奥美拉唑联合硫糖铝治疗急性非静脉曲张性上消化道出血的临床分析

目的探讨急性非静脉曲张性上消化道出血的临床方法与效果。方法急性非静脉曲张性上消化道出血患者160例根据治疗药物的不同分为治疗组与对照组各80例,两组均予以常规治疗,在此基础上治疗组加用奥美拉唑联合硫糖铝治疗。结果治疗组的总有效率明显高于对照组,平均止血时间明显少于对照组,差异均有统计学意义（P〈0.05）;两组不良反应都比较少,差异无统计学意义（P〉0.05）。结论急性非静脉曲张性上消化道出血当前多采用非手术治疗,而基于奥美拉唑与硫糖铝的药物治疗有比较好的临床效果。     

硫糖铝壳聚糖凝胶的稳定性实验

目的:考察硫糖铝壳聚糖凝胶在光照、高温、低温、高湿、加速实验及室温留样观察条件下的稳定性.方法:取硫糖铝壳聚糖凝胶,分别置于光照(4500LX),高温(40℃、60℃),高湿(25℃,相对湿度75%;25℃,相对湿度92.5%),加速(40℃,相对湿度:75%)及室温条件下,在规定的时间取样,观察样品性状,测定样品中铝的含量、沉降容积比、再分散次数.结果:本品的性状,沉降容积比,再分散次数及铝的含量在实验条件下无明显改变.结论:本品原辅料对铝的含量测定无影响,性质稳定.     

Salivary immunoreactive endothelin in patients with upper gastrointestinal diseases

Endothelins have been implicated in gastric mucosal damage in a variety of animal models. Furthermore, clinical reports also show elevated gastric mucosal endothelin-1 levels in patients suffering from peptic ulcer diseases. We have demonstrated, first, the presence of immunoreactive endothelin (IR-ET) in human saliva. We also show that endothelins are rather stable in human saliva. The present study was undertaken to determine whether patients with endoscopically proven upper gastrointestinal diseases have a salivary excess of IR-ET, compared with patients with a normal esophagogastroduodenoscopy. Saliva was collected from fasting subjects prior to esophagogastroduodenoscopy. The levels of IR-ET were measured by the radioimmunoassay method. The salivary concentrations of IR-ET in the studied subjects were as follows: 8.9 +/- 1.0 fmol/mL (mean +/- standard error of the mean) for patients with gastric ulcers (n = 18); 7.3 +/- 1.0 fmol/mL for patients with duodenal ulcers (n = 22); and 6.8 +/- 0.6 fmol/mL for patients with gastritis (n = 28). These values are all higher than that of normal subjects (4.4 +/- 0.5 fmol/mL, n = 20; P < 0.001, P < 0.01, and P < 0.05, respectively). No significant differences in salivary IR-ET were noted between patients with a normal esophagogastroduodenoscopy and patients with esophagitis (3.8 +/- 0.7 fmol/mL, n = 4) or gastric cancer (5.3 +/- 1.4 fmol/mL, n = 4). There were no significant differences in the salivary IR-ET levels between males and females. However, the salivary IR-ET levels in the smokers (8.0 +/- 0.6 fmol/mL, n = 38) were significantly higher (P < 0.01) than those of the non-smokers (6.0 +/- 0.4 fmol/mL, n = 58). There was no correlation of IR-ET levels with age. Our findings suggest that salivary endothelin may have a contributing role in certain gastroduodenal diseases.     

Unmet needs in non-steroidal anti-inflammatory drug-induced upper gastrointestinal diseases

The use of traditional and cyclooxygenase (COX)-2-selective non-steroidal anti-inflammatory drugs (NSAID) for the relief of pain and inflammation increases the risk of gastrointestinal side-effects ranging from dyspepsia to symptomatic and complicated ulcers. The COX-2-selective agents were designed to provide comparable pain relief to traditional NSAID, with a reduced rate of adverse gastrointestinal events. However, there appears to be little clinically significant difference between COX-2 and traditional NSAID in terms of dyspepsia, a common cause of the discontinuation of a traditional NSAID. Furthermore, concomitant aspirin use substantially reduces the gastrointestinal safety advantage of COX-2-selective drugs. An increase in the numbers of people taking low-dose aspirin for cardioprotection, an aging population and potential chemoprevention benefits are resulting in the rising consumption of NSAID. Proton pump inhibitors have a demonstrated role in the treatment and prevention of both non-selective NSAID and selective COX-2 inhibitor-related upper gastrointestinal damage. However, the use of gastroprotective agents is far from optimal, and many high-risk patients are not being clearly identified. At the same time, inappropriate low-dose aspirin use is placing low cardiovascular risk patients at risk of gastrointestinal bleeding. Combined with the recent withdrawal of rofecoxib and valdecoxib from the market because of excess cardiovascular adverse events, and concerns about the safety of other COX-2 inhibitors, a review of strategies to reduce the overall risks in users of anti-inflammatory drugs is timely. This article examines the current issues of understanding and managing NSAID-induced upper gastrointestinal diseases.     

几种新型助悬剂用于硫糖铝混悬液的助悬效果观察比较

本文用离心沉降法评价了几种新型助悬剂对硫糖铝混悬液的助悬效果，找到了适用于硫糖铝混悬液的较好助悬剂为：１％的皂土及０．５５％的琼脂加工品。     

磷酸铝凝胶联合泮托拉唑及凝血酶治疗上消化道出血疗效观察

目的:观察磷酸铝凝胶联合泮托拉唑、凝血酶治疗上消化道出血的临床效果.方法:选取上消化道出血住院病人80例,随机分为两组.治疗组40例,给予泮托拉唑40 mg静脉滴注,2次/日,磷酸铝凝胶20 g口服,3次/日;凝血酶1～2 kU溶于生理盐水20 ml中口服,日3次.对照组40例,给予泮托拉唑40 mg静脉滴注,2次/日,凝血酶1～2 kU溶于生理盐水20 ml中口服,3次/日.结果:治疗组总有效率97.5%,明显高于对照组85%,差异有统计学意义(P<0.05).结论:磷酸铝凝胶联合泮托拉唑、凝血酶对于上消化道出血的疗效优于应用泮托拉唑加凝血酶.     

磷酸铝凝胶治疗新生儿上消化道出血疗效观察

目的 观察磷酸铝凝胶治疗新生儿上消化道出血的疗效.方法 将58例上消化道出血的新生儿随机分为2组,每组29例,积极治疗原发病,留置胃管,禁食,对症处理.治疗组予鼻饲磷酸铝凝胶,观察组予常规治疗.观察其疗效及不良反应.结果 治疗组有效率93.1％,对照组有效率82.8％,两组比较差异有显著性(P＜0.01);起效时间比较,治疗组起效早于对照组,差异有显著性(P＜ 0.01).结论 磷酸铝凝胶治疗新生儿消化道出血用药方便,疗效确切,起效快,无副作用,值得临床推广.     

硫糖铝壳聚糖凝胶的制备及质量控制

目的:研究硫糖铝壳聚糖凝胶的制备方法及质量控制.方法:通过正交实验对硫糖铝壳聚糖凝胶处方进行筛选,并通过鉴别,检查,含量测定等进行质量控制.结果:筛选出了硫糖铝壳聚糖凝胶制备的处方:每1000 mL硫糖铝壳聚糖凝胶含:硫糖铝100g;水溶性壳聚糖3 g;甲基纤维素4g;聚山梨酯8020 g;糖精钠0.2 g;10%羟苯甲酯和羟苯乙酯乙醇溶液(1:1)8.33 mL;水适量.本处方3 h的沉降容积比为0.97,静置48 h,翻转3～4次即可均匀.制酸力,每10mL平均为161.5 mL,鉴别反应灵敏,含量测定中,铝的平均回收率为98.52%(RSD=0.78%),硫的平均回收率为91.46%(RSD=0.20%).结论:筛选后的处方符合制剂的质量要求.     

Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases

BACKGROUND: Most patients with vascular-occlusive diseases benefit from low-dose aspirin (75-325 mg/day). However, they have an increased risk of upper gastrointestinal bleeding (UGIB). AIMS: To analyse the incidence and factors influencing the occurrence of UGIB in patients taking low-dose aspirin for the prevention of cardiovascular diseases outside clinical trials. METHODS: We studied 903 consecutive patients discharged on low-dose aspirin from the Cardiology Department of a general hospital. Data were collected from medical charts and structured telephone interviews. RESULTS: Forty-one patients (4.5%) presented with UGIB requiring hospitalization during follow-up (45 +/- 22 months). The incidence of UGIB was uniform during follow-up (1.2 UGIB per 100 patient years). Multivariate analysis showed that a history of peptic ulcer or UGIB [risk ratio: 3.1, 95% CI: (1.5-6.5)] and aspirin dose (per 100 mg/day) [1.8 (1.5-2.9)] was associated with higher risk of UGIB. On the other hand, antisecretory [0.22 (0.07-0.75)] and nitrovasodilator drugs [0.73 (0.55-0.96)] were associated with a decreased risk. CONCLUSIONS: Cardiovascular patients on long-term low-dose aspirin have a stable risk of major UGIB, which is higher than published controlled clinical trials. Antisecretory and nitrovasodilator drugs protect from UGIB, whereas previous peptic ulcer or UGIB and higher doses of aspirin increase the risk.     

上消化道大出血的护理体会

上消化道出血是指屈氏（Treitz）韧带以上的消化道出血,是临床上常见的急危重症之一,常可威胁患者生命。本文是对上消化道出血急救护理的阐述。     

Antidepressants and risk of upper gastrointestinal bleeding

Selective serotonin reuptake inhibitors (SSRIs) are nowadays the most widely used antidepressants in the world, mainly because they have a better adverse reaction profile and a higher safety margin in overdoses, when compared to other antidepressants. These drugs recently have been the target of important debates concerning safety issues, among them the possibility that they may increase the risk of bleeding. Over the 1990s, an increasing number of individual cases of bleeding disorders were reported in the literature and to the pharmacovigilance programmes which prompted several epidemiological and pharmacological studies. In this review we have examined all available data. The whole evidence supports the hypothesis that antidepressants with a relevant blockade action on serotonin reuptake mechanism increase the risk of bleeding. Such disorders may have different degrees of severity and may be located anywhere in the body. The epidemiological evidence is, however, more robust for upper gastrointestinal bleeding. It has been estimated that upper gastrointestinal bleeding may occur at a frequency ranging from 1 in 100 to 1 in 1,000 patient-years of exposure to high-affinity drugs (the SSRIs), with the very old patients being in the highest part of the range. The increased risk may be of particular relevance when the SSRIs are associated with NSAIDs as well as low-dose aspirin.     

Antibacterial peptides and gastrointestinal diseases

Defensins and cathelicidins are small cationic peptides produced by neutrophils and epithelial cells. They are highly expressed during infection. The role of constitutive and inducible antibacterial peptides has been extensively studied over the recent years; especially in the gastrointestinal (GI) tract, where the balance between the luminal bacteria and antibacterial peptides is crucial in the maintenance of a healthy GI tract. There are reports showing that the expressions of defensins and cathelicidins in the gut are dysregulated in various disease states. They could participate in the development of different disorders ranging from inflammation to cancer. Experimental findings showed that supplementation with animal cathelicidin promoted gastric ulcer healing in rats and suppressed tumorigenesis of gastric cancer in mice. Mouse cathelicidin could alleviate murine colitis by preserving mucus content and suppression of apoptosis. Other clinical applications for these antibacterial peptides are awaiting for further studies.     

Gastric retention and stability of lipidized Bowman-Birk protease inhibitor in mice

Bowman-Birk protease inhibitor (BBI) was modified with a reversible lipidizing agent. The palmitoylated product, Pal-BBI, and BBI were iodinated and orally administered to mice using a gavage needle. A prolonged retention of Pal-BBI was found in the stomach. Furthermore, a significant amount of Pal-BBI was detected as intact polypeptide in the stomach of mice fed with Pal-BBI, while only degradation products were detected with BBI. There was also a significant increase of radioactivity in the blood and liver in mice 1.5 h post-administration of Pal-BBI. These results indicate that lipidized polypeptide can have a longer retention and lower digestion in the stomach. They also suggest that the Pal-BBI may have a higher gastrointestinal absorption than the original polypeptide.     

Dual COX inhibition and upper gastrointestinal damage

Aspirin and non-aspirin NSAIDs injure the gastrointestinal tract principally as a result of their inhibition of prostaglandin synthesis. This is mediated via abrogation of the secretion of mucus and bicarbonate and by reduction in mucosal blood flow. Topical injury and inhibition of platelet thromboxane may also contribute respectively to damage and ulcer bleeding. Recognition of a second cyclooxygenase, COX-2, enabled drugs to be developed that selectively target this enzyme which is expressed in inflamed joints. These have proved to be effective treatments whilst causing little or no acute gastroduodenal injury and reduced ulcers and their complications. Future strategies may capitalise upon the phenomenon of substrate diversion of lipoxygenase products. Balanced cyclooxygenase/lipoxygenase inhibition maybe less harmful than cyclooxygenase inhibition. Also, nitric oxide can subserve many of the protective effects of prostaglandins and NO-donating NSAIDs are under evaluation.     

Radiology and endoscopy in acute upper gastrointestinal bleeding.

Of 112 patients admitted with acute upper gastrointestinal bleeding, the presumed bleeding site was detected in 61-5% of cases by radiology and in 57% of cases on endoscopy. Thirty-one patients who had barium-meal examination were operated on and the surgical and radiological findings agreed in 26 (84%). Twenty-three patients who had endoscopy were operated on and the surgical and endoscopic findings agreed in 15 (65%). In 10 cases radiology detected a lesion not identified on endoscopy and in nine endoscopy detected a lesion not seen at radiology. We suggest that when there are two potential sources of bleeding radiology as well as endoscopy can detect the actively bleeding lesion. The supplementary nature of radiology and endoscopy is emphasised and we conclude that both methods should be used if there is any doubt at the initial radiological or endoscopic examination about the source of the bleeding.