云南白药对全髋关节置换术出血量的影响

目的研究云南白药在围术期对全髋关节置换术术中出血量及术后引流量的影响。方法2006至2008年我科收治的股骨颈骨折行全髋关节置换术60例,随机分成两组,分别服用云南白药胶囊和空胶囊;术前术后测定凝血酶原时间(PT),记录全部病人术中出血量及术后24 h引流量。结果实验组和对照组病人的凝血酶原时间(PT)差异有统计学意义(P<0.01);试验组的术中出血量、术后24 h引流量分别为(380±78)ml(、336±77)ml,较对照组(481±77)ml(、418±68)ml明显减少,差异具有统计学意义(P<0.01)。结论云南白药胶囊能够明显减少全髋关节置换术围术期出血量。     

内镜下套扎与硬化夹心联合法治疗食管静脉曲张出血的研究

目的　了解套扎与硬化夹心联合法 (套扎 硬化 套扎 )能否获得优于单纯内镜下食管静脉曲张结扎 (EVL)的疗效。方法　对 98例肝硬化食管静脉曲张伴活动性出血或近期出血的患者随机采用单纯EVL或夹心法治疗 (EVL组 5 0例 ,夹心法组 4 8例 )。EVL组每条曲张静脉结扎皮圈不超过 3个 ,夹心法组每条曲张静脉结扎 2个皮圈 ,并在两个结扎点之间的曲张静脉内注射 1～ 3ml硬化剂。夹心法组 7例在首次内镜治疗时接受食管静脉造影检查。 7～ 10d重复 1次内镜治疗 ,直至静脉曲张消除。结果　 7例行静脉造影检查 ,其中 6例硬化剂在曲张静脉内滞留时间超过 4 5min。两种方法控制活动性食管静脉曲张出血 (EVB)的止血成功率相同 (10 0 .0 % ) ;两组间静脉曲张消除率相似 (夹心法组 93.8% ,EVL组 90 .2 % ,P >0 .0 5 ) ,但夹心法组一次治疗后静脉曲张消除率明显高于EVL组 (6 6 .7%比10 .0 % ,P <0 .0 0 1) ,达到消除的平均治疗次数明显减少 (1.2± 0 .4比 3.8± 1.5 ,P <0 .0 1) ,所需时间显著缩短 [(13.1± 4 .3)d比 (42 .5± 16 .7)d ,P <0 .0 1];与EVL组相比 ,夹心法组再出血率较低 (8.3%比2 8.0 % ,P <0 .0 5 ) ,随访期内静脉曲张复发率明显下降 (8.3%比 4 4 .0 % ,P <0 .0 0 5 ) ;两组间并发症发生率相似 (夹心法组 1     

Bleeding from gastric ulcer halted by laparoscopic suture ligation

In a 48-year-old Japanese man there was an uncontrollable and recurrent bleeding from a gastric ulcer and laparoscopic surgery was done. Two cannulae were placed in the gastric cavity through the abdominal wall and suture ligation of the bleeding vessel at the posterior wall of the stomach was done under videovisual control with endoscopic guidance. The bleeding ceased, complications were nil, and he remains well.This article reports on surgery done to repair uncontrollable, recurrent bleeding from a gastric ulcer. Two cannulae were placed in the gastric cavity through the abdominal wall and suture of the vessel at the posterior wall of the stomach was done with videovisual control and endoscopic guidance. This approach is concluded to have supplied minimal-access surgery, cost effectiveness, early discharge, less pain, and doctor-patient satisfaction.     

Trends and Predictors for Vagotomy When Performing Oversew of Acute Bleeding Duodenal Ulcer in the United States

Background In the era of Helicobacter pylori treatment, the role of vagotomy in bleeding duodenal ulcers is debatable. National outcomes were evaluated to determine the current surgical treatment and use of vagotomy for bleeding duodenal ulcers. Methods Data from the Nationwide Inpatient Sample (NIS) were used from years 1999 to 2003. Patients were selected using diagnostic codes for acute duodenal ulcer bleed and procedure codes for simple oversew of a bleeding ulcer and vagotomy. Data were analyzed using multiple linear and logistic regression. Results Between 1999 and 2003, 100,931 patients with an acute bleeding duodenal ulcer were identified. Over time, there was a decrease in the number of acute bleeding ulcers (p = 0.027) and a decrease in the number of vagotomies (p = 0.027). A high co-morbidity index [odds ratio (OR), 0.60, p = 0.017], operation in the Midwest (OR 0.50, p < 0.001) and operation in the West (OR 0.68, p = 0.034) were predictive of no vagotomy during surgery for a bleeding duodenal ulcer. Conclusions A vagotomy is not commonly performed during surgical treatment of an acute bleeding duodenal ulcer. This variation in practice was not fully explained by patient characteristics. We must seek new evidence to determine the safety of combined medical and surgical management of this clinical problem. Presented at DDW/SSAT May 20–24, Los Angeles, California.     

益气止血药对脾不统血证模型动物前列腺素的作用

采用复合因素的脾不统血证大鼠模型 ,以 6 酮 前列腺素F1α(6 酮 PGF1α)和血栓素B2(TXB2 )作为观测指标 ,对益气止血药对脾不统血证模型大鼠血浆和子宫前列腺素的影响进行了研究。结果 :大剂量组益气止血药能降低脾不统血证模型血浆和子宫的 6 酮 PGF1α及子宫 6 酮 PGF1α/TXB2 比值。说明 6 酮 PGF1α及 6 酮 PGF1α/TXB2 比值升高可能是脾不统血证的重要机理之一。     

生长抑素对肝硬化食道胃底静脉曲张破裂出血作用的临床研究

目的 观察生长抑素制剂（施他宁、善得定）对于肝硬化食道胃底静脉曲张破裂出血的治疗效果,并与垂体后叶素进行比较。方法 ６４例患者随机分为垂体后叶素组（ｎ＝２１）、施他宁组（ｎ＝２０）、盖得定组（ｎ＝２３）进行治疗。结果 垂体后叶素组、施他宁组和善意得定组患者自接诊后至完全止血时的出血量,及接诊后至止血后４８小时生命 体征基本平稳时的输血量无显著性差异（Ｐ〉０．０５）。各治疗组２４小时内的止血率均为８     

小儿消化性溃疡并出血66例临床分析

探讨小儿消化性溃疡并出血６６例。方法：纤维内窥镜检查证实３６例,胃肠钡餐造影确诊３０例。结果：内科保守治疗６４例,外科手术治疗２例。并对小儿消化性溃疡并出血的高危因素进行分析,发现与年龄、环境、长期误诊误治及血型均有一定关系。     

米索前列醇用于产后出血的预防

目的：米索前列醇预防产后出血的效果。方法：选择１９９８年８月至１９９９年７月在我院住院分娩的３００例单胎头位孕妇,随机分为米索前列醇组,催产素组,每组１５０例,米索组在胎儿娩出前,胎头着冠时给产妇直肠内置米前列醇６００ｕｇ。催产素组在胎儿娩出后产妇臂部肌注催产素２０Ｉｕ。观察两组产后２ｈ内出血量。结果：产后２ｈ平均出血量米索前列醇组明显低于催产素组,差异有极显性。产后出血发生率米索前列醇组为３．     

硝普钠在高血压脑出血术中的降压及脑保护作用

目的探讨硝普钠在高血压脑出血围术期的降压及脑保护作用。方法选择高血压脑出血患者56例,分为硝普钠组(36例)和对照组(即硝酸甘油组,20例)。对两组患者围术期的平均动脉压、心率、颈内静脉血氧饱和度及术后病死率进行对比观察。结果硝普钠组患者用药后的平均动脉压、心率、颈内静脉血氧饱和度均比术前明显改善,而硝酸甘油组则改变不明显;硝普钠组患者术后病死率比硝酸甘油组明显下降。结论硝普钠具有降低外周血管阻力、减轻心脏前负荷、降低左室充盈压及改善心功能的作用,且不降低心输出量,从而纠正全身各重要脏器的缺血、缺氧状况,并且静脉滴注给药可使降压幅度平稳且复压迅速;术中连续应用硝普钠对神经胶质细胞具有延迟保护作用,因此,硝普钠对高血压脑出血患者具有较好的降压及脑保护作用,并能降低该类患者术后的病死率。     

中医药治疗经间期出血的Meta分析

目的：系统评价中医药治疗经间期出血的疗效。方法：检索近8年中医药干预经间期出血的随机对照临床试验,并对文献结果进行Meta分析。结果：最终15篇临床研究文献入选,研究结果异质性检验：x2＝14.93,P＝0.38。故采用固定效应模型进行统计分析,合并后OR值为5.21,95%,可信区间为3.54～7.66,菱形位于中间线的右侧,经Z检验,Z＝8.39,P〈0.00001,中医药治疗效果显著。“漏斗图”图形显示存在发表偏倚。结论：①中医药治疗经间期出血与西药治疗疗效相当,且可发挥其副作用少、安全性高的优势;②在有力证据方面,中医药（尤其针灸）治疗经间期出血需要更多高质量的研究文献,现阶段文献资料欠严谨。