消化内镜治疗非静脉曲张性上消化道出血后再出血危险因素分析

目的：探讨消化内镜治疗上消化道出血后再出血危险因素。方法：选取本院收治的300例经消化内镜治疗止血成功的上消化道出血患者作为研究对象,根据患者的再出血情况,分为A组（再出血,n=76）和B组（未出血,n=224）,对两组患者临床资料进行对比分析。结果：两组在上消化道出血史、性别、年龄、血小板、血红蛋白、血尿素氮方面比较差异均无统计学意义（P〉0.05）;A组在单一内镜治疗、入院时休克、HGB〈90 g/L、Ⅰa级出血、支持治疗缺乏、后续PPIs缺乏、恶性肿瘤出血方面,与B组比较差异均有统计学意义（P〈0.05）;单一内镜治疗、HGB〈90 g/L、Ⅰa级出血、支持治疗缺乏、后续PPIs缺乏、恶性肿瘤出血均是上消化道出血止血后再出血的危险因素（P〈0.05）。结论：消化内镜治疗上消化道出血后再出血的危险因素包括支持治疗不足、喷射样出血、血色素水平低、缺少后续PPIs、恶性肿瘤出血,临床上应当密切观察、加强防护,早期实施手术治疗,以免病情加重。     

Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

AIM: To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.METHODS: Retrospective data collection from four referral centers, all of which had a formal out-of-hours emergency endoscopy service, even at weekends. A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled. Analyzed parameters included time from patients’ arrival until endoscopy, mortality, rebleeding, need for surgery and length of hospital stay.RESULTS: The weekday and weekend admission groups comprised 326 and 62 patients, respectively. There were no significant differences in baseline characteristics between the two groups, except for younger age in the weekend group. Most patients (97%) had undergone early endoscopy, which resulted in a low mortality rate regardless of point of presentation (1.8% overall vs 1.6% on the weekend). The only outcome that was worse in the weekend group was a higher rate of rebleeding (12% vs 21%, P = 0.030). However, multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding, rather than weekend admission.CONCLUSION: Early endoscopy for peptic ulcer bleeding can prevent the weekend effect, and nighttime admission was identified as a novel risk factor for rebleeding, namely the nighttime effect.     

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。     

Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding

BACKGROUND AND AIMS: To prospectively validate in patients with non-variceal upper gastrointestinal bleeding three risk scoring systems (the Baylor College scoring system, the Rockall's risk scoring system and the Cedars-Sinai Medical Centre predictive index) previously proposed to be predictive of rebleeding/death after upper gastrointestinal bleeding. PATIENTS AND METHODS: We calculated values of the scores for 343 patients, who underwent endoscopy after non-variceal upper gastrointestinal haemorrhage during the years 1997-1999. We compared the observed outcomes with the ones expected upon the original series contributed by the authors. Discriminative ability was evaluated by calculating the area under the receiver operating characteristic curve. RESULTS AND CONCLUSIONS: Rockall's score accurately predicted rebleeding in low- and intermediate-risk categories (< 6), but not in high-risk patients. The rates of rebleeding were significantly higher than the ones predicted by the low-risk categories of either Cedars-Sinai index (< or = 2) or Baylor score (< or = 6). The predicted and the observed mortality was not significantly different throughout all the categories of Rockall's score, except for patients with a score of 4. All the scores had better discriminative ability for mortality than for rebleeding. The Rockall's score identifies a low-risk group of patients (Rockall's score < or = 2) for rebleeding and mortality.     

颅内血肿微创清除术治疗高血压脑出血的进展

颅内血肿微创清除术的发明已有28年时间,因其应用正压连续冲刷的方法,特别是应用生化酶血肿液化技术,对血肿进行液化,而非机械的破碎,故在治疗过程中安全,可保持颅压的平稳,并能快速清除血肿,缓解颅内压力,在治疗高血压脑出血方面取得了良好疗效.随着此项技术不断应用与推广,特别是在广大的基层医院,高血压脑出血患者得到了有效治疗.     

蛛网膜下腔出血再出血的原因与预防

目的：通过对127例蛛网膜下腔出血（SAH）入院的患者,41例病人再出血的原因进行临床分析,探讨其临床预防措施。方法：本文对41例SAH患者再出血的原因进行回顾性分析,分析SAH再出血的危险因素,针对这些病因,提出有效预防措施。结果：诱发SAH再出血的危险因素：用力排便为31．7％;过早下床活动为24．4％;情绪激动为17．1％;并发症为21．9％;其他为4．9％。结论：SAH患者通过控制情绪激动,防止便秘,避免早期下床活动,防治感染,可有效预防再出血。     

Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy

AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80...     

Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding

BackgroundCurrent guidelines recommend endoscopic therapy to be performed within 12 h for acute variceal bleeding (AVB). However, the optimal timing of endoscopic therapy for AVB remains unclear.AimsTo examine the relationship between the endoscopy timing and clinical outcomes in AVB, with emphasis on liver function and endoscopy timing.MethodsFrom January 2010 to June 2017, cirrhotic patients with AVB confirmed by endoscopy were evaluated. The primary outcome was a composite of 6-week rebleeding and mortality. We stratified patients according to the MELD score.ResultsIn 411 patients, the overall composite outcome rate was 30.9% (n = 127) at 6 week. Patients who underwent urgent endoscopy (≤12 h) had a significantly higher composite outcome than patients who underwent non-urgent endoscopy (>12 h) (34.4% vs. 19.1%; P = 0.005). Low-risk patients who underwent urgent endoscopy were more likely to reach the composite outcome (adjusted OR, 0.84 per 4 h; 95% CI, 0.73–0.98; P = 0.027). These findings persisted even after adjustment for baseline characteristics between the urgent and non-urgent groups.ConclusionsUrgent endoscopy is significantly associated with a poorer outcome in patients with AVB, especially in low-risk patients. Our result provides a treatment strategy according to the severity of underlying liver disease in patients with AVB.     

情志护理对脑出血患者急性期再出血的影响的临床研究

目的：观察中医七情致病理论通过调理情志对脑出血急性期再出血的影响。方法：将160例脑出血急性期患者均分为两组：观察组和对照组,均在脑出血常规治疗的基础上应用脑出血护理常规,观察组在此基础上突出根据患者不同的情绪进行相应情志护理干预,动态监测两组患者头颅CT、血压、血糖、心率和呼吸频率,评估脑出血的情况以及脑出血急性期与血压、血糖、心率、呼吸频率的相关性。观察结果用SPSS13．0统计软件进行统计学分析。结果：观察组再出血率显著低于对照组（P〈0．05）,观察组血压、血糖、心率、呼吸频率在治疗过程中稳定,显著优于对照组（P〈0．05）。结论：中医情志护理能显著减少脑出血急性期再出血发生率,主要是通过稳定患者的情绪,增强患者治疗的依从性和信心,稳定患者血压、血糖、心率和呼吸频率,提示患者生命体征的平稳对脑出血急性期再出血有一定的影响。     

Nonvariceal upper gastrointestinal bleeding refractory to endoscopy: The role of interventional radiology and surgery

Acute nonvariceal upper gastrointestinal bleeding is a common and life-threatening emergency. Despite optimal endoscopic and pharmacologic therapy, 8%-10% of patients continue to bleed or develop rebleeding. Surgery has been the traditional salvage treatment in these patients. However, surgery is associated with high morbidity and mortality rates. In the past few decades, transarterial embolization has emerged as a promising nonoperative alternative to surgery. High technical (69%-100%) and clinical success rate (63%-97%) were reported. However, comparative studies between the 2 treatment modalities are retrospective in nature. Current guidelines suggest transarterial embolization to be an alternative to surgery if expertise is available. This review attempts to summarize the published literature and to provide our view on the role of radiology and surgery for acute nonvariceal upper gastrointestinal bleeding refractory to endoscopic treatment. Factors leading to rebleeding and preventive measures to improve outcomes are also discussed.