AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscop...AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.展开更多
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,en...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.展开更多
目的:探讨肝硬化上消化道大出血患者体内脂质过氧化状态的变化及丹参注射液对其的影响.方法:肝硬化上消化道大出血患者91例,随机分为丹参注射液治组(n=36)和传统治疗组(n=55).分别测定患者血中超氧化物岐化酶(SOD)活性和过氧化脂质(LPO...目的:探讨肝硬化上消化道大出血患者体内脂质过氧化状态的变化及丹参注射液对其的影响.方法:肝硬化上消化道大出血患者91例,随机分为丹参注射液治组(n=36)和传统治疗组(n=55).分别测定患者血中超氧化物岐化酶(SOD)活性和过氧化脂质(LPO)含量.结果:传统治疗组患者血中LPO含量在出血后明显增加,72h左右达最高峰(11.0±4.1 nmol/L),较出血前或12h内(7.8±3.3 nmol/L)明显升高(P<0.01),1wk后开始下降,4wk后可不同程度恢复.而经丹参注射液治疗的患者血中LPO含量亦于72h左右达最高峰,但变化幅度较小(9.9±4.6nmol/L vs 7.8±3.1nmol/L,P<0.05),恢复较快.两组SOD活性变化与LPO含量变化相反,72h降至最小值(传统治疗组:0.87±0.2 nkat/L vs 1.3±0.2 nkat/L,P<0.01;丹参注射液治组:0.9±0.3 nkat/L vs 1.4±0.2 nkat/L,P<0.01),4 wk后可不同程度恢复.丹参注射液治疗组患者的预后明显优于传统治疗组(P<0.01),且Child-Pugh B级者优于C级(P<0.05).结论:丹参注射液可提高机体的抗氧化能力,改善肝硬化上消化道大出血患者的预后.展开更多
目的:探讨不同输血方法对急性上消化道非大量出血患者预后的影响。方法:选取本院2016年1月-2018年1月收治的急性上消化道非大量出血患者86例,所有患者均给予抑酸、抑酶、止血等常规药物加输血治疗。依据输血方式的不同,将行限制性输血...目的:探讨不同输血方法对急性上消化道非大量出血患者预后的影响。方法:选取本院2016年1月-2018年1月收治的急性上消化道非大量出血患者86例,所有患者均给予抑酸、抑酶、止血等常规药物加输血治疗。依据输血方式的不同,将行限制性输血治疗者设为限制组(n=56),行积极行输血治疗者设为积极组(n=30),记录患者的输液量、住院时间、输血情况(输血次数、输血量、输血前及出院时血红蛋白水平)、住院期间不良事件情况(再出血、死亡、并发症)等。结果:两组患者每日输液量、输血次数、输血量比较差异无统计学意义(t=1.059、1.227、1.579,P>0.05);限制组输血前血红蛋白水平(59.37±10.08)g/L,低于积极组的(81.44±11.46)g/L(t=4.094,P<0.05),但出院时两组患者的血红蛋白水平(98.64±12.06)g/L vs(104.94±13.07)g/L比较差异无统计学意义(t=1.941,P>0.05);限制组患者的死亡率为5.36%,与积极组的6.67%比较差异无统计学意义(χ^(2)=1.157,P>0.05);限制组患者的住院时间(8.06±0.35)d,短于积极组的(11.64±0.69)d(t=6.087,P<0.05);限制组和积极组患者的再出血发生率(8.93% vs 13.33%)、并发症发生率(17.88% vs 26.67%)比较,差异均有统计学意义(χ^(2)=8.357、7.034,P<0.05)。结论:限制性输血和积极性输血均是急性上消化道非大量出血的有效治疗方法,但限制性输血可缩短住院时间,减少再出血和并发症的发生,可考虑推广使用。展开更多
文摘AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.
文摘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.
文摘目的:探讨肝硬化上消化道大出血患者体内脂质过氧化状态的变化及丹参注射液对其的影响.方法:肝硬化上消化道大出血患者91例,随机分为丹参注射液治组(n=36)和传统治疗组(n=55).分别测定患者血中超氧化物岐化酶(SOD)活性和过氧化脂质(LPO)含量.结果:传统治疗组患者血中LPO含量在出血后明显增加,72h左右达最高峰(11.0±4.1 nmol/L),较出血前或12h内(7.8±3.3 nmol/L)明显升高(P<0.01),1wk后开始下降,4wk后可不同程度恢复.而经丹参注射液治疗的患者血中LPO含量亦于72h左右达最高峰,但变化幅度较小(9.9±4.6nmol/L vs 7.8±3.1nmol/L,P<0.05),恢复较快.两组SOD活性变化与LPO含量变化相反,72h降至最小值(传统治疗组:0.87±0.2 nkat/L vs 1.3±0.2 nkat/L,P<0.01;丹参注射液治组:0.9±0.3 nkat/L vs 1.4±0.2 nkat/L,P<0.01),4 wk后可不同程度恢复.丹参注射液治疗组患者的预后明显优于传统治疗组(P<0.01),且Child-Pugh B级者优于C级(P<0.05).结论:丹参注射液可提高机体的抗氧化能力,改善肝硬化上消化道大出血患者的预后.
文摘目的:探讨不同输血方法对急性上消化道非大量出血患者预后的影响。方法:选取本院2016年1月-2018年1月收治的急性上消化道非大量出血患者86例,所有患者均给予抑酸、抑酶、止血等常规药物加输血治疗。依据输血方式的不同,将行限制性输血治疗者设为限制组(n=56),行积极行输血治疗者设为积极组(n=30),记录患者的输液量、住院时间、输血情况(输血次数、输血量、输血前及出院时血红蛋白水平)、住院期间不良事件情况(再出血、死亡、并发症)等。结果:两组患者每日输液量、输血次数、输血量比较差异无统计学意义(t=1.059、1.227、1.579,P>0.05);限制组输血前血红蛋白水平(59.37±10.08)g/L,低于积极组的(81.44±11.46)g/L(t=4.094,P<0.05),但出院时两组患者的血红蛋白水平(98.64±12.06)g/L vs(104.94±13.07)g/L比较差异无统计学意义(t=1.941,P>0.05);限制组患者的死亡率为5.36%,与积极组的6.67%比较差异无统计学意义(χ^(2)=1.157,P>0.05);限制组患者的住院时间(8.06±0.35)d,短于积极组的(11.64±0.69)d(t=6.087,P<0.05);限制组和积极组患者的再出血发生率(8.93% vs 13.33%)、并发症发生率(17.88% vs 26.67%)比较,差异均有统计学意义(χ^(2)=8.357、7.034,P<0.05)。结论:限制性输血和积极性输血均是急性上消化道非大量出血的有效治疗方法,但限制性输血可缩短住院时间,减少再出血和并发症的发生,可考虑推广使用。
