奥美拉唑联合内镜下金属夹治疗消化性溃疡活动性出血的疗效观察

目的:观察内镜下金属夹联合静脉注射奥美拉唑(OME)治疗及单用OME对消化性溃疡活动性出血患者的疗效。方法:将75例胃镜证实的消化性溃疡并活动性出血患者按随机对照的方法分成2组。①治疗组:内镜下金属夹联合静脉注射奥美拉唑40mg2次/d治疗,疗程1周。②对照组:单用静脉注射奥美拉唑40mg,2次/d,疗程1周。治疗期间观察止血时间、再出血情况、输血量等。结果:治疗组止血总有效率94.1%,对照组止血总有效率73.2%,治疗组治愈率明显优于对照组(χ2=5.69,P<0.05),差异有显著意义。再出血率治疗组为2/34(5.9%)、对照组为11/41(26.8%),P<0.05。治疗组的止血时间与对照组相比,差异有显著性意义(P<0.05)。治疗组的输血量(3.1±2.0)单位(每单位200ml),对照组的输血量(2.2±1.9)单位,差异无显著意义(P>0.05)。结论:内镜下金属夹联合静脉注射奥美拉唑治疗消化性溃疡活动性出血患者,疗效好,再出血率降低,止血时间缩短,优于单用OME组,值得临床推广应用。     

内镜乳头括约肌切开对胆囊排空功能的影响

目的观察乳头括约肌切开术(EST)对胆囊排空功能的影响。方法以超声测定38例患 者行EST前1d，术后2周、1月、3月的空腹胆囊体积；并于脂餐后20～120min每隔20min检测餐后胆囊体积，以不同时间的最小值计算出胆囊排空率。结果EST术后空腹胆囊体积及脂餐后胆囊体积较术前明显缩小，1月后趋于稳定，在术后3月空腹胆囊体积由术前(31.4±10.6)ml下降为(17.2±8.7)ml，差异有非常显著性(P＜0.01)；脂餐后胆囊体积由(18.2±5.6)ml下降为(7.1±2.5)ml，差异有非常 显著性(P＜0.01)；胆囊排空率由(4l.9±13.4)％上升为(59.9±11.7)％，差异有非常显著性(P＜0.01)。结论EST后胆囊排空功能增强。     

钛金属夹与肾上腺素盐水注射法治疗消化性溃疡出血的对照研究

目的对照研究内镜下注射肾上腺素盐水与钛金属夹钳夹法治疗消化性溃疡出血的疗效。方法将68例消化性溃疡出血的病人(男40例,女28例,平均年龄42.62±3.57岁)分成金属夹组(n=35)和注射组(n=33),进行内镜止血治疗。结果两组病例均即时止血,两组的再出血率分别为5.71％(2/35)和9.09％(3/33)(P>0.05),两组治疗相关性并发症发生率分别为0％和42％(14/33)(P<0.01)。结论应用钛金属夹治疗上消化性溃疡出血具有设备简单、疗效好、安全性高、几无并发症等优点,值得推广应用。     

内镜注射结合静脉注射奥美拉唑对消化性溃疡活动性出血的疗效研究

体内、外研究表明,止血成功和胃内pH值密切相关,迅速抑制胃酸是药物治疗的关键,对内镜下有血管显露和活动性出血的溃疡出血患,单纯药物治疗的效果欠佳,内镜下介入治疗是首选方法。内镜与药物治疗结合,可降低患的再出血率、手术率和死亡率,本采用随机对照的研究方法,对比内镜注射治疗联用不同剂量的抑酸药奥美拉唑(OME)与单用OME治疗溃疡活动性出血的疗效。     

内镜下选择性组织粘合剂注射治疗肝硬化食管静脉曲张破裂出血的探讨

目的 探讨内镜下选择性注射组织粘合剂治疗肝硬化食管静脉曲张破裂出血的近期止血和持续止血效果。方法 将40例肝炎后肝硬化食管静脉曲张破出血患者分为组织粘合剂注射治疗组(A组，20例)和对照组(B组，20例)，A组予组织粘合剂(氰丙烯酸盐)1ml及生理盐水2ml以三明治夹心法选择性注入于破裂血管内，B组予垂体后叶素静脉滴注，持续7天。结果 氰丙烯酸盐治疗组中20例均获立即止血(止血率100％)，3天内再出血1例(成功率95％)，2周内持续止血18例(成功率90％)，B组3日内止血13例(65％)，P＜0．05，2周内持续止血10例(50％)，P＜0．01。结论 内镜下选择性注射组织粘合剂治疗肝硬化食管静脉曲张破裂出血，安全，有效。     

2型糖尿病磺脲类失效的强化胰岛素治疗—胰岛素有效剂量及相关因素分析

目的　探讨2型糖尿病磺脲类失效患者应用强化胰岛素治疗的有效胰岛素剂量及相关因素。方法　61例磺脲素失效的2型糖尿病患者根据曾是否应用胰岛素分为2组，即初次应用胰岛素组(组1)和已应用胰岛素组(组2)。结果　组2的有效胰岛素剂量显著高于组1(36.2±10.6IU/dvs30.1±10.5IU/d,P＜0.05)。在组2中，其与C肽释放曲线的0.5h、1h值呈显著性负相关(分别是r=-0.52，P＜0.05；r=-0.56，P＜0.05)；而在组1中，其与糖耐量试验的餐后1h血糖值呈显著性正相关(r=0.42，P＜0.01)。     

小剂量心得安加川芎嗪预防食管静脉曲张破裂出血的实验与临床研究

目的探讨小剂量心得安与川芎嗪联用预防肝硬变食管静脉曲张破裂出血(EVB)复发的疗效、副反应及其作用机制.方法在用药前后采用血管插管法对8只肝硬变犬血流动力学指标进行检测.在临床上对治疗组(n=38,po心得安10 mg+川芎嗪50 mg,3次/d)和安慰剂组(n=36,服维生素B110 mg+维生素PP 50 mg,3次/d)进行前瞻性对照研究,随访2 a,并用彩色多普勒超声仪监测其门脉系统血流动力学变化.结果小剂量心得安与川芎嗪联用可使肝硬变犬WHVP,HVPG,Rpv及Ppv明显降低,对HR,MAP无明显影响.用药4 wk后治疗组患者Qpv,Qsv,Dpv,Dsv及Qaz均显著下降(分别为1439±494 vs1152±387,948±436 vs 529±362,1.43±0.25vs1.36±0.28,1.20±0.24vs0.85±0.16,0.94±1.18vs0.71±1.04,P＜0.05/0.01);随访2 a,安慰剂组再出血率和死亡率均显著高于治疗组(P＜0.05);临床上未见明显副作用.结论小剂量心得安与川芎嗪联用预防EVB复发是安全有效的.     

无痛内镜下注射止血联合大剂量洛赛克治疗消化性溃疡出血的临床研究

[目的]观察无痛内镜下注射止血联合大剂量洛赛克治疗消化性溃疡出血的临床效果。[方法]选择诊断为消化性溃疡出血患者90例,随机分为大剂量洛赛克治疗组(A组)、无痛内镜止血联合常规剂量洛赛克治疗组(B组)、无痛内镜止血联合大剂量洛赛克治疗组(C组),每组30例。A组患者用洛赛克40mg静脉推注,每日3次,连续5d;B组患者于内镜检查前先用洛赛克40mg静脉推注,于异丙酚镇静下行内镜检查出血点,注射1/10 000肾上腺素止血,内镜止血后继续用洛赛克40mg静脉推注,每日2次,连续5d;C组患者除内镜止血后静脉推注洛赛克40mg,每日2次改为每日3次外,其余同B组。[结果]与A组比较,B、C组的止血时间缩短、再出血率下降、手术率及住院时间降低,差异有统计学意义(P0.05);与B组比较,C组的止血时间缩短、再出血率下降、手术率及住院时间降低,差异有统计学意义(P0.05)。[结论]无痛内镜下注射止血联合大剂量洛赛克治疗消化性溃疡出血安全有效,符合基层医院的条件,也符合患者舒适化医疗的需求,值得在基层医院推广。     

内镜超声检查对胆总管扩张的诊断价值

目的评价内镜超声检查(EUS)对胆总管扩张的病因诊断价值。方法32例患者在EUS 前均做过体表B超检查。患者的病因诊断均在病理或手术(包括奥狄括约肌切开取石)后确定。结果(1)32例患者的B超及EUS对胆总管直径的测定结果分别为(1.04±0.41)cm和(0.97±0.36)cm,两者差异无显著性(P＞0.05)。(2)对胆总管扩张的病因诊断率EUS为29/32(90.6％),明显高于体表B超19/32(59.4％),P＜0.01;X线电子计算机断层扫描(CT)21/32(65.6％),P＜0.05。EUS与磁共振胆胰管成像(MRCP)13/16(81.3％)和内镜逆行胰胆管造影(ERCP)31/32(96.9％)诊断率 相似(P＞0.05)。结论EUS对胆总管扩张的病因有很高的诊断价值。     

内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效

目的探讨内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效。方法选取210例消化性溃疡出血的患者,根据治疗方式分为3组,各70例。内镜注射组为内镜下注射肾上腺素,电凝组治疗方式为电凝联合注射肾上腺素,钛夹组为钛夹联合注射肾上腺素,术后观察比较3组止血效果与术后并发症情况。结果 3组首次止血率、止血失败率比较无统计学差异(P0.05),止血成功率、再出血率比较差异显著(P0.05)。钛夹组止血成功率、再出血率与内镜注射组比较,差异有统计学意义(P0.05)。3组患者均未出现穿孔及其他并发症。结论内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血疗效相当,且创伤较小,并发症少。     

Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection: a prospective randomized comparative trial

BACKGROUND: Epinephrine injection is the most common endoscopic therapy for peptic ulcer bleeding. Controversy exists concerning the optimal dose of proton pump inhibitors (PPI) for patients with bleeding peptic ulcers after successful endoscopic therapy. The objective of this study was to determine the optimal dose of PPI after successful endoscopic epinephrine injection in patients with bleeding peptic ulcers. METHODS: A total of 200 peptic ulcer patients with active bleeding or nonbleeding visible vessels (NBVV) who had obtained initial hemostasis with endoscopic injection of epinephrine were randomized to receive omeprazole 40 mg infusion every 6 h, omeprazole 40 mg infusion every 12 h or cimetidine (CIM) 400 mg infusion every 12 h. Outcomes were checked at 14 days after enrollment. RESULTS: Rebleeding episodes were fewer in the group with omeprazole 40 mg infusion every 6 h (6/67, 9%) as compared with that of the CIM infusion group (22/67, 32.8%, p < 0.01). The volume of blood transfusion was less in the group with omeprazole 40 mg every 6 h than in those groups with omepraole 40 mg infusion every 12 h (p= 0.001) and CIM 400 mg infusion every 12 h (p < 0.001). The hospital stay, number of patients requiring urgent operation, and death rate were not statistically different among the three groups. CONCLUSION: A combination of endoscopic epinephrine injection and a large dose of omeprazole infusion is superior to combined endoscopic epinephrine injection with CIM infusion for preventing recurrent bleeding from peptic ulcers with active bleeding or NBVV.     

Endoscopic hemoclip versus triclip placement in patients with high-risk peptic ulcer bleeding

BACKGROUND: Hemoclip placement is an effective endoscopic therapy for peptic ulcer bleeding. Triclip is a novel clipping device with three prongs over the distal end. So far, there is no clinical study concerning the hemostatic effect of triclip placement. AIM: To determine the hemostatic effect of the triclip as compared with that of the hemoclip. METHODS: A total of 100 peptic ulcer patients with active bleeding or nonbleeding visible vessels received endoscopic therapy with either hemoclip (N = 50) or triclip placement (N = 50). After obtaining initial hemostasis, they received omeprazole 40 mg intravenous infusion every 12 h for 3 days. The main outcome assessment was hemostatic rate and rebleeding rate at 14 days. RESULTS: Initial hemostasis was obtained in 47 patients (94%) of the hemoclip group and in 38 patients (76%) of the triclip group (P= 0.011). Rebleeding episodes, volume of blood transfusion, the hospital stay, numbers of patients requiring urgent operation, and mortality were not statistically different between the two groups. CONCLUSION: Hemoclip is superior to triclip in obtaining primary hemostasis in patients with high-risk peptic ulcer bleeding. In bleeders located over difficult-to-approach sites, hemoclip is more ideal than triclip.     

Comparison of oral omeprazole and endoscopic ethanol injection therapy for prevention of recurrent bleeding from peptic ulcers with nonbleeding visible vessels or fresh adherent clots

OBJECTIVES: Omeprazole is a potent inhibitor of gastric acid secretion. Recently it was reported that p.o. omeprazole therapy reduced the rebleeding rate in patients with nonbleeding visible vessels or adherent clots. The aim of this study was to ascertain whether p.o. administration of omeprazole can be an effective alternative to endoscopic injection therapy in peptic ulcers with stigmata of recent hemorrhage. METHODS: A total of 101 patients who had peptic ulcer bleeding based on endoscopic findings of nonbleeding visible vessels or fresh adherent clots were randomly assigned to receive omeprazole (40 mg p.o. every 12 h) or endoscopic ethanol injection therapy. RESULTS: Rebleeding rates were 22.9% (11 of 48) in the omeprazole group and 20.8% (11 of 53) in the endoscopic injection therapy group. The rebleeding rates of clinical significance were 14.6% and 13.2%, respectively. There was no significance difference in the rebleeding rate, requirement for surgery, total units of blood transfused, or mortality between the two groups. CONCLUSIONS: Oral omeprazole administration is comparable to endoscopic ethanol injection therapy for prevention of rebleeding in patients with nonbleeding visible vessels or adherent clots.     

The influence of intravenous omeprazole on intragastric pH and outcomes in patients with peptic ulcer bleeding after successful endoscopic therapy--a prospective randomized comparative trial.

BACKGROUND/AIMS: The role of omeprazole in preventing rebleeding in patients with peptic ulcer bleeding after successful endoscopic therapy has been controversial. In this study, we used 3 different formulas of intravenous omeprazole in the above patients. We wished to compare the intragastric pH and outcomes among them. METHODOLOGY: Between July 1996 and May 1997, after having obtained initial hemostasis with endoscopic therapy, a total of 20 patients with peptic ulcer bleeding (spurting/oozing/non-bleeding visible vessel: 6/4/10) received intravenous bolus of omeprazole 20 mg every 3 hours; 20 patients (3/5/12) received intravenous bolus of omeprazole 40 mg every 6 hours; and, 20 patients (5/4/11) received intravenous bolus of omeprazole 80 mg every 12 hours for 3 days. One intragastric pH meter (Gastrograph Mark III, Medical Instruments Corp. Switzerland) was used to record 24-hour intragastic pH. RESULTS: The intragastric pH in the patients receiving omeprazole 20 mg every 3 hours was 6.1, 6.0-6.2 (mean: 95% CI); in patients receiving omeprazole 40 mg every 6 hours it was 6.4, 6.2-6.5; and, in patients receiving omeprazole 80 mg every 12 hours it was 5.8, 5.7-5.9. The duration of intragastric pH > 6.0 in omeprazole 20 mg every 3 hours was 70.9%, 57.3%-84.4% (mean: 95% CI); in omeprazole 40 mg every 6 hours it was 83.1%, 73.1%-93.1%; and, in omeprazole 80 mg every 12 hours it was 66%, 51.5%-80.4%. Patients with peptic ulcers receiving omeprazole 40 mg intravenous bolus every 6 hours had the highest intragastric pH as compared with the other 2 groups (p < 0.0001). There were no significant differences concerning rebleeding rates, volume of blood transfusion, hospital stay, numbers of operation and mortality among the 3 groups. CONCLUSIONS: After initial hemostasis had been obtained, patients with peptic ulcer bleeding receiving 40 mg intravenous bolus every 6 hours had the highest intragastric pH. However, they had similar outcomes with the other 2 groups.     

Poor responders to intravenous omeprazole in patients with peptic ulcer bleeding

BACKGROUND/AIMS: Although proton pump inhibitors are highly effective in raising intragastric pH, there still remains a small group of patients who resist acid suppression. A high dose of omeprazole has been shown to reduce rebleeding rate in patients with bleeding peptic ulcers after endoscopic therapy. The primary objective of this study was to assess the incidence of peptic ulcer bleeding patients who were resistant to intravenous omeprazole. The secondary objective was to evaluate the relationship between intragastric pH and rebleeding rate in studied patients after successful endoscopic therapy. METHODOLOGY: Between Oct. 1996 and Aug. 1999, 88 bleeding peptic ulcer patients who had obtained initial hemostasis with endoscopic therapy were enrolled in this study. In these patients, 40 mg of omeprazole was given as intravenous bolus followed by 40 mg intravenously every 6 h for 3 days. Thereafter, omeprazole was given 20 mg orally once daily for 2 months. The intragastric pH was recorded for 24 hours after the first dose of omeprazole. The occurrence of rebleeding was observed for 14 days. RESULTS: The mean intragastric pH value of these 88 patients was 6.07, (95% CI: 5.91-6.23). Four patients (5%) were found to have omeprazole resistance (pH < 4.0, 50% of the time). By the 3rd days after entering the study, more patients with a mean pH < 6 rebled (5/25 vs. 3/63, p<0.05). CONCLUSIONS: About five percent of patients with peptic ulcer bleeding respond poorly to intravenous omeprazole. Rebleeding rate is higher in patients with a mean intragastric pH of less than 6.     

Effect of oral esomeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers

BACKGROUND: After endoscopic treatment of bleeding peptic ulcer, a high-dose infusion of omeprazole substantially reduces the risk of recurrent bleeding. The role of oral proton pump inhibitors for these patients is uncertain. The purpose of the present study was to assess whether the use of oral esomeprazole would reduce the frequency of recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. METHODS: Patients with actively bleeding ulcers or ulcers with non-bleeding visible vessels were treated with an epinephrine injection followed by thermocoagulation. After hemostasis had been achieved, they were randomly assigned in a double-blind fashion to receive esomeprazole (40 mg p.o. twice daily for 3 days) or placebo. The outcome measures studied were recurrent bleeding, blood transfusion requirement, surgery and death. RESULTS: A total of 70 patients were enrolled, 35 in each group. Bleeding recurred within 30 days in two patients (5.7%) in the esomeprazole group, as compared with three (8.6%) in the placebo group (P = 0.999). Blood transfusion requirement was 2.8 +/- 1.4 units in the esomeprazole group and 2.7 +/- 1.3 units in the placebo group (P = 0.761). Duration of hospitalization was 4.82 +/- 1.8 days in the esomeprazole group and 4.58 +/- 2.7 days in the placebo group (P = 0.792). No patients needed surgery for control of bleeding and no patients died in both groups. CONCLUSIONS: After successful endoscopic treatment of bleeding peptic ulcer, oral use of esomeprazole might offer no additional benefit on the risk of recurrent bleeding.     

A prospective,randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding

OBJECTIVES: Endoscopic heater probe thermocoagulation and hemoclip are considered to be safe and very effective in the treatment of bleeding peptic ulcer. So far, there are only few reports concerning hemostasis with endoscopic hemoclip. The aims of this study were to compare the hemostatic effects of both therapeutic modalities in patients with peptic ulcer bleeding. METHODS: A total of 80 patients with active bleeding or nonbleeding visible vessels were randomized to receive endoscopic hemoclip (n = 40) or heater probe thermocoagulation (n = 40). RESULTS: Initial hemostasis was achieved in 34 patients (85%) in the hemoclip group and 40 patients (100%) in the heater probe group (p = 0.01277). Rebleeding occurred in three patients (8.8%) in the hemoclip group and two patients (5%) in the heater probe group (p > 0.1). Among patients with difficult-to-approach bleeding, we obtained a better hemostatic rate in the heater probe group (nine of 11 patients vs three of 10, p = 0.02417). The volume of blood transfused after entry into the study, duration of hospital stay, number of patients requiring urgent surgery, and the mortality rate were not statistically significantly different between the two groups. CONCLUSIONS: For patients with peptic ulcer bleeding, heater probe thermocoagulation offers an advantage in achieving hemostasis than hemoclip. In difficult-to-approach bleeders, heater probe is a more suitable therapeutic modality.     

Non-Bleeding Visible Vessel Treatment: Perendoscopic Injection Therapy versus Omeprazole Infusion

Background: The non-bleeding visible vessel in a peptic ulcer is the highest risk factor for a bleeding recurrence among not actively bleeding lesions. Perendoscopic injection of sclerosing compounds is usually used as prophylaxis against rebleeding.

Methods: Forty-two patients with visible vessels in a peptic ulcer at an emergency endoscopic procedure have been studied: 21 patients underwent prophylactic perendoscopic hemostasis, and 21 patients were infused with omeprazole intravenously.

Results: Eight patients (19%), four in each group, had early rebleeding (within 48 h after the enrollment). There was no significant difference between the two types of treatment. At the endoscopic control after 48 h there were significantly more lesions with higher risk of rebleeding (Forrest IIa and IIb) in the group treated with perendoscopic hemostasis.

Conclusions: Our data suggest that omeprazole infusion is a valid alternative to injection treatment of non-bleeding visible vessels.     

A prospective, randomized trial of large- versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding

BACKGROUND: Endoscopic injection of epinephrine in the treatment of bleeding peptic ulcer is considered highly effective, safe, inexpensive, and easy to use. However, bleeding recurs in 6% to 36% of patients. The aim of this study was to determine the optimal dose of epinephrine for endoscopic injection in the treatment of patients with bleeding peptic ulcer. METHODS: One hundred fifty-six patients with active bleeding or nonbleeding visible vessels were randomized to receive small- (5-10 mL) or large-volume (13-20 mL) injections of a 1:10,000 solution of epinephrine. RESULTS: The mean volume of epinephrine injected was 16.5 mL (95% CI [15.7, 17.3 mL]) in the large-volume group and 8.0 mL (95% CI [7.5, 8.4 mL]) in the small-volume group. Initial hemostasis was achieved in all patients studied. The number of episodes of recurrent bleeding was smaller in the large-volume group (12/78, 15.4%) compared with the small-volume group (24/78, 30.8%, p = 0.037). The volume of blood transfused after entry into the study, duration of hospital stay, numbers of patients requiring urgent surgery, and mortality rates were not statistically different between the 2 groups. CONCLUSIONS: Injection of a large volume (>13 mL) of epinephrine can reduce the rate of recurrent bleeding in patients with high-risk peptic ulcer and is superior to injection of lesser volumes of epinephrine when used to achieve sustained hemostasis.     

Long-term Results of Heater Probe Thermocoagulation for Patients with Massive Peptic Ulcer Bleeding: A Prospective Observation

Objective : The long-term rebleeding rate of a bleeding ulcer after endoscopic hemostasis is, so far, not clear. The goal of this study is to present the natural history of bleeding ulcers after heater probe thermocoagulation. Methods : Between September 1986 and June 1991, we used heater probe to treat 202 patients with active bleeding or nonbleeding visible vessels at the ulcer craters. We were able to follow 159 patients for 2±7 yr (mean ± SD: 54.5 ± 19.9 months). Patients with active bleeding or nonbleeding visible vessels who did not receive endoscopic hemostasis or surgery in our previous studies served as controls. Results : The energy applied to each patient in the heater probe group was 886 ± 844 J (mean ± SD). The ultimate hemostatic rate in the heater probe group was 91.2% (145/159). In the period of long-term follow-up, there were 32 episodes of rebleeding in 24 patients (16.6%). Most rebleeding episodes (22/32) subsided spontaneously. Only one rebleeding patient died before a surgical attempt. The rebleeding rate was less than that of the controls (43/87, p < 0.0001). Conclusion : Heater probe thermocoagulation is very effective in arrest of peptic ulcer bleeding. In the long-term follow-up, heater probe thermocoagulation can decrease rebleeding rate in most patients with peptic ulcer hemorrhage.