Chronic Kidney Disease,Hemodynamic Instability,and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding

The results of studies that evaluated predictive factors for rebleeding in non-variceal upper gastrointestinal bleeding are inconsistent. The aim of this study was to investigate predictive factors for 30-day rebleeding in these patients. A consecutive 312 patients presenting symptoms and signs of gastrointestinal bleeding were enrolled in this prospective, observational study. Clinical and demographic characteristics and endoscopic findings were evaluated for potential factors associated with 30-day rebleeding using logistic regression analysis. Overall, 176 patients were included (male, 80.1%; mean age, 59.7±16.0 yr). Rebleeding within 7 and 30 days occurred in 21 (11.9%) and 27 (15.3%) patients, respectively. We found that chronic kidney disease (CKD) (OR, 10.29; 95% CI, 2.84-37.33; P<0.001), tachycardia (pulse>100 beats/min) during the admission (OR, 3.79; 95% CI, 1.25-11.49; P=0.019), and Forrest classes I, IIa, and IIb (OR, 6.14; 95% CI, 1.36-27.66; P=0.018) were significant independent predictive factors for 30-day rebleeding. However, neither Rockall nor Blatchford scores showed statistically significant relationships with 30-day rebleeding in a multivariate analysis. CKD, hemodynamic instability during hospitalization, and an endoscopic high-risk appearance are significantly independent predictors of 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. These factors may be useful for clinical management of such patients.     

康复新液预防食管曲张静脉套扎术后再出血的疗效观察

目的探析对肝硬化食管曲张静脉套扎术(EVL)患者术后予以康复新液预防再出血的效果。方法抽取我院消化内科收治的82例行肝硬化EVL术患者,按随机数字表法分对照组、研究组,各41例,术后常规预防再出血治疗为对照组,在此基础上联合康复新液治疗为研究组,比较两组预防效果。结果经治疗观察,研究组患者术后早期再出血率较低,且术后胃镜复查其溃疡面愈合有效率较高,与对照组比差异具统计学意义(P<0.05)。结论对肝硬化EVL术后患者予以康复新液治疗,可有效地预防其再出血,并利于溃疡面愈合,促使患者及早康复,值得推广。     

消化内镜联合四联疗法治疗胃溃疡出血的临床效果

目的：分析消化内镜联合四联疗法治疗胃溃疡出血的临床效果。方法选择2013年3月～2014年3月本院收治的98例胃溃疡出血患者,随机分为治疗组与对照组,各49例,对照组采取四联疗法治疗,治疗组采取消化内镜联合四联疗法治疗,分析两组患者的临床疗效。结果治疗组的总有效率为93.88%,明显高于对照组的75.51%,差异有统计学意义（P〈0.05）。治疗组的再出血发生率为10.20%,对照组的再出血发生率为30.61%,治疗组的再出血发生率明显低于对照组,差异有统计学意义（P〈0.05）。结论消化内镜联合四联疗法治疗胃溃疡,止血效果良好,治愈率较高。     

MELD联合多项血清学指标对失代偿期肝硬化患者食管静脉曲张短期再出血的预测

食管静脉曲张破裂出血（EVB）是失代偿期肝硬化患者的常见并发症,预测EVB的危险性对合理选择药物或手术方式、改善疗效和判断预后极为重要。目的：评估MELD评分联合多项血清学指标对失代偿期肝硬化患者首次EVB后短期内再出血的预测价值。方法：收集失代偿期肝硬化的EVB患者168例,其中随访3个月后再出血者51例。检测白细胞、血红蛋白、血小板（PLT）、白蛋白、胆红素、肌酐、ALT、AST、凝血酶原时间国际标准化比值、D．二聚体、血清钠指标,计算MELD评分。应用单因素和Logistic多因素回归分析筛选再出血的独立危险因素,建立回归方程并拟合ROC曲线,比较回归方程和单独MELD评分的曲线下面积（AUC）。结果：D-二聚体（OR=1．2714）、MELD（OR=2．3340）、Na（OR=0．8136）、PLT（OR=0．9431）是引起食管静脉曲张再出血的独立预测因子,回归模型为LogisticP=0．1073＋0．3013×D-二聚体＋1．1132XMELD-0．0688×Na-0．0396×PLT,其AUC明显高于单独MELD评分（0．873对0．738,P=0．0028）,敏感性为66．7％,特异性96．1％。结论：MELD评分联合D-二聚体、血清钠、PLT对失代偿期肝硬化患者首次EVB后短期内再出血有较好的预测能力。     

预防食管静脉曲张破裂再出血的随机对照临床试验

目的比较预防食管静脉曲张再出血的两种药物方案（联用方案：５－单硝酸异山梨醇酯（ＩＳ－５－ＭＮ）联用螺内酯；单用方案：螺内酯）的疗效。方法所有经临床、实验室资料及内镜证实为食管静脉曲张出血的６３例连续的病便，在出血停止、生命体征平稳的两周后被随机分成两组，分别接受联用方案（ｎ＝３２，ＩＳ－５－ＭＮ４０ｍｇＱＮｐｏ，螺内酯２０～４０ｍｇＱＩＤｐｏ）和单用方案（螺内酯２０～４０ｍｇＱＩＤｐｏ）。全部病人随访至研究终点。结果联用方案组３２例患者的平均无出血时间（ＭＦＢＤ）比单用方案组长，但无统计学意义（３１０±５８ｖｓ１８０±４４天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０８６７）。ＣｈｉｌｄＡ和ＣｈｉｌｄＢ的两组患者的ＭＦＢＤ的差异有显著性（ＣｈｉｌｄＡ，３７２±４ｖｓ２５９±６４天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０４９８；ＣｈｉｌｄＢ，２８０±３２ｖｓ１６７±８７天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０４９１），但ＣｈｉｌｄＣ的两组的ＭＦＢＤ无统计学上的差别（６５±２２ｖｓ５３±１２天，ＬｏｇＲａｎｋ检验Ｐ＝０．８３１５）。结论５－单硝酸异山梨醇酯联用螺内酯对预防ＣｈｉｌｄＡ和ＣｈｉｌｄＢ的食管静脉曲张再出血较单用螺内酯有效。     

肝硬化食管胃静脉曲张破裂出血行规律内镜下治疗的临床价值

目的　评价肝硬化食管胃静脉曲张破裂出血（esophagogastric variceal bleeding,EGVB）患者行规律内镜下治疗的临床价值。方法　2015年1月—2018年1月,在南京鼓楼医院行内镜下止血治疗的305例肝硬化EGVB病例纳入回顾性队列研究,按是否规律内镜下治疗分成2组,即规律内镜治疗组（n=145）和未规律内镜治疗组（n=160）,主要观察指标为再出血率,次要观察指标为随访时间、再出血间隔时间和再出血死亡率。结果　2组患者在性别构成、平均年龄、病因构成、病因是否控制、肝脏储备功能、是否服用非选择性β受体阻滞剂等方面差异均无统计学意义（P>0.05）,基线资料具有可比性。再出血率规律内镜治疗组为11.7%（17/145）,未规律内镜治疗组为41.9%（67/160）（χ2=38.74,P<0.001）;随访时间规律内镜治疗组为（28.14±11.11）个月,未规律内镜治疗组为（21.10±12.37）个月（t=5.21,P<0.001）;再出血间隔时间规律内镜治疗组为12.0（6.0,23.0）个月,未规律内镜治疗组为1.0（1.0,6.0）个月（U=164.00,P<0.001）;再出血死亡率规律内镜治疗组为1.4%（2/145）,未规律内镜治疗组为10.6%（17/160）（χ2=11.13,P=0.001）。结论　相较于未行规律内镜下治疗者,肝硬化EGVB患者行规律内镜下治疗更具临床意义,可显著降低再出血率、延长再出血时间间隔、减少再出血死亡率。     

部分脾栓塞联合心得安预防食管胃底静脉曲张再出血的研究

[目的]评价部分脾动脉栓塞术（PSE）联合心得安预防食管胃底静脉曲张再出血的临床疗效.[方法]55例食管胃底静脉曲张破裂出血患者,随机分为两组,其中心得安组28例,PSE联合心得安组27例,比较两组患者外周血象变化,门静脉、脾静脉管径变化,以及3个月、6个月、1年、2年不同时间段的再出血率、病死率和并发症情况.[结果]术后1个月PSE联合心得安组较心得安组外周血白细胞及血小板显著升高,门静脉及脾静脉管径明显缩小,再出血率降低,差异有统计学意义（P＜0.05）.[结论] PSE联合心得安预防食管胃底静脉曲张再出血较单独使用心得安有更好的疗效.     

Huge recurrent subperiosteal hematoma in a 9-year-old boy: case report with special reference to pathologic and anatomic studies

Introduction Huge subperiosteal hematomas extending beyond the cranial sutures are rare and clinically, their distinction from subgaleal hematomas may be difficult. Case report We report a subperiosteal hematoma that involved the entire scalp including the orbit and recurred within 6 months. Discussion We discuss our neuroradiologic and histopathologic findings and our management strategy.     

门脉高压症门奇断流术后再出血原因分析及预防

目的 探讨和分析门脉高压症门奇断流术后再出血原因及预防措施。方法 对１９９２～１９９９年间２５４例门静脉高压症行门奇断流术，术后因上消化道再出血的２３例病例进行回顾性临床分析。结果 再出血率为９．０９％。２３例中男１９例，女４例；年龄２３～６８岁，平均４３．５岁。２３例胃镜均示不同程度的胃粘膜充血、水肿、囊烂、渗血等；食管、胃底静脉曲张１６例；伴活动出血４例；１３例发现有门静脉血栓形成。再手术１４     

Endoscopic management of gastric varices

Understanding the basic pathophysiology and anatomy of gastric varices is critical to the appropriate management of acute variceal bleeding. The high morbidity and mortality of gastric variceal bleeding combined with poor response to treatments for esophageal variceal bleeding has demanded a highly differentiated approach. This review focuses on gastric fundal varices for which the most recent Baveno VI consensus guidelines recommend endoscopic cyanoacrylate-based therapy as first-line intervention. We discuss the evolution of endoscopic techniques, not only to achieve effective hemostasis but also to limit inherent risks and complications. Long-term data reveal that low rebleeding rates are feasible when gastric varices are completely obliterated. Both primary and secondary prophylaxis should become part of standard treatment algorithms.