重型脑伤合并消化道应激性溃疡出血的疗效分析

目的：通过对61例重型脑伤合并消化道应激性溃疡出血的内科综合治疗,评价其疗效在治疗中的地位。方法：对61例重型脑伤合并消化道应激性溃疡出血的患者进行内科综合治疗,分析其疗效。结果：消化道应激性溃疡出血一般发生在人院的2～6d,占观察例数的86．9%（53例）,出血后,在治疗的两周内痊愈42例（占68．9％）。结论：重型脑伤合并消化道应激性溃疡出血是临床危急重症,积极的了解和祛除病因,持续监控;积极的、有效的综合治疗,能取得满意的疗效,提高痊愈率和患者的生存质量。     

高龄开放性骨折86例护理配合

目的：探讨潘托拉唑预防呼吸衰竭并发上消化道出血的效果及护理方法。方法：将92例呼吸衰竭患者随机分为治疗组和对照组各46例，治疗组用潘托拉唑预防治疗，对照组用雷尼替丁预防治疗，观察两组患者胃液的pH值及有无上消化道出血的临床表现，并采取有针对性的防护措施。结果：治疗组胃液的pH值明显高于对照组（P〈0．05）。上消化道出血治疗组1例，占2．17％；对照组8例，占13．4％，两组比较有显著性差异（P〈0．05）。结论：潘托拉唑能提高呼吸衰竭患者胃内的pH值，预防或减少上消化道出血；护理人员严密观察病情变化，熟练掌握用药注意事项，及时采取积极有效的护理措施，是预防或减少呼吸衰竭并发上消化道出血的重要因素。     

纤维支气管镜检查术后并发出血的护理

目的：探讨纤维支气管镜检查术后并发出血的护理。方法：对我科2005年6月-2006年3月期间40例纤维支气管镜检查术后并发出血的病例护理进行回顾性分析。结果：少量出血36例（占出血总数90％），中量出血3例（占7．5％），大量出血1例（占2．5％）。结论：针对不同程度的出血，采取有效治疗及护理措施，均能很好控制出血。     

颅脑损伤后合并上消化道出血264例临床观察

2000年至2004年我科在治疗颅脑损伤合并消化道出血中，应用鼻饲管注入冰盐水、云南白药、去甲肾上腺素、凝血酶，结合静点泮托拉唑钠治疗，在原发病得到稳定控制情况下，消化道出血治愈率占72．2％。     

产后出血36例的临床观察及护理

目的探讨产后出血患者的临床表现及护理对策。方法对36例产后出血患者进行临床抢救及护理。结果治愈35例，占97．22％；好转1例，占2．78％。有效（治愈加好转）率迭100％。结论做好临床观察、预防、治疗及护理是防治产后出血的重要措施。     

肝硬化并上消化道出血52例临床分析

目的：探讨肝硬化合并上消化遭出血患者的出血原因，并指导治疗。方法：对52例肝硬化合并上消化遭出血患者均行急诊胃镜检查及Child-pugh分级。结果：（1）52例肝硬化合并上消化道出血的原因：静脉曲张破裂出血占51．92％，非静脉曲张破裂出血占48．08％，两者比较。无显著性差异（P〉0．05）。在Child—pughA级中。静脉曲张破裂出血占23．08％，非静脉曲张破裂出血占5．77％．两者比较，有显著性差异（P〈0．05），在Child-pughC级中，非静脉曲张破裂出血占25．00％，静脉曲张破裂出血占11．53％，两者比较。有显著性差异（P〈0．05）；（2）非静脉曲张破裂出血原因包括消化性溃疡和门脉高压性胃病，在Child-pughC级中，门脉高压性胃病出血占17．31％，消化性溃疡出血占7．69％，两者比较，有显著性差异（P〈0．05）。结论：肝硬化合并上消化道出血病因中．门脉高压性胃病及消化性溃疡也是消化道出血的重要原因，尤其在肝功能Child-pughC级的患者中更应引起重视。     

消化道出血的诊断体会

消化道出血是内科最常见的急症之一，占内科住院病人的2％-3％。尽管近年来在治疗上，包括中西医药物治疗、内镜和手术治疗等，方法均有改进与提高，然而病死率仍然在10％左右。其预后取决与能否迅速确定出血部位和病因，以及是否得到有效救治等因素有关。本文就消化道出血的诊断基本程序作一初步探讨。     

上消化道出血患者的护理体会

上消化道出血是指屈氏韧带以上的消化道出血，主要症状为大量呕血或黑便，病死率约为10％。我科自2002年1月至2003年10月共收治48例上消化道出血患者，由于精心护理，使临床疗效显著提高，除2例转外科手术治疗外，其余内科保守治疗效果满意。现将我们的护理体会报告如下：     

噬血细胞综合征合并消化道出血患者的护理

目的总结噬血细胞综合征合并消化道出血患者的护理体会。方法对我科收治的7例噬血细胞综合征合并消化道出血患者的护理体会进行回顾性分析和总结。结果噬血细胞综合征患者常出现血小板降低、纤维蛋白原降低,在治疗过程中应用大剂量糖皮质激素可诱发消化道出血症状,护理过程中加强消化道出血的评估、临床观察、急救措施、药物、心理护理及口腔、肛周、全身皮肤、高热等基础护理。结论对于噬血细胞综合征患者及时有效的救治原发病,积极预防消化道出血的并发症,护理人员密切临床观察、熟练准确的操作以及精心的护理是噬血细胞综合征合并消化道出血患者治疗护理成功的关键。     

奥美拉唑静脉注射治疗消化道溃疡合并出血病人的护理

消化道溃疡是内科常见病,主要是指发生在胃和十二指肠的慢性溃疡,本病的发生与胃酸及胃蛋白酶有着密切的关系.消化道溃疡合并出血则属于内科急症,我科2007年8月-2008年10月收治45例消化道溃疡合并出血病人,临床采用静脉注射奥美拉唑进行治疗,并对病人实施有效的护理,获得满意疗效.现将护理体会报告如下.     

老年人消化性溃疡的临床特点与护理干预

目的:探讨不同年龄阶段老年人消化性溃疡的临床特点与护理干预效果.方法:回顾性分析392例老年人消化性溃疡患者的临床资料,并分析实施护理干预措施的效果.结果:本组年轻老年人与老老年人在溃疡类型及胃溃疡大小方面差异无统计学意义.通过用药指导、健康教育、心理护理和饮食指导等护理干预措施及内科保守治疗均获得良好的治疗效果.结论:在老年人消化性溃疡治疗过程中护理干预不可缺少.     

老年人急性上消化道大量出血的临床研究

目的探讨老年人急性上消化道大量出血的临床特点及治疗。方法对本院2005年1月至2007年12月收治的老年人急性上消化道大量出血病例资料进行分析。结果58例老年人上消化道大出血患者均有出血前用药史,呕血53例,仅黑便5例,消化性溃疡43例,急性糜烂性胃炎5例,胃癌3例,食管癌2例,食管胃底静脉曲张2例,其他3例。仅1例手术后并发肺栓塞死亡,其余均内科综合治疗出血停止后出院。结论老年人急性上消化道大量出血与非甾体抗炎药有关,以消化性溃疡多见,急性胃黏膜损害及肿瘤亦占相当比例,内科综合治疗效果好,积极预防有望减少出血。     

内镜下尼龙圈套扎治疗消化性溃疡大出血的临床观察及护理

目的探讨内镜下尼龙圈套扎对消化性溃疡大出血的治疗价值及护理。方法对37例消化性溃疡大出血患者采用内镜下尼龙圈套扎止血,术后密切观察病情及合理的饮食护理。结果37例消化性溃疡大出血病人,36例即时止血成功,且无复发出血及穿孔。结论尼龙圈套扎是一种安全有效的内镜下治疗消化性溃疡大出血的方法,高质量的术前术后护理是手术成功的重要因素之一,耐心细致的健康教育是防止复发的重要环节之一。     

Ulcers and nonvariceal bleeding

Peptic ulcer remains the commonest and most significant cause of nonvariceal upper gastrointestinal bleeding. The incidence of peptic ulcer bleeding is rising in elderly patients, particularly for duodenal ulcer. Patients presenting with upper gastrointestinal bleeding who have low Rockall scores are at low risk of rebleeding and death. These patients currently utilize considerable health-care resources, but could safely be managed at home. The Rockall score can be used to predict the risk of rebleeding and death following variceal bleeding, but for patients with ulcer bleeding, its ability to predict death is questioned. Acid suppression is effective in preventing rebleeding from peptic ulcer. Standard doses of intravenous omeprazole may be as effective as high-dose regimens. Oral omeprazole also reduces rebleeding following endoscopic therapy for peptic ulcer. Mallory-Weiss tears result in significant bleeding in 23 % of cases. Endoscopic therapy may only be required in cases in which active bleeding is present. Endoscopic therapy is effective and safe in patients with major peptic ulcer bleeding who are over 80 years old. For peptic ulcer, injection of larger volumes of epinephrine (adrenaline; mean 16.5 ml) are more effective than small volumes (mean 8 ml). Injection of normal saline alone is less effective than bipolar electrocoagulation. The addition of fibrin glue to epinephrine injection does not confer an additional benefit over epinephrine alone. Argon plasma coagulation can be used to treat a range of lesions in the gastrointestinal tract. It is also effective for treatment of bleeding ulcer, but is no better than established methods. Haemoclips may be useful in bleeding Mallory-Weiss tears, but their use is difficult in patients bleeding from peptic ulcer. The presence of a large ulcer and active bleeding at the time of endoscopy are independent predictors of failure of endoscopic therapy.     

护理干预对消化性溃疡患者医嘱依从性及疗效的影响

目的:探讨护理干预对消化性溃疡患者医嘱依从性及疗效的影响.方法:将80例消化性溃疡患者随机分为干预组45例和对照组35例,对照组给予常规治疗及护理,干预组在此基础上对患者实施护理干预,出院后采用电话、随访方式调查两组的医嘱依从性、溃疡病复发情况及不遵医的原因.结果:干预组对医嘱依从率高于对照组(P＜0.05),复发率明显低于对照组(P＜0.01),经济问题成为不遵医的主要原因.结论:护理干预能提高消化性溃疡患者的医嘱依从性,减少溃疡的复发.     

循证护理应用于消化性溃疡患者的效果观察

目的:探讨循证护理模式对消化性溃疡患者的影响和效果。方法:回顾性分析120例消化性溃疡患者(观察组)的循证护理资料,并与采用常规护理的120例消化性溃疡患者(对照组)作对照研究。观察两组病人的健康知识掌握情况、溃疡愈合情况、护理满意度和溃疡复发情况。结果:两组病人在健康知识掌握情况、溃疡愈合情况、护理满意度和溃疡复发情况方面均存在显著差异(P<0.05)。结论: 循证护理有利于提高消化性溃疡患者了解健康知识及对护理的满意度,有利于溃疡的愈合,降低了溃疡复发率,从而提高了消化性溃疡患者的治疗效果。     

Endoscopic band ligation for control of acute peptic ulcer bleeding

BACKGROUND AND STUDY AIMS: The use of endoscopic band ligation (EBL) is being extended to treat various causes of upper and lower gastrointestinal bleeding. The aim of this study was to evaluate the usefulness of EBL for control of acute peptic ulcer bleeding and to define the lesions that are most suitable for this technique. PATIENTS AND METHODS: 19 patients with major stigmata of acute peptic ulcer bleeding were treated using EBL; 11 patients had active bleeding and eight patients had a nonbleeding visible vessel. RESULTS: The site of acute peptic ulcer bleeding was the stomach in 12 patients, the duodenum in four patients, and Billroth II anastomosis in three. Initial hemostasis was achieved in 19 patients (100 %) in a single session. There were no rebleeding episodes in any of the patients, and there was no bleeding-related or procedure-related death. During long-term outpatient follow-up, bleeding did not recur. CONCLUSIONS: EBL is an effective and safe endoscopic treatment for small-sized nonfibrotic acute peptic ulcer bleeding. Larger studies in patients with acute peptic ulcer bleeding are needed to confirm these promising results.     

Randomized trial of N-butyl-2-cyanoacrylate compared with injection of hypertonic saline-epinephrine in the endoscopic treatment of bleeding peptic ulcers

BACKGROUND AND STUDY AIMS: Theoretically, the injection of cyanoacrylate may be effective for peptic ulcer bleeding, but randomized clinical trials are rare. The aim of this study was to compare the efficacy of N-butyl-2-cyanoacrylate (Histoacryl) and hypertonic saline-epinephrine (HSE) in the endoscopic treatment of major peptic ulcer hemorrhage. PATIENTS AND METHODS: A total of 126 patients with major peptic ulcer hemorrhage and active bleeding or a nonbleeding visible vessel were randomly allocated to endoscopic injection with HSE (63 patients; group 1) or to injection with Histoacryl (63 patients; group 2). The two groups were well matched for age, sex, initial hemoglobin values, ulcer size and location, and bleeding stigmata. RESULTS: Initial hemostasis was achieved in 58 cases (92.1%) in group 1 and in 60 cases (95.2%) in group 2 (P=0.717). Rebleeding rates were 16 of 58 in group 1 and seven of 60 in group 2 (P=0.051). There were no significant differences regarding the rates of permanent hemostasis (51 of 63 in group 1 vs. 57 of 63 in group 2, P=0.203), emergency surgery (seven of 58 in group 1 vs. three of 60 in group 2, P=0.200), or hospital mortality due to bleeding (0 in group 1 and 0 in group 2). With regard to the rebleeding rate, there was a significant difference between group 1 and group 2 in the subgroup with active arterial bleeding (11 of 26 in group 1 and four of 29 in group 2, P=0.039) but not in the subgroup with a nonbleeding visible vessel (five of 32 in group 1 and three of 31 in group 2, P=0.708). There were no statistically significant differences in hemostatic results between the two treatment groups in the subgroups with gastric ulcers or duodenal ulcers. Although no complications followed HSE therapy, arterial embolization with infarction occurred in two patients in the Histoacryl group, of whom one died. CONCLUSIONS: Compared with HSE injection, Histoacryl injection showed no statistically significant differences in hemostatic results, except for decreasing the rebleeding rate in the patients with active arterial bleeding. However, the use of Histoacryl to control peptic ulcer bleeding should be reserved as a last resort before surgery, because of possible embolic complication.     

消化性溃疡患者凝血功能和D-二聚体检测的临床意义

目的研究消化性溃疡（PU）患者血浆中凝血功能指标和D-二聚体（D-D）的变化及临床意义。方法选择32例PU患者和50例PU合并出血患者及21例健康对照者,进行了凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（Fib）和D-D的检测和分析。结果PU组的PT、APTT、Fib、TT及I）ID的水平与健康对照组比较差异无统计学意义（P〉0．05）。PU合并出血组的PT、APTT、Fib、TT及DID与健康对照组比较,差异有统计学意义（P〈0．01）,PU组和PU合并出血组之间上述各项指标差异均有统计学意义（P〈0．01）。结论PU患者合并出血者因出血可使机体内处于血栓前状态,并可能会出现继发性纤溶亢进。     

3042例上消化道出血患者病因分析及护理对策

目的 探讨3042例上消化道出血患者的病因,并提出护理对策.方法 回顾性分析本院1991年3月～2009年3月3042例上消化道出血住院患者的病因,并提出对策.结果 消化性溃疡出血为上消化道出血的主要病因,占46.96％,其中十二指肠溃疡呈下降趋势;急性胃黏膜病变为上消化道出血的第2病因,占28.76％,呈上升趋势;年龄＜60岁组患者十二指肠溃疡是上消化道出血的主要病因(占44.35％),年龄≥60岁组患者急性胃黏膜病变为上消化道出血的主要病因(41.21％).结论 消化性溃疡出血与急性胃黏膜病是上消化道出血的主要病因,其中十二指肠溃疡呈下降趋势,其也是年龄＜ 60岁组患者的主要病因;急性胃黏膜病变呈上升趋势,其也是年龄≥60岁患者的主要病因.在护理工作中,应针对不同年龄患者病因与疾病谱变化情况,开展针对性的健康教育,促进患者行为改变,从而达到防病、治病的目的.