洛赛克治疗消化性溃疡出血疗效观察

消化性溃疡并出血是消化性溃疡最常见并发症，也是上消化道出血的最常见原因。我院近两年来，共收治消化性溃疡出血患106例，其中用洛赛克治疗44例，与雷尼替丁治疗41例进行比较，效果显，现报告如下。     

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。     

内镜下注射止血加用热探头凝固治疗消化性溃疡并出血失败的原因分析

本文旨在分析内镜注射止血加热探头凝固性止血治疗消化性溃疡并出血失败的有关原因。     

奥美拉唑联合内镜下止血夹治疗消化性溃疡并出血的疗效观察

目的探讨奥美拉唑联合内镜下止血夹治疗消化性溃疡并活动性出血的临床效果。方法收集我院消化科收治的消化性溃疡并活动性出血患者65例,随机分为两组,其中治疗组31例,对照组34例。治疗组采用内镜下止血夹联合静脉推注奥美拉唑40 mg,2次/d,治疗1周。对照组采用静脉推注奥美拉唑40 mg,2次/d,,治疗1周。治疗期间收集患者止血效果、止血时间和再出血情况方面的数据,通过统计比较这三个指标在两组间的分布差异。结果治疗组止血总有效率为96.77%,明显优于对照组的64.71%,(P0.05)。治疗组止血时间为(1.8±1.2)d,对照组止血时间为(5.5±1.4)d,与对照组相比,治疗组止血时间更短(P0.05)。患者再出血方面,治疗组有1例,占比3.23%,对照组有7例,占比20.59%,与对照组相比,治疗组患者更不容易发生再出血(P0.05)。结论通过对消化性溃疡并活动性出血的两种治疗方法比较发现,奥美拉唑联合内镜下止血夹治疗消化性溃疡效果更好。具有止血效果显著、止血时间短、再出血率低的优点。因此,临床上可广泛采用奥美拉唑联合内镜下止血夹法治疗消化性溃疡并活动性出血。     

内镜止血联用大剂量洛赛克治疗溃疡病大出血

目的：探讨内镜止血联用大剂量洛赛克治疗消化性溃疡大出血的临床价值。方法：对３２例溃疡病大出血患者进行内镜治疗,然后将内镜止血成功的２１例继续抑酸治疗,１０例用大剂量洛赛克,１１例用常规剂量西米替丁。结果：内镜即刻止血成功２１例,失败１例。     

内镜下血管钳夹加止血合剂注射治疗消化性溃疡并出血的临床观察

为探索治疗溃疡病并出血的新方法,我们采用内镜人血管钳类加止血合剂注射治疗消化性物异出血,并以药物治疗为对照,加以分析。20例溃疡并出血病人采用内镜下钛夹钳夹血管加止血合剂注射治疗(内镜治疗组)。中胃溃疡3例,十二指肠球部溃疡17例。重度出血15人,占75％,中度出血5人,占25％。注射用止血合剂由3％高渗盐水、立止血、肾     

内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血疗效分析北大核心CSCD

目的探讨内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效。方法选取2014年1月至2015年12月期间青海省人民医院消化内科收治的168例消化性溃疡出血患者作为研究对象,根据患者入院顺序进行编号,将其随机分为A、B、C 3组,每组各56例。A组患者接受内镜下金属钛夹夹闭止血治疗,B组患者接受内镜下注射止血治疗,C组患者接受内镜下金属钛夹联合注射止血治疗。治疗完成后,比较3组的临床疗效、即时止血率、再出血率、外科手术率以及术后并发症发生情况。结果治疗前,3组患者的一般资料、病例分布及病情分级等方面比较差异无统计学意义(P>0.05)。治疗后,C组治疗总有效率为94.6%,显著高于A组和B组的82.1%、75.0%(P=0.017);A组与C组的即时止血率均为100%,显著高于B组的92.9%(P=0.017);C组的再次出血发生率为1.8%,显著低于A组和B组的10.7%、16.1%(P=0.034);但在转外科手术率及术后并发症发生率方面,3组比较差异无统计学意义(P>0.05)。结论内镜下金属钛夹联合注射肾上腺素治疗消化性溃疡出血近期疗效确切,具有较好的止血效果,可降低再出血发生率,具有一定的临床价值。     

内镜止血联合PPI抑制剂静脉泵入治疗老年消化性溃疡出血的临床疗效

目的:观察内镜止血联合PPI抑制剂静脉泵入对老年消化性溃疡出血患者的疗效。方法:选取老年消化性溃疡出血患者84例,随机分为治疗组和对照组,每组42例,对照组给予单纯静脉泵入埃索美拉唑治疗,治疗组患者先在内镜下行止血治疗,随后联合静脉泵入埃索美拉唑。观察2组患者治疗后的止血效果、临床预后情况。结果:治疗后治疗组患者的平均止血时间、输血量和住院时间均明显低于对照组(均P0.05)。治疗组48 h内出血停止患者明显多于对照组(88.09%vs 80.95%,P0.05);治疗组转开腹手术治疗和发生止血后再出血各1例,明显少于对照组(P0.05)。治疗组总有效率明显高于对照组(95.23%vs 85.71%,P0.05)。结论:内镜下止血联合PPI抑制剂静脉泵入治疗老年消化性溃疡出血,止血有效率高,平均止血时间、住院时间短,是临床上有效的止血方法。     

思密达联合洛赛克治疗消化性溃疡出血50例疗效观察

目的 探讨思密达联合洛赛克治疗消化性溃疡出血的疗效。方法 运用思密达联合洛赛克治疗消化性溃疡出血50例，与单用洛赛克治疗消化性溃疡出血44例比较。结果 两药合用效果好，前者疗效明显优于后者，值得临床推广使用。结论 两药合用效较好，值得临床推广使用。     

洛赛克治疗十二指肠球部溃疡并出血疗效观察

目的探讨洛赛克治疗十二指肠球部溃疡并出血的疗效。方法将经胃镜确诊为十二指肠球部溃疡并出血的60例患者，随机分为治疗组和对照组。治疗组30例，给予洛赛克40mg，静脉滴注，2次／d，连用5天；对照组30例，给予雷尼替丁100mg，静脉滴注，2次／d，连用5天；比较这两种抑酸剂对十二指肠球部溃疡并出血的疗效。结果治疗组总有效率为96．7％，对照组总有效率为70．O％，两组总有效率比较差异有显著性（P〈0．05）。结论洛赛克治疗十二指肠球部溃疡并出血有很高的止血率，无明显副作用，是治疗十二指肠球部溃疡并出血的一种安全、有效的药物，值得临床推广使用。     

大剂量洛赛克联用善宁治疗难治性上消化道出血

[目的]探讨大剂量洛赛克联用善宁治疗难治性上消化道出血的疗效。[方法]111例患者随机分为治疗组(56例)和对照组(55例)。2组均用善宁0.1mg静脉注射后,以25μg/h微量泵持续静脉推注,出血停止后维持48h。治疗组同时应用洛赛克80mg静脉缓慢推注,继之以8mg/h微量泵持续静脉推注;对照组同时应用洛赛克40mg静脉推注,继之以4mg/h微量泵持续静脉推注。2组均于出血停止后维持48h。[结果]治疗组显效率及总有效率均高于对照组(均P<0.05);2组急性静脉曲张性上消化道出血疗效差异无统计学意义,急性非静脉曲张性上消化道出血总有效率差异有统计学意义(P<0.01)。[结论]大剂量洛赛克联用善宁治疗难治性上消化道出血疗效优于常规剂量。     

上消化道溃疡急性穿孔96例保守治疗的体会

目的总结上消化道溃疡急性穿孔保守治疗的体会。方法对2008-01～2009-12接受保守治疗的上消化道溃疡急性穿孔患者96例的临床资料进行回顾性分析。结果全组96例上消化道溃疡急性穿孔患者全部治愈,无出现腹腔脓肿、再穿孔和死亡病例。随访半年,预后良好84例,复发10例,死亡2例。结论对于上消化道溃疡急性穿孔的治疗,在严格掌握适应证的前提下对患者采取保守治疗,可以取得满意效果。     

Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: Is Helicobacter pylori infection a risk factor for hemorrhage?

Aim: In this study, the aim was to determine the demographic characteristics of elderly patients with gastroduodenal ulcer who had undergone endoscopic hemostasis by comparing them with younger patients. Methods: A total of 353 patients with Forrest class I–IIa hemorrhagic gastroduodenal ulcer who underwent endoscopic hemostasis at our hospital between December 2004 and May 2010 were divided into two groups: one for those 75 years or older (old‐old group; n = 71; age ≥75 years) and one for those younger than 75 years (younger group; n = 282; age <75 years). Then, their demographic characteristics were compared. Results: There were significantly more female patients, patients with underlying chronic renal failure and patients using non‐steroidal anti‐inflammatory drugs in the old‐old group than in the younger group. In addition, the prevalence of open‐type atrophy in the background gastric mucosa was significantly higher in the old‐old group. Although more than half the patients in each group were infected with Helicobacter pylori, the prevalence was significantly higher in the younger group. Of the patients who underwent endoscopic hemostasis only once, those in the old‐old group constituted a significantly higher medical cost than those in the younger group. Comparison of deaths between the two groups revealed that the old‐old patients were more likely to develop severe complications associated with hematemesis, such as aspiration pneumonia. Conclusions: The observed lower prevalence of Helicobacter pylori infection among the elderly patients compared to the younger patients with hemorrhagic gastroduodenal ulcer suggests that other factors, such as non‐steroidal anti‐inflammatory drugs use and chronic renal failure, predispose the elderly to hemorrhagic ulcer.     

Endoscopic hemoclip treatment for bleeding peptic ulcer

AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.     

内镜下注射治疗消化性溃疡出血

目的 探讨内镜下注射止血的临床应用及意义。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者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％，二组有显著性差异。结论 内镜注射止血治疗简单有效，可降低手术率和再出血率。     

高清晰放大内镜对消化性溃疡再生黏膜形态的观察及临床意义

目的探讨高清晰放大内镜下观察消化性溃疡再生黏膜形态的改变及其临床意义。方法使用Olympus GIF—Q240Z型电子放大内镜对58例门诊病例，经常规胃镜检查后，转换高清晰放大功能，详细观察消化性溃疡再生黏膜的形态。结果55例良性溃疡中栅状再生黏膜占3．6％，纺锤状再生黏膜占16．4％，结节状再生黏膜占12．7％，两种或两种以上再生黏膜占67．3％。3例早期癌的再生黏膜均为结节状再生黏膜。结论高清晰放大内镜所观察到的消化性溃疡再生黏膜形态的三大类型对于判断病程的长短、治愈的难易程度、溃疡复发的危险性均密切相关。结节状再生黏膜的出现提示增生受阻，应高度警惕癌变的可能。     

Assessment of endoscopic Doppler to guide hemostasis in high risk peptic ulcer bleeding

Abstract

Introduction: Rebleeding or emergency surgery in failed endoscopic therapy of peptic ulcer bleeding are associated with high rates of morbidity and mortality. The clinical benefit of an endoscopic Doppler (ED) examination prior to endoscopic injection therapy was evaluated in high risk ulcer patients for rebleeding episode. Standard injection therapy (non-Doppler (ND)) was compared with targeted injection therapy after examination of the supplying vessel in the ulcer base by the ED.

Materials and methods: Sixty patients with peptic ulcer bleeding (Forrest Ia–IIa; Rockall score of 5 or higher) were included in the study. Patients were assigned to ED or ND group with conventional therapy by chance. In the ND group injection was directed by the visual aspect of the ulcer, whereas in ED therapy was directed by ED.

Results: Thirty-five patients were allocated to the ED group, and 25 to the ND group, respectively. No significant differences in patient or ulcer characteristics were observed regarding ulcer size, localization, Forrest classification or endoscopic treatment. Recurrent bleeding was observed in 7/35 (20%) in the ED group and in 13/25 (52%) of patients in the ND group (p?=?.013). Fewer ED patients needed surgery for rebleeding (1/35 vs. 6/25; p?=?.017). Bleeding related, but not all-cause mortality was significantly lower in the ED group (1/35 vs. 6/25, p?=?.017).

Discussion: In this comparative analysis, use of ED to guide hemostatic therapy was associated with a significant reduction in recurrence of bleeding, surgical intervention and bleeding associated mortality.     

善得定治疗癌性上消化道出血临床观察

目的为观察善得定治疗恶性肿瘤所致上消化道出血的疗效及副作用方法选用恶性肿瘤所致上消化道出血６６例，随机分为善得定治疗组和垂体后叶素对照组，治疗组病人先用善得定０１ｍｇ＋０．９％ＮＳ２０ｍｌ静推，后用善得定以每小时２５微克滴速静滴维持２４～４８小时，对照组用垂体后叶素以每小时２～５Ｕ滴速静滴维持２４～４８小时，同时给硝酸甘油０．５ｍｇ吞下含服。结果治疗组总有效率为８８２３％（３０／３４），对照组总有效率为６２５０％（２０／３２），两组差异有显著意义（Ｐ＜００５），治疗组每例平均输血量为７００８０±３２７１８ｍｌ，对照组输血量平均每例为１１７６００±３２４１２ｍｌ，两组差异显著（Ｐ＜０００１）。两组均无严重副作用。结论癌性上消化道出血是晚期肿瘤常见并发症及致死原因之一，善得定较传统的垂体后叶素治疗具有止血快、止血率高，副作用少等优点，且可减少输血量，值得临床广泛推广使用。