Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

Upper gastrointestinal hemorrhage caused by superwarfarin poisoning

Superwarfarins are a class of rodenticides. Gastrointestinal hemorrhage is a fatal complication of superwarfarin poisoning, requiring immediate treatment. Here, we report a 55-year-old woman with tardive upper gastrointestinal hemorrhage caused by superwarfarin poisoning after endoscopic cold mucosal biopsy.

Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Hemorrhage:A Retrospective Analysis

Objective:The role of urgent endoscopy in nonvariceal upper gastrointestinal hemorrhage(NVUGIH)remains controversial.We designed a retrospective study to compare the outcomes between urgent endoscopy(within 12 h)and non-urgent endoscopy for patients with NVUGIH.Methods:A total of 540 hospitalized patients with NVUGIH were included in our study.Patients who received endoscopy within 12 h or after 12 h were divided into two groups,the urgent and non-urgent endoscopy groups,respectively.The clinical outcomes including rebleeding,mortality,endoscopic re-intervention,need for emergency surgery and interventional radiotherapy were compared between the groups.Patients with Glasgow-Blatchford scores(GBS)<12 and>12 were defined as the lower-and high-risk groups,respectively,and the predictors of rebleeding and mortality in both groups were analyzed individually.Results:Patients with NVUGIH in the urgent endoscopy group had a higher rate of rebleeding(27.6%vs.16.9%,P=0.003)and blood transfusion(73.2%vs.55.5%,P<0.001)than those in the non-urgent endoscopy group,while the mortality and the length of hospitalization were not significantly different between the groups(P>0.05).For lower-risk patients,urgent endoscopy was independently associated with a higher likelihood of rebleeding(adjusted OR:1.73,95%CI:1.03-2.88),while it was not associated with in-hospital mortality.However,the urgent need for endoscopy was not associated with rebleeding and in-hospital mortality in high-risk patients.Conclusion:Endoscopy within 12 h did not provide any advantage in the outcomes of patients with NVUGIH,and may even lead to an increased rebleeding rate in lower-risk patients.

Pseudoxantoma elasticum,as a repetitive upper gastrointestinal hemorrhage cause in a pregnant woman

Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms: atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d'orange finding in the fundus; thinning of the retinal nerve fiber in OCT (optic coherence tomography); bilateral and reticular papillary lesions with yellowish-color in the neck region (plucked chicken appearance); presence of bleeding foci in fundus; and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticum diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticum cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling.

Effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage

Objective: To study the effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage. Methods: Patients diagnosed with cirrhosis-induced upper gastrointestinal hemorrhage in No. 215 Hospital of Shaanxi Nuclear Industry between June 2015 and March 2017 were selected as the research subjects, and random number table was used to divide them into the GSH group who accepted reduced glutathione combined with conventional therapy and the control group who accepted conventional therapy. Serum levels of liver function indexes, vasoactive molecules and oxidative stress reaction molecules in two groups of patients were detected before treatment and 3 d after treatment. Results: 3 d after treatment, serum ALT, AST, γ-GT, TBIL, PRA, AT-Ⅱ, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of both groups of patients were significantly lower than those before treatment while SOD, GSH-Px and CAT levels were significantly high than those before treatment, and serum ALT, AST, γ-GT, TBIL, PRA, AT-II, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of GSH group were significantly lower than those of control group while SOD, GSH-Px and CAT levels were significantly higher than those of control group. Conclusion: The adjuvant reduced glutathione therapy for cirrhosis-induced upper gastrointestinal hemorrhage can improve the liver function, regulate the secretion of vasoactive molecules and reduce the oxidative stress response.

Potential role of new technological innovations in nonvariceal hemorrhage

The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.

Rare presentation of primary (AL) amyloidosis as gastrointestinal hemorrhage without systemic involvement

We are reporting a rare case of a patient with primary(AL) amyloidosis presenting with an acute non-varicealupper gastrointestinal hemorrhage in the absence ofother systemic involvement. The case report involves a58-year-old woman with significant cardiac history andhereditary blood disorder who came in complaining ofabdominal pain and coffee-ground emesis for two days.Computed tomography(CT) scan of the abdomen andpelvis with contrast revealed segmental wall thickeningof the proximal jejunum with hyperdense, heterog-enous luminal content. Similar findings were evident inthe left lower small bowel region, suspicious for smallbowel hematoma and the possibility of intraluminalclots. Esophagogastroduodenoscopy performed postresuscitation showed punctate, erythematous lesionsthroughout the stomach as well as regions of smallbowel mucosa that appeared scalloped, ulcerated, andhemorrhaged on contact. Despite initial treatment for immunostain-positive focal cytomegalovirus gastritis, follow-up esophagogastroduodenoscopy after two months continued to demonstrate friable and irregular duodenal mucosa hinting at a different underlying etiol-ogy. Pathology reports from analyses of biopsy samples highlighted infiltration and expansion of the lamina pro-pria and submucosa. Subsequent staining with congo red/crystal violet and appropriate subtyping established the diagnosis of AL(kappa)-type amyloidosis. The sig-nificance of this case lies in the fact that our patient did not have the typically seen diagnostic systemic involvements-namely of heart and kidneys-usually seen in primary(AL) amyloidosis patients. It was the persis-tent endoscopic findings and biopsy results which gave clues to the physicians regarding the possibility of an abnormal protein-deposition entity.

Etiological Analysis of 419 Cases of Digestive Tract Hemorrhage

Aim: To study common cause of digestive tract hemorrhage and the relationship between etiology and age. Methods: Retrospective analysis about the data of 419 cases of digestive tract hemorrhage in digestive internal medicine from January 2016 to January 2018 in Jingzhou Central Hospital. Results: 419 cases of digestive tract hemorrhage include 305 cases of hemorrhage in upper digestive tract and 114 cases of hemorrhage in lower digestive tract. The first 5 causes of upper digestive tract hemorrhage in middle-aged and young group were: duodenal bulb ulcer, gastric ulcer, esophageal and stomach bottom varices bleeding in cirrhosis of schistosomiasis, compound ulcer, esophageal and stomach bottom varices bleeding in hepatitis B cirrhosis. The first 5 causes of upper digestive tract hemorrhage in elderly group were: gastric ulcer, duodenal bulb ulcer, esophageal and stomach bottom varices bleeding in hepatitis B cirrhosis, esophageal and stomach bottom varices bleeding in cirrhosis of schistosomiasis, gastric cancer. The first 5 causes of lower digestive tract hemorrhage in middle-aged and young group were: ulcerative colitis, colorectal polyps, hemorrhoids, crohn’s disease, ischemic bowel disease. The first 5 causes of lower digestive tract hemorrhage in elderly group were: colorectal polyps, colon cancer, ulcerative colitis, ischemic bowel disease, hemorrhoids. Conclusion: In the cases of upper digestive tract hemorrhage, peptic ulcer should be paid attention to in middle-aged and young people, and elderly should be noted in gastric cancer. Ulcerative colitis should be paid attention to in middle-aged and young people with lower digestive tract hemorrhage, and elderly should be noted in colorectal polyps and colon cancer.

急性上消化道出血继发急性肾损伤和病情进展危险因素分析

目的:探讨急性上消化道出血(AUGIB)患者继发急性肾损伤(AKI)和病情进展的危险因素。方法:回顾性分析厦门大学附属东南医院2021年1月至2023年6月收治的233例上消化道出血患者临床资料,根据入院后是否发生AKI分为AKI组(n=67)和非AKI组(n=166),AKI患者根据病情是否进展分为进展组(n=21)和无进展组(n=46)。采用单因素和多因素分析上消化道出血继发急性肾损伤和病情进展的危险因素。结果:233例AUGIB患者中消化道溃疡患者157例、食管胃底静脉曲张42例、急性胃黏膜损伤18例、食管贲门撕裂综合征10例、异物6例。AKI患者67例,发生率为28.76%,其中,21例发生AKI进展,进展率为31.34%。单因素分析发现,冠心病、肝硬化、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上AUGIB患者AKI发生率较高(P<0.05)。多因素分析发现,冠心病(OR=2.706,95%CI 1.127~6.494)、血小板计数<50×10^(9)/L(OR=3.570,95%CI 1.249~10.203)、上消化道出血分级高危及以上(OR=3.078,95%CI 1.145~8.227)是AKI发生的独立危险因素。单因素分析发现,67例AUGIB继发AKI患者中,男性、糖尿病、乙型肝炎、肝硬化、既往上消化道出血病史、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上患者AKI进展发生率较高(P<0.05)。多因素分析发现,肝硬化(OR=7.975,95%CI 1.400~45.441)、血小板计数<50×10^(9)/L(OR=19.612,95%CI 2.640~145.703)、上消化道出血分级高危及以上(OR=6.814,95%CI 1.183~27.985)是AKI进展的独立危险因素。结论:AUGIB患者要警惕AKI的发生,冠心病、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI发生的独立危险因素,而肝硬化、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI进展的独立危险因素。

生长抑素联合奥美拉唑治疗上消化道出血的效果及安全性分析

目的分析上消化道出血应用生长抑素联合奥美拉唑的治疗效果及安全性。方法70例上消化道出血患者,以随机数字表法分为参照组和观察组,各35例。参照组患者以奥美拉唑开展治疗,观察组患者以奥美拉唑+生长抑素开展治疗。对比两组治疗效果、不良反应发生情况、止血时间和住院时间及治疗前后凝血功能[D-二聚体(D-D)、血浆纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)]。结果观察组总有效率97.14%高于参照组的80.00%(P<0.05)。观察组止血时间(12.32±3.36)h、住院时间(7.18±1.74)d短于参照组的(18.23±5.32)h、(10.13±2.23)d(P<0.05)。观察组不良反应发生率2.86%低于参照组的17.14%(P<0.05)。治疗后,观察组D-D(0.53±0.22)mg/L、APTT(26.03±2.12)s、PT(11.13±0.58)s低于参照组的(0.96±0.39)mg/L、(28.42±3.11)s、(13.68±0.68)s,FIB(2.93±0.29)g/L高于参照组的(2.21±0.32)g/L(P<0.05)。结论上消化道出血应用生长抑素联合奥美拉唑治疗效果显著,可有效改善机体的凝血功能,减少出血量,缩短住院时间,并且用药后不良反应较少,安全性较高,值得推广。

吲哚布芬与氯吡格雷治疗缺血性心脑血管疾病合并上消化道出血患者的效果与安全性

目的:分析吲哚布芬与氯吡格雷在治疗缺血性心脑血管疾病合并上消化道出血患者中的效果与安全性。方法:选取2021年3月—2023年4月潮州市中心医院收治的60例缺血性心脑血管疾病合并上消化道出血患者,随机将其分为两组,各30例。对照组实施氯吡格雷治疗,观察组实施吲哚布芬治疗,对比两组临床疗效、炎症因子、不良反应情况。结果:干预后,观察组的总有效率为96.67%(29/30),高于对照组的76.67%(23/30),差异有统计学意义(P<0.05)。干预后,观察组hs-CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率6.67%(2/30),低于对照组的26.67%(8/30),差异有统计学意义(P<0.05)。结论:与氯吡格雷相比,吲哚布芬在治疗缺血性心脑血管疾病合并上消化道出血患者中具有良好的临床效果,能有效改善炎症因子水平,降低不良反应发生率,安全性好。

不同时机内镜治疗老年急性上消化道出血对患者临床结局的影响

目的:探讨不同时间内镜治疗老年急性上消化道出血对患者临床结局的影响。方法:选取晋江市医院2021年5月—2023年5月收治的100例急性上消化道出血患者为对象,根据不同治疗方式进行分组,其中在发病12h内采取内镜治疗为观察组,在发病12~24h采取内镜治疗为参照组,各50例。对比两组围手术期相关指标、生化指标及临床治疗结局。结果:观察组输血量少于参照组,手术时间、呕血或黑便停止时间、术后进食时间及住院时间均短于参照组(P<0.05)。治疗后,观察组血小板、血红蛋白及血清白蛋白指标均高于参照组(P<0.05)。两组再出血、转入重症监护病房、术后30 d复发及死亡发生率比较,差异均无统计学意义(P>0.05)。结论:与发病12~24 h采取内镜治疗相比,对老年急性上消化道出血在发病12h内进行内镜治疗可取得更为理想的干预及止血效果,积极缩短相关治疗时间。

双侧子宫动脉上行支结扎术在防治前置胎盘剖宫产产后出血中的应用

目的:探讨双侧子宫动脉上行支结扎术在防治前置胎盘剖宫产产后出血(PPH)中的临床效果。方法:选取2018年3月—2023年3月黔东南苗族侗族自治州剑河县人民医院拟行剖宫产治疗的前置胎盘产妇孕60例为研究对象,按随机数字表法分为对照组及研究组,各30例。对照组采用宫腔填塞止血,研究组采用双侧子宫动脉上行支结扎术止血。比较两组围术期相关指标(PPH发生率、术中及术后24 h出血量、手术时间、住院时间)及术后并发症。结果:研究组PPH发生率低于对照组,差异有统计学意义(P=0.012);研究组术中出血量、术后24 h出血量少于对照组,手术时间及住院时间短于对照组,差异有统计学意义(P<0.05);研究组术后并发症发生率低于对照组,差异有统计学意义(P<0.001)。结论:前置胎盘剖宫产术中采用双侧子宫动脉上行支结扎术能够减少术中及术后出血量,降低PPH发生率、术后并发症发生率,缩短手术时间及住院时间。

Blatchford分级管理在急性上消化道出血患者中的应用

目的探究Blatchford分级管理在急性上消化道出血患者中的应用效果。方法选择2020年1月至2023年1月江苏省如皋市中医院诊治的92例急性上消化道出血患者,依据随机数字表法将其分为对照组和观察组,每组46例。对照组采取常规护理,观察组应用Blatchford分级管理。比较两组干预前后我效能感量表(GSES)评分、粪便隐血试验转阴时间、恢复肠鸣音时间、止血时间及住院时间;观察并发症的发生情况。结果干预后,两组GSES评分均较干预前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组粪便隐血试验转阴时间、恢复肠鸣音时间、止血时间及住院时间短于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论Blatchford分级管理可缩短急性上消化道出血患者的临床恢复时间,降低并发症的发生率,预后良好。

急性上消化道出血患者D-D、AT-Ⅲ与幽门螺杆菌感染检测意义

背景尽管近年来,消化道出血(acute upper gastrointestinal bleeding,AUGIB)患病人数有所下降,但其整体病死率仍高达5%-11%.机体凝血-纤溶过程中的物质D-二聚体(D-dimer,D-D)、抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)及幽门螺杆菌(Helicobacter pylori,H.pylori)与肝硬化患者消化道出血有关,但关于其与AUGIB危险分层的研究较少.目的探究急性上AUGIB患者D-D、AT-Ⅲ与H.pylori感染检测意义.方法选取2019-06/2023-10我院120例AUGIB患者作为观察组,另选取同期健康体检者120例作为对照组.比较两组D-D、AT-Ⅲ、H.pylori感染率,并比较不同危险分层患者临床资料及、D-D、AT-Ⅲ与H.pylori感染情况,分析AUGIB危险分层的影响因素,以受试者工作特征曲线评价D-D、AT-Ⅲ与H.pylori感染对中高危AUGIB的诊断价值.结果观察组血浆D-D水平及H.pylori感染率高于对照组,AT-Ⅲ水平低于对照组(P<0.05);中高危患者年龄、血浆D-D水平及H.pylori感染率高于低危患者,血红蛋白及AT-Ⅲ水平低于低危患者(P<0.05),Logistic回归分析结果显示,年龄、血红蛋白、D-D、AT-Ⅲ及H.pylori感染均为AUGIB危险分层的独立影响因素(P<0.05);D-D、AT-Ⅲ与H.pylori感染单独预测诊断中高危AUGIB的AUC值分别是0.813、0.776、0.711,三者联合预测诊断AUC值为0.933,明显大于各指标单独诊断,最佳敏感度及特异度分别是85.29、91.86%.结论D-D、AT-Ⅲ、H.pylori感染均与AUGIB的发生及危险分层有关,临床对其进行检测,可诊断AUGIB患者危险分层.

ABC评分、AIMS65评分、格拉斯哥-布拉奇福德评分对上消化道出血病人死亡的预测价值比较

目的 比较ABC(年龄、血液学、合并症)评分、AIMS65评分、格拉斯哥-布拉奇福德评分(GBS)预测急性上消化道出血(AUGIB)病人死亡方面的表现。方法 回顾性收集2018年12月至2022年1月于徐州医科大学附属医院确诊为AUGIB的330例病人资料,根据病人住院期间的生存情况,分为存活组(304例)和死亡组(26例)。收集病人的一般资料和实验室检查结果,进行ABC、AIMS65和GBS,评估3种评分对AUGIB病人住院死亡的预测能力。结果 两组病人的年龄、血清白蛋白(ALB)、国际标准化比值(INR)、ABC评分、AIMS65评分、GBS及有无吸烟、恶性肿瘤、心衰、黑便、晕厥等的比较差异有统计学意义(P<0.05)。与存活组相比,死亡组病人的ABC评分[9.50(7.50,12.00)比3.00(2.00,5.00)]、AIMS65评分、GBS、INR[1.53(1.16,1.90)比1.03(0.96,1.16)]显著升高(P<0.05)。logistic回归分析显示ALB、INR、ABC评分是AUGIB病人住院死亡的独立危险因素。ROC曲线显示三种评分对AUGIB病人住院死亡均有一定预测价值,ABC评分预测住院死亡的价值较高,AUC 95%CI为0.90(0.87,0.94)、P<0.001,灵敏度为84.6%,特异度为90.5%;AIMS65评分和GBS具有中等预测价值,AUC 95%CI分别为0.84(0.80,0.88)、P<0.001,0.82(0.78,0.86)、P<0.001,灵敏度分别为76.9%、69.2%,特异度分别为81.6%、87.8%。结论 ABC评分对AUGIB病人住院死亡的预测价值较好,AIMS65评分和GBS的预测价值中等。

凝血指标与血小板参数指导急性上消化道出血患者输血治疗的临床价值

目的分析凝血指标与血小板参数指导急性上消化道出血患者输血治疗的临床价值。方法选取2015年2月至2020年2月鄂州市中医医院收治的120例急性上消化道出血患者作为实验组,另选取同期120名健康体检者作为对照组。比较实验组与对照组、实验组输血治疗前后凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIb)、凝血酶时间(TT)、血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)。结果实验组APTT、PT、TT均长于对照组,Fib水平、PLT均低于对照组,PDW宽于对照组,MPV小于对照组,差异有统计学意义(P<0.05)。治疗后,实验组APTT、PT、TT均短于治疗前,Fib水平、PLT均高于治疗前,MPV小于治疗前,PDW窄于治疗前,差异有统计学意义(P<0.05)。结论凝血功能和血小板相关参数可鉴别上消化道出血,APTT、Fib和PLT可为上消化道出血患者临床输血治疗提供参考价值,值得临床推广应用。

胃镜下止血治疗急性上消化道出血的临床效果

目的:分析急性上消化道出血患者采用胃镜下止血治疗的临床效果。方法:选取2021年1月—2022年12月贵阳市息烽县人民医院收治的80例急性上消化道出血患者作为研究对象,根据随机数字表法分为观察组和对照组,各40例,对照组采用常规治疗方案,观察组采用胃镜下止血治疗方案。比较两组治疗效果。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.034)。治疗前,两组血红蛋白水平比较,差异无统计学意义(P>0.05);治疗后,两组血红蛋白水平高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组止血时间、肠鸣音恢复时间、大便潜血转阴时间短于对照组,差异有统计学意义(P<0.001)。结论:胃镜下止血治疗急性上消化道出血的临床效果显著,可快速止血,避免失血过多,促进患者恢复。

蛇毒血凝酶单独与联合生长抑素在急性上消化道出血患者中的应用

目的观察蛇毒血凝酶单独与联合生长抑素在急性上消化道出血患者中的应用效果。方法选择2019年1月至2023年11月在我院治疗的急性上消化道出血患者64例为研究对象,随机分为蛇毒血凝酶组和蛇毒血凝酶联合生长抑素组(以下称为联合组),每组32例。两组患者均给予常规药物治疗,蛇毒血凝酶组在常规药物治疗上给予蛇毒血凝酶治疗,联合组在常规药物治疗上给予蛇毒血凝酶与生长抑素联合治疗。比较两组患者的临床疗效和临床指标(止血时间、血压稳定时间、隐血试验转阴时间),并测定治疗前后的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(DD)、纤维原蛋白(FIB)]水平,并统计不良反应发生率。结果两组患者的临床疗效比较,联合组明显高于蛇毒血凝酶组,差异有统计学意义(P<0.05)。两组患者的临床指标比较,联用组在止血时间、血压稳定时间、隐血试验转阴时间方面均明显短于蛇毒血凝酶组,差异均有统计学意义(均P<0.05)。治疗后,两组患者凝血功能指标中的PT、APTT水平均明显低于治疗前,FIB和DD水平均明显高于治疗前,差异均有统计学意义(均P<0.05);治疗后,两组患者的凝血功能指标比较,联合组的PT、APTT水平均明显低于蛇毒血凝酶组,FIB和DD水平均明显高于蛇毒血凝酶组,差异均有统计学意义(均P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论蛇毒血凝酶与生长抑素联合应用对急性上消化道出血患者的治疗效果较单独使用蛇毒血凝酶更佳,能快速止血,改善凝血功能,且安全性良好,值得临床应用。

利伐沙班联合导管溶栓在老年颅内出血患者急性上肢深静脉血栓形成的血小板∕淋巴细胞比率及预后影响

目的分析利伐沙班联合导管溶栓在老年颅内出血患者急性上肢深静脉血栓形成的血小板淋巴细胞比率及预后影响。方法选取南京医科大学第一附属医院2018年10月~2022年9月收治的老年颅内出血并发急性上肢深静脉血栓患者43例导管拔除后予以利伐沙班口服的患者作为观察组,并选取同期43例单纯溶栓患者为对照组。评估观察两组患者治疗后的临床疗效、血小板淋巴细胞比率(PLR)等情况。结果观察组总有效率93.02%(4043)显著高于对照组79.07%(3143),差异有统计学意义(χ2=4.038,P<0.05)。观察组血浆二聚体(D-D)、纤维蛋白原(Fib)、PLR均显著低于对照组[(0.71±0.14)mg L vs.(0.83±0.22)mg L、(3.52±0.38)g L vs.(4.37±0.42)g L、(220.83±53.1)vs.(281.12±89.73)],凝血酶原时间(PT)、活化部分凝血酶时间(APTT)均显著高于对照组[(15.14±1.31)s vs.(14.18±1.52)s、(44.29±4.53)s vs.(40.28±4.17)s],差异均有统计学意义(t=3.018、9.841、3.784、3.137、4.271,P<0.05)。治疗2周后,观察组患肢与健肢肘上、肘下20 cm处周径差值显著低于对照组[(1.52±0.23)cm vs.(1.83±0.27)cm、(1.02±0.12)cm vs.(1.69±0.35)cm],差异均有统计学意义(t=5.731、11.874,P<0.05)。观察组不良反应发生率低于对照组,但差异无统计学意义(P>0.05)。结论利伐沙班联合导管溶栓治疗急性上肢深静脉血栓,可以取得一定的临床疗效,DVT形成的生理机制与PLR相关,PLR指标对DVT的形成及预后评估有帮助。