善宁治疗上消化道癌肿合并出血

我们1995—10／2003—05应用善宁治疗上消化道癌肿合并出血，现将结果报告如下。     

善宁治疗肝癌上消化道出血36例

我科自1998年以来应用善宁治疗肝癌上消化道出血36例,其中包括食道胃底静脉曲张破裂出血31例,门静脉高压性胃粘膜病变致上消化道出血5例。分别与垂体后叶素组14例、奥美拉唑组3例进行对比观察。现报道如下。 1 材料和方法 1.1 研究对象 53例患者均经肝脏B超、肝脏CT及甲胎蛋白定量检查诊断为原发性肝癌。所有患者均有呕血、黑便、头晕、低血压等症状。均行急诊胃镜检查,结果示食道胃底     

善宁治疗非食管静脉曲张性上消化道出血40例观察

善宁(奥曲肽)治疗食管静脉曲张(EV)破裂出血效果良好，但对非EV性上消化道出血报道较少。1998年1月至2003年12月，我们对40例非EV性上消化道出血患者应用善宁、洛赛克治疗，并与单纯应用洛赛克患者进行对照观察。现报告如下。     

洛赛克治疗老年上消化道出血

我们于1990年～1994年间应用阿斯特拉公司生产的洛赛克(Losec)治疗36例老年急性上消化道出血,并以雷尼替丁做对照,现报道于下.     

善宁联合洛赛克治疗门脉高压性胃粘膜病变出血

目前随着急诊胃镜的广泛开展,人们发现门脉高压性胃粘膜病变(PHG)所致的出血占肝硬化门脉高压病人上消化道出血的12％～59％。有效的止血除     

善宁治疗肝硬化上消化道出血28例

目的:寻找一种治疗肝硬化上消化道出血较好的药物。方法:应用善宁首剂0.1mg静注或皮下注射后继以0.3mg/24h静脉维持。另一组用脑垂体后叶素进行对照。结果:善宁组有效率82.1％,对照组有效率60.0％,两组对照差异有显著意义,且善宁组3天止血率较对照组明显,副作用少。结论:善宁治疗肝硬化并上消化道出血效果较好。止血时间提前,副作用少,可适用于临床。     

善得定联合洛赛克治疗肝硬化上消化道出血55例疗效观察

2000～2007年,我们采用善得定联合洛赛克治疗肝硬化上消化道出血.取得较满意疗效.现报告如下.     

垂体后叶素与善宁联用治疗肝硬化并上消化道出血疗效观察

1999年1月～2005年12月,我们采用善宁联合垂体后叶素治疗肝硬化并上消化道出血患者50例,疗效显著,且副作用较小。现报告如下。     

善得定立止血与洛赛克联合治疗肝硬化并上消化道大出血30例

我们近两年联合应用善得定、立止血、洛赛克治疗肝硬化合并食道胃底静脉曲张破裂出血30例,取得较好疗效,现报告如下。 1 临床资料 1.1 一般资料 30例病人均经B超或CT、生化等辅助检查,确诊为肝硬化,胃镜或食道吞钡摄片证实有食道胃底静脉曲张,并排除其他原因引起的出血,其中男21例,女9例,年龄18～78岁,平均45岁。患者均有呕血、排柏油样或暗红色大便、伴不同程度血压下降、头晕、冷汗、心率增快。估计出血量800～2000ml以上。     

洛赛克治疗老年急性上消化道出血80例疗效观察

本文比较了洛赛克（ｌｏｓｅｃ）与信法丁（ｆａｍｏｔｉｎｅ）治疗８０例老年人急性上消化道出血的止血疗效。结果洛赛克总有效率为９６．７％，较信法丁８３．３％显著（Ｐ＜０．０５）。在应用中，未发现其对各重要器官的功能和合并症造成影响，实验室检查无异常发现，副作用轻微。提示了对患有４种以上合并症，出血量达＞１０００亳升，病因为急性胃粘膜病、胃癌的老年人急性上消化道出血，洛赛克是一种可供优先选择的药物，疗程一般为５天左右。     

Epidemiology of acute upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding is an important emergency situation. Population-based epidemiology data are important to get insight in the actual healthcare problem. There are only few recent epidemiological surveys regarding acute upper gastrointestinal bleeding. Several surveys focusing on peptic ulcer disease showed a significant decrease in admission and mortality of peptic ulcer disease. Several more recent epidemiological surveys show a decrease in incidence of all cause upper gastrointestinal bleeding. The incidence of peptic ulcer bleeding remained stable. Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, responsible for about 50% of all cases, followed by oesophagitis and erosive disease. Variceal bleeding is the cause of bleeding in cirrhotic patients in 50-60%. Rebleeding in upper gastrointestinal bleeding occurs in 7-16%, despite endoscopic therapy. Rebleeding is especially high in variceal bleeding and peptic ulcer bleeding. Mortality ranges between 3 and 14% and did not change in the past 10 years. Mortality is increasing with increasing age and is significantly higher in patients who are already admitted in hospital for co-morbidity. Risk factors for peptic ulcer bleeding are NSAIDs use and H. pylori infection. In patients at risk for gastrointestinal bleeding and using NSAIDs, a protective drug was only used in 10%. COX-2 selective inhibitors do cause less gastroduodenal ulcers compared to non-selective NSAIDs, however, more cardiovascular adverse events are reported. H. pylori infection is found in about 50% of peptic ulcer bleeding patients. H. pylori should be tested for in all ulcer patients and eradication should be given.     

内镜治疗在急性非静脉曲张上消化道出血中的应用

急性非静脉曲张上消化道出血是临床常见的急危重症。内镜技术在急性非静脉曲张上消化道出血的治疗中有重要价值。近年此领域有了持续的新进展。本文即就内镜治疗对急性非静脉曲张上消化道出血的适宜治疗患者、治疗时机以及治疗方法和策略等方面给予简述。     

急性上消化道出血救治研究现状

急性上消化道出血为临床常见急症,近几年来国内关于急性上消化道出血急救推荐指南、共识不断更新,但由于我国地域医疗水平及医疗资源发展的不均衡,急救体系尚待健全,院内快速多学科合作模式有待完善.急性上消化道出血救治应遵循“降阶梯”思维,应建立规范的诊治流程.2020年春季启动的中国急性上消化道出血急诊救治快速通道建设,将对规...     

Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate

AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal upper gastrointestinal bleeding(NV-UGIB).METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding.RESULTS Of the 45 patients treated endoscopically without initialhemostasis or with early rebleeding, 33(76.7%) were treated with modified cyanoacrylate glue, 16(37.2%) underwent surgery, and 3(7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS(23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients(78.8%): 19 out of 24(79.2%) during the first endoscopy and in 7 out of 9(77.8%) among early rebleeders. Two patients(22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.     

氩离子凝固术联合中药治疗上消化道出血的临床研究

[目的]探讨内镜下氩离子凝固术（APC）联合自拟止血一号方治疗非静脉曲张性上消化道出血的临床疗效。[方法]对120例确诊为非静脉曲张性上消化道出血患者,在内镜下行APC止血,予以质子泵抑制剂、静脉补液等常规治疗后,随机分为2组：治疗组（60例）,在常规治疗的基础上加用自拟止血一号方煎剂口服;对照组（60例）仅予常规治疗。比较2组治疗总有效率及再出血率、死亡率、输血量、平均住院日、住院费用等指标。[结果]治疗组和对照组的总有效率分别为96．61％和88．33％（P〈0.05）;再出血率为3．33％和11．67％（P〈0.05）;死亡率为1．67％和5．00％（P〈0.05）;输血量为（2．34±2．05）U和（4．35±3．45）U（P〈0．05）;平均住院日为（10．59±4．88）d和（15．79±8．00）d（P〈0．05）;住院费用为（8．16±1．43）千元和（13．35±1．91）千元（P〈0．05）。[结论]APC联合中药治疗上消化道出血是一种疗效显著、死亡率及输血量低、住院天数短、经济实惠的治疗方法。     

急性非静脉曲张性上消化道出血临床分析

目的分析非静脉曲张性上消化道出血的临床特征。方法回顾分析我院消化内科2009年1月-2011年12月期间收治的经胃镜证实的301例非静脉曲张性上消化道出血病例,分析总结非静脉曲张性上消化道出血的常见病因及临床诊治情况。结果非静脉曲张性上消化道出血的常见病因依次为消化性溃疡、消化道肿瘤、急性胃黏膜病变,内科保守治疗的有效率为96.35%(290/301),内镜下止血成功率93.55%(58/62)。结论消化性溃疡是非静脉曲张性上消化道出血最常见的病因。在消化道出血的救治中,急诊内镜、选择性血管造影以及内外科的紧密配合与协作发挥着重要作用。     

奥曲肽治疗血吸虫肝硬化上消化道出血的临床评价

[目的]探讨奥曲肽治疗血吸虫肝硬化上消化道出血的临床诊治特点和治疗效果。[方法]选择我院2011年4月~2014年1月收治的符合此次研究纳入标准的血吸虫肝硬化上消化道出血患者50例作为研究对象,按照随机对照原则,将患者随机分为对照组和实验组。实验组接受奥曲肽治疗,对照组进行垂体后叶素治疗,比较2组患者的临床疗效以及不良反应发生率等。[结果]实验组和对照组患者接受治疗后,实验组治疗总有效率为92.0%,对照组患者治疗总有效率为64.0%,2组比较差异有统计学意义（P〈0.01）;实验组患者的平均止血时间、再出血率以及并发症发生率均低于对照组,2组比较差异有统计学意义（P〈0.05）。[结论]奥曲肽在治疗血吸虫肝硬化上消化道出血方面较传统方法（垂体后叶素）临床效果显著,不良反应少,改善了患者的预后,提高了患者的生存质量,故该治疗方法值得在临床上进一步推广应用。     

Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes

The clinical outcome of upper gastrointestinal bleeding has improved due to advances in endoscopic therapy and standardized peri‐endoscopy care. Apart from validating clinical scores, artificial intelligence‐assisted machine learning models may play an important role in risk stratification. While standard endoscopic treatments remain irreplaceable, novel endoscopic modalities have changed the landscape of management. Over‐the‐scope clips have high success rates as rescue or even first‐line treatments in difficult‐to‐treat cases. Hemostatic powder is safe and easy to use, which can be useful as temporary control with its high immediate hemostatic ability. After endoscopic hemostasis, Doppler endoscopic probe can offer an objective measure to guide the treatment endpoint. In refractory bleeding, angiographic embolization should be considered before salvage surgery. In variceal hemorrhage, banding ligation and glue injection are first‐line treatment options. Endoscopic ultrasound‐guided therapy is gaining popularity due to its capability of precise localization for treatment targets. A self‐expandable metal stent may be considered as an alternative option to balloon tamponade in refractory bleeding. Transjugular intrahepatic portosystemic shunting should be reserved as salvage therapy. In this article, we aim to provide an evidence‐based comprehensive review of the major advancements in endoscopic hemostatic techniques and clinical outcomes.