低分子肝素与低分子右旋糖酐预防全髋关节置换术后深静脉血栓的研究

目的探讨低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓的临床效果和安全性。方法回顾性分析2007年4月至2009年4月32例THA术后预防性应用LMWH和LMWD患者发生DVT和术后出血的情况,其中抗凝组术前12h均应用LMWH2500U,术后6h后应用LMWH剂量为5 000 U/d者14例(高剂量组)、2 500 U/d者18例(低剂量组),时间7～14d,均联合手术当日应用LMWD500ml至1000ml;并与2003年4月至2005年4月35例THA术后未应用LMWH和LMWD患者35例(对照组)进行比较。各组患者性别、年龄、病因、病程、假体类型等比较,差异均无统计学意义(P>0.05),具有可比性。结果术后1个月内对照组9例(25.7%)、高剂量组1例(7.1%)、低剂量组2例(11.1%)发生DVT,其中对照组有1例DVT继发PTE死亡,抗凝组无死亡。对照组与后两组比较差异均有统计学意义(P<0.05);高、低剂量组间比较差异无统计学意义(P>0.05)。高剂量组、低剂量组及对照组术后出血量和输血量分别为(401.5±90.7)和(619.2±264.8)、(363.5±96.6)和(486.7±269.7)、(319.7±89.2)和(430±192.5)mL;高、低剂量组之间、低剂量组与对照组比较,差异均无统计学意义(P>0.05);而高剂量组与对照组间差异有统计学意义(P<0.05)。抗凝组未发生溃疡出血、心功能不全等严重出血并发症。结论低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓是一种安全有效的方法。     

低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓临床效果和安全性分析

目的 探讨低分子肝素(low molecular weight heparin,LMWH)联合低分子右旋糖酐注射液(Low molecular weight dextran injection,LMWD)预防人工全髋关节置换(total hip arthroplasty,THA)术后深静脉血栓(deep vein thrombosis,DVT)的临床效果和安全性.方法 回顾性分析2007年4月至2009年4月32例THA术后预防性应用LMWH和LMWD患者发生DVT和术后出血的情况,其中抗凝组术前12 h均应用LMWH 2500U,术后6 h后应用LMWH剂量为5 000 U/d者14例(高剂量组)、2500 U/d者18例(低剂量组),时间7～14 d,均联合手术当日应用LMWD500 ml至1000 ml;并与2003年4月至2005年4月35例THA术后未应用LMWH和LMWD患者35例(对照组)进行比较.各组患者性别、年龄、病因、病程、假体类型等比较,差异无统计学意义(P>0.05),具有可比性.结果 术后1个月内对照组9例(25.7%)、高剂量组1例(7.1%)、低剂量组2例(11.1%)发生DVT,其中对照组有1例DVT继发PTE死亡,抗凝组无死亡.对照组与后两组比较差异有统计学意义(P<0.05);高、低剂量组间比较差异无统计学意义(P>0.05).高剂量组、低剂量组及对照组术后出血量和输血量分别为(401.5±90.7)和(619.2±264.8)、(363.5±96.6)和(486.7±269.7)、(319.7±89.2)和(430±192.5)ml;高、低剂量组之间、低剂量组与对照组比较,差异均无统计学意义(P>0.05);而高剂量组与对照组间差异有统计学意义(P<0.05).抗凝组未发生溃疡出血、心功能不全等严重出血并发症.结论 低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓是一种安全有效的方法.     

托烷司琼预防全麻术后恶心呕吐效果的Meta分析

目的:系统评价托烷司琼预防全麻术后恶心呕吐(PONV)的有效性。方法:电子搜索PubMed,CNKI等数据库,收集1990-2010年发表的关于托烷司琼预防术后恶心呕吐的研究,按Cochrane系统评价的方法评价其质量,并提取资料,采用Review Manager 4.2软件进行统计分析。结果:Meta分析表明,诱导前静注托烷司琼较术毕静注托烷司琼术后恶心呕吐的发生率低[OR(95%CI)为0.34(0.13,0.89)],但都低于空白对照组PONV的发生率[OR(95%CI)分别为0.09(0.05,0.17),0.31(0.19,0.49)]。托烷司琼5 mg昂丹司琼4或8 mg预防PONV的效果无统计学差异[OR(95%CI)分别为0.88(0.54,1.45)和0.47(0.20,1.06)]。结论:诱导前或术毕静注托烷司琼能减少恶心呕吐的发生率,且诱导前静注效果更佳。而托烷司琼与同类药物昂丹司琼在降低PONV的发生率方面没有明显的差异。     

那曲肝素钙注射液和磺达肝癸钠注射液预防骨科手术后静脉血栓栓塞症的药物经济学评价

目的：比较那曲肝素钙注射液和磺达肝癸钠注射液预防骨科手术后静脉血栓栓塞症(VTE)的药物经济学评价。方法：回顾性分析2020年1月至2021年10月景德镇市第二人民医院收治的90例骨科手术患者的病历资料,根据术后不同干预方法分为两组,观察组和对照组各45例。对照组行那曲肝素钙注射液预防性治疗,观察组行磺达肝癸钠注射液预防性治疗,比较两组患者凝血功能指标、不良事件及临床相关指标、药物经济学。结果：治疗后,两组患者血小板计数(PLT)、凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)水平比较,差异无统计学意义(P>0.05),观察组患者抗凝血酶Ⅲ(AT-Ⅲ)低于对照组(P<0.05);两组患者不良事件发生率比较,差异无统计学意义(P>0.05);那曲肝素钙注射液总成本为723.80元,总有效率为86.67%,药物治疗成本比(C/E)=8.35,磺达肝癸钠注射液总成本为1 862.00元,总有效率为93.33%,C/E=19.95,那曲肝素钙注射液费用及C/E均低于磺达肝癸钠注射液(P<0.05)。结论：预防骨科手术后VTE采用那曲肝素钙注射液和磺...     

磺达肝癸钠与依诺肝素的治疗对比分析

目的 本研究观察在接受经皮冠脉介入治疗(PCI)的非ST段抬高的急性冠脉综合征(NSTE-ACS)患者使用抗凝药物磺达肝癸钠,随访患者的不良心血管事件和出血的发生率,并与依诺肝素作对比分析.方法 入选了确诊为NSTE-ACS患者70例,均给予常规药物治疗,并随机分为两组:A组(36例),加用磺达肝癸钠(安卓)2.5 mg,每天皮下注射1次,用药7 d;B组(34例),加用依诺肝素1 mg/kg,每天皮下注射2次,用药7 d;两组此后均行PCI治疗,术中均应用常规剂量肝素(85IU/Kg),术后继续使用磺达肝癸钠或依诺肝素.观察两组患者第9 d、30 d、90 d时的不良心血管事件和出血的发生率.结果 ①磺达肝癸钠组与依诺肝素组的不良心血管事件的发生率比较差异无统计学意义(P>0.05).② 磺达肝癸钠组和依诺肝素组的出血发生率比较差异有统计学意义(P<0.05).③两组复合终点比较差异有统计学意义(χ2=12.59,P<0.05).结论 ①在NSTE-ACS患者中行PCI治疗前应用磺达肝癸钠疗效等同于依诺肝素.②磺达肝癸钠应用于NSTE-ACS患者有良好的安全性,出血不良反应少.     

肝素雾化吸入对豚鼠凝血时间及小鼠尾出血时间的影响

目的 :研究雾化吸入低分子量肝素 (LMWH )和标准肝素 (SH)对动物凝血时间和出血时间的影响。方法 :LMWH和SH超声雾化后经简易面罩吸入 ,连用7d ,观察对豚鼠凝血时间和小鼠尾出血时间的影响。结果 :与N S组比较 ,LMWH800IU/L、400IU/L和SH800IU/L、400IU/L对豚鼠凝血时间和小鼠尾出血时间均无显著影响 (P>0.05) ;LMWH800IU/L、400IU/L和SH800IU/L、400IU/L之间也无显著性差异 (P>0.05)。结论 :LMWH和SH雾化吸入是抗哮喘治疗的一种安全的给药途径     

低分子肝素预防髋、膝关节术后下肢深静脉血栓形成的临床观察

目的探讨低分子肝素(LMWH)对预防髋、膝关节术后下肢深静脉血栓(DVT)的有效性和安全性。方法将52例行髋、膝关节手术的患者随机分为治疗组和对照组各26例。对照组不予任何抗凝药物,术后24h开始行物理方法预防DVT;治疗组在对照组治疗基础上于术前12h、术后给予LMWH腹部皮下注射,2组均治疗7d。观察并比较2组术后双下肢DVT和不良反应发生情况及血常规指标。结果治疗组治疗后DVT发生率为3.8%,低于对照组的26.9%,差异有显著统计学意义(P<0.05)。2组患者血小板计数(PLT)、血红蛋白(Hb)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及不良反应发生率比较差异均无统计学意义(P>0.05)。结论应用LMWH预防髋、膝关节术后DVT疗效确切,对凝血机制无影响,安全性好,值得临床推广应用。     

利伐沙班和低分子肝素预防关节镜下膝多发韧带损伤重建术后下肢深静脉血栓的前瞻性随机对照研究

目的:采用前瞻性随机对照研究分析的方法比较利伐沙班与低分子肝素(LMWH)对膝关节镜下多发韧带损伤重建术后下肢深静脉血栓发病率的影响,探讨利伐沙班在预防膝关节镜下多发韧带重建手术后下肢深静脉血栓(DVT)的疗效和安全性。方法:选取2015年1月~2016年6月首都医科大学附属北京潞河医院运动医学科收治的105例行关节镜下膝多发韧带损伤重建手术的患者,随机分成3组:利伐沙班组(A组):术后给予利伐沙班10mg,1次/d。经口服;LMWH组(B组):术后给予LMWH 100 u·kg~(-1),1次/d,皮下注射;对照组(C组):采用物理和机械预防。结果:105名患者中发生DVT13例,其中利伐沙班组2例,LMWH组2例,对照组9例。无肺栓塞及死亡病例。3组患者围手术期失血量差异均无统计学意义(P>0.05)。利伐沙班组和LMWH组DVT发生率无统计学意义(P>0.05),利伐沙班组和LMWH组DVT发生率与对照组相比均有显著性差异(P<0.05),3组患者均未发生症状性肺栓塞,没有死亡病例。结论:利伐沙班和低分子肝素(LMWH)都可以有效预防患者膝关节镜下多发韧带重建术后下肢深静脉血栓的发生,利伐沙班有较好的安全性,并不增加出血风险。     

腹股沟疝修补术不同解剖入路疗效的Meta分析

目的比较经腹腔腹膜前(TAPP)和经完全腹膜外(TEP)疝修补术的优势。方法收集2005年1月~2014年8月已发表的关于TAPP和TEP疝修补术的国内外文献,针对结果进行统计分析。采用标准化均数差(SMD)或优势比(OR)及95%可信区间(95%CI)描述效应量。结果共7篇文献符合标准纳入,包括1373例(TAPP组)和3689例(TEP组)进行分析。两组的手术时间比较,差异有统计学意义(P<0.01)(SMD为0.33,95%CI为0.13~0.54);两组的术后镇痛时间比较,差异有统计学意义(P<0.01)(SMD为0.55,95%CI为0.28~0.82);两组的术后并发症发生率比较,差异无统计学意义(P>0.05)(OR为0.66,95%CI为0.42~1.02);两组的术后复发率比较,差异无统计学意义(P>0.05)(OR为1.10,95%CI为0.36~3.37)。结论 TAPP疝修补术具有节省时间、痛苦小的优点,与TEP疝修补术相比,具有一定优势。     

奥曲肽对胰十二指肠切除术后胰瘘及胃排空的影响

目的观察奥曲肽对胰十二指肠切除术后胰瘘(POPF)的预防作用和对胃排空的影响。方法按随机数字表法将67例胰十二指肠切除术患者分为奥曲肽组(n:35)和对照组(,l=32)。奥曲肽组给予术后当日皮下注射奥曲肽1 mL(100μg),q8h,共7 d;对照组给予皮下注射相同体积的氯化钠注射液。研究终点为患者出现胃排空延迟或者出现POPF等并发症。进行胃闪烁显像和氢呼气试验(HBT),并对其他影响胃排空的因素进行相关分析。结果两组胃排空延迟的发生率无显著差异(P>0.05)。术后7d,奥曲肽组中胃闪烁显像的半衰期为(76.3±15.2)min,对照组为(86.7±18.0)min;奥曲肽组HBT(65.0±6.5)min后达到最大,对照组(67.0±5.7)min后达到最大。两组胰瘘发生率无显著差异(P>0.05)。多因素分析显示,术后腹腔感染(OR=0.206,95%CI:0.051⁰.836,P=0.027)和出血(OR=1.341,95%CI:1.0490.836,P=0.027)和出血(OR=1.341,95%CI:1.049¹.715,P=0.019)是术后胃排空延迟危险因素,术前胆道引流为保护因素(OR=3.828,95%CI:0.9791.715,P=0.019)是术后胃排空延迟危险因素,术前胆道引流为保护因素(OR=3.828,95%CI:0.979¹4.967,P=0.054),而与应用奥曲肽无相关性(OR=1.047,95%CI:0.32514.967,P=0.054),而与应用奥曲肽无相关性(OR=1.047,95%CI:0.325¹0.591,P=0.154)。结论预防性使用奥曲肽并不影响胰十二指肠切除术后的胃排空。也不会降低POPF的发生率。     

Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux or low molecular weight heparin in a large cohort of consecutive patients undergoing major orthopaedic surgery – findings from the ORTHO-TEP registry

AIMS

In large randomized trials, thromboprophylaxis with fondaparinux in major orthopaedic surgery (MOS) has been shown to be superior to low molecular weight heparin (LMWH) prophylaxis with comparable safety. However, patients treated under trial conditions are different from unselected patients and efficacy and safety outcomes may be different in unselected patients in daily practice. We performed a retrospective cohort study to compare the efficacy and safety of venous thromboembolism (VTE) prophylaxis with fondaparinux or LMWH in 3896 consecutive patients undergoing major orthopaedic surgery at our centre.

METHODS

All patients undergoing MOS between January 2006 and December 2009 were retrospectively analyzed using patient charts, hospital admission and discharge database, quality management database, transfusion unit database and VTE event documentation. VTE standard prophylaxis at our institution was LMWH (3000–6000 aXa units once daily) from January 2006 to December 2007 or fondaparinux 2.5 mg from January 2008 to December 2009. In these two large cohorts of unselected consecutive patients, in-hospital incidences of VTE, surgical complications, severe bleeding and death were evaluated.

RESULTS

Symptomatic VTE was found in 4.1% of patients in the LMWH group (62/1495 patients; 95% CI 0.032, 0.052) compared with 5.6% of patients receiving fondaparinux (112/1994 patients, 95% CI 0.047, 0.067; P= 0.047). Distal deep vein thrombosis (DVT) was significantly more frequent in the fondaparinux group (3.9%, 95% CI 0.031, 0.048; vs. 2.5%; 95% CI 0.018, 0.034; P= 0.021). No significant differences in the rates of major VTE or death were found. Rates of severe bleeding, transfusion of RBC concentrates, plasma and platelet concentrates were comparable between both treatment groups. However, patients receiving fondaparinux had significantly lower rates of surgical revisions (1.6%, 95% CI 0.011, 0.022 vs. 3.7%, 95% CI 0.028, 0.047; P < 0.001). Multivariate analysis revealed previous VTE (HR 18.2, 95% CI 11.6, 28.5; P < 0.001) and female gender (HR 1.9, 95% CI 1.3, 2.7; P < 0.001), but not fondaparinux prophylaxis (HR1.3, 95% CI 0.9, 1.7; P= 0.184) to be associated with significantly increased VTE risk.

DISCUSSION

Thromboprophylaxis with fondaparinux is less effective to prevent distal VTE than LMWH in unselected patients undergoing MOS, but is equally effective with regard to rates of major VTE and death. However, differences in efficacy of LMWH or fondaparinux are of little relevance compared with a history of VTE or female gender, which were found to be the main VTE risk factors in MOS. The safety profile of fondaparinux was comparable with LMWH with regard to rates of severe bleeding complications, but patients receiving fondaparinux had significantly less surgical complications requiring surgical revisions. Both our efficacy and safety findings differ from data derived from large phase III trials testing fondaparinux against LMWH in MOS, where overall rates of symptomatic VTE were lower and the safety profile of fondaparinux was different.

CONCLUSION

We conclude that the strict patient selection and surveillance in phase-III trials results in lower VTE and bleeding event rates compared with unselected routine patients. Consequently, the efficacy and safety profile of thromboprophylaxis regimens needs to be confirmed in large registries or phase IV trials of unselected patients.     

Safety and efficacy of ximelagatran: meta-analysis of the controlled randomized trials for the prophylaxis or treatment of venous thromboembolism

BACKGROUND: Ximelagatran has been approved in Europe for VTE prophylaxis in orthopedic surgery at fixed doses and without laboratory monitoring. Aim of the study was to evaluate safety and efficacy of ximelagatran in a meta-analysis of prophylaxis and/or treatment randomized controlled trials. METHODS: Absolute risk of events for ximelagatran and OR for its comparison with LMWH and coumarins were calculated. Subgroup analysis was performed for ximelagatran regimen, comparator agent, type of surgery, starting time of prophylaxis. RESULTS: Twelve studies and 16,992 patients were meta-analysed. Ximelagatran showed an absolute risk of major VTE of 4.04% and 1.69% and of major bleedings of 1.68% and 1.03% in prophylaxis and treatment trials, respectively. In prophylaxis trials, a significant excess mortality (OR: 2.5; 95% CI: 1.02 - 6.13) and an excess in major bleedings (OR: 1.41; 95% CI: 0.93 - 2.14) was found in the whole ximelagatran group. No evidence of treatment effect for major VTE was seen in the comparison with LMWH (OR: 1.01; 95% CI: 0.52 - 1.97). The cohort of patients treated with 24 mg b.i.d. showed similar results. An increase in the absolute risk of bleeding (from 1.04% to 3.03%) was found between post and preoperative administration of ximelagatran. Major VTE risk was increased when ximelagatran was compared to b.i.d. LMWH. CONCLUSIONS: Ximelagatran can be considered for its potential advantages for prevention and treatment of VTE. Future efforts are needed by researchers to prospectively investigate the best postoperatively starting time and by clinicians to monitor overall mortality in prophylactic use.     

利伐沙班和磺达肝癸钠在髋、膝关节置换术后预防静脉血栓有效性和安全性的meta分析

目的比较利伐沙班和磺达肝癸钠在髋、膝关节置换术后预防静脉血栓的有效性和安全性,为临床用药提供参考数据。方法通过收集利伐沙班、磺达肝癸钠与依诺肝素预防静脉血栓的随机双盲对照试验进行meta分析,采用ITC程序间接比较利伐沙班与磺达肝癸钠的有效性和安全性。结果共纳入研究文献11篇,病例总数20 217例;与依诺肝素相比,利伐沙班能降低近端DVT[RR=0.21,95%CI(0.14,0.32)]和症状性VTE[RR=0.67,95%CI(0.33,0.69)]发生的风险,差异有统计学意义;磺达肝癸钠预防近端DVT和症状性VTE效果与依诺肝素相比,差异无统计学意义(P=0.06),但能增加大出血事件[RR=1.60,95%CI(1.16,2.20)]发生风险,其差异有统计学意义;间接比较显示利伐沙班疗程<15 d疗效和安全性与磺达肝癸钠差异无统计学意义;与磺达肝癸钠相比,当利伐沙班疗程>15 d,能更有效预防近端DVT[RR=0.18,95%CI(0.05,0.61)]和症状性VTE[RR=0.22,95%CI(0.06,0.86)],在大出血事件的风险上差异无统计学意义[RR=1.47,95%CI(0.37,5.88)]。结论利伐沙班与磺达肝癸钠疗程相近时,两者疗效和安全性比较差异无统计学意义;适当延长利伐沙班疗程可能会更好地预防静脉血栓栓塞。     

Proton pump inhibitors versus H2-antagonists: a meta-analysis of their efficacy in treating bleeding peptic ulcer

PURPOSE: To evaluate whether proton pump inhibitors are more effective than H2-antagonists (H2-A) for the treatment of bleeding peptic ulcer. DATA SOURCES: PubMed database until January 2000. STUDY SELECTION: Comparative randomized trials of proton pump inhibitors (omeprazole, lansoprazole, or pantoprazole) vs. H2-A (cimetidine, ranitidine or famotidine). DATA EXTRACTION: Meta-analysis combining the odds ratios (OR) of the individual studies in a global OR (Peto method). OUTCOMES EVALUATED: Persistent or recurrent bleeding, need for surgery, or mortality. DATA SYNTHESIS: Eleven studies fulfilled the inclusion criteria and contained data for at least one of the planned comparisons. Persistent or recurrent bleeding was reported in 6.7% (95% CI: 4.9-8.6%) of the patients treated with proton pump inhibitors, and in 13.4% (95% CI: 10.8-16%) of those treated with H2-A (OR 0.4; 95% CI: 0.27-0.59) (chi2-homogeneity test, 18; P=0.09). Surgery was needed in 5.2% (95% CI: 3.4-6.9%) of the patients treated with proton pump inhibitors, and in 6.9% (95% CI: 4.9-8.9%) of the patients treated with H2-A (OR 0.7; 95% CI: 0.43-1.13). Respective percentages for mortality were 1.6% (95% CI: 0.9-2.9%) and 2.2% (95% CI: 1.3-3.7%) (OR 0.69; 95% CI: 0.31-1.57). SUB-ANALYSIS: Five studies evaluated the effect of both therapies given in bolus injections on persistent or recurrent bleeding rate, which was 6% (95% CI: 3.6-8.3%) and 8.1% (95% CI: 5.3-10.9%), respectively (OR, 0.57; 95% CI: 0.31-1.05). Persistent or recurrent bleeding in high risk patients (Forrest Ia, Ib and IIa) occurred in 13.2% (95% CI: 7.9-8%) of the patients treated with proton pump inhibitors and in 34.5% (27-42%) of those treated with H2-A (OR 0.28; 95% CI: 0.16-0.48). In patients not having endoscopic therapy, persistent or recurrent bleeding was reported, respectively, in 4.3% (95% CI: 2.7-6.7%) and in 12% (95% CI: 8.7-15%) (OR 0.24; 95% CI: 0.13-0.43). Less marked differences were observed in patients having adjunct endoscopic therapy: 10.3% (95% CI: 6.7-13.8%) and 15.2% (11.1-19.3%) (OR 0.59; 95% CI: 0.36-0.97). Moreover, the significance disappeared in this group when a single outlier study was excluded. CONCLUSIONS: Proton pump inhibitors are more effective than H2-A in preventing persistent or recurrent bleeding from peptic ulcer, although this advantage seems to be more evident in patients not having adjunct sclerosis therapy. This beneficial effect seems to be similar or even more marked in patients with Forrest Ia, Ib or IIa ulcers. However, proton pump inhibitors are not more effective than H2-A for reducing surgery or mortality rates. Nevertheless, the data are too scarce and heterogeneous to draw definitive conclusions, and further comparative trials are clearly warranted.     

Comparative safety and efficacy of urokinase and recombinant tissue plasminogen activator for peripheral arterial occlusion: a meta-analysis

STUDY OBJECTIVE: To evaluate differences in the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and urokinase in the treatment of peripheral arterial occlusion. DESIGN: Systematic review and meta-analysis of prospective comparative trials. DATA SOURCE: PubMed/MEDLINE database from 1966-October 2004. MEASUREMENTS AND MAIN RESULTS: The literature was systematically searched to identify prospective comparative trials of urokinase and rt-PA for the treatment of peripheral arterial occlusion. The primary outcome measure was successful complete lysis of the occlusion. Other outcome measures were hemorrhage (major, minor, or combined), intracranial hemorrhage, limb loss, and mortality. Six trials were identified, five of which were randomized. On meta-analysis, the rate of clot lysis was higher with rt-PA than with urokinase (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.12-2.10, p=0.007). However, urokinase was associated with lower rates of minor (OR 0.52, 95% CI 0.28-0.97, p=0.04) and total (OR 0.51, 95% CI 0.29-0.91, p=0.02) bleeding. Rates of major hemorrhage, intracranial hemorrhage, limb loss, and mortality were similar between agents. CONCLUSION: Urokinase was less effective than rt-PA in successfully lysing acute peripheral arterial occlusion, but it was associated with lower rates of total and minor bleeding. Overall, rt-PA was a reasonable substitute for urokinase, now that urokinase has been removed from the market in the United States. However, judicious monitoring for minor bleeding is necessary.     

Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin

AIM: To evaluate the role of Helicobacter pylori infection and other clinical factors in the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. SUBJECTS AND METHODS: A case-control study was carried out of consecutive current users of low-dose aspirin admitted because of upper gastrointestinal bleeding. Within a cohort of 695 patients with upper gastrointestinal bleeding, 98 patients had taken low-dose aspirin and no other non-steroidal anti-inflammatory drug. Controls were 147 low-dose aspirin users without upper gastrointestinal bleeding of similar age, sex and extent of aspirin use as cases. H. pylori infection was determined by CagA/VacA serology and 13C-urea breath test in all cases and controls. Adjusted odds ratios (OR) are provided. RESULTS: H. pylori infection was identified as an independent risk factor of upper gastrointestinal bleeding in this population (OR, 4.7; 95% confidence interval (95% CI), 2.0-10.9), but the presence of CagA-positive serology was not. Other risk factors identified were a previous ulcer history (OR, 15.2; 95% CI, 3.8-60.1), alcohol use (OR, 4.2; 95% CI, 1.7-10.4) and use of calcium channel blockers (OR, 2.54; 95% CI, 1.25-5.14). Antisecretory therapy (OR, 0.1; 95% CI, 0.02-0.3) and nitrovasodilators (OR, 0.2; 95% CI, 0.1-0.6) decreased the risk of bleeding. CONCLUSIONS: H. pylori infection is a risk factor for upper gastrointestinal bleeding in low-dose aspirin users, which might have therapeutic implications in high-risk patients.     

含多替拉韦与含依非韦伦方案抗逆转录治疗对人类免疫缺陷病毒感 染母婴影响的荟萃分析

目的:分析含多替拉韦方案对比含依非韦伦方案抗逆转录治疗对人类免疫缺陷病毒(HIV)感染母婴影响情况。 方法:检 索建库至 2023 年 6 月在 PubMed、EMBase、the Cochrane Library、Medline、中国知网、万方、维普、中国生物医学文献数据库公开发 表的中英文研究,采用纽卡斯尔-渥太华量表(NOS)评分方法,纳入符合条件的文献,提取相关数据资料,利用 RevMan 5. 4 软件 进行荟萃分析。 结果:最终共纳入文献 6 篇,其中多替拉韦组 2 769 例患者,依非韦伦组 6 006 例患者。 两组孕产妇抗逆转录治 疗后病毒应答率比较差异有统计学意义(RR= 1. 25,95%CI 1. 06~1. 46,Z = 2. 73,P<0. 05)。 胎儿及新生儿情况分析中,两组新 生儿出生体质量比较差异有统计学意义(MD= 0. 14,95% CI 0. 05~0. 22,Z = 3. 03,P<0. 05),而在胎儿及新生儿严重不良事件胎 儿宫内死亡(OR= 1. 08,95%CI 0. 78~1. 49,Z = 0. 47,P>0. 05)、早产(RR = 0. 95,95% CI 0. 85 ~ 1. 07,Z = 0. 82,P>0. 05)、新生儿 死亡(OR= 0. 71,95% CI 0. 25~2. 00,Z = 0. 65,P>0. 05)比较差异无统计学意义。 结论:孕期使用含多替拉韦抗逆转录治疗方案 的病毒应答率高于含依非韦伦治疗组,同时依非韦伦治疗组新生儿体质量低于含多替拉韦组。     

套扎与β受体阻滞剂预防食管静脉曲张首次出血的系统评价

目的系统评价套扎与β受体阻滞剂对比预防肝硬化食管静脉曲张首次出血的疗效和安全性。方法计算机检索中国生物医学文献光盘数据库、Cochrane图书馆、Cochrane图书馆临床对照试验资料库、MEDLINE、EMBASE等数据库,收集套扎与β受体阻滞剂预防肝硬化食管静脉曲张首次出血的随机对照试验,采用Cochrane协作网推荐的RevMan5.1软件对数据进行统计分析。结果共纳入12个随机对照试验,包括1065例患者,套扎组525例和药物组540例。结果显示,2组在首次上消化道出血发生率方面无差异,OR为0.73（95%CI为0.53～1.01）;套扎组首次曲张静脉出血率明显低于药物组,OR为0.55（95%CI为0.38～0.79）;2组随访期病死率、出血相关病死率比较无差异,OR分别为1.11（95%CI为0.82～1.50）、0.98（95%CI为0.76～1.27）;套扎组不良反应发生频率较高的主要是套扎相关性溃疡、胸骨后疼痛、消化不良,药物组发生频率较高的为低血压、心动过缓、腹胀、眩晕,套扎组发生率明显低于药物组,OR为0.47（95%CI为0.31～0.71）;同时,漏斗图比较对称,存在发表偏倚的可能性小。结论套扎和β受体阻滞剂均可以作为预防肝硬化食管静脉曲张首次出血的一线方法 ,但套扎疗效和安全性优于β受体阻滞剂。     

氟哌噻吨美利曲辛片辅助治疗难治性胃食管反流病的Meta分析

目的 系统评价氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病（refractory gastroesophageal refluxdisease,RGERD）的疗效和安全性。方法 采用Cochrane系统评价方法,检索Pubmed、CNKI、CBM、万方数据库。检索从建库至2016年1月,氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病的随机对照试验（RCT）,对符合纳入标准的临床实验研究进行质量评价和资料提取后,采用RevMan 5.2进行Meta分析。结果 共纳入9个研究共计1 004例患者,Meta分析结果显示,与对照组（常规药物）相比,试验组（氟哌噻吨美利曲辛片联合常规药物）对难治性胃食管症状应答更显著[OR=5.41,95% CI=（3.20,9.14）,P<0.000 01],6个研究评价了治疗4周后的症状缓解有效率,结果实验组明显优于对照组[OR=6.18,95% CI=（2.99,12.76）,P<0.000 01],3个研究评价了治疗8周后症状缓解有效率,结果显示实验组优于对照组[OR=3.96,95% CI=（2.18,7.21）,P<0.000 01],5个研究均采用汉密尔顿抑郁量表（Hamilton DepressionScale,HAMD）和汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）评价治疗期末抑郁和焦虑的改善,Meta分析结果显示,实验组对抑郁和焦虑的改善程度均优于对照组,差异有统计学意义（HAMD：SMD=-2.04,95% CI=（-2.98,-1.11）,P<0.000 1;HAMA：SMD=-1.23,95% CI=（-1.47,-1.00）,P<0.000 01）;5个试验报道了治疗过程中的不良反应,分析结果显示,2组差异无统计学意义（OR=1.65,95% CI=（0.76,3.59）,P=0.21）,且症状均较轻微,可耐受。结论 分析结果显示,氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病相对常规药物疗效更显著,且不良反应无明显差异,但该结论仍需大规模多中心研究进一步证实。     

磺达肝癸钠治疗非急诊血运重建急性心肌梗死的效果与安全性

目的探讨急性心肌梗死且未行急诊血运重建患者使用磺达肝癸钠的近期疗效和安全性。方法480例急性心肌梗死患者（未接受急诊再灌注治疗）按随机数随机分为依诺肝素组和磺达肝癸钠组,各240例。依诺肝素组给予依诺肝素1mg／kg（年龄〈75岁）或0．75mg／kg皮下注射（年龄≥75岁）,1次／12h;磺达肝癸钠组给予磺达肝癸钠2．5mg／kg皮下注射,1次／24h,均连用5～9d。比较2组治疗9d内主要不良心脏事件（MACE）、严重出血发生率和30d及6个月随访情况。结果治疗9d轻微出血和总出血磺达肝癸钠组均较依诺肝素组减少[19例（7．9％）比44例（18．3％）和25例（10．4％）比57例（23．7％）,风险比（HR）分别为0．412、0．413,95％置信区间（CI）0．241～0．706、0．258～0．662,P=0．001、P=0．000]。随访1个月,磺达肝癸钠组MACE发生率低于依诺肝素组[37例（15．4％）比59例（24．6％）,HR=0．600,95％CI为0．398～0．905,P=0．015],至6个月时差异无统计学意义[62例（25．8％）比77例（32．1％）,HR=0．751,95％C10．537～1．049,P=0．098]。结论磺达肝癸钠治疗早期未行血运重建急性心肌梗死患者近期疗效优于依诺肝素,且出血并发症少。