208例上消化道出血患者的病因分析及胃镜诊断体会

目的对208例上消化道出血患者的病因进行分析,探讨胃镜的诊断价值。方法回顾性分析我院2010年6月-2012年6月收治的208例上消化道出血患者胃镜诊断结果。结果消化性溃疡是不同年龄组上消化道出血的主要病因,中青年组消化性溃疡出血比率(42.4%)高于老年组(27.7%,P<0.05)。消化道肿瘤在老年组上消化道出血中所占的比例为23.7%,明显高于中青年组的7.6%(P<0.01),是老年人上消化道出血的常见原因。急诊胃镜组病因检出率为97.5%,高于非急诊胃镜组的87.5%(P<0.05)。结论上消化道出血的病因较多,以消化性溃疡最为常见。胃镜对上消化道出血病因诊断有较高价值,可作为首选方法。     

急诊胃镜在上消化道出血诊断与治疗中的应用

目的研究急诊胃镜在上消化道出血患者的诊断与治疗效果,总结其应用价值。方法选取2013年1月~2013年11月上消化道出血患者100例,按1:1比例将其分成急诊组50例(给予急诊胃镜诊治),对照组50例(给予普通胃镜诊治),比较两组诊治效果。结果①确诊率:急诊组为94%,对照组为84%,急诊组高于对照组(P0.05);②急诊组止血时间12h、12~24h、24h的例数分别为27例、15例、8例,对照组相应为10例、23例、17例,两组差异明显(P0.05);③输血率:急诊组为70%,对照组84%,急诊组低于对照组(P0.05)。结论急诊胃镜诊治上消化道出血患者,确诊率高、止血时间短、输血率低,更值得推广。     

非甾体抗炎药致上消化道出血的临床特征

目的研究非甾体抗炎药(NSAIDs)致上消化道出血的临床特征.方法调查上海4家医院的上消化道出血住院患者的临床资料,根据出血前10d内是否服用过NSAIDs,将其分为两组进行比较.结果424例上消化道出血患者中有70例(16.51%)服用过NSAIDs.两组比较,患者的性别、消化道溃疡史、出血程度、病变大小及部位比较差异无显著性(P＞0.05);但NSAIDs组患者的年龄偏大,较多患者有消化道出血史、心血管病史,出血前消化道症状不明显,溃疡或糜烂更易多发,平均住院天数明显减少(P＜0.05).结论应采取适宜策略降低NSAIDs的不良反应.     

急诊胃镜联合奥美拉唑治疗消化道出血临床疗效分析

目的探讨急诊胃镜联合奥美拉唑治疗消化道出血的临床疗效。方法选取120例经急诊内镜检查确诊为消化道出血的患者为研究对象,采取随机数字法随机分为常规组和观察组,每组60例。常规组患者给予常规止血治疗,观察组在常规治疗的基础上给予急诊胃镜联合奥美拉唑治疗,观察比较两组患者的临床治疗效果、住院期间再出血率、病死率、住院时间以及不良反应发生情况。结果观察组患者的治疗总有效率(96.7%)显著高于常规组(85.0%),差异有统计学意义(P0.05);观察组患者临床疗效显著优于常规组(P0.01)。观察组患者住院期间再出血率(10.0%)显著低于常规组(35.0%)、住院时间明显短于常规组,差异有统计学意义(P0.01)。两组患者治疗期间均无明显的不良反应发生。结论急诊胃镜联合奥美拉唑治疗消化道出血安全有效,无明显的不良反应发生,值得推广应用。     

鄂西北458例上消化道出血诊治过程的临床回顾

目的 分析总结鄂西北山区上消化道出血的病因及治疗方法.方法 对我院消化科2007年1月～2010年1月收治的458例上消化道出血病人的病历资料,进行回顾性分析.结果 ①鄂西北上消化道出血病因依次为消化性溃疡、上消化道肿瘤者、静脉曲张者、急性黏膜病变者、慢性炎症者、少见疾病等.②上消化道出血以中年人最多见,其次为老年人、青年人、少年患者.③上消化道出血男性病人多于女性,为2.75∶1.④急诊胃镜检查率68.6%(314/458),明了出血原因达96.2%,急诊胃镜下止血成功率93.6%.结论 鄂西北上消化道出血男性患者多于女性,以中年人居多,首位原因是溃疡,肿瘤为第2位原因,应提高警惕.急诊胃镜检查有很好的诊断价值和治疗价值.     

连续观察内镜下胃肠黏膜损伤200例临床分析

目的　通过内镜观察探讨胃肠黏膜损伤与非甾体抗炎药 (NSAIDs)的关系。方法　连续观察了 2 0 0例内镜下胃肠黏膜损伤病例。根据是否服用NSAIDs药物将患者分为NSAIDs组 (Ⅰ组 )及非NSAIDs组 (Ⅱ组 )。结果　Ⅰ、Ⅱ组患者分别占 4 6 5 %及 5 3 5 % (P >0 0 5 )。与Ⅱ组比较 ,Ⅰ组中 >6 0岁者占 81 7% (P <0 0 0 1) ,无症状者占 5 8 8% (P <0 0 5 ) ,患心血管疾病者占 70 6 % (P <0 0 5 ) ,胃溃疡占 5 0 0 % (P <0 0 5 ) ,溃疡并发出血占 11 8% (P <0 0 1)。Ⅰ组合并上消化道出血的相对危险是Ⅱ组的 7 0 4倍 (χ2 =6 2 17,P <0 0 5 )。结论　NSAIDs相关性胃肠黏膜损伤具有较为特异的临床及胃镜下表现 ,其合并上消化道出血的危险性较高 ,应引起重视。     

影响老年患者急诊冠状动脉介入术后消化道出血的因素分析

目的分析老年急性心肌梗死(AMI)接受急诊PCI患者术后出现消化道出血(GIB)的危险因素。方法入选2014年1月~2015年12月因ST段抬高型心肌梗死住院行急诊PCI的老年患者622例,根据住院期间是否出现GIB分为GIB组45例和对照组577例,分析影响住院期间GIB的危险因素。结果与对照组比较,GIB组年龄[(73.2±9.7)岁vs(69.5±10.6)岁,P=0.014],女性(46.7%vs 30.2%,P=0.029)、肾功能异常(24.4%vs9.5%,P=0.045)、用替格瑞洛(42.2%vs 27.0%,P=0.038)及替罗非班(31.1%vs 17.2%,P=0.026)、住院时间[(5.9±2.1)d vs(5.1±1.4)d,P=0.012]、停用抗栓药(24.4%vs 9.2%,P=0.004)及院内病死率(6.7%vs1.2%,P=0.029)升高。年龄每增长10岁、女性、肾功能异常、用替格瑞洛及替罗非班是老年患者住院期间出现GIB的独立危险因素。结论多种因素导致老年急诊PCI后GIB,应高度关注这些高危患者,及时处理,改善预后。     

消化性溃疡患者非甾体类抗炎药服用史和幽门螺杆菌感染的协同致病性

目的探讨消化性溃疡患者非甾体类抗炎药(NSAIDs)服用史和幽门螺杆菌(HP)感染的协同致病性。方法消化性溃疡患者155例(其中溃疡合并上消化道出血患者46例),再选取同期就诊的非胃十二指肠疾病患者91例为对照组。调查NSAIDs服用史,检测HP感染。结果服用NSAIDs合并HP感染患胃溃疡的OR值为18.87(95%CI为12.03~30.09),明显高于单纯HP感染和单独服用NSAIDs患胃溃疡的OR值之和;服用NSAIDs合并HP感染患十二值肠溃疡的OR值23.79(95%CI为13.21~38.51)明显低于单纯HP感染和单独服用NSAIDs患十二指肠溃疡的OR值之和;服用NSAIDs合并HP感染的胃溃疡和十二指肠溃疡合并上消化道出血的OR值分别为3.62(95%CI为1.01~17.98)和0.98(95%CI为0.28~7.89),均低于单纯HP感染和单独服用NSAIDs的胃溃疡和十二肠溃疡合并消化道出血的OR值之和;对照未服用NSAIDs者,偶尔服药与短期服药及长期服药溃疡出血者之间比较差异无统计学意义(P>0.05)。结论 NSAIDs和HP感染在消化性溃疡的发生中具有协同作用;在胃溃疡合并上消化道出血的发病中无协同作用;胃溃疡合并上消化道出血与服用NSAIDs时间长短无关。     

消化性溃疡相关致病因素协同致病性分析

目的 了解消化性溃疡患者相关致病因素(主要是服用NSAIDs与Hp感染)的协同致病作用.方法 应用病例对照研究的方法 对200例消化性溃疡患者及52例溃疡合并上消化道出血者及同一时期就诊的206例非胃十二指肠疾病患者进行NSAIDs服用情况的调查和Hp感染的检测. 结果 服用NSAIDs合并Hp感染者患胃溃疡的OR值为19.11,明显高于单纯服用NSAIDs者(OR值5.93)和单纯Hp感染者(OR值5.74)患胃溃疡的OR值之和;服用NSAIDs合并Hp感染的胃溃疡发生上消化道出血的OR值为3.73,十二指肠溃疡患者发生上消化道出血的OR值为0.93,均低于单纯服用NSAIDs和单纯Hp感染的胃溃疡患者(OR值分别为3.9和0.56)和十二指肠溃疡患者(OR值分别为4.7和0.42)发生上消化道出血的OR值之和;与无溃疡未服NSAIDs者比较,间断服药者溃疡出血的OR值为3.99,短期服药者的OR值为2.89,长期服药者的OR值为3.39,三组比较无显著差异(P＞0.05).患十二指肠溃疡的老年患者为33/120(27.5%),与非老年组比较有非常显著性差异(P＜0.01). 结论 服用NSAIDs和Hp感染在胃溃疡的形成中存在协同作用;在溃疡合并上消化道出血的发病中并无协同作用;溃疡合并上消化道出血与服用NSAIDs的时间长短无关;年龄因素在十二指肠溃疡的发病过程中发挥重要作用.     

老年人上消化道出血与口服NSAIDs、Hp感染相互关系的探讨

目的 探讨老年人上消化道出血与服用NSAIDs、Hp感染之间的关系。方法 采用病例对照分析的方法对146例老年上消化道出血的病例组及非上消化道出血的对照组进行胃镜检查和Hp感染检测，并统计NSAIDs服用史。结果 老年人上消化道出血者（包括胃镜疡和十二指肠溃疡）服用NSAIDs较对照组明显增加；胃溃疡病例组Hp感染明显低于对照组；而十二指肠溃疡患者，两组之间Hp感染率无明显差异，Logistic回归分析结果证明，服用NSAIDs可以增加老年人（包括胃溃疡和十二指肠溃疡）上消化道出血的危险性；Hp感染与胃溃疡所致上消化道出血的危险性呈负相关，而与十二指肠溃疡所致上消化道出血无明显关系。偶尔服用NSAIDs同样可以增加老年人上消化道出血的危险性。结论 服用NSAIDs可增加老年人上消化道出血的危险性；Hp感染可减少胃溃疡上消化道出血的危险性，而与十二指肠溃疡关系不明显。服用NSAIDs与Hp感染是老年人上消化道出血的两个独立因素。     

Management of syncope referred urgently to general hospitals with and without syncope units.

OBJECTIVE: We tested the hypothesis that management of patients with syncope admitted urgently to a general hospital may be influenced by the presence of an in-hospital structured syncope unit. BACKGROUND: The management of syncope is not standardized.Methods We compared six hospitals equipped with a syncope unit organized inside the department of cardiology with six matched hospitals without such facilities. The study enroled all consecutive patients referred to the emergency room from 5 November 2001 to 7 December 2001 who were affected by transient loss of consciousness as their principal symptom. RESULTS: There were 279 patients in the syncope unit hospitals and 274 in the control hospitals. In the study group, 30 (11%) patients were referred to the syncope unit for evaluation. In the study group, 12% fewer patients were hospitalized (43 vs 49%, not significant) and 8% fewer tests were performed (3.3+/-2.2 vs 3.6+/-2.2 per patient, not significant). In particular, the study group patients underwent fewer basic laboratory tests (75 vs 86%, P=0.002), fewer brain-imaging examinations (17 vs 24%, P=0.05), fewer echocardiograms (11 vs 16%, P=0.04), more carotid sinus massage (13 vs 8%, P=0.03) and more tilt testing (8 vs 1%, P=0.000). In the study group, there was a +56% rate of final diagnosis of neurally mediated syncope (56 vs 36%, P=0.000). CONCLUSION: Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital.     

Effect of helicobacter pylori infection on the risk of upper gastrointestinal bleeding in users of nonsteroidal anti-inflammatory drugs

PURPOSE: We evaluated whether infection with Helicobacter pylori, including specific cytotoxic-associated antigen (CagA)-positive strains, increase the risk of upper gastrointestinal bleeding in users of nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: Cases with upper gastrointestinal bleeding and recent NSAID use, including aspirin, who were admitted during 2001, were compared with age- and sex-matched outpatient controls who had recent NSAID use. H. pylori infection was diagnosed by serum antibodies or the (13)C-urea breath test; and CagA seropositivity was diagnosed by enzyme-linked immunoassay. RESULTS: H. pylori was detected significantly more frequently in cases of bleeding than controls (79% [63/80] vs. 56% [45/80], P = 0.004). Cases of bleeding were more likely than controls to have a history of peptic ulcer (34% [n = 27] vs. 13% [n = 10], P = 0.003), previous upper gastrointestinal bleeding (19% [n = 15] vs. 6% [n = 5], P = 0.03), recent dyspepsia (29% [n = 23] vs. 15% [n = 12], P = 0.06), and <3 months of NSAID use (58% [n = 46] vs. 40% [n = 32], P = 0.04). CagA positivity was not associated with gastrointestinal bleeding. In a multivariate analysis, H. pylori infection was the only significant risk factor for upper gastrointestinal bleeding (odds ratio = 1.7; 95% confidence interval: 1.2 to 2.5; P = 0.004). CONCLUSION: H. pylori infection almost doubles the risk of upper gastrointestinal bleeding among users of NSAIDs.     

Nonsteroidal antiinflammatory drugs and lower gastrointestinal bleeding

To define the association of the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (ASA), and lower gastrointestinal bleeding (GIB) a retrospective, case-controlled study was undertaken of 188 patients admitted to three community hospitals in three cities with a diagnosis of lower GIB. Information was obtained about NSAID usage among these patients, and the data were compared with an age- and sex-matched control group of 185 patients admitted with a nongastrointestinal diagnosis, derived from a daily admission list. At the time of admission, in the New Jersey group, NSAID consumption was present in 26 of 90 (29%) patients with lower GIB compared with 16 of 90 (18%) of controls (P<0.05, odds ratio 1.88, 95% CI 1.2–3.1) whereas, in the South Carolina group 34 of 98 (35%) were taking NSAID compared with 18 of 95 (19%) of controls (P<0.01, odds ratio 2.27, 95% CI 1.2–4.4). These data indicate that there is a significantly increased rate of NSAID ingestion in patients admitted with lower GIB, implying that NSAID may unmask bleeding from a variety of lower gastrointestinal lesions.     

Overt gastrointestinal bleeding in patients with acute myocardial infarction: retrospective analysis of risks and outcomes

Overt gastrointestinal bleeding (GIB) is one of the noncardiac complications in patients with acute myocardial infarction (AMI).Identification of patients at increased risk of overt GIB could aid in targeting more aggressive treatment,and lead to improved outcomes.The aim of this study is to determine the frequency,risk factors,and prognostic significance of overt GIB in patients with AMI.Methods A retrospective review of the medical records of 1443 patients admitted to the Chinese PLA General Hospital with AMI was conducted.Charts were reviewed for clinical characteristics,possible precipitating factors and complications.Patients were categorized as having or not having overt GIB(GIB associated with hemodynamic changes or the need for transfusions).Results Twenty nine (2.0%) patients developed overt GIB within 30 days after AMI.Patients with overt GIB had higher 30-day mortality rate than those without (44.8% vs.9.9%,P ＜ 0.001).Multivariate logistic regression analysis showed major determinants of in-hospital overt GIB secondary to AMI were gender of female (odds ratio 2.41,95% confidence interval [CI] 1.08 to 5.37),age=75 years (odds ratio 1.58,95% CI 1.13 to 2.20),prior history of AMI (odds ratio 2.28,95% CI 1.17 to 4.88),pneumonia (odds ratio 3.47,95% CI 1.50 to 8.03) and anemia at admission (odds ratio 2.37,95% CI 1.04 to 5.37).Conclusions In patients with AMI,overt GIB is associated with higher in-hospital mortality,and female sex,older age,prior AMI,pneumonia and anemia at admission are predictors of overt GIB during hospitalization.(J Geriatr Cardiol 2008;5:195-198)     

非类固醇抗炎药物与消化性溃疡出血

非类固醇抗炎药物(NSAIDs)广泛应用于临床,由此引起的胃、十二指肠损害越来越受到人们的关注。我们的研究包括溃疡出血组、消化性溃疡组、住院病人组、健康人组,结果示消化性溃疡组服用NSAIDs明显高于其他组,特别是十二指肠溃疡病人,多数病人在出血前有服NSAIDs历史,且药物频率大于其它组。部分服用NSAIDs病人以出血为首发症状,扑热息痛对消化溃疡出血并无影响。     

Gastrointestinal bleeding in patients admitted to cardiology: risk factors and a new risk score

ObjectiveAlthough the early use of a risk stratification score in gastrointestinal bleeding (GIB) is recommended, so far there has been no risk score for GIB in patients admitted to the cardiology department. To describe the risk factors of GIB and develop a new risk score model in patients admitted to the cardiology department.MethodsA total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB were recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB. A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort.ResultsMale, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and alanine aminotransferase (ALT) were associated with GIB. The model had a high predictive accuracy (AUROC 0.816 and 95% CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841 and 95% CI, 0.807~0.874). Besides, the prediction of the model was better than HAS-BLED score (AUROC 0.557; 95% CI, 0.513~0.602) and CRUSADE score (AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score of 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay, and in-hospital mortality all increased gradually (P< 0.001).ConclusionsMale, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to the cardiology department.     

Etiology and Outcome of Patients with Upper Gastrointestinal Bleeding: A Study from South of Iran

Background/Aim:

The prevalence of acute upper gastrointestinal bleeding (AUGIB) has undergone a change after implementation of eradication therapy for Helicobacter pylori in peptic ulcers effective prevention of esophageal variceal bleeding and eventually, progressive use of low dose aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs). To evaluate this subject, we performed a prospective study in two main University Hospitals of Shiraz (the largest city of southern Iran).

Materials and Methods:

All adults who were admitted in emergency room with impression of AUGIB and existing patients who developed AUGIB were included in the study. Gastroscopy was done with a follow-up for the next 15 days.

Results:

572 patients (mean age: 54.9 years) entered in the study. The most common presenting symptom was hematemesis or coffee-ground vomits (68%). 75% of patients gave history of consumption of low dose aspirin or other NSAIDs regularly. Gastric and/or duodenal ulcers were the most common causes (252/572, 44%) of AUGIB (Gastric ulcer: 173/572, 30% and duodenal ulcer: 93/572, 16%, respectively). Esophageal varices were the third common cause (64/572, 11%). 36 (6%) of the patients died. Mean age of these patients was higher than the patients who were alive (64.8 vs. 54.2 years, P = 0.001). Other than age, orthostatic hypotension on arrival (267/536 vs. 24/36, P = 0.018) and consumption of steroids (43/536 vs. 10/36, P = 0.001) were significant factors for increasing mortality.

Conclusions:

The most common cause of AUGIB, secondary only to NSAIDs consumption, is gastric ulcer. Mortality of older patients, patients who consumed NSAIDs and steroids concomitantly, and patients with hemodynamic instability on arrival were higher.     

产科急症子宫切除术11例临床分析

目的探讨产科急症子宫切除术在抢救产后大出血中的应用价值。方法对该院产科2007-01～2012-01收治的11例因产科急症行子宫切除术患者的临床资料进行回顾性分析及文献复习。结果 11例中,行次全子宫切除8例,全子宫切除3例,均痊愈出院。急症子宫切除术率,经产妇（0.152%）高于初产妇（0.011%）（P=0.000）;剖宫产手术者（0.126%）高于阴道分娩者（0.012%）（P=0.000）。结论产科急症子宫切除术是治疗急性产后大出血的有效手段之一。     

Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage.

To assess the efficacy of selective intestinal decontamination with norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage, 119 patients were included in a prospective randomized study. Group 1 (n = 60) received norfloxacin orally or through a nasogastric tube, 400 mg twice daily for 7 days beginning immediately after emergency gastroscopy; group 2 (n = 59) was the control group. We found a significantly lower incidence of infections (10% vs. 37.2%; P = 0.001), bacteremia and/or spontaneous bacterial peritonitis (3.3% vs. 16.9%; P less than 0.05), and urinary infections (0% vs. 18.6%; P = 0.001) in patients receiving norfloxacin, as a consequence of decrease in the incidence of infections caused by aerobic gram-negative bacilli. The decrease in mortality observed in the treated group (6.6% vs. 11.8%) did not reach statistical significance. The cost for antibiotic treatment showed a 62% reduction in the treated group compared with the control group. The results show that selective intestinal decontamination with norfloxacin is useful in preventing bacterial infections in cirrhotics with gastrointestinal hemorrhage.