上消化道大出血的分析研究

本文论述了上消化道大出血病因、诊断方法、止血措施等,重点阐述了三腔二囊管压迫止血、内镜下止血、经静脉肝内门体静脉分流术等止血的措施和方法,为消化道大出血临床实践提供了一定的理论指导.     

Upper Gastrointestinal Bleeding in dengue Fever

Twenty-six virologically and serologically confirmed Dengue patients with signs of upper gastrointestinal tract bleeding (13.1%) were studied during the 1987 outbreak in southern Taiwan. Within a 1-yr period from 1987 to 1988 in Kaohsiung Chang Gung Memorial Hospital, there were 198 patients with Dengue fever confirmed. Viral isolation and serological studies indicated that type I Dengue was the cause. There was no evidence of sequential secondary infection among them. The 26 patients were evaluated gastroduodenoscopically. Most of the Dengue patients who developed upper gastrointestinal bleeding had gastric ulcers or duodenal ulcers; superficial and hemorrhagic gastritis are the other relevant endoscopic findings. Thirteen patients (50%) had a past history of peptic ulcer symptoms, whereas the other 13 did not. Dengue infection is a precipitating factor in inducing peptic ulcer bleeding because of hemostatic derangements. Supportive therapy and blood transfusions alone were adequate treatment, except for one patient who required surgery due to massive bleeding of a duodenal ulcer. No mortality was observed in this study.     

Upper Gastrointestinal Bleeding in Patients with CKD

Background and objectives

Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3–5 CKD who were not receiving dialysis was analyzed.

Design, setting, participants, & measurements

Patients with stages 3–5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates.

Results

In total, 2968 patients with stages 3–5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m² higher eGFR. A history of upper gastrointestinal bleeding (P<0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk.

Conclusions

In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.