善得定与垂体后叶素治疗肝硬化并发上消化道出血的疗效比较

目的　比较奥曲肽 (善得定 )与垂体后叶素对肝硬化并发上消化道出血的止血效果。方法　将 60例肝硬化并发上消化道出血的患者随机分为两组。治疗组 3 1例 ,首次给善得定 10 0 μg静推 ,然后以 2 0 μg/h ,静滴 ,持续 48～ 96h ;对照组 2 9例 ,首次静推垂体后叶素 10IU ,继之以 0 1～ 0 3IU/min静滴 ,持续 48～ 96h ,其他治疗两组相同。结果　治疗组有效 2 9例 ,有效率为 93 5 % ,出现副反应 3例 ,副反应发生率为9 7%。对照组有效 2 1例 ,有效率为 72 4% ;出现副反应 11例 ,副反应发生率为 3 7 9%。结论　对肝硬化并发上消化道出血 ,善得定的效果显著优于垂体后叶素。     

加倍剂量善得定治疗食管胃底静脉曲线破裂出血的观察

目的：探讨加倍剂量善得定治疗食管,胃底静脉曲张破裂出血的疗效。方法：40例因食管,胃底静脉曲线破裂出血患随机分为加倍剂量组及常规剂量组,分别给预善得定50μg/h及25μg/h,维持静点,观察止血疗效。结果：加倍剂量组及常规剂量组善复得定治疗食管,胃底静脉曲张破裂出血均疗效明显,总有效率分别为94．74％和95．24％,两组无显性差异,结论：善得定是一种治疗食管,胃底静脉曲张破裂出血的有效药物,常规剂量25μg/h即可收到显疗效,无需无限制增大剂量。     

新凝灵与垂体后叶素治疗门脉性肝硬化并发上消化道出血的疗效比较

目的　比较新凝灵与垂体后叶素治疗门脉性肝硬化并发上消化道出血的疗效。方法　选择门脉性肝硬化并发上消化道出血 5 6例 ,随机分为 2组 ,新凝灵组 3 0例 ,男性 2 0例 ,女性 10例 ,年龄 (5 0± 6)岁 ,新凝灵 60 0mg ,静滴 1次 /d ,连用 4～ 5d ;垂体后叶素组 2 6例 ,男性 18例。女性 8例 ,年龄 (4 9± 16)岁 ,垂体后叶素 10 0U加入 10 %葡萄糖 5 0 0ml中持续静滴 ,速度 0 .2U/ml·min- 1 ,连用 3～ 5d。结果　新凝灵组 3 0例全部止血成功 ,垂体后叶素组 2 6例 ,只有 2 2例止血成功 ,两组止血成功率比较 ,新凝灵组优于垂体后叶素组 (P <0 .0 5 )。便潜血转阴天数及住院天数 ,新凝灵组分别为 (5 14± 1 2 )d ,(12 .0± 1.6)d ,而垂体后叶素组分别为 (6.7± 1.4)d ,(15 .8± 1.4)d。两组便潜血转阴时间与住院时间相比 ,新凝灵组均少于垂体后叶素组 (P均 <0 .0 1)。结论　应用新凝灵静滴治疗门脉性肝硬化并发上消化道出血 ,在止血效果、输血量、住院天数、大便潜血转阴等方面 ,明显优于垂体后叶素。     

善得定治疗食管静脉曲张破裂出血41例

近年来，同内外相继应用人工合成的八肽生长抑素类似物—善得定（Sandostatin）治疗食管静脉曲张破裂出血，取得了一定的疗效。我们应用该药治疗食管静脉曲张破裂出血41例，疗效亦较好，现报告如下。1对象和方法1．1对象选择我院近年收治的肝炎后肝硬变并食管静脉曲张破裂出血92例，随机分为二组，分别用善得定、垂体后叶素和双气囊二腔管（下称二胶管）治疗。A组即善得定治疗组41例，男32例，女9例，平均年龄45.07±11．32岁，B组即垂体后叶素治疗组32例，男25例，女7例，平均年龄41．19±9．13岁；C组为三腔管压迫止血组19例，男15例，…     

奥曲肽对食管静脉曲张破裂出血的疗效观察

目的观察奥曲肽对食管静脉曲张破裂出血的疗效。方法50例食管静脉曲张破裂出血住院病例（均为胃镜证实）随机分为两组：A组（25例）采用奥曲肽治疗，B组（25例）采用垂体后叶素治疗，观察两组止血效果。结果奥曲肽组止血成功率91．5％，垂体后叶素组成功率62％。结论奥曲肽治疗食管静脉曲张破裂出血疗效明显优于垂体后叶素。     

食管,胃底静脉曲张破裂出血止血药物疗效对比

为探讨慢性肝炎所致食管、胃底静脉曲张破裂出血的有效止血方法,我们将单独使用生长抑素、垂体后叶素、生长抑素加洛赛克、垂体后叶素加洛塞克进行疗效对比,以期为提高止血效果提供参考。1　对象和方法1.1　对象　慢性肝炎83例,临床诊断均符合1995年病毒性肝炎学术会议诊断方案。其中男70例,女13例;年龄14～71岁。出血前均经钡剂X线检查证实有食管、胃底静脉曲张。排除其他原因所致上消化道出血,有柏油样便和(或)呕血300ml以上。随机分成生长抑素组(A组)18例,垂体后叶素组(B组)21例,垂体后叶素加洛塞克组(C组)22例,生长抑素加洛塞克组(D组…     

生长抑素与垂体后叶素治疗肝硬化并上消化道大出血疗效比较

目的比较生长抑素与垂体后叶素治疗肝硬化并上消化道大出血疗效。方法82例出血患者随机分为两组：A组45例，给予生长抑素治疗；B组37例，给予垂体后叶素治疗。结果A、B两组总止血率分别为822％和51、4％，P〈0.05，统计学上有显著差异。结论生长抑素治疗食管胃底静脉曲张破裂出血的临床疗效要优于垂体后叶素，是治疗食管胃底静脉曲张破裂出血的比较理想的药物。     

不明原因下消化道出血血管造影及导管治疗

目的：明确下消化道出血原因及止血治疗。材料与方法：对２１例不明原因下消化道出血病人行选择性血管造影，并经导管灌注垂体后叶素、明胶频繁绵条栓塞。结果：血管造影诊断阳性率为９７％，１６例病人治疗后均止血。结论：血管造影是诊断不明原因下消化道出血的首选方法，垂体后叶素灌注短期（１周）止血效果显，但易复发，栓塞治疗更重要的在于确定病变部位以利手术。     

奥曲肽与洛赛克联合治疗肝硬化合并上消化道出血32例临床观察

目的 探讨奥曲肽联合洛赛克治疗肝硬化合并上消化道出血的临床疗效.方法 将临床统计的63例肝硬化合并上消化道出血患者随机分为治疗组和对照组,治疗组32例,对照组31例.治疗组32例患者行奥曲肽联合洛赛克静脉滴注治疗,疗程为3 d;对照组行垂体后叶素静脉滴注治疗,疗程为3 d.统计两组患者止血时间,以及患者血压、心率的恢复情况.结果 治疗组32例患者中,经过治疗29例止血,治疗后再出血3例,再出血率为9.38%;对照组31例患者中,经过治疗止血17例,治疗后再出血9例,再出血率为29.03%.结论 奥曲肽联合洛赛克治疗肝硬化合并上消化道出血止血率高,再出血率低,值得临床进一步推广使用.     

多药联合治疗支气管扩张并大咯血50例体会

目的：观察垂体后叶素＋硝苯地平＋止血敏＋强的松联用对支气管扩张大咯血的临床治疗效果。方法：94例患者随机将其分为A、B两组：A组44例,B组50例。A组首次使用垂体后叶素5U溶于20mL生理盐水后静脉缓推,以后500mL液体中加入20U维持滴注,每天总量20～40U。同时并用止血敏1g加入葡萄糖250mL稀疏释后静滴,2～3次/d。口服硝苯地平10mg,3～4次/d。B组首次使用5U垂体后叶素溶于20mL生理盐水后静脉缓推,以后500mL液体中加入20u维持滴注,每天总量20～40U。同时并用止血敏1g加入葡萄糖250mL稀疏释后静滴。2～3次/d。口服硝苯地平10mg,3～4次/d,强的松30mg/d。结果：A组有效止血44例,占95%,平均止血时间7d;B组有效止血48例,占96%,平均止血时间5d（P〈0.05）。结论：垂体后叶素＋硝苯地平＋止血敏＋强的松联用能缩短支气管扩张大咯血治疗时间。     

Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

Objective

To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment.

Methods

Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates.

Results

The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435).

Conclusion

Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.     

中脑周围非动脉瘤性蛛网膜下腔出血的CT与临床分析

目的 :分析中脑周围非动脉瘤性蛛网膜下腔出血 (PNSH )的CT与临床表现。材料和方法 :根据CT图像示是否合并脑室内出血 ,将 6 1例PNSH分为A、B两组 ,记录出血部分、出血量、入院时意识水平及是否出现脑血管痉挛、迟发性脑缺血、急性脑积水、颅内再出血等并发症。结果 :两组出血量有差别 ,A组患者中意识水平正常 ,住院期间发生脑血管痉挛 3例 ( 0 8% ) ,脑积水 3例 ( 0 8% ) ;B组入院检查意识出现嗜睡及局部神经症状 ,产生脑血管痉挛 2例 ( 0 9% ) ,迟发性脑缺血 9例 ( 4 0 9% ) ,急性脑积水 14例 ( 6 3 6 % ) ,颅内再出血 3例 ( 13 6 % )。结论 :PNSH合并脑室内出血 ,伴脑血管痉挛、迟发性脑缺血、急性脑积水、颅内再出血等并发症的出现率高于没有脑室出血的PNSH ,且预后差。     

Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

Objective

To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding.

Materials and Methods

From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined.

Results

The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 ± 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding.

Conclusion

Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.     

消化内镜联合四联疗法对胃溃疡伴活动性出血的疗效观察及再出血原因分析

目的观察消化内镜联合四联疗法对胃溃疡伴活动性出血的治疗效果,并分析其再出血的相关危险因素。方法选取2016年9月至2018年9月焦作煤业集团有限责任公司中央医院消化科收治的88例胃溃疡伴活动性出血患者作为研究对象,并按照随机数表法将其随机分为观察组与对照组,每组44例,观察组患者采用消化内镜联合四联疗法治疗,对照组患者单纯采用四联疗法治疗,对比两组患者的临床疗效,观察两组患者治疗后再出血的发生情况,并分析再出血的相关危险因素。结果治疗2周后,观察组患者的临床疗效明显优于对照组(Mann-Whitney U=708.500,Z=-2.380,P=0.017);经多因素Logistic回归分析发现,血红蛋白含量低、溃疡为A1期及未联合消化内镜治疗是患者再出血的独立危险因素(OR=1.792、1.165、1.879,P=0.015、0.022,0.031)。结论胃溃疡伴活动性出血患者应用消化内镜联合四联疗法治疗,可有效提高治疗效果,降低再出血发生率,且患者血红蛋白含量低及溃疡为A1期也是胃溃疡伴活动性出血患者再出血的独立危险因素,应加以重视。     

The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

Objective

To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography.

Materials and Methods

We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates.

Results

Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure.

Conclusion

The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.     

Transcatheter arterial embolization in patients with bleeding duodenal ulcer: an alternative to surgery

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) in patients with bleeding/rebleeding duodenal ulcers.

Material and Methods: Over a 6-year-period, 40 consecutive patients with bleeding/rebleeding after endoscopic therapy and/or surgery for duodenal ulcer were included in the study. Superselective angiographic catheterization and coil embolization were performed by the same interventional radiologist.

Results: Lasting hemostasis was achieved in 26 of 40 patients (65%). Transfusion requirement was reduced from median 14 (range 3-35) units of blood before TAE to 2 (range 0-53) units after TAE. Ten patients died, five because of continuous bleeding. No adverse effects as a result of TAE were seen.

Conclusion: TAE is an effective and safe treatment in a significant proportion of patients with bleeding duodenal/rebleeding ulcers after therapeutic endoscopy and/or surgery.     

奥美拉唑联合奥曲肽治疗肝硬化并发上消化道大出血

目的：探讨奥美拉唑联合奥曲肽治疗肝硬化并发上消化道大出血的疗效。方法：治疗组：选本院2004-11～2008-11,45例肝硬化并发上消化道大出血患者给予奥美拉唑联合奥曲肽治疗;对照组：选取同时期的48例肝硬化并发上消化道大出血患者给予奥曲肽治疗。比较两组止血时间、止血疗效及不良反应等。结果：治疗组止血有效者共40例,占88.89%,对照组止血有效者共33例,占68.75%,两组止血疗效相比较具有显著性差异,χ2=15.28,（P〈0.05）。治疗组平均止血时间、48h再出血率均由于对照组,两组相比χ2=14.95、χ2=13.22均（P〈0.05）具有统计学意义。结论：奥美拉唑联合奥曲肽治疗肝硬化并发上消化道大出血具有止血快、再出血率低及止血效果好等特点。     

内镜下套扎治疗食管静脉曲张破裂出血（附43例）

目的：探讨内镜下套扎治疗食管静脉曲张破裂出血的临床疗效。方法：对我院86例食管静脉曲张破裂出血患者分别给予内镜下套扎治疗与内科药物治疗,比较两组治疗疗效。结果：治疗组：止血成功率达90.7%,死亡率达4.7%,再出血率达11.6%。对照组则依次为69.8%、23.3%、32.6%。两组止血成功率、死亡率、再出血率的比较,均（P〈0.05）。结论：内镜套扎治疗食管静脉曲张破裂出血具有创伤小、止血迅速、临床疗效好,值得推广使用。     

Combined Transjugular Intrahepatic Portosystemic Shunt Plus Variceal Obliteration versus Transjugular Intrahepatic Portosystemic Shunt Alone for the Management of Gastric Varices: Comparative Single-Center Clinical Outcomes

PurposeTo compare the safety and clinical outcomes of combined transjugular intrahepatic portosystemic shunt (TIPS) plus variceal obliteration to those of TIPS alone for the treatment of gastric varices (GVs).Materials and MethodsA single-center, retrospective study of 40 patients with bleeding or high-risk GVs between 2008 and 2019 was performed. The patients were treated with combined therapy (n = 18) or TIPS alone (n = 22). There were no significant differences in age, sex, model for end-stage liver disease score, or GV type between the groups. The primary outcomes were the rates of GV eradication and rebleeding. The secondary outcomes included portal hypertensive complications and hepatic encephalopathy.ResultsThe mean follow-up period was 15.4 months for the combined therapy group and 22.9 months for the TIPS group (P = .32). After combined therapy, there was a higher rate of GV eradication (92% vs 47%, P = .01) and a trend toward a lower rate of GV rebleeding (0% vs 23%, P = .056). The estimated rebleeding rates were 0% versus 5% at 3 months, 0% versus 11% at 6 months, 0% versus 18% at 1 year, and 0% versus 38% at 2 years after combined therapy and TIPS, respectively (P = .077). There was no difference in ascites (13% vs 11%, P = .63), hepatic encephalopathy (47% vs 55%, P = .44), or esophageal variceal bleeding (0% vs 0%, P > .999) after the procedure between the groups.ConclusionsThe GV eradication rate is significantly higher after combined therapy, with no associated increase in portal hypertensive complications. This translates to a clinically meaningful trend toward a reduction in GV rebleeding. The value of a combined treatment strategy should be prospectively studied in a larger cohort to determine the optimal management of GVs.