凝血酶治疗新生儿上消化道出血疗效观察

新生儿上消化道出血是新生儿许多危重症的并发症之一 ,常因出血量大而危及生命。 1 999年 6月至 2 0 0 1年 6月收治新生儿上消化道出血患儿 2 8例 ,采用凝血酶治疗 ,疗效满意。现报告如下。1　资料与方法1 1　一般资料　 1 999年 6月至 2 0 0 1年 6月我科共收治新生儿上消化道出血患儿 52例 ,随机分为两组。治疗组 2 8例 ,男 1 6例 ,女 1 2例 ;足月儿 1 6例 ,早产儿 9例 ,过期产儿 3例 ;日龄 :<3ｄ 1 8例 ,～ 7ｄ 6例 ,>7ｄ 4例 ;基础疾病 :新生儿窒息 9例 ,缺氧缺血性脑病 1 1例 ,新生儿吸入性肺炎 3例 ,新生儿败血症 2例 ,新生儿硬肿症 3…     

凝血酶联合云南白药治疗上消化道出血的临床疗效

目的观察凝血酶联合云南白药治疗上消化道出血的临床疗效。方法将60例符合诊断标准的上消化道出血的病例,随机分为对照组和观察组,各30例。两组入院后在常规对症处理的基础上,对照组给予凝血酶治疗,观察组给予凝血酶联合云南白药治疗,比较两组治疗效果。结果两组治疗效果比较,总有效率分别为93%及83%,差异均具有显著统计学意义(P<0.05)。结论应用凝血酶联合云南白药是治疗上消化道出血的一种安全有效的方法。     

去甲肾上腺素与凝血酶交替使用治疗上消化道出血疗效观察

去甲肾上腺素激动α1受体使血管强烈收缩,临床上常将该药适当稀释后口服用于制止上消化道出血。而凝血酶的凝血过程,是由凝血因子参与的生化反应过程。凝血酶使可溶性纤维蛋白原转变为不溶性纤维蛋白,网罗血液中的有形成     

奥美拉唑联合凝血酶治疗上消化道出血疗效评估

目的探讨在上消化道出血患者中,应用奥美拉唑和凝血酶进行治疗的临床疗效。方法选取我院收治的上消化道出血患者52例进行分析,将其随机分为对照组和观察组,每组26例。对照组采用常规治疗方案,观察组在对照组的基础上加用奥美拉唑和凝血酶。观察两组患者的临床治疗效果,以及不良反应发生情况。结果观察组治疗有效率(96.2%)明显高于对照组(76.9%),患者止血时间短于对照组,差异具有统计学意义(P<0.05)。两组在不良反应发生率上相比差异不大,不具有统计学意义(P>0.05)。结论对于上消化道出血患者而言,应用奥美拉唑和凝血酶进行治疗的临床疗效更佳,显著缩短了患者的止血时间,且不良反应发生较少,是一种安全有效的治疗方法。     

奥美拉唑联合凝血酶治疗上消化道出血疗效观察

目的观察奥美拉唑联合凝血酶治疗上消化道出血的效果。方法将76例上消化道出血患者随机分为观察组和对照组各38例。对照组仅给予常规治疗,观察组在对照组治疗基础上给予奥美拉唑联合凝血酶治疗。观察比较2组的临床疗效。结果观察组总有效率为94.7%,高于对照组的84.2%,差异有统计学意义(P<0.05)。结论奥美拉唑联合凝血酶治疗上消化道出血疗效显著。     

凝血酶联合奥美拉唑治疗上消化道出血的疗效分析

目的探讨凝血酶联合奥美拉唑治疗上消化道出血的疗效。方法2011年10月-2012年10月本院共治疗上消化道出血患者80例,将其随机分为治疗组和对照组,两组均给予必要的基础治疗,并给予奥美拉唑静脉滴注．治疗组在此基础上加用凝血酶,观察两组患者的止血时间以及治疗有效率。结果治疗组止血时间为（29．61±6．13）h,显著少于对照组的（44．21±9．88）h,差异有统计学意义（P〈0．05）;治疗组总有效率为95．0％,对照组总有效率为80．0％,治疗组总有效率显著高于对照组,差异有统计学意义（P〈0．05）。结论凝血酶联合奥美拉唑治疗上消化道出血止血效果好,不良反应少,值得推广应用。     

奥美拉唑联合凝血酶治疗上消化道出血的疗效观察

目的 探讨奥美拉唑联合凝血酶治疗上消化道出血的临床疗效.方法 90例上消化道出血患者随机分为观察组与对照组,各45例.对照组给予奥美拉唑治疗,观察组给予奥美拉唑联合凝血酶治疗.对比两组患者临床疗效、输血量、止血时间、住院时间及不良反应发生情况.结果 观察组治疗总有效率为88.9％ 显著高于对照组的71.1％,差异具有统...     

凝血酶联合西咪替丁治疗新生儿上消化道出血疗效观察

目的:观察凝血酶、西咪替丁联合应用治疗新生儿上消化道出血的临床疗效。方法:64例新生儿上消化道出血患儿随机分为对照组30例和治疗组34例,在常规治疗的基础上,治疗组加用凝血酶和西咪替丁辅治。结果:总有效率治疗组97.1%,对照组73.3%,两组比较有显著性差异(χ2=5.590,P<0.05)。结论:凝血酶联合西咪替丁治疗新生儿上消化道出血疗效明显。     

凝血酶治疗新生儿上消化道出血的研究

目的　探讨凝血酶治疗新生儿上消化道出血的临床效果。方法　对 2 0 0 0年至今收住院的新生儿上消化道出血患儿 17例 ,除常规综合疗法外 ,静脉滴注维生素K1 10mg/d ,连用 4～ 7d。结果　治疗组 17例 ,显效 16例 ,显效率 97% ,对照组 15例 ,显效 7例 ,显效率 40 % ,两组比较有明显差异性 (P <0 0 0 1)。治疗组止血时间 1 3 5± 0 6d ,对照组平均止血时间 3 2±0 5d ,两组比较有明显差异性 (P <0 0 0 1)。结论　凝血酶治疗新生儿上消化道出血为一种安全、方便 ,无副作用的首选止血药物     

洛赛克加凝血酶治疗脑出血并发上消化道出血疗效观察

目的观察洛赛克加凝血酶治疗脑出血并发上消化道出血的疗效。方法将44例脑出血并发上消化道出血患者随机分为洛赛克加凝血酶治疗组21例和雷尼替丁加凝血酶对照组23例,比较两组的治疗效果。结果洛赛克加凝血酶治疗组总有效率达85.7%,疗效优于雷尼替丁加凝血酶对照组(P<0.05),未见明显不良反应。结论洛赛克加凝血酶治疗脑出血并发消化道出血疗效显著,用药方便安全,有应用价值。     

Dose-effect relationship for several coagulation markers during administration of the direct thrombin inhibitor S 18326 in healthy subjects

AIMS: We conducted a phase I placebo-controlled trial with two i.v. doses (0.5 mg h-1 and 3 mg h-1) of S 18326, a selective thrombin inhibitor that interacts with the catalytic site of thrombin, with the aim to study the relationships between increasing plasma levels of S 18326 and changes in coagulation tests and thrombin generation markers. METHODS: Thirty-six healthy male volunteers were divided into three groups. In each group, 10 volunteers were randomly assigned to receive S 18326 and two to receive a placebo. Following a bolus of 4.5 mg, doses were 0.5 mg h-1 in the first group and 3 mg h-1 in the two other groups, administered as an i.v. infusion for 24 h. Blood was drawn repeatedly up to 36 h after the bolus, and tested for the activated clotting time (ACT) and activated partial thromboplastin time (APTT). The APTT reagent was chosen among five commercial reagents to yield a linear increase in the clotting time among possible therapeutic S 18326 concentrations in vitro. To accurately measure the thrombin-inhibiting effects of low doses of S 18326 (< 0.5 microm), we developed a specific chromogenic assay. We also measured F1 + 2 prothrombin fragment levels to assess the effect of S 18326 on thrombin generation in vivo. RESULTS: A two-compartment pharmacokinetic model was fitted to the S 18326 plasma concentration vs time data by using population pharmacokinetic methods. Results of the pharmacodynamic-pharmacokinetic relationships showed that both the ACT and APTT methods yielded a linear increase according to the S 18326 concentration measured using a highly sensitive analytical method. At the end of infusion, ACT was prolonged 1.20 and 1.95-fold in the 0.5 mg h-1 and the 3 mg h-1 groups, respectively, and APTT was prolonged 1.27 and 2.75-fold. Thrombin inhibition plateaued above 0.5 microm of S 18326 according to an Emax model, confirming that the test was highly sensitive. F1 + 2 levels fell significantly after the 24 h S 18326 infusion (0.83 nm to 0.6 nm and 0.80 nm to 0.44 nm in the 0.5 mg h-1 and the 3 mg h-1 groups, respectively), but remained stable after the placebo infusion. CONCLUSIONS: Our results support specific monitoring of the thrombin inhibitor S 18326 with ACT and APTT to establish the safety range of the drug in further studies. Moreover, the fall in F1 + 2 prothrombin fragments suggests that S 18326 effectively reduces the retroactivation of factors V and VIII by thrombin.     

全胃切除术后两种消化道重建术的效果比较

目的 比较改良袢式空肠代胃术与P型空肠代胃术的优缺点及临床应用价值.方法 56例胃癌患者依据胃切除术后消化道重建方式分为两组,观察组35例采取改良袢式空肠代胃术;对照组21例采取P型空肠代胃术,比较两组临床效果.结果 两组手术时间和术中出血量差异无统计学意义(P＞0.05).观察组排空时间[(61±23)min]较对照组[(37±19)min]长(t=3.03,P＜0.05),每次饮食量[(308±44) ml]较对照组[(262±34) ml]高(t=2.55,P＜0.05),每天饮食次数[(4.2±1.2)次]较对照组[(5.7±2.3)次]少(t=2.46,P＜0.05).观察组术后并发症发生率(14.3％)显著低于对照组(42.9％)(x2=5.71,P＜0.05).结论 全胃切除术后,采用改良袢式空肠代胃术重建消化道,相对于P型空肠代胃术,能有效提高患者术后生活质量,降低并发症发生率,但并未使手术过程复杂化.     

三黄散治疗肝硬化并发上消化道出血疗效观察

目的 探讨三黄散治疗肝硬化并发上消化道出血的临床效果.方法 将肝硬化并发上消化道出血患者60例随机分为观察组和对照组,对照组给予常规西医综合治疗措施,观察组在此基础上给予三黄散治疗,评估两组患者治疗效果 结果 观察组患者大便潜血转阴及住院时间均短于对照组,两组比较差异有统计学意义(尸＜0.05).观察组总有效率为93.33％,对照组为66.67％,两组比较差异有统计学意义(P＜0.05).两组治疗过程均无明显不良反应发生.结论 三黄散治疗肝硬化并发上消化道出血临床效果明确、安全性高,值得在临床上应用.     

中西医结合治疗144例上消化道出血的疗效观察

目的 对中西医结合治疗上消化道出血的临床效果进行分析.方法 有144例患者采用中西医结合治疗,设为观察组;另有144例患者采用西医治疗,设为对照组.并对这两组患者的治疗效果进行分析对比.结果 观察组治疗的总有效率为91.67%,高于对照组的81.94%,差异有统计学意义（P〈0.05）.结论 采用中西医结合的方法治疗上消化道出血患者,效果明显,有临床应用价值.     

奥曲肽垂体后叶素治疗肝硬化上消化道出血的疗效分析

目的:评价奥曲肽对肝硬化上消化道出血的临床疗效。方法:将肝硬化上消化道出血患者随机分为两组,治疗组30例,对照组30例。治疗组在常规治疗基础上加用奥曲肽;对照组在常规治疗基础上加用垂体后叶素。结果:治疗组的总止血率优于对照组。结论:奥曲肽对肝硬化上消化道出血有较好疗效,可作为肝硬化上消化道出血的有效治疗措施之一。     

甘露醇对动物静脉血栓形成及凝血时间的影响

目的:研究甘露醇对动物实验性血栓形成及凝血时间的影响;方法:给大白鼠颈外静脉、家兔耳缘静脉及小白鼠尾静脉注射10%～20%甘露醇100～200mg·kg-1,观察其对动物体外血栓形成及凝血时间的影响.结果:20%甘露醇200 mg·kg-1对大白鼠、家兔体外血栓形成有促进的作用,促进率分别为30.6%,31.5%;10%甘露醇对大白鼠和家兔体外血栓形成几乎无促进作用,与生理盐水比较差异无显著性(P＞0.05);10%～20%甘露醇100～200 mg·kg-1对小白鼠体外凝血时间具有缩短作用,与生理盐水比较差异有显著性(P＜0.05).结论:20%甘露醇200 mg·kg-1对大白鼠和家兔体外血栓形成有弱的促进作用,不同浓度甘露醇对小白鼠凝血时间均有缩短,     

急诊内镜诊治上消化道出血的临床分析

目的探讨急诊内镜检查对上消化道出血诊断与治疗的作用与效果。方法选取2008年1月至2008年12月收治的上消化道出血患者83例,分析患者消化道出血病因,内镜诊疗时间对病因检出率的影响。结果患者进行内镜诊疗的时间在12h以内与12～24h的检出率相比差距无统计学意义(P>0.05),12h以内检出率相比25～48h检出率显著提高(P<0.01)。结论内镜检查在上消化道出血急诊中具有较好的临床价值,在诊断与治疗中均有良好的效果,诊断时间最好不要超过12h。     

Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU

Background: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD. Objective: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.Design: Retro-and prospective follow-up.Patients: Post-operative patients with mechanical ventilation (MV) for 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10–91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67, range 18–85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.Results: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p>0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% CI 0.5–1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p>0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% CI 48–113) in the non-SDD group versus 19 (95% CI 8–22) in the SDD group (adjusted hazard ratio 4.5 (95% CI 2.9–7.1)). Conclusion: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.