不同剂量生大黄鼻饲对重症颅脑损伤患者上消化道出血的影响

目的:探讨不同剂量生大黄鼻饲对重症颅脑损伤患者上消化道出血的影响。方法:将180例重症颅脑损伤患者随机分成对照组、A组、B组、C组。对照组用20 ml温开水鼻饲;A组、B组、C组分别予生大黄16,33,60 mg/kg鼻饲,每天3次。观察四组患者上消化道出血发生率和腹泻发生率。结果:鼻饲生大黄7 d,B组、C组的消化道出血发生率低于对照组和A组;而B组的上消化道出血发生率和C组比较差异无统计学意义(P>0.05)。B组的腹泻发生率低于C组。结论:为了防止腹泻的发生,重型颅脑伤患者每次使用生大黄33 mg/kg,每天3次的鼻饲剂量防治上消化道出血的发生是可行的。     

重型颅脑损伤上消化道出血防治方法初探

目的　探讨重型颅脑损伤患者应用胃肠减压和早期管饲营养素预防和治疗上消化道出血的效果。方法　对 75例急重型颅脑损伤伴昏迷的患者常规置胃管行胃肠减压 ,并交替灌注流食或营养素 ,观察上消化道出血的情况。结果　 75例患者中有 6例发生消化道出血 ,其中死亡 1例。结论　颅脑损伤后尽早胃肠减压和营养素管饲 ,可以预防和治疗上消化道出血并发症。     

Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy

Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors(PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear.     

Basic requirements of gastroenterologists to treat upper gastrointestinal bleeding: competency and sedation issues

This article reviews the components of adequate training required for a gastroenterologist to treat upper gastrointestinal bleeding (UGIB). The current status of endoscopic simulators is critically reviewed to determine whether these should be part of the UGIB armamentarium in the training of individuals and whether credentialing could be accomplished through this method of instruction. Finally, the author discusses the appropriate use of sedation in patients with UGIB.     

Gastric Antral Vascular Ectasia: Case Report and Review of the Literature

Gastric antral vascular ectasia is the source of up to 4% of nonvariceal upper gastrointestinal bleeding. It can present with occult bleeding requiring transfusions or with acute gastrointestinal bleeding. It is associated with significant morbidity and mortality and has been associated with such underlying chronic diseases as scleroderma, diabetes mellitus, and hypertension. Approximately 30% of cases are associated with cirrhosis. We report two cases of gastric antral vascular ectasia with two strikingly different endoscopic appearances. We further describe the clinical, endoscopic, histologic, and therapeutic aspects of this entity.     

急性脑出血并发上消化道出血患者垂体激素变化的研究

目的探讨急性脑出血并发上消化道出血患者血促卵泡激素（FSH）、促甲状腺激素（TSH）、促肾上腺皮质激素（ACTH）的变化规律，研究垂体激素变化与上消化道出血的相关性。方法以电化学发光法测定脑出血并发上消化道出血36例的急性期血FSH、TSH、ACTH水平并与36例胃肠疾病所致的上消化道出血患者及健康人作对照，观察脑出血并发上消化道出血患者FSH、TSH、ACTH水平与上消化道出血的相关性。结果脑出血并发上消化道出血组的血FSH、TSH水平较胃肠疾病所致的上消化道出血组和正常对照组为低，差异有统计学意义（P〈0．05）；脑出血并发上消化道出血组的血ACTH水平较胃肠疾病所致的上消化道出血组和正常对照组为高，差异有统计学意义（P〈0．05）。结论脑出血可使下丘脑-垂体功能受到直接或间接损害，引发中枢神经系统神经元内环境紊乱，ACTH的升高，可能引起皮质醇升高，导致上消化道应激性溃疡，发生上消化道出血。     

3042例上消化道出血患者病因分析及护理对策

目的 探讨3042例上消化道出血患者的病因,并提出护理对策.方法 回顾性分析本院1991年3月～2009年3月3042例上消化道出血住院患者的病因,并提出对策.结果 消化性溃疡出血为上消化道出血的主要病因,占46.96％,其中十二指肠溃疡呈下降趋势;急性胃黏膜病变为上消化道出血的第2病因,占28.76％,呈上升趋势;年龄＜60岁组患者十二指肠溃疡是上消化道出血的主要病因(占44.35％),年龄≥60岁组患者急性胃黏膜病变为上消化道出血的主要病因(41.21％).结论 消化性溃疡出血与急性胃黏膜病是上消化道出血的主要病因,其中十二指肠溃疡呈下降趋势,其也是年龄＜ 60岁组患者的主要病因;急性胃黏膜病变呈上升趋势,其也是年龄≥60岁患者的主要病因.在护理工作中,应针对不同年龄患者病因与疾病谱变化情况,开展针对性的健康教育,促进患者行为改变,从而达到防病、治病的目的.     

急性消化道大出血的血管造影诊断及介入治疗

目的 :评价急性消化道大出血的血管造影诊断和经导管介入治疗的价值。方法 :从 1989年到 1999年对 2 2例急性消化道大出血行选择性内脏动脉造影检查 ,其中 9例在发现出血灶的同时经导管介入治疗。结果 :2 2例中显示出血灶 19例 ,阳性率 86 % ,其中 8例显示造影剂外溢。 9例经导管栓塞或灌注血管收缩剂治疗 ,出血得到控制。结论 :选择性内脏动脉造影是诊断急性消化道大出血有价值的方法 ,经导管介入治疗安全可行     

Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

Gardner’s syndrome (GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and mid-rectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodeno-jejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.     

Pharmacologic therapy for nonvariceal upper gastrointestinal bleeding

There are many clinical outcome measures for evaluation of the effectiveness of a pharmacologic agent in the management of upper gastrointestinal bleeding (UGIB). As a preemptive treatment, it should reduce the need for emergency endoscopy and endoscopic intervention, facilitate the efficient identification of the bleeding source and, hence, shorten procedure time and reduce the risk of procedure-related complications. As an effective adjunctive therapy after endoscopic hemostasis, it should reduce the incidence of recurrent bleeding and the need to repeat endoscopic hemostasis. This article provides an overview of different pharmacologic agents that have been used in the management of UGIB.     

机械通气患者消化道出血的高危因素分析

目的 具有保护作用.Logistic多元回归分析表明气道峰压≥30 cmH2O(RR=3.73,95%CI=1.59～9.46)、肾功能衰竭(RR=1.16,95%CI=1.02～2.32)、血小板计数<50×109L-1(RR=2.67,95%CI=1.32～15.78)、APTT延长(RR=4.58,95%CI=2.32～12.96)是机械通气患者发生消化道出血的独立危险因素,而肠内营养(RR=0.30,95%CI=0.13～0.67)则是独立保护因素.结论 持续机械通气超过48 h的ICU患者消化道出血发生率较高,且大多发生于接受机械通气最初48 h内;高气道峰压,肾功能衰竭,血小板计数<50×109L-1和APTT延长是机械通气患者发生消化道出血的独立危险因素,肠内营养则是独立保护因素.     

亳州市区上消化道出血病因及相关因素分析

目的研究亳州市区上消化道出血的病因构成及相关危险因素。方法对2009年12月至2012年12月亳州市人民医院消化内科收治的320例上消化道出血住院患者的临床资料进行回顾性分析。结果本地区上消化道出血主要病因依次为十二指肠溃疡（PU）、食管胃底静脉曲张（EGV）、急性胃黏膜病变（AGML）和胃癌（GC）。本地区贲门黏膜撕裂发病率较其他地方偏高。上消化道出血常见的年龄为中年组,其次是青年组,最少的为老年组。上消化道出血常见于冬、春季,而夏秋季较少。结论本地区上消化道出血的主要病因构成比与国内发病率基本一致。但MWS发病率高于其他地方,提示,临床诊治过程中应加以注意。上消化道出血的病因构成可能与年龄、气候、李节、生活习惯等因素相关。     

Effect of tranexamic acid on the treatment of patients with upper gastrointestinal bleeding: A double-blinded randomized controlled clinical trial

Objective: To determine the efficacy of tranexamic acid (TXA) in the management of acute upper gastrointestinal (GI) bleeding.Methods: A total of 70 patients with acute upper GI bleeding were included in this double-blinded randomized controlled clinical trial from September 2018 to December 2018. Patients were divided into the control group (received fluid therapy and intravenous infusion of pantoprazole, 35 cases) and the TXA group (received intravenous TXA besides the treatment of control group, 35 cases). Rebleeding, admission duration, and need for blood transfusion were compared between the two groups. Results: Fifteen patients (42.9％) in the TXA group and 10 patients (28.6％) in the control group stayed in hospital for more than 3 days during their admission (P=0.21). Rebleeding occurred in 8 patients (22.9％) and 5 patients (14.3％) of the TXA group and the control group, respectively (P=0.35). More patients in the TXA group (21 cases, 60％) received blood transfusion than the control group (8 cases, 22.9％) (P=0.02). Conclusions: TXA did not improve the outcome of patients with acute upper GI bleeding.     

非静脉曲张性上消化道出血内镜下止血的护理配合

目的:总结内镜下注射组织粘合剂、局部注射止血合剂和电凝三联疗法治疗非静脉曲张性上消化道出血的治疗和护理效果。方法:对273例非静脉曲张性上消化道出血患者进行内镜下三联疗法止血,术前、术中、术后给予了相应的护理措施。结果:273例患者中,无效4例,内镜下止血成功269例,有效治疗率为98.53%。结论:三联疗法是非静脉曲张性上消化道出血内镜下紧急止血的有效方法,而有效的护理措施是内镜下止血的重要保障。     

79例老年上消化道出血临床分析

目的 :探讨老年上消化道出血的原因和不同制酸剂对出血的治疗效果。方法 :对我院 1998年 1月至2 0 0 4年 6月共 79例老年上消化道出血患者的临床资料进行回顾性分析。男 4 5例 ,女 34例 ,年龄 6 0～ 85岁 ,平均 6 7 6岁 ,患者被随机分为两组分别接受洛赛克和法莫替丁治疗。统计治疗 3天的总有效率和引起出血的原发疾病百分比。结果 :引起出血的原发疾病中 ,胃、十二指肠溃疡 30例 (38 0 %) ,胃黏膜病变 2 8例 (35 4 %) ,门静脉高压症并发食管静脉曲张破裂出血 14例 (17 7%) ,上消化道肿瘤 5例 (6 3%) ,其他 2例 (2 5 %)。洛赛克组总有效率 95 2 %,法莫替丁组总有效率 78 4 %(P <0 0 5 )。结论 :老年上消化道出血主要由胃、十二指肠溃疡和胃黏膜病变引起。质子泵抑制剂洛赛克治疗老年上消化道出血疗效显著。     

急性脑卒中患者并发消化道大出血的危险因素调查分析

目的调查分析急性脑卒中患者并发消化道大出血的独立危险因素。方法选取2017年1月至2019年1月于我院治疗的急性脑卒中患者70例为研究对象,其中并发消化道大出血38例,发生率54.29%。采用多因素logistic回归分析确定急性脑卒中患者并发消化道大出血的危险因素。结果多因素logistic回归分析显示,有饮酒史、消化道疾病,脑卒中类型和病情严重程度是急性脑卒中患者并发消化道大出血的危险因素(P<0.05)。结论急性脑卒中并发消化道大出血往往能提示增高的死亡风险,应重视其发生的危险因素,并采取相应护理。     

脑出血并发上消化道出血的相关性分析

目的为早期胃肠功能保护、预防消化道出血并发症的发生及判断预后提供临床资料。方法采用回顾性分析的方法,对82例脑出血的患者是否并发上消化道出血的相关性进行分析,根据脑出血病例在急性期有无合并上消化道出血分成观察组和对照组,比较两组间的脑出血病变特点。结果观察组和对照组在脑出血病变部位、脑出血量大小、是否破入脑室、意识状况及发病时血压、病死率等方面比较差异有统计学意义。结论脑出血病变的部位及出血量大小以及是否破入脑室与是否并发上消化道出血关系密切,并发消化道出血的患者脑出血病变更重,死亡率明显升高,预后不良,应在积极治疗原发病的同时早期进行胃肠功能保护。     

肠溶阿司匹林和氯吡格雷在抗血小板治疗中上消化道出血的相关危险因素分析

[目的]分析肠溶阿司匹林和氯吡格雷在抗血小板治疗中导致上消化道出血的相关危险因素.[方法]回顾性分析2009年2月至2013年5月冠状动脉硬化性心脏病患者98例的临床资料,其中58例患者采用肠溶阿司匹林联合氯吡格雷抗血小板治疗（观察组）;其余40例患者则单独采用肠溶阿司匹林或氯吡格雷抗血小板治疗（对照组）,比较两组患者的上消化道出血发生率并分析统计导致患者上消化道出血的相关危险因素.[结果]观察组上消化道出血发生率8.6％明显高于对照组2.5％（P＜0.05）;Logistic回归分析发现高龄（＞60岁）、服用时间超过3个月、有既往消化道出血病史和抗血小板药物联合使用是抗血小板治疗中增加上消化道出血的危险因素.[结论]抗血小板药物联合使用增加患者上消化道出血的几率,同时对高龄、服药时间较久及既往有上消化道出血史的患者应高度警惕上消化道出血的可能.     

经内镜金属钛夹治疗消化道急性大出血

目的 探讨经内镜金属钛夹治疗消化道急性出血的适应证、疗效及安全性.方法 使用Olympus HX-600-135型钛夹治疗非静脉曲张性消化道急性大出血患者94例.结果 94例中即时止血率91.5%（86/94）,止血后再发出血率仅2.3%（2/86）.结论 内镜钛夹治疗各种非静脉曲张性消化道急性大出血是一种安全、有效、经济、简便的治疗措施.     

纤维胃镜在小儿上消化道出血诊治中的应用

目的探讨纤维胃镜在小儿上消化道出血诊治中的应用价值。方法采用日本产OLYMPUS GIF-XP20型纤维胃镜检查对2007年12月至2011年5月收治的102例上消化道出血患儿行胃镜检查及幽门螺杆菌(Hp)定性检查。结果上消化道出血病因中以消化性溃疡为主(其中胃溃疡20例,十二指肠球部溃疡39例);其次是急性胃黏膜病变。24 h内行胃镜检查者定位诊断率100%;24～48 h内检查者定位诊断率为90.6%;超过48 h以上检查者诊断率为85.5%。Hp阳性60例,阳性率58.8%。本组102例上消化道出血患儿,成功插镜率100%。结论小儿上消化道出血多由于消化性溃疡所致,与Hp感染相关。早期纤维胃镜可明确出血病因,简单易行,安全可靠,是小儿上消化道出血诊断的首选方法。