急性非静脉曲张性上消化道出血患者再出血危险评估和临床分级护理干预效果

目的运用Rockall危险性积分评估急性非静脉曲张性上消化道出血(ANVUGIB)患者再出血危险程度,并评估临床分级护理干预效果。方法将2014年1—12月入院的56例患者设为对照组,将2015年1—12月入院的51例患者设为实验组。在消化道出血治疗基础上,对照组给予常规护理,实验组实施基于Rockall危险性积分的临床分级护理干预。观察2组住院期间再出血发生情况,对比2组焦虑、抑郁情绪改善情况,以及患者疾病认知和遵医嘱行为。结果实验组再出血总发生率7.8%,显著低于对照组的25.0%(P0.05);干预后,2组SDS和SAS评分均显著下降(P0.05或P0.01),且实验组显著低于对照组(P0.01);实验组疾病知识和认知行为掌握人数比例显著高于对照组(P0.05或P0.01),遵医嘱行为依从率显著高于对照组(P0.05)。结论基于Rockall危险性评分的临床分级护理干预能有效降低ANVUGIB患者再出血风险,缓解焦虑、抑郁情绪,提高患者疾病认知和遵医嘱行为。     

Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE)

BACKGROUND: Patients who have experienced a recent major bleeding episode are usually excluded from clinical studies of venous thromboembolism (VTE) treatment. Therefore, recommendations based on evidence from clinical trials may not be suitable for these patients. The Registro Informatizado de la Enfermedad TromboEmbolica (RIETE) is a multicenter, observational registry designed to gather and analyze data on VTE treatment practices and clinical outcomes in patients with acute VTE. OBJECTIVES: The aim of this analysis was to study outcomes of patients with VTE who had experienced recent major bleeding (< 30 days prior to VTE diagnosis). METHODS: Patients with objectively confirmed symptomatic acute VTE are consecutively enrolled into the RIETE registry. Patient characteristics, details of antithrombotic therapy, and clinical outcomes at 3 months were recorded. RESULTS: Of 6361 patients enrolled up to January 2004, 170 (2.7%) had experienced recent major bleeding: 69 (40.6%) gastrointestinal tract, 60 (35.3%) intracranial, 41 (24.1%) other. The incidences of major bleeding (4.1%) and recurrent pulmonary embolism (PE) (2.4%) were significantly higher in patients with recent major bleeding. Among them, patients with cancer had an increased incidence of major bleeding [odds ratio (OR) 10.0, 95% confidence interval (CI) 2.3, 50; P < 0.001] and fatal PE (OR 4.1, 95% CI 0.98, 17; P < 0.05). CONCLUSIONS: Patients with VTE and recent major bleeding prior to VTE diagnosis (2.7% of total enrolled patients) had poorer clinical outcomes compared with those who had not experienced recent major bleeding. In patients who had recent major bleeding prior to enrollment, those with cancer had a poorer clinical outcome than those without cancer.     

消化性溃疡伴出血的护理体会

目的 探讨消化性溃疡合并出血的治疗和护理措施．方法 对80例消化道溃疡合并出血者，采用积极的内科治疗及适当的护理措施．结果 治愈78例，占97．3％，2例转外手术治疗，占2．7％ ．结论 积极的内科治疗加适当的护理可有效治疗消化道出血．     

200例手背浅静脉穿刺后不同止血方法的效果观察

通过对200例静脉输液患者采用棉球按压止血和棉签按压止血的效果进行观察,发现前者皮下瘀血发生率明显低于后者(P＜0.005),说明用棉球按压止血是一种较好的方法.     

Minimizing factor requirements for surgery without increased risk

Summary.  The most common type of surgical procedure in patients with haemophilia is orthopaedic surgery on the lower limb. These procedures are of great importance for the improvement of the function and quality of life of patients with haemophilia, but in many countries resources are lacking to provide the factor concentrates needed for these operations. We have attempted to reduce the level of replacement during and after total hip or total knee replacement without jeopardizing the outcome of the procedures. The results from 30 operations in 27 patients are presented. Steady-state levels down to 0.5 IU mL⁻¹ did not appear to increase the amount of blood loss or cause an increased incidence of complications, compared with higher levels. In addition, we review the possibilities to reduce the amount of factor concentrate by performing a combination of orthopaedic procedures and using local haemostatic agents or antifibrinolytic agents.     

北京地区门脉高压食管胃静脉曲张出血调查分析

目的；研究不同因素对门脉高压食管胃静脉曲张了血转归的影响。方法：对北京地区16家医院826例门脉高压管胃静脉曲张出血住院患者病例资料进行了分析，包括：年龄，性别，肝硬化病因，肝硬化病程，出血病程，出血次数，出血程度，肝Child分级，降门脉压药物使用，三腔两囊管，内镜下食管静脉套扎术（EVL),内镜下食管静脉硬化术（EVS），外科治疗等因素对门脉高压食管胃静脉曲张出血转归的影响进行分析；对影响转归的各种因素进行多因素逐步Logistic回归分析；并对各种止血方法疗效进行比较。结果：本组资料门脉高压食管胃静脉曲张破裂出血转归与患者年龄，出血病程，出血程度，肝功能分级，胆红素，白蛋白，凝血酶原时间，奥曲肽，凝血酶，巴曲酶，三腔两囊管，EVL及EVS等多因素相关；目前门脉高压食管胃静脉曲张出血以内科治疗为主，总止血成功率为90．90％；死亡97例，死亡率为11．74％。EVS能改善门脉高压食管胃静脉曲张出血转归，止血成功率达98．88％，为门脉高压食管胃静脉破裂中重度出血治疗首选方法。     

A systematic description of the post-EMR defect to identify risk factors for clinically significant post-EMR bleeding in the colon

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Mapping the distribution of small bowel angioectasias

Background: Angioectasias are a prominent cause of small bowel (SB) bleeding frequently identified during capsule endoscopy (CE). Subsequent management depends upon grade/severity and location. There is increasing evidence that the location of SB angioectasias is not random. We aimed to map the distribution of SB angioectasias, and assess whether this impacted clinical outcomes.

Materials and methods: Retrospective study examining CEs performed over a 10-year period at a tertiary referral centre. Information regarding number, location, and Saurin classification (P0–2) of SB angioectasias was collected. Clinically significant angioectasias (P1/P2) and active SB bleeding were analysed further. Outcomes of patients with P2 angioectasias or active SB bleeding were recorded.

Results: 164 SBCE examinations reported angioectasias. 554 P1-2 angioectasias and active bleeds were seen, 435 (78.52%) within the first tertile of SB transit time (SBTT). 277 (50%) angioectasias were identified within the first 10% of SBTT. 40/75 (53.3%) patients with >1 P2 angioectasia and/or active bleed were referred for intervention. Of initial interventions, 24 patients underwent upper GI endoscopy; 13 underwent double balloon enteroscopy (DBE). 9/37(24.3%) had no identifiable angioectasias on endoscopy. Of those receiving ablative therapy, 20/28 (71.4%) re-presented with iron-deficiency anaemia or bleeding. In this group, average angioectasia position was 15.6% of SBTT, compared with 7.9% in those who did not re-represent (p?=?0.344). Patients who re-presented had an average 1.6 additional P1 angioectasias, compared with 7.6 amongst those who did not return (p?=?0.017).

Conclusions: Clinically significant angioectasias are overwhelmingly located within the proximal SB. The majority are within reach of conventional endoscopy. However, AEs are often multiple and many patients re-present following intervention.