. Half the elderly presented with upper abdominal pain and one-third had an atypical presentation. Analgesic ingestion in the preceding 4 weeks was present in 29% of the elderly. In the elderly, bleeding was the most frequent complication occurring in 50%; perforation occurred in 2%. In those with bleeding ulcers, 44% had history of analgesic usage. The mortality of bleeding peptic ulcer in the elderly, was 11% and this was largely due to concurrent medical conditions. Only two deaths occurred due to bleeding ulcer.     

Complications associated with ulcer recurrence following gastric surgery for ulcer disease

The present study is an attempt to assess the risks of the complications associated with recurrent ulcers in patients who have undergone gastric surgery and to determine whether these risks differ from those observed in patients receiving long term maintenance treatment with H2-receptor antagonists for ulcer disease. One hundred and thirty studies reported in the literature during the past three decades have been analysed to determine both the approximate rate of ulcer recurrence and the proportion of patients with recurrent ulcers who have presented with either haemorrhage or perforation following the various types of gastric surgery for ulcer disease. From these data, estimates of the risks of haemorrhage and of perforation during the years following gastric surgery have been calculated. Vagotomy and antrectomy is associated with a low risk of ulcer recurrence (< 1%) and the risk of complications in later years is accordingly very small (< 0.5°/o). Partial gastrectomy, although associated with low recurrence rates, has a higher risk of complications (1.3% for haemorrhage, 0.3% for perforation) because the proportion of recurrent ulcers that present with haemorrhage or perforation is high (33% and 8%, respectively). Truncal vagotomy plus drainage (TV+D) and highly selective vagotomy (HSV) are associated with recurrence rates of 9% and 12%, respectively, but ulcer recurrences following these operations are less frequently accompanied by complications then recurrences after gastric resection and, as a result, the risks of haemorrhage (1.7% for TV+D; 1.3% for HSV) are similar to the risks after gastric resection. During long term (five years or more) maintenance treatment with H2-receptor antagonists, the risks of haemorrhage and perforation are < 2% and < 0.5%, respectively. It appears, therefore, that the likelihood of developing haemorhage or perforation following gastric surgery is of the same order as that during maintenance treatment with H2-receptor antagonists, at least during the first decade of follow-up.     

Markers of slow-healing peptic ulcer in the elderly

Little is known about ulcer outcome in the elderly. The aims of the present paper were to establish whether risk factors of slow-healing peptic ulcer can be demonstrated in the elderly and whether clinical differences exist between ulcer patients whose age of onset of the disease was before or after 65 years old. The short-term, open study, involving 1052 elderly patients (over 65 years) in 37 gastroenterology centers throughout Italy aimed to compare two schedules of ranitidine treatment: 150 mg twice daily versus 300 mg at bedtime. As nonsignificant differences were found between these two schedules, the sample was considered as a whole. It included 319 gastric ulcer (GU) patients, 699 duodenal ulcer (DU) patients, and 34 concomitant GU and DU cases. Ninety-three patients dropped out of the trial; 79/294 GU, 138/635 DU, and 10/30 GU+DU were found still unhealed after four weeks and 20 GU, 15 DU, and 1 GU+DU remained so after eight weeks. Statistical analysis was performed using likelihood-ratio and Pearson's chi-squared tests and Cox's models. Univariate analysis showed that the indicators of slow-healing GU were ulcer size (P=0.002) and persisting ulcer symptoms (P=0.0001); indicators of slow-healing DU were ulcer size (P=0.0001), persisting ulcer symptoms (P=0.0001), alcohol (P=0.0003), and NSAID (P=0.0088) consumption. DU patients taking antiplatelet drugs have significantly better results after four weeks and worse results after eight weeks (P=0.0352). Cox's models revealed that the persistence of ulcer symptoms is the most important factor predicting unhealing ulcers (GU,P=0.0008; DU,P=0.0002), while ulcer size is only important for DU (P=0.0215). Patients with ulcer disease onset before 65 years of age were more frequently males; DU subjects were more frequently smokers, with a family history of ulcer and no NSAID consumption. In conclusion, persistence of ulcer symptoms and ulcer size are indicators of slow-healing ulcer in the elderly; in the case of DU, NSAID and alcohol consumption may be additional factors.This study was performed under the auspices of the R. Farini Foundation for Gastrointestinal Research.Centers participating in the study: Alba (G. Prandi, R. Bianco); Asti (C. Moro, M. Grassini); Avezzano (A. de Sanctis, A. Sedici); Belluno (F. Costan Biedo, P. Olivieri); bussolengo (S. Adamo, G. Sartori); Cagliari (P. Loriga, C. Caschili); Castelfranco V. to (S. Bertazzo, G. Pesce); Castrovillari (S. Leone, G. Mollica); Conegliano V. to (G. Lollo, P. Lunardi); Cosenza (A. Belmonte, G. Manno); Cuneo (G. Ferro, A. Manca); Fano (M. Cuzzupoli, A. Olivieri); Fiesole (P. Ciani, L. Manneschi); Gorizia (E. Benedetti, S. Fayenz); Lanciano (S. Di Matteo, F. Cifani); Malo (C.F. Azzini, A. Pilotto); Monza (S. Magni, A. Lomazzi); Melito P.S. (G. Dattola); Napoli (B. De Luca, D. Di Cesare); Negrar (A. Geccherle, C. Manfrini); Novara (M. Del Piano, F. Montino); Orbassano (G. Emanueli, C. Calcamuggi); Oristano (A. Tuveri, M. Sau); Padova (R. Naccarato, F. Di Mario); Palermo (G. Barbagallo-Sangiorgi, S. Vigneri); Polistena (G. Gerace); Popoli (A. Pomidori, R. Lattanzio); Prato (A. Candidi-Tomasi, M. Lami); Reggio Calabria (P. Califano, C. Campolo); Roma (L. Capurso, M. Koch); Rovereto (A. Bernardi, M.C. Paler); S. Vito al Tagliamento (G. Tasca, A. Pighin); Scilla (G. Naim); Terni (A. Della Spoletina, F. Bellavigna); Torino (G. Babando, L. Lombardo); Venezia (M. Pasquino, M.E. Benvenuti); Vercelli (W. Giorgelli, G. Ardizzone).     

Clinical and experimental research on weile jiaonang for peptic ulcer

AIM To observe the therapeutic effect of weile jiaonang (WLJN) for peptic ulcer (PU) and its toxicity toanimals, and to find out the nontoxic Chinese medicines in replacing those chemical medicines with sideeffect.METHODS Five hundred and forty patients with PU were divided into three groups, therapeutic group byWLJN, control group taking famotidine and combined group with WLJN and famotidine. One hundred andeighty patients in each group were studied. The diagnosis of 540 patients with PU is in accordance with thebasis provided by the National Scientific Congress of Digestive System Disease convened in Hangzhou, 1978.The study followed the criterion provided by this Congress.RESULTS Total effective rate in therapeutic group was 93.3%, and 93.3% in control group. Combinedgroup achieved a total effective rate of 100%. For all three groups, there was no significant differencestatistically, but the control group appeared obvious side effects. The result of acute toxic experiments onwhite mice showed that there no death and toxic side effect even the highest dosage was given, which wasequivalant to 120 times to the dosage of patients. The result of chronic toxic experiment showed there was noobvious pathologic change in three dosed groups. The tails of mice in dosed groups were more smooth delicateand cleaner than those in control group.CONCLUSION Through observation in clinic and exprimental animal, it is proved that weilejiaonang isparticularly effective and safe Chinese patent drug against PU.     

Bleeding peptic ulcer occurring in hospitalized patients

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 ± 15 years versus 59 ± 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.     

消化性溃疡36例甲襞微循环观察

目的:观察消化性溃疡(PU)甲襞微循环的改变。方法:采用XG—5BI型黑白微循环摄影摄像电脑装置和加权积分法对36例PU病人进行甲襞微循环观察。结果:发现PU病人甲襞管袢稽形、血流变慢、血色变暗、乳头变平,与对照组相比,P<0.01;胃溃疡(GU)病人甲襞管袢密度变小,红细胞聚集,与对照组相比,P<0.01。用加权积分法计算。十二指肠溃疡(DU)和GU总积分均显著高于对照组。结论:上述观察证实了PU病人甲襞微循环有显著异常。     

小剂量阿司匹林与老年人消化性溃疡并发出血的危险性

目的研究小剂量阿司匹林（ＡＳＡ，每天２５～５０ｍｇ）对老年人消化性溃疡并发出血危险性的影响。方法回顾性分析７０例老年消化性溃疡患者的临床资料，根据患者发现消化性溃疡时是否正在服用小剂量ＡＳＡ分为两组，对照分析两组并发上消化道出血的发生率及可能影响出血危险性的有关因素。结果两组患者的年龄、性别、既往溃疡病、溃疡病出血史及本次溃疡部位、大小和幽门螺杆菌感染率，差异均无显著性（Ｐ＞００５）。服ＡＳＡ组和未服ＡＳＡ组上消化道出血的发生率分别为５２９％和１７０％，差异有极显著性（Ｐ＜００１）。服小剂量ＡＳＡ患者并发上消化道出血的相对危险度为未服ＡＳＡ患者的５５倍，差异有极显著性（Ｐ＜００１）。结论服小剂量ＡＳＡ明显增加老年人消化性溃疡并发上消化道出血的危险性。     

根除老年人消化性溃疡合并幽门螺旋杆菌感染的治疗策略

目的对质子泵抑制剂（PPI）或铋剂三联疗法作为初治方案以及序贯疗法或四联疗法作为补救方案根除老年人消化性溃疡（PUA）合并幽门螺旋杆菌（Hp）感染的疗效进行比较。方法2009年7月至2010年7月间261例胃镜下尿素酶法诊断的PUA合并Hp感染患者,随机采用PPI三联疗法、铋剂三联1周疗法进行根除,观察治疗过程中不良反应发生率。PUA患者经上述抗Hp治疗后继续4周抗溃疡治疗,停药1月后复查胃镜并比较两种方法对Hp根除率及溃疡愈合率的疗效差异。对于首次三联疗法根除Hp失败者,随机应用10日序贯疗法和PPI、铋剂四联1周疗法再次行Hp根除。观察疗程中不良反应发生率,停药1个月后采用”C呼气试验观察Hp根除率。统计分析采用符合方案（PP）群组分析和意向治疗（ITT）群组分析。结果相比于铋剂三联疗法,PPI三联疗法Hp根除率（ITT：77．7％vs62．6％;PP：79．5％v564．1％;P〈0．05）及溃疡愈合率（ITT：78．5％vs64．9％;PP：80．3％vs66．4％;P〈0．05）高,不良反应发生率无明显差异（1TT：10．8％vs16．8％：PP：11．0％vs17．2％;P〉0．05）。对于首次三联疗法失败者以10日序贯疗法补救,Hp根除率较高（ITT：84．6％vJ61．5％;PP：86．8％v563．2％;P〈0．05）,且不良反应发生率较四联疗法低（ITT：12．8％VS35．9％;PP：13．2％VS36．8％;P〈0．05）。结论PPI三联1周疗法进行Hp感染根除可作为PUA患者首选,有较高的溃疡愈合率和Hp根除率;首次根除失败者可优先改用10日序贯疗法进行补救。     

Some factors associated with mortality in perforated peptic ulcer: A case-control study

This study examined the associations of individual coexisting illnesses, septicaemia, intra-abdominal abscess, marital status, smoking and alcohol use, with mortality following perforation of peptic ulcer without pre-operative evidence of haemorrhage. Patients who died in hospital following ulcer perforation (cases; n= 300) were compared with patients who survived following ulcer perforation (controls; n= 276) The controls were frequency-matched to the cases on age, sex and perforation site. Data were analysed by logistic regression. Cardiac, respiratory, cerebrovascular, renal, liver and malignant diseases, and septicaemia and intra-abdominal abscess were associated with mortality and the coexisting illnesses were significantly increased in cases compared to controls both on admission and at the end of hospital stay. During hospitalization, the odds of pneumonia decreased in cases, otherwise there was little change in strengths of associations over this period. Being widowed or never married was positively associated with mortality, and moderate alcohol use was negatively associated. In conclusion, this study identifies several coexisting illnesses, septicaemia and intra-abdominal abscess as risk factors for mortality following ulcer perforation. The results suggest that, with little exception, the same level of mortality risk is associated with coexisting illnesses whether the beginning or end of hospital stay is used as the index time point.