生长抑素联合泮托拉唑治疗肝硬化合并上消化道出血的疗效观察

目的 探究生长抑素联合泮托拉唑治疗肝硬化合并上消化道出血的治疗效果。方法 选取大连市普兰店区第二人民医院内科2017年1月~2018年4月收治的肝硬化合并上消化道出血者共60例,以抽取红黄球方式分组,红球为实验组,黄球为对照组,每组30例。实验组采用生长抑素联合泮托拉唑治疗,对照组采用生长抑素治疗。分别观察两组患者临床治疗效果、止血时间、输血量、住院所需时间、血红蛋白水平、不良反应总出现率。结果 实验组止血时间[（23.62±4.92）vs（34.55±6.20）h]、输血量[（243.92±50.33）ml vs（492.39±55.20）ml]、住院所需时间[（7.66±1.09）d vs（17.20±2.09）d]、不良反应总出现率（6.67% vs 30.00%）均低于对照组,差异具有统计学意义（P＜0.05）。实验组临床治疗总有效率（86.67% vs 60.00%）、血红蛋白水平[（120.60±15.00）g/L vs （103.01±15.37）g/L]均高于对照组,差异具有统计学意义（P＜0.05）。结论 与单一用药相比,给予肝硬化合并上消化道出血患者采用生长抑素联合泮托拉唑治疗,不仅利于改善其血红蛋白水平,更利于减少输血量、住院时间、用药不良反应,进而提升治疗效果。     

奥美拉唑联合奥曲肽治疗肝硬化上消化道出血疗效观察

目的：观察奥曲肽联合奥美拉唑治疗肝硬化上消化道出血的临床疗效。方法将我院收治2008年~2013年的128例肝硬化上消化道出血患者随机分为两组,治疗组(78例)应用奥曲肽联合奥美拉唑治疗,对照组(50例)单独使用奥美拉唑治疗,观察两组患者止血率、平均止血时间和48h内再出血率。结果治疗组48h止血率为91%(71/78),对照组48h止血率为72%(36/50),两组比较差异有统计学意义(P<0.01)。治疗组患者平均止血时间为(21.42±4.21)h,对照组患者平均止血时间为(28.16±5.62)h,两组比较差异有统计学意义(P<0.05)。治疗组患者48h内再出血率为7.6%,对照组为26.3%,两组比较差异有统计学意义(P<0.01)。结论奥曲肽联合奥美拉唑治疗肝硬化上消化道出血可以缩短止血时间,止血效果好。     

大剂量生长抑素联合内镜下止血术对急性上消化道出血患者的作用研究

目的:探讨大剂量生长抑素联合内镜下止血术对急性上消化道出血患者的作用.方法:随机将杞县中医院2018年9月至2020年9月期间87例急性上消化道出血患者分为两组,对照组43例予内镜下止血术治疗,观察组44例在对照组基础上予以大剂量生长抑素治疗.持续使用7d后观察对比两组患者临床疗效、胃肠功能、凝血指标以及不良反应.结果:观察组总有效率(93.17％)高于对照组(76.74％)(P<0.05);观察组胃泌素、生长抑素以及胃动素水平低于对照组(P<0.05);凝血酶时间、凝血酶原时间以及活化部分凝血活酶时间低于对照组(P<0.05);观察组不良反应恶心、呕吐、腹胀总发生率(13.62％)和对照组(9.28％)无差异(P<0.05).结论:大剂量生长抑素联合内镜下止血术治疗急性上消化道出血患者效果确切,能够改善凝血功能及胃肠功能.     

泮托拉唑联合奥曲肽治疗肝硬化并上消化道大出血43例

目的 观察泮托拉唑联合奥曲肽治疗肝硬化并上消化道大出血的疗效.方法 将83例肝硬化并上消化道出血患者分为治疗组(泮托拉唑联合奥曲肽治疗)和对照组(单用奥曲肤治疗),观察相关指标.结果 治疗组12h内止血20例(46.5%),72h总止血41例(95.37%).对照组12h内止血6例(15.0%),72h总止血31例(37.5%).治疗组12h内止血成功率和72h内总止血率均明显高于对照组(P<0.05).两组均无明显不良反应.结论 泮托拉唑加奥曲肽治疗肝硬化并上消化道大出血具有止血迅速、不良反应少、安全等优点.     

门诊静脉输液患儿500例的护理干预方法探讨

目的：分析并总结门诊静脉输液患儿的有效护理方法。方法随机将本院门诊输液治疗室收治的500例输液治疗的患儿分成实验组与对照组各250例,对照组给予常规基本护理措施;实验组对患儿家长开展健康宣教、加强心理护理、转移患儿注意力、给予暗示与激励疗法、给予微笑服务、做到勤巡视以及构建温馨环境等护理干预措施。结果实验组一次性静脉穿刺成功率显著高于对照组(<0.01),存在统计学意义;实验组由于脱针导致重新注射率显著低于对照组(<0.05),存在统计学意义。结论对门诊静脉输液患儿实施全面的护理干预,可以有效提升一次性静脉穿刺的成功率,明显减低静脉输液时由于脱针导致的重注率。     

肝硬化并发上消化道出血临床观察

目的：探讨与分析肝硬化并发上消化道出血的危险因素,为相关疾病的防控提供参考依据。方法将2012年9月~2013年9月于我院接受治疗的90例肝硬化并发消化道出血患者作为研究对象,回顾性分析其临床资料,随机将其分为对照组与观察组各45例,对照组给予常规气囊止血方案,观察组则服用奥美拉唑配合生长抑素治疗,对比观察两组患者的临床治疗效果。结果观察组患者显效28例,有效15例,总有效率高达95.56%,显著高于对照组的66.67%,组间对比差异显著,<0.05。结论对肝硬化并发上消化道出血患者的临床治疗宜在常规治疗的基础上加用奥美拉唑治疗方案,能够显著抑制胃酸分泌,对人体副作用小,值得临床推广。     

肝硬化伴上消化道出血的护理

晚期肝硬化并发食道下端或胃底静脉曲张破裂出血,属危急重症,可因大出血休克或诱发肝性昏迷而死亡,病死率高达50％。因此必须及时给予抢救、治疗与护理。现总结了6例晚期肝硬化并发上消化道出血患者,针对出血止血、预防肝昏迷谈点体会。     

肝硬化伴上消化道出血的护理

晚期肝硬化并发食道下端或胃底静脉曲张破裂出血,属危急重症,可因大出血休克或诱发肝性昏迷而死亡,病死率高达50%.因此必须及时给予抢救、治疗与护理.现总结了6例晚期肝硬化并发上消化道出血患者,针对出血止血、预防肝昏迷谈点体会.     

康复新液辅助生长抑素治疗非甾体药物致上消化道出血临床疗效及安全性研究

目的:探讨康复新液辅助生长抑素治疗非甾体药物致上消化道出血的临床疗效及安全性。方法:收集90 例符合纳入标准的非甾体药物致上消化道出血患者作为观察对象,随机分为对照组45 例和观察组45 例。常规治疗基础上,对照组给予生长抑素治疗。观察组在对照组基础上给予康复新液辅助治疗。比较两组患者临床疗效、止血时间、再出血率、血清炎性因子水平及不良反应。结果:临床疗效显示,观察组患者治疗总有效率高于对照组(95.6% vs 82.2%),组间比较有统计学差异(P<0.05)。与对照组相比,观察组的止血时间明显缩短[(1.4±0.5)d vs (2.6±0.7)d,P<0.05],而再出血率组间比较无统计学差异(4.4% vs 11.1%,P>0.05)。治疗后,观察组患者血清TNF-α、IL-6 水平降低[(5.46±0.93)ng/ L vs (8.37±1.08)ng/ L,(19.37±3.43)ng/ L vs (38.22±8.14)ng/ L],组间比较都有统计学差异(P<0.05)。治疗过程中,无严重不良反应病例。观察组和对照组患者不良反应发生率分别为22.2%和15.6%,组间比较无统计学差异(P>0.05)。结论:康复新液辅助生长抑素在非甾体药物致上消化道出血中应用效果良好,能够提高治疗有效率,缩短止血时间,减轻炎性反应,且不良反应轻微,临床上值得应用。     

分级分区干预模式在急诊上消化道出血患者中的护理分析

目的:探讨分级分区干预模式在急性上消化道出血患者中的护理效果.方法:收集2018年4月至2020年7月期间于本院急诊治疗的78例急性上消化道出血患者临床资料,按就诊时间段的不同将患者分为对照组和观察组,每组各39例.对照组采用常规护理;观察组采用分级分区干预模式.比较两组患者治疗期间止血情况、治疗情况,采用采用Blatchford入院危险性积分(Blatchford risk score system,BRS)评估消化性出血的风险.结果:观察组止血成功率明显高于对照组(P<0.05);出血次数少于对照组,止血时间与出院时间短于对照组(P<0.05);护理后BRS评分较对照组低(P<0.05).结论:分级分区护理模式可提高急性上消化道出血患者止血成功率,减少出血次数,缩短止血时间及出院时间,降低消化道出血危险性.     

Upper gastrointestinal bleeding in patients with liver cirrhosis

Patients with liver cirrhosis may develop upper gastrointestinal hemorrhage from a variety of lesions, which include those that arise by virtue of portal hypertension, namely gastroesophageal varices and portal hypertensive gastropathy and other lesions seen in the general population. Do patients with liver cirrhosis, hemorrhage from varices and other lesions equally, or are they more likely to bleed from varices? The aim of this study is to determine predominant causes of bleeding in patients with liver cirrhosis and upper gastrointestinal bleeding. PATIENTS AND METHODS: A retrospective review of 40 patients with liver cirrhosis based on the clinical and biochemical parameters of the Child-Pugh score, and upper gastrointestinal bleeding was carried out at an inner city hospital. Endoscopy diagnoses were documented. RESULTS: Of 40 patients, 38 patients had cirrhosis associated with alcohol consumption. Twelve of the above 38 patients who consumed alcohol also had hepatitis C virus (HCV) infection. Eleven patients had only varices on endoscopic examination, 17 had varices plus coexisting lesions. From these 17 patients, nine were found to have bled from varices, and eight were found to have bled from coexisting lesions. Twelve patients who had no varices bled from other lesions. Of 40 patients, 28 had varices, and 20 actually bled from varices. In this study there was no correlation between severity of liver cirrhosis as determined by the Child-Pugh score and the absence or presence of varices. CONCLUSION: Patients with liver cirrhosis and upper gastrointestinal bleeding hemorrhage from a variety of lesions. In this study of 40 patients, (70%) had gastroesophageal varices diagnosed at upper endoscopy, while 50% actually bled from varices.     

Prophylactic sclerotherapy of large esophageal varices

We randomly assigned 95 patients with large esophageal varices (Grade 3 or 4) who had not previously had upper gastrointestinal tract bleeding to two groups: 49 received intravariceal sclerotherapy, and 46 were followed as controls. Over a mean follow-up of 13 months there was no difference between the sclerotherapy group and the control group in mortality (24.4 percent) or any significant difference in average hospital stay per month (3.0 vs. 2.6 days). Sclerotherapy was associated with significantly more episodes of upper gastrointestinal bleeding (26 vs. 10 episodes, P less than 0.05); 75 percent of deaths in the sclerotherapy group were related to bleeding, as compared with 18 percent in the control group. An additional 54 patients with cirrhosis who did not qualify for the study were also followed--20 with small varices and 34 with none. Mortality was 20 and 15 percent, respectively; no deaths were due to bleeding. We conclude that prophylactic sclerotherapy does not provide clinical benefit to patients with large esophageal varices.     

肝硬化患者上消化道出血与血脂水平相关性分析

目的分析肝硬化患者上消化道出血与血脂水平的相关性。方法选取2017年7月至2019年6月126例肝硬化合并上消化道出血患者作为病例组,选取同期100例未发生上消化道出血的肝硬化患者作为对照组。收集患者一般资料,并测定三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)。进行单因素分析、Spearman秩相关分析、Logistics回归分析,并作ROC曲线。结果病例组患者的TG、TC、HDL-C、LDL-C、ApoA1、ApoB、ApoE水平均低于对照组(P<0.05)。Spearman秩相关分析显示,TC、HDL-C、LDL-C、ApoA1、ApoB水平与上消化道出血呈负相关(P<0.05),TG、ApoE水平与上消化道出血无显著相关性(P>0.05)。Logistics回归分析显示,TC、LDL-C低水平是上消化道出血的危险因素。LDL-C作为上消化道出血预测因子的准确性高于TC,当LDL-C水平低于2.565 mmol/L时(AUC=0.861,灵敏度82%,特异性73%),及TC水平低于3.995 mmol/L时(AUC=0.736,灵敏度75%,特异性64%),上消化道出血风险明显增加。结论血脂代谢异常与肝硬化患者上消化道出血密切相关,TC、LDL-C低水平是上消化道出血的危险因素,当LDL-C水平低于2.565 mmol/L、TC水平低于3.995 mmol/L时,上消化道出血风险明显增加。     

凝血酶原时间与血小板检验方式对诊断肝硬化疾病的临床价值研究

目的 研究凝血酶原时间（PT）与血小板检验方式对肝硬化疾病患者进行诊断的临床价值。方法 选取2016年5月~2017年5月在我院诊治的100例肝硬化患者作为观察组,并选取同期进行健康体检的100例健康者作为对照组,分别检测PT与血小板,对比两组血小板指标、PT,观察疾病组出血现象和无出血现象患者的血小板指标和PT。结果 观察组血小板体积（MPV）、血小板分布宽度（PDW）明显高于对照组,血小板计数（PLT）、血小板压积（PCT）明显低于对照组,差异有统计学意义（P＜0.05）;观察组PT明显高于对照组,差异有统计学意义（P＜0.05）;无出血患者PCT、PLT明显低于出血患者,MPV、PDW、PT明显高于出血患者,差异有统计学意义（P＜0.05）。结论 凝血酶原时间和血小板检验与肝硬化患者病情发展有直接的关系,且随着病情的加重,会发生相应的改变,对临床诊断肝硬化具有重要的临床价值。     

慢性重型肝炎分类的研究

目的 探讨慢性重型肝炎、肝硬化失代偿的临床特点及更合理的分型标准.方法 应用SPASS软件,回顾分析了肝硬化失代偿患者106例、单纯慢性重型肝炎患者（以下简称重型Ⅰ组）124例及肝硬化合并慢性重型肝炎患者（以下简称重型Ⅱ组）100例临床资料.结果 （1）三组患者年龄以重型Ⅰ组年龄偏小,为30岁左右,肝炎肝硬化失代偿组患者年龄偏大,为50岁左右;（2）肝硬化失代偿组、重型Ⅰ型及重型Ⅱ型患者的临床生化指标：白蛋白、球蛋白、转氨酶、凝血功能、血糖、血脂及胆碱酯酶统计学均有差异;（3）三组患者并发的上消化道出血、肝肾综合征在本次分析中差异无统计学意义,而腹水、肝性脑病两种并发症不论在数量上还是等级上均有差异,其严重程度分别为：重型Ⅱ组＞重型Ⅰ组＞肝硬化失代偿组;（4）对三组患者的预后分析发现,肝硬化失代偿患者预后明显优于重型Ⅰ、Ⅱ组的患者.结论 三组患者各有其临床特点及预后,故考虑慢性重型肝炎可分为二个亚型,在慢性肝炎基础上发生的肝衰竭为慢性重型肝炎Ⅰ型,在肝硬化基础上发生的肝衰竭为慢性重型肝炎Ⅱ型.肝硬化失代偿独立命名.     

Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group.

BACKGROUND. The value of beta-adrenergic-antagonist drug therapy for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices is uncertain, both positive and negative study results having been reported. METHODS. In this study, we analyzed data on individual patients from four randomized, controlled trials to assess the efficacy of this treatment. Of the 589 patients studied, 286 received a beta-adrenergic-antagonist drug (propranolol in 203 and nadolol in 83) and 303 received placebo. RESULTS. After two years, the mean (+/- SE) percentage of patients who had had no upper gastrointestinal bleeding was 78 +/- 3 percent in the beta-adrenergic-antagonist treatment group and 65 +/- 3 percent in the control group (P = 0.002). The percentage of patients without fatal bleeding was 90 +/- 2 percent in the treatment group and 82 +/- 3 percent in the control group (P = 0.01). The percentage of patients surviving after two years was 71 +/- 3 percent in the treatment group and 68 +/- 3 percent in the control group (P = 0.34). After age and severity of cirrhosis were taken into account, the survival rate was better in the treatment group (P = 0.09). The percentage of surviving patients who had had no bleeding after two years was 62 +/- 3 percent in the treatment group and 53 +/- 3 percent in the control group (P = 0.04). Both propranolol and nadolol prevented a first episode of bleeding. Severe cirrhosis and especially the presence of ascites were associated with bleeding (P less than 0.001) and death (P less than 0.001) in both groups. The efficacy of beta-adrenergic-antagonist therapy in the prevention of bleeding (P less than 0.001) and of fatal bleeding (P = 0.004) and in the prevention of bleeding or death (P = 0.005) was the same after adjustment for cause and severity of cirrhosis, ascites, and size of varices. CONCLUSIONS. Propranolol and nadolol are effective in preventing first bleeding and reducing the mortality rate associated with gastrointestinal bleeding in patients with cirrhosis, regardless of severity.     

Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen

BACKGROUND: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. METHODS: We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. RESULTS: We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). CONCLUSIONS: Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs.     

Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices

We conducted a prospective, randomized, multicenter, single-blind trial of propranolol as compared with placebo in the prevention of first upper gastrointestinal tract bleeding in patients with cirrhosis of the liver. A total of 230 patients (90 percent with alcoholism and 46 percent with a Child-Pugh grade C classification) with large esophageal varices without previous bleeding were randomly assigned to receive either propranolol (n = 118) or placebo (n = 112), after they had been divided into two groups according to the severity of their liver disease. The end points of the study were bleeding and death. The dose of propranolol was progressively increased to decrease the heart rate by 20 to 25 percent. The final doses were 40 mg of conventional propranolol and 160 and 320 mg of long-acting propranolol daily in 22 percent, 60 percent, and 18 percent of patients, respectively. The mean (+/- SD) follow-up time among survivors without bleeding was 436 +/- 172 days. The cumulative percentages of patients free of bleeding two years after inclusion in the study were 74 percent (95 percent confidence limits, 61 and 83) in the propranolol group and 39 percent (95 percent confidence limits, 15 and 69) in the placebo group (P less than 0.05). Cumulative two-year survival was 72 percent (95 percent confidence limits, 60 and 81) in the propranolol group and 51 percent (95 percent confidence limits, 37 and 64) in the placebo group (P less than 0.05). The advantage of propranolol over placebo was maintained when potentially confounding variables were adjusted with use of the Cox model. Side effects occurred in 17 percent of the patients who received propranolol and led to the stopping of treatment in 11 percent. We conclude that propranolol can decrease the incidence of first bleeding and death during a period of two years in patients with cirrhosis and large varices.     

泮托拉唑治疗消化性溃疡合并上消化道出血的临床价值评价

目的 观察泮托拉唑治疗消化性溃疡合并上消化道出血的临床疗效。方法 选取2015年5月~2018年3月我院收治的100例消化性溃疡合并上消化道出血患者为研究对象,随机分为实验组和对照组,各50例。对照组患者采用奥美拉唑治疗,实验组患者采用泮托拉唑治疗。比较两组临床疗效及不良反应情况。结果 实验组治疗总有效率高于对照组（96.00% vs 80.00%）,差异有统计学意义（P＜0.05）;实验组患者不良反应发生率低于对照组（6.00% vs 24.00%）,差异有统计学意义（P＜0.05）。结论 泮托拉唑治疗消化性溃疡合并上消化道出血临床疗效可靠,安全性高。