高血压脑出血术后再出血相关危险因素分析

目的分析高血压脑出血术后再出血相关危险因素,以减低再出血发生率。方法回顾性分析168例经手术治疗的高血压脑出血患者临床资料,采用Logisitc回归分析方法寻找术后再出血相关危险因素。结果术后血肿扩大40例（23.8%）,回归分析表明术前血肿体积为影响术后再出血的独立危险因素（P=0.004,回归系数0.034）,与再出血的发生率呈显著的正相关。结论术前血肿体积大小可作为预测术后再出血的独立指标。     

Detachable coil embolisation of ruptured intracranial aneurysms: A single center study,a decade experience

Objective

The introduction of detachable coils revolutionised the management of patients with intracranial aneurysms and is now considered a first-line treatment in our institution. The purpose of this study was to review 10 years of experience with this method.

Methods

A retrospective review of prospectively collected data on 711 patients undergoing endovascular treatment of ruptured intracranial aneurysm between 1996 and 2005 with regard to technical feasibility, procedural complications, rebleeding, anatomical outcome, need for retreatment and overall clinical outcome.

Results

Endovascular treatment failed in 25 aneurysms from a total of 717 (4%). Aneurysm rupture complicated 37 procedures (4.7%) leaving 10 patients permanently disabled or dead (1.3%). Thromboembolic events complicated 35 procedures (4.5%) leaving 8 patients permanently disabled or dead (1%). One other patient died because of fatal parent vessel rupture. Further 6 procedures were complicated by arterial dissection and 18 by coil loop protrusion, however all of these patients achieved independent recovery. Overall morbidity–mortality was 2.9%. Further subarachnoid heamorrhage occurred in 16 patients (2.3%), 12 of which died. Altogether, 121 aneurysms from 511 (24%) were recanalized on follow up angiography, 52 required retreatment (7.1%). At 6 months follow up, 580 patients (82%) were independent, while 130 patients (18%) were disabled or dead.

Conclusion

Detachable coil embolisation of intracranial aneurysms is a very feasible treatment method associated with a small risk of permanent morbidity–mortality. Risk of further bleeding is small, but related with devastating outcome. Approximately 25% of aneurysms will recanalize and 7% will require retreatment. Despite these shortcomings, vast majority of patients will achieve independent recovery.     

Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: report of two cases and literature review

Although three-dimensional computed tomographic angiography (3D-CTA) is less complicated and time-consuming than conventional cerebral angiography (CCA) and represents a reliable alternative for evaluating cerebral aneurysms, some patients experience aneurysmal rerupture during 3D-CTA. Two women, 79 and 71 years old, who presented with severe subarachnoid hemorrhage (SAH) underwent 3D-CTA within 3 h after SAH onset. Their images clearly indicated extravasation from their aneurysms. Neither patient recovered from deep coma, and both died within 2 days. We reviewed the literature with special reference to the condition of SAH patients at admission and the interval between SAH onset and 3D-CTA, and discuss serious complications of 3D-CTA study. Although aneurysmal rerupture may reflect the natural course, rerupture during 3D-CTA, especially in SAH patients who are in poor clinical condition during the acute stage, should be recognized as a potentially fatal complication. Their blood pressure must be strictly controlled and factors such as their clinical condition and the interval from the ictus must be considered.     

Aneurysmal Rebleeding : Factors Associated with Clinical Outcome in the Rebleeding Patients

Objective

Aneurysmal rebleeding is a major cause of death and disability. The aim of this study is to investigate the incidence of rebleeding, and the factors related with patient''s outcome.

Methods

During a period of 12 years, from September 1995 to August 2007, 492 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) underwent surgery at our institution. We reviewed the patient''s clinical records, radiologic findings, and possible factors inducing rebleeding. Also, we statistically analyzed various factors between favorable outcome group (FG) and unfavorable outcome group (UG) in the rebleeding patients.

Results

Rebleeding occurred in 38 (7.7%) of 492 patients. Male gender, location of aneurysm (anterior communicating artery) were statistically significant between rebleeding group and non-rebleeding group (p = 0.01 and p = 0.04, respectively). Rebleeding occurred in 26 patients (74.3%) within 2 hours from initial attack. There were no statistically significant factors between FG and UG. However, time interval between initial SAH to rebleeding was shorter in the UG compared to FG (FG = 28.71 hrs, UG = 2.9 hrs).

Conclusion

Rebleeding occurs more frequently in the earlier period after initial SAH. Thus, careful management in the earlier period after SAH and early obliteration of aneurysm will be necessary.     

断流术后再出血原因分析(附20例分析)

目的 探讨断流术后再出血的原因。方法 回顾性分析20例断流术后再出血的临床资料。结果 20例断流术后再出血中由食管静脉曲张所致出血5例，门静脉高压性胃病所致出血15例，其中包括门静脉高压性胃黏膜病交10例，肝源性消化性溃疡5例。结论 断流术后再出血的主要病因是门静脉高压性胃病，其次是食管静脉曲张。断流术后再出血患者应争取急诊内镜检查，明确出血原因。     

Clinical features and outcomes in 154 patients with haemorrhagic moyamoya disease: comparison of conservative treatment and surgical revascularization

Abstract

Objectives:

Rebleeding is an unsatisfactory outcome for patients with haemorrhagic MMD. This study mainly investigated clinical features and outcomes in haemorrhagic MMD.

Methods:

A retrospective review was performed on a total of 154 patients with haemorrhagic MMD comprising 126 surgically treated and 28 conservatively treated patients.

Results:

There were 102 female and 52 male patients with a mean age at the initial bleeding of 33.95?years. Preoperative rebleeding occurred in 37 patients, and multivariate Cox regression analysis demonstrated that age at the time of initial bleeding (P?<?0.001, HR?=?1.093) was a risk factor for preoperative rebleeding. Of 124 patients with surgical revascularization, perioperative ischaemic stroke occurred in five (4.03%) and intracranial bleeding in four (3.23%). The mean follow-up period was 36.12?months. Recurrent bleeding occurred in six (10.17%) of 59 patients treated with direct revascularization, seven (20.69%) of 34 patients treated with indirect revascularization, two (6.45%) of 31 patients treated with combined revascularization and six (21.43%) of 28 patients treated conservatively. Kaplan–Meier analysis revealed no statistical differences in preventing rebleeding between direct, indirect and combined revascularization and conservative treatment (P?=?0.311).

Conclusions:

Age at the initial bleeding is a risk factor for rebleeding in haemorrhagic MMD. Although surgical revascularization show the tendency to decrease the rebleeding rate, there is no statistical difference between direct revascularization, indirect revascularization, combined revascularization and conservative treatment in preventing rebleeding. Further study is needed to determine whether surgical revascularization is effective in select population or with certain techniques.     

Timing of rebleeding in high-risk peptic ulcer bleeding after successful hemostasis: A systematic review

BACKGROUND:

Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.

OBJECTIVE:

To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.

METHODS:

An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses >40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.

RESULTS:

Of 756 citations, six RCTs were included (561 patients; 58.5% to 89.5% male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5% (95% CI 8.4% to 14.7%) experienced rebleeding, 55.6% (95% CI 41.1% to 70.1%) rebled within three days, 20% (95% CI 8.3% to 31.7%) between four and seven days, 17.8% (95% CI 6.6% to 28.9%) at eight to 14 days, and 6.7% (95% CI 0% to 14%) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4% (95% CI 11.5% to 17.3%) overall, with interval rates of 39.5% (95% CI 28.9% to 50.15%), 34.6% (95% CI 24.2% to 44.9%), 19.7% (95% CI 11% to 28.4%) and 6.2% (95% CI 0.95% to 11.5%). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.

CONCLUSION:

In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.     

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

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,并按照入院顺序单双号将其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。     

高位肠-腔人工血管架桥术治疗门脉高压症断流术后再出血48例分析

目的：探讨高位肠系膜上静脉-下腔静脉人工血管架桥术（简称高位肠-腔人工血管架桥术）治疗门脉高压症断流术后上消化道再出血的疗效。方法：对郑州大学第一附属医院2005-2011年48例门脉高压症患者行断流术后再次出血的患者行高位肠-腔人工血管架桥术治疗的临床资料回顾性分析。结果：本组患者术后自由门静脉压力平均下降9cmH_2O。1例切口感染,1例腹腔感染,9例发热,2例肝性脑病,1例人工血管内血栓形成,8例出现乳糜漏,以上并发症均通过非手术治疗治愈。1例死于肝肾综合征。结论：门脉高压症断流术后上消化道再出血行高位肠-腔人工血管架桥术,手术创伤小,近、远期疗效好,是一种治疗门脉高压症断流术后上消化道再出血有效的方法。