急性非静脉曲张上消化道出血临床特征分析

目的分析急性非静脉曲张上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANNUGIB)病因构成、内镜下表现,探讨影响患者预后的危险因素。方法收集我院2005年1月-2010年12月已确诊因急性非静脉曲张上消化道出血(AN-VUGIB)首次入院且资料完整的患者临床资料,共计858例。出院后随访30 d,并将死亡或出院后30 d为临床研究终点,回顾性分析ANVUGIB临床特征。结果 (1)老年组发病率明显高于青、中年组,急性胃黏膜病变占老年组发病病因首位,而青、中年组中十二指肠球部溃疡占首位。(2)出血后行急诊胃镜(≤48 h)检查内镜下有出血征象明显多于>48 h的胃镜检查。(3)女性在十二指肠球部溃疡比率明显高于男性,复合性溃疡比率较男性高,男性在胃溃疡、胃癌、急性胃黏膜病变以及食管癌和Mallory-Wiess综合征比率高于女性。(4)老年组病死率明显高于青、中年组(6.8%、0、1.9%),老年组再出血发生率高于青、中年组(9.3%、4.4%、4.9%)。结论 ANVUGIB以高龄男性多见,青、中年组发病病因中十二指肠球部溃疡占首位,老年组发病病因以急性胃黏膜病变为首位。ANVUGIB老年患者死亡率和再出血率均高于青、中年组,急诊胃镜有助于ANVUGIB的诊断。     

肝硬化合并非静脉曲张性上消化道出血临床分析

目的:分析肝硬化合非静脉曲张性上消化道出血的临床情况.方法:试验时间为2019年10月至2020年10月,抽取肝硬化合并非静脉曲张性上消化道出血患者35例作为研究组,同期抽取肝硬化合并静脉曲张性上消化道出血患者35例作为参照组.分析各指标水平、危险因素和基础疾病.结果:两组患者各指标水平比对后,输血量和血尿素氮水平有差...     

急性非静脉曲张性上消化道出血的临床护理进展

急性非静脉曲张性上消化道出血是常见的临床急危重症。该病起病急,病情变化迅速,临床研究表明,积极有效的护理措施对患者病情进展及预后至关重要。本文旨在对急性非静脉曲张性上消化道出血的临床护理措施（急救护理、护理评估、用药护理、心理护理、饮食护理、预见性护理、健康教育、出院指导）做一综述,以期为临床护理工作提供一定依据。     

非静脉曲张良性上消化道出血内窥镜诊疗体会

目的 分析非静脉曲张性上消化道出血的病因，探讨不同原因引起的非静脉曲张良性上消化的出血的内镜治疗方法；方法 回顾性分析我院2000～2003年193例非静脉曲张良性上消化道出血内镜诊断和治疗；结果 ①消化性溃疡出血是非静脉曲张良性上消化道出血的主要病因，②早期内窥镜检查能提高出血责任病灶检出的阳性率，③绝大多数良性上消化小量渗血均可以通过内镜下局部注射及局部电凝法止血，④确认为小动脉/小静脉出血时，止血夹止血是主要的治疗方法；结论 ①无内窥镜诊疗禁忌症者，应及时内镜探查以明确出血原因，确定引起出血的责任病灶；②对于不同情况的上消化道出血应区别对待，使用不同的内镜止血方法，才能达到满意的治疗效果；③溃疡瘢痕出血的内镜下止血方法有待于进一步探讨。     

老年急性非静脉曲张性上消化道出血临床特点分析

目的总结分析急性非静脉曲张性上消化道出血≥75岁老年患者的临床特点,以便进一步了解该类患者的特殊性,为更好的临床诊治提供参考。方法回顾性分析165例于2006～2007年收住消化内科的非静脉曲张性上消化道出血患者的临床病历资料,其中老年组（≥75岁）96例,非老年组（〈60岁）59例,详细记录其临床表现、实验室检查、内镜下表现及伴随的其他系统疾病,并进行对比和分类分析。结果老年组与非老年组急性非静脉曲张性上消化道出血的首要原因均为溃疡病,老年组胃溃疡发病率（20.8%）高于非老年组（8.5%）（P〈0.05）,而非老年组十二指肠球部溃疡（57.6%）及复合性溃疡（15.3%）发病率高于老年组（39.6%及5.2%）（P〈0.05）,老年组急性糜烂出血性胃炎发病率（13.5%）明显高于非老年组（3.4%）（P〈0.05）,老年组有上腹痛和（或）上腹部压痛者（49%）低于非老年组（66.1%）（P〈0.05）。与非老年组比较,老年组伴随的其他系统疾病明显增高（P〈0.01）;应用阿司匹林/非甾体类抗炎药（NSAIDs）明显增多（P〈0.01）;血尿素氮数值明显增高（P〈0.01）;住院时间明显延长（P〈0.05）。2组幽门螺杆菌感染情况比较无显著性差异（P〉0.05）。结论≥75岁老年患者非静脉曲张性上消化道出血病情较非老年组重,住院时间长,治疗也较为复杂。对于老年组急诊内镜下诊治可以明确诊断,并可同时进行镜下止血治疗。     

急性非静脉曲张性上消化道出血220例诊治体会

目的探讨急性非静脉曲张性上消化道出血临床病因及诊治。方法回顾分析2005年1月～2006年12月南昌县人民医院急性非静脉曲张性上消化道出血220例住院患者的临床资料。结果以消化性溃疡、上消化道肿瘤、应激性溃疡、急慢性上消化道黏膜炎症为常见病因，表现为黑便或呕血，抗酸及内镜止血效果好。结论各种病因所致的急性非静脉曲张性上消化道出血各有其临床特点。     

急性非静脉曲张性上消化道出血24例临床分析

我院消化科2007年共收治病人1 464例,其中上消化道出血患者486例占全部住院病人的30%.以呕血为首发症状者64例,全部行胃镜和急诊胃镜检查,其中24例属急性非静脉曲张性上消化道出血者.24例均为住院患者,男19例,女5例,年龄18～72岁,平均年龄48岁.上消化道出血部位及其性质均以胃镜和病理细胞学检查作为确切依据.24例患者均以呕血、咖啡样液体继之黑便为主.上腹痛、饱胀不适14例,嗳气返酸6例,头晕、心悸、晕厥4例.胃镜表现:消化性溃疡15例,其中胃溃疡9例,十二指肠球部溃疡6例,胃癌3例,食管癌2例,贲门癌2例,急性胃黏膜病变2例.     

生长抑素治疗急性非静脉曲张性上消化道出血疗效观察

目的观察生长抑素治疗非静脉曲张性上消化道出血的疗效。方法将105例非静脉曲张性上消化道出血患者随机分为A组（53例）和B组（52例）,A组为生长抑素联合奥美拉唑组,B组为单用奥美拉唑组,观察两组的止血效果。结果A组止血显效率和总有效率均高于B组,差异有统计学意义（P〈0．05）。结论生长抑素治疗非静脉曲张性上消化道出血有显著疗效,值得推广应用。     

非静脉曲张上消化道出血内镜急诊止血297例临床分析

近年来，由于开展急诊内镜检查，非静脉曲张上消化道出血的病因诊断率大为提高，并在内镜直视下采取各种止血措施，对改善预后、降低病死率、减少输血量、缩短疗程等都起到积极的作用。我们对我院自2001年1月至2002年7月因上消化道出血进行内镜检查排除静脉曲张297例的治疗进行回顾分析。根据内镜检查时间的不同分为急诊内镜检查组和非急诊内镜检查组，其中急诊内镜组有215例，非急诊检查的有82例，根据资料现总结如下。     

老年人急性非食管静脉曲张性上消化道出血的临床特点

目的 分析老年人上消化道出血的临床特点。方法 回顾性总结206例非食管静脉曲张性上消化道出血患者住院病历，其中老年组105例，非老年组101例。详细记录临床、实验室及内镜检查结果。结果 老年组与非老年组上消化道出血的首要原因均为溃疡病，分别为83．8％与84．2％，但老年组胃溃疡患病率(18．1％)明显高于非老年组(5．0％，P＜0．05)；老年组应用阿司匹林／非甾体类抗炎药(NSAID)明显增多，达29．5％，非老年组仅为3.0％(P＜0．05)；与非老年组比较，老年组平均止血时间明显延长，分别为6．9d和5．6d，再出血比例明显增高，分别为6．7％和0；所需平均输血量、需手术者以及需重症监护者均明显高于非老年组。两组患者平均住院时间、转归以及幽门螺杆菌感染情况差异无显著性。结论 老年人上消化道出血临床病情较非老年人重，病程延长，治疗更为复杂。急诊的内镜检查与内镜下止血治疗是安全有效的措施。     

Acute upper gastrointestinal bleeding (UGIB) – Initial evaluation and management

Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the ‘on-call’ gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is ‘non-variceal’ and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory–Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.     

Epidemiology of acute upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding is an important emergency situation. Population-based epidemiology data are important to get insight in the actual healthcare problem. There are only few recent epidemiological surveys regarding acute upper gastrointestinal bleeding. Several surveys focusing on peptic ulcer disease showed a significant decrease in admission and mortality of peptic ulcer disease. Several more recent epidemiological surveys show a decrease in incidence of all cause upper gastrointestinal bleeding. The incidence of peptic ulcer bleeding remained stable. Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, responsible for about 50% of all cases, followed by oesophagitis and erosive disease. Variceal bleeding is the cause of bleeding in cirrhotic patients in 50-60%. Rebleeding in upper gastrointestinal bleeding occurs in 7-16%, despite endoscopic therapy. Rebleeding is especially high in variceal bleeding and peptic ulcer bleeding. Mortality ranges between 3 and 14% and did not change in the past 10 years. Mortality is increasing with increasing age and is significantly higher in patients who are already admitted in hospital for co-morbidity. Risk factors for peptic ulcer bleeding are NSAIDs use and H. pylori infection. In patients at risk for gastrointestinal bleeding and using NSAIDs, a protective drug was only used in 10%. COX-2 selective inhibitors do cause less gastroduodenal ulcers compared to non-selective NSAIDs, however, more cardiovascular adverse events are reported. H. pylori infection is found in about 50% of peptic ulcer bleeding patients. H. pylori should be tested for in all ulcer patients and eradication should be given.     

Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspectives

Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.     

Initial management of nonvariceal upper gastrointestinal bleeding and timing of endoscopy

Acute nonvariceal upper gastrointestinal bleeding is a common cause of hospital admission with significant associated health care expenditures and a significant but improving mortality rate. Initial management includes proper resuscitation with close hemodynamic monitoring, a blood transfusion threshold of 7 g/dL in most patients, early risk stratification using validated prognostic scores, and timely upper endoscopy. Current guidelines recommend that upper endoscopy be performed within 24 hours of presentation, except for patients at very low risk of adverse outcomes who may undergo more elective upper endoscopy. The role of urgent endoscopy for patients at higher risk for adverse outcomes remains controversial.     

急性非静脉曲张上消化道出血风险评估的临床研究

目的 探讨Rockall(RS)和Blatchford(BRS)评分系统对急性非静脉曲张上消化道出血(ANVUGIB)预后风险评估的准确性和临床实用性.方法 记录我院2009年1月至2009年12月间收治的195例符合研究标准及资料完整的ANVUGIB患者的临床资料,分别计算各患者RS和BRS分值进行危险分层,出院后随访30 d,并将死亡或出院后30 d的疾病转归作为临床研究终点.检验两评分系统对预后的预测能力.结果 195例患者中男150例,女45例,男女比例2.3:1.年龄15～85岁,平均(53.97±18.34)岁.年龄≥60岁患者(老年组)90例,年龄<60岁患者(非老年组)105例.生存182例(93.3%),死亡13例(6.7%),生存患者中再出血11例(5.6%).老年组患者病死率[12.2%(11/90)]、合并基础疾病率[43.3%(39/90)]及服阿司匹林[24.4%(22/90)]均高于非老年组患者[1.9%(2/105)、16.2%(17/105)和11.4%(12/105),P值均<0.05].RS预测死亡风险的曲线下面积(AUC)=0.742(P=0.004),预测再出血风险的AUC=0.469(P=0.101);BRS评分系统预测死亡风险AUC=0.493(P=0.067),预测再出血风险AUC=0.341(P=0.092).RS分值与住院天数呈正相关性,而BRS与住院天数关系无统计学意义.结论 RS评分系统对死亡预测能力良好,其分值高低与住院天数长短呈正相关,但对再出血预测能力较差.BRS对住院患者死亡和再出血预测能力均不理想,不适用于住院患者不良预后的风险预测.     

Regional differences in outcomes of nonvariceal upper gastrointestinal bleeding in Saskatchewan

BACKGROUND:

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with significant mortality.

OBJECTIVE:

To examine several factors that may impact the mortality and 30-day rebleed rates of patients presenting with NVUGIB.

METHODS:

A retrospective study of the charts of patients admitted to hospital in either the Saskatoon Health Region (SHR) or Regina Qu’Appelle Health Region (RQHR) (Saskatchewan) in 2008 and 2009 was performed. Mortality and 30-day rebleed end points were stratified according to age, sex, day of admission, patient status, health region, specialty of the endoscopist and time to endoscopy. Logistic regression modelling was performed, controlling for the Charlson comorbidity index, age and sex as covariates.

RESULTS:

The overall mortality rate observed was 12.2% (n=44), while the overall 30-day rebleed rate was 20.3% (n=80). Inpatient status at the time of the rebleeding event was associated with a significantly increased risk of both mortality and rebleed, while having endoscopy performed in the RQHR versus SHR was associated with a significantly decreased risk of rebleed. A larger proportion of endoscopies were performed both within 24 h and by a gastroenterologist in the RQHR.

CONCLUSION:

Saskatchewan has relatively high rates of mortality and 30-day rebleeding among patients with NVUGIB compared with published rates. The improved outcomes observed in the RQHR, when compared with the SHR, may be related to the employ of a formal call-back endoscopy team for the treatment of NVUGIB.