吻合器痔上黏膜环切术300例术后出血的处理

目的总结吻合器痔上黏膜环切术（PPH）出血的处理经验,以便有效减少出血的发生,提高疗效。方法选择2003年3月～2012年7月在本院接受PPH手术治疗的300例患者,对出血情况等临床资料进行临床分析。结果 300例患者术后存在不同程度出血,其中,术中即刻出血220例,占73.30%,其中,搏动性出血70例（23.30%）,其余为吻合口渗血（50.00%）;术后出血15例,其中,24h以内的3例,大出血1例（〉200mL）;大于24h的12例,大出血2例（〉100mL）;其余为少量便血12例（4.00%）。经积极处理,均停止出血。结论 PPH手术出血值得重视,需积极预防及有效处理。     

绝经后阴道出血的病因分析

目的：探讨绝经后阴道出血的相关性病因。方法：对280例生理性绝经1年以上阴道出血患者进行l临床及病理分析。结果：280例绝经后阴道出血患者中,生殖器炎症160例（占57.14％）,功能性子宫出血60例（占21.43％）,恶性肿瘤29例（占10.35％）,其他良性病变31例（占11.07％）。结论：引起绝经后阴道出血最多的原因是生殖器炎症,对发病年龄越大,绝经时间越长的绝经后阴道出血患者更应警惕其恶性肿瘤的发生。     

Does withholding aspirin for one week reduce the risk of post‐sphincterotomy bleeding?

BACKGROUND: Complications of endoscopic sphincterotomy are closely related to the endoscopic technique. To date, there have been no studies to indicate that aspirin increases the risk of bleeding after endoscopic sphincterotomy. AIM: To compare the incidence of post-sphincterotomy bleeding in patients with and without prior aspirin therapy. METHODS: Eight hundred and four patients were recruited into this retrospective study: 124 patients continued to take aspirin until the day of sphincterotomy (Group 1), 116 patients had their aspirin discontinued for 1 week before sphincterotomy (Group 2) and 564 patients had never taken aspirin (Group 3). The primary outcome analysed was the incidence of post-sphincterotomy bleeding. RESULTS: Sixty-seven patients (8.3%) developed post-sphincterotomy bleeding. The incidences of post-sphincterotomy bleeding in Groups 1, 2 and 3 were 9.7%, 9.5% and 3.9%, respectively. Group 1 showed significantly increased post-sphincterotomy bleeding when compared with Group 3 (P=0.01), and the risk was also significantly increased when Group 2 was compared with Group 3 (P=0.01). However, there was no significant difference in post-sphincterotomy bleeding between Groups 1 and 2 (P=0.96). CONCLUSIONS: Aspirin therapy increased the risk of post-sphincterotomy bleeding. Withholding aspirin for 1 week before endoscopic sphincterotomy did not seem to decrease the risk of post-sphincterotomy bleeding.     

肝硬化上消化道出血病灶性质89例分析

目的 分析肝硬化患者合并上消化道出血的病灶性质。方法 对89例肝硬化合并上消化道出血的患者在入院后12h～24h内行急诊胃镜检查以明确出血病灶性质。结果 发现病灶为食管胃底静脉曲张破裂出血49例，占55．17％，消化性溃疡出血21例，占23．86％，门脉高压性胃病出血15例，占16．87％，其他病灶4例，占4．1％。结论 肝硬化患者合并上消化道出血的病灶性质不尽相同，应针对不同病灶性质给予相应的治疗措施。     

止血带宽度与上肢止血压力和术后总失血量的关系探讨

目的探讨止血带宽度与上肢止血压力和术后总失血量的关系。方法将上肢手术应用止血带止血患者200例随机分为4组,每组50例。A组使用5cm宽气囊止血带,B组应用8cm宽气囊止血带,C组应用10cm宽气囊止血带,D组应用12cm宽气囊止血带。评价4组术中有效止血压力和计算术中、术后失血量及总失血量。结果 4组术中失血量比较差异无统计学意义(P>0.05)。A～D组随着相应的止血压力降低,术后失血量和总失血量也随之减少(P<0.05)。结论随着上肢止血带宽度增加使止血压力相应减小、总出血量亦相应降低。     

血清学检测在快速尿素酶试验假阴性出血性溃疡患者中的诊断价值

目的观察快速尿素酶试验（RUT）在出血性消化性溃疡患者中敏感性,探讨血清学检测（免疫印迹法,IBT）能否提高RUT假阴性消化性溃疡并出血患者H.pylori感染检出率。方法采用RUT、组织学（W-S染色法）和IBT三种方法检测2009年1月~8月经胃镜确诊的39例出血性消化性溃疡（出血组）住院患者H.pylori感染情况与33例非出血性消化性溃疡（非出血组）门诊患者进行对照研究。以最少两种诊断方法阳性为H.pylori感染诊断参照标准。结果RUT在出血组H.pylori阳性率43.6%低于非出血组81.8%（P=0.001）,差异有统计学意义。出血组IBT阳性率87.2%明显高于RUT阳性率43.6%（P〈0.001）;也高于W-S染色法阳性率64.1%,差异有统计学意义（P=0.012）。出血组RUT灵敏度65.4%显著低于非出血组96.3%（P=0.005）。出血组RUT阴性患者22例,依参照标准IBT可检出RUT假阴性患者9例,在出血性消化性溃疡RUT阴性患者中H.pylori检出率为40.9%。结论RUT在出血性消化性溃疡患者中灵敏度降低,假阴性患者增加。血清学（IBT）可作为H.pylori感染出血性消化性溃疡RUT阴性患者的补救措施或可选方法之一,有助于提高消化性溃疡并出血时H.pylori感染检出率。     

The usefulness of transabdominal ultrasound for the diagnosis of lower gastrointestinal bleeding

BACKGROUND: Lower gastrointestinal bleeding is a frequent cause of hospitalization, but diagnostic methods for this condition are not fully established. Transabdominal ultrasound is a widely accepted diagnostic tool in bowel diseases. AIM: To evaluate the usefulness of transabdominal ultrasound for lower gastrointestinal bleeding. METHODS: We reviewed the medical records of consecutive patients who underwent transabdominal ultrasound as the first diagnostic procedure for acute haematochezia during the period June 1999 to June 2004. The study group comprised 111 patients and all underwent colonoscopy thereafter. Detection and diagnosis of lower gastrointestinal bleeding by ultrasonographic examination were evaluated by comparing the ultrasound diagnosis with the colonoscopic findings and final diagnosis. RESULTS: The bleeding site was localized by colonoscopy in 90 of the 111 patients (81%). The bleeding site was localized by ultrasound in 59 of the 90 patients (66%). When the bleeding site was in the rectum, ultrasonographic detectability was 30% (10/33); ultrasonographic detectability was 82-100% when the bleeding site was elsewhere. Rectal bleeding and diverticular bleeding were difficult to diagnose by ultrasound, but for the other diseases, diagnosis by ultrasonographic examination was possible in 91-100% of cases. CONCLUSIONS: Ultrasonographic examination may be an effective screening method for lower gastrointestinal bleeding.     

产后出血原因及防治分析135例

目的:探讨产后出血原因、内在联系及防治对策.方法:回顾性分析135例产后出血的出血量、出血原因、防治措施.结果:单一因素引起产后出血36例(26.7%),2～5个因素引起99例(73.3%).引起产后出血的因素越多,出血量逐渐递增,单因素与多因素引起的产后出血量差异有显著性(P＜0.05).6例发生休克,3例行子宫次全切除,1例行子宫全切除术,131例经过综合措施处理,出血停止.结论:产后出血往往是多因素综合作用的结果,应采取综合措施及时处理,全面掌握病情是预防和治疗产后出血的关键.     

绝经后子宫出血60例病因分析

目的 前瞻性研究绝经后子宫出血的原因。方法 对绝经后子宫出血病人行宫腔镜检查,对可疑病灶行活检术和／或诊刮术,以病理检查结果作为病因诊断的依据。结果 ６０例绝经后子宫出血病人的出血原因为：子宫内膜萎缩出血及子宫内膜炎共２８例（４６．７％）;子宫内膜增殖症１２例（２０．０％）;子宫内膜癌６例（１０．０％）;子宫内膜息肉７例（１１．７％）;其他原因７例（１１．７％）。结论 子宫内膜萎缩出血及子宫内膜炎     

Selective serotonin re-uptake inhibitors and the risk of bleeding

Despite their safety, selective serotonin re-uptake inhibitors (SSRIs) are associated with bleeding. The authors critically reviewed the medical literature on SSRIs to identify subgroups of patients at risk of bleeding complications. The authors performed a literature search using MEDLINE from 1966 to 1st September 2004 using; ‘haemorrhage, serotonin uptake inhibitors and antidepressive agents’ as search terms and followed up on citations in each paper that was relevant to SSRI associated bleeding. The authors reviewed 7 retrospective analytical studies and 24 case reports of bleeding in 43 different people. Analytical studies support an association between SSRI consumption and upper gastrointestinal (GI) bleeding and perioperative bleeding. Little evidence links SSRI use with intracerebral haemorrhage. The risk of GI bleeding appeared to be highest among patients consuming SSRIs with NSAIDs. Combining aspirin or NSAIDs with SSRIs may further increase the risk of bleeding. Clinicians should caution patients about combining SSRIs with aspirin or NSAIDs. Pharmacotherapy to reduce the risk of GI bleeding should be consid-ered in high risk patients.     

Selective serotonin re-uptake inhibitors and the risk of bleeding

Despite their safety, selective serotonin re-uptake inhibitors (SSRIs) are associated with bleeding. The authors critically reviewed the medical literature on SSRIs to identify subgroups of patients at risk of bleeding complications. The authors performed a literature search using MEDLINE from 1966 to 1st September 2004 using; 'haemorrhage, serotonin uptake inhibitors and antidepressive agents' as search terms and followed up on citations in each paper that was relevant to SSRI associated bleeding. The authors reviewed 7 retrospective analytical studies and 24 case reports of bleeding in 43 different people. Analytical studies support an association between SSRI consumption and upper gastrointestinal (GI) bleeding and perioperative bleeding. Little evidence links SSRI use with intracerebral haemorrhage. The risk of GI bleeding appeared to be highest among patients consuming SSRIs with NSAIDs. Combining aspirin or NSAIDs with SSRIs may further increase the risk of bleeding. Clinicians should caution patients about combining SSRIs with aspirin or NSAIDs. Pharmacotherapy to reduce the risk of GI bleeding should be considered in high risk patients.     

小切口胆囊切除术中出血的原因及预防

目的 :探讨小切口胆囊切除术 (Minicholecysectomy ,MC)中出血原因及预防。 方法 :对本院 1991年 4月至 2 0 0 2年 12月 6 10 0例MC术中较多出血 19例 (0 31% )的原因及处理进行回顾和分析。结果 :19例较多出血中有 2例 (10 5 % )大出血 ,11例 (5 7 9% )术中延长切口止血。无术后继发出血 ,全部治愈。结论 :仔细分辨Calot三角解剖结构 ,熟练的深部打结和缝扎胆囊三角系膜技术 ,把握延长切口的时机是预防术中出血及避免严重后果的关键。     

Effect of age on international normalized ratio at the time of major bleeding in patients treated with warfarin

STUDY OBJECTIVES: Because the risk of major bleeding associated with warfarin increases with increasing international normalized ratio (INR) as well as with advanced age, we evaluated the association between age and INR in patients with major bleeding events related to anticoagulation with warfarin. DESIGN: Retrospective record review. SETTING: Two university-affiliated anticoagulation clinics. PATIENTS: Sixty-six patients (mean age 61.2 yrs, range 21-90 yrs) receiving warfarin therapy who experienced major bleeding, defined as bleeding requiring hospitalization, during a 20-month index period. MEASUREMENTS AND MAIN RESULTS: In patients aged 65 years or older, the mean INR at the time of a major bleeding event was significantly lower than that in patients younger than 65 years (INR 3.1 vs 4.2, respectively; p=0.01). For every 1-year increase in age, mean INR at the time of a major bleeding event decreased by 0.03 (p=0.02). CONCLUSION: Patients aged 65 years or older experience warfarin-related major bleeding events at a mean INR 1.1 units lower (95% confidence interval -1.9 to -0.27) than patients younger than 65 years. Older patients may require more aggressive management of overanticoagulation to minimize the risk of major bleeding.     

功能失调性子宫出血的非血管介入治疗(附31例分析)

目的：研究无水乙醇非血管介入治疗功能失调性子宫出血的临床价值。方法：31例功能失调性子宫出血患者，表面麻醉后行子宫腔造影，了解子宫腔容量，同时注入等量无水乙醇，保留3－5分钟后抽出，反复2－3次，观察疗效。结果：29例（93．55％）出血停止，13例（41．94％）月经量恢复正常，16例（51．61％）月经量减少，18例（58．06）恢复 正常月经周期，2例（4．65％）手术切除。结论：非血管介入治疗功能失调性子宫出血疗效确切，方法简单、安全。     

米索前列醇预防剖宫产术后出血25例

目的:观察米索前列醇用于预防剖宫产术后出血的效果.方法:选择有产后出血高危因素的剖宫产患者50例,随机分为治疗组对照组各25例.治疗组手术后30 min内直肠置入米索前列醇200 μg,对照组臀部肌肉注射缩宫素20 U,观察两组术中及术后的出血量.结果:术中出血量两组差异无显著性;而术后2 h内平均出血量治疗组125 mL,对照组217 mL,差异有显著性(P＜0.05);产后24 h出血量治疗组平均236 mL,对照组平均477 mL,差异有显著性(P＜0.05).结论:米索前列醇促进子宫收缩作用明显,能很好的预防剖宫产术后出血,且用药方便、安全.     

绝经后阴道出血134例临床分析

目的：分析引起绝经后阴道出血的病因及诊断方法。方法：对134例绝经后阴道出血患者进行临床及病理分析。结果：因良性疾患引起出血占58．20％，非器质性疾病占32．08％、恶性肿瘤占9．70％。子宫内膜病理分析；增生性反应25例、分泌反应3例、萎缩性4例、破碎宫内膜和经期内膜11例。恶性肿瘤以宫颈癌和子宫内膜癌为主，随着绝经后出血时年龄增加，绝经年期的延长，发生恶性肿瘤危险性也随之上升。诊刮中宫腔深度＞8．5cm发生恶性肿瘤可能性上升。结论：绝经后阴道出血虽以良性病变为主，但恶性肿瘤仍占有一定比例，同时随着绝经后出血时年龄增长，绝经年期延长恶性肿瘤的发生有增加，必须重视绝经后阴道出血。     

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy

BACKGROUND: The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge. AIM: To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding. METHODS: Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding. RESULTS: A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach. CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.     

Discrepancies in identification of bleeding events after percutaneous coronary intervention

STUDY OBJECTIVE: To evaluate the level of agreement between two sets of criteria, the Thrombolysis in Myocardial Infarction (TIMI) criteria and investigator-developed criteria, for identifying bleeding events in patients who had undergone a percutaneous coronary intervention (PCI) and to measure length of hospital stay (LOS) as a surrogate marker of bleeding severity. DESIGN: Retrospective chart review. SETTING: Two university-affiliated medical centers. PATIENTS: Four hundred twenty-two consecutive patients who had undergone PCI from December 1, 2001-June 30, 2002. MEASUREMENTS AND MAIN RESULTS: Data were collected on the number of bleeding events that occurred within 1 week after PCI (limited to one event/patient) and on LOS. Bleeding was assessed by TIMI criteria and by investigator-developed criteria. Bleeding according to TIMI criteria included intracranial hemorrhage, spontaneous hematuria or hematemesis, or decreases in hemoglobin level. Bleeding according to investigator-developed criteria included intracranial, retroperitoneal, intraocular, or clinically overt bleeding without a specified decrease in hemoglobin level. Agreement between criteria was assessed by means of the kappa statistic. Of the 422 patients, 23 (5%) experienced TIMI-defined bleeding events and 229 (54%) investigator-defined bleeding events. A kappa value of 0.09 (95% confidence interval 0.06-0.13) indicated a poor level of agreement between the two sets of bleeding criteria. The effect of this discrepancy on LOS was 66 fewer days of care when TIMI criteria were applied versus investigator-developed criteria in the 206 patients who experienced bleeding events that met investigator criteria (total LOS 645 days) but not TIMI criteria (total LOS 579 days). CONCLUSION: Bleeding assessment with use of TIMI criteria versus investigator-developed criteria yielded discrepant bleeding event rates and LOS, making it difficult to accurately compare bleeding rates and consequences across clinical trials and in practice. Consensus bleeding criteria are needed for applications in clinical evaluations of antithrombotic agents.     

重度食管静脉曲张病人上消化道出血的预后因素分析

目的　探讨重度食管静脉曲张 (LEV)出血的预后因素。方法　将 41例LEV出血病人分为好转组 (15例 )和死亡组 (2 6例 ) ,分别比较child pugh分级 ,实验参数 [凝血酶原时间 (PT)、凝血因子、血小板计数 (BPC) ],B超脾大小 (厚度及斜径 ) ,年龄及病程 ,呕血次数及出血间隔时间。结果　两组PT、BPC、child pugh分级、年龄、出血间隔时间比较差异有显著意义 ,P值分别为 <0 0 5、<0 0 5、<0 0 2、<0 0 2、<0 0 1。结论　PT、child pugh分级、年龄与食管静脉曲张 (EV)出血的预后呈正相关 ,BPC、出血间隔时间、年龄与EV出血的预后呈负相关。     

海洛因依赖者脱毒期上消化道出血情况分析

目的:了解海洛因依赖者脱毒期间上消化道出血情况。方法:对2000年-2004年上半年在我院住院的病历进行统计。结果:共统计1366例海洛因依赖患者的病历,其中有3·95%在脱毒期出现上消化道出血症状;上消化道出血的发生率在不同日用量、既往有无消化系统疾病、戒断后时间早迟之间差异有显著性(P<0·01);在胃出血与十二指肠出血之间差异亦有显著性(P<0·01);1366例患者采用H2受体阻滞剂防治后仅1例发生上消化道出血。结论:海洛因滥用量大、既往有消化系统疾病以及戒断后时间长的海洛因依赖者脱毒期间易发生上消化道出血症状;尽早给予H2受体阻滞剂防治,对预防上消化道出血的发生非常有效。