Upper-gastrointestinal bleeding secondary to peptic ulcer disease:Incidence and outcomes

AIM:To evaluate the incidence,surgery,mortality,and readmission of upper gastrointestinal bleeding(UGIB)secondary to peptic ulcer disease(PUD).METHODS:Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta,Canada from 2004 to 2010(n=7079)using the International Classification of Diseases Codes(ICD-10).A subset of the data was validated using endoscopy reports.Positive predictive value and sensitivity with 95%confidence intervals(CI)were calculated.Incidence of UGIB secondary to PUD was calculated.Logistic regression was used to evaluate surgery,in-hospital mortality,and 30-d readmission to hospital with recurrent UGIB secondary to PUD.Co-variants accounted for in our logistic regression model included:age,sex,area of residence(i.e.,urban vs rural),number of Charlson comorbidities,presence of perforated PUD,undergoing upper endoscopy,year of admission,and interventional radiological attempt at controlling bleeding.A subgroup analysis(n=6356)compared outcomes of patients with gastric ulcers to those with duodenal ulcers.Adjusted estimates are presented as odds ratios(OR)with95%CI.RESULTS:The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were85.2%(95%CI:80.2%-90.2%)and 77.1%(95%CI:69.1%-85.2%),respectively.The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per100000.Overall risk of surgery,in-hospital mortality,and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%,8.5%,and 4.7%,respectively.Interventional radiology to control bleeding was performed in 0.6%of patients and 76%of these patients avoided surgical intervention.Thirty-day readmission significantly increased from 3.1%in 2004 to 5.2%in 2010(OR=1.07;95%CI:1.01-1.14).Rural residents(OR rural vs urban:2.35;95%CI:1.83-3.01)and older individuals(OR≥65 vs<65:1.57;95%CI:1.21-2.04)were at higher odds of being readmitted to hospital.Patients with duodenal ulcers had higher odds of dying(OR=1.27;95%CI:1.05-1.53),requiring surgery(OR=1.73;95%CI:1.34-2.23),and being readmitted to hospital(OR=1.54;95%CI:1.19-1.99)when compared to gastric ulcers.CONCLUSION:UGIB secondary to PUD,particularly duodenal ulcers,was associated with significant morbidity and mortality.Early readmissions increased over time and occurred more commonly in rural areas.

Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding

AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.

One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable

AIM:To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease(PUD),erosive gastritis(EG)or duodenitis(ED).METHODS:Retrospective cohort study using ICD-10codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD,EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne,Australia.Patients were divided into"high risk"(those who would benefit from gastroprotection)and"not high risk"groups as defined by established guidelines.Mean Rockall score,transfusion requirement,length of stay,rebleeding rates,need for surgery and in-hospital mortality was compared between"high risk"and"not high risk"groups.Within the"high risk"group,those on gastroprotection and those with no gastroprotection were also compared.RESULTS:Five hundred and seven patients were included for analysis of which 174 were classified as high risk.Median values of complete Rockall Score(5vs 4,P=0.002)and length of stay(5 d vs 4 d,P=0.04)were higher in the high risk group but in-hospital mortality was lower(0.6%vs 3.9%,P=0.03).130out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization.Past history of PUD(OR=3.7,P=0.006)and clopidogrel use(OR=3.2,P=0.007)significantly predicted prescription of gastroprotective therapy.Using proton pump inhibitor protection rates of 50%-85%from published studies,an estimation of13%to 22%of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.CONCLUSION:Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.

Endoscopic hemoclip treatment for bleeding peptic ulcer

AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.

Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease

AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.

Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin

AIM:To investigate the usefulness of anti-ulcer drugs for the prevention and treatment of low-dose aspirin- induced peptic ulcer. METHODS:Upper gastrointestinal endoscopy was performed in 68 patients receiving daily low-dose aspirin(81 or 100 mg/day).The endoscopic findings were classified according to the Lanza score,and the scores were compared between groups categorized according to the concomitant use of anti-ulcer drugs and the types of drugs used.In another study,31 hemorrhagic peptic ulcer patients who had been receiving low-dose aspirin were enrolled.The patients were randomly classified into the proton pump inhibitor (PPI)-treated group and the H2 receptor antagonist (H2RA)-treated group.The administration of low-dose aspirin was continued concomitantly,and endoscopic examinations were performed 8 wk later. RESULTS:The Lanza scores(mean±SD)of the gastro-mucosal lesions were 1.0±1.9 and 1.9±2.3 in 8 and 16 patients receiving prevention therapy with a PPI and an H2RA,respectively.Both scores were significantly smaller than the scores in 34 patients who were not receiving prevention therapy(4.7±1.0)and in 10 patients receiving cytoprotective anti-ulcer drugs (4.3±1.6).In the prospective study,18 and 13 patients received a PPI and an H2RA,respectively.Endoscopic examinations revealed that the tissue in the region of the gastro-mucosal lesions had reverted to normal in all patients in the PPI-treated group and in 12 patients (92%)in the H2RA-treated group;no significant differences were observed between the groups. CONCLUSION:H2RA therapy was effective for both the prevention and treatment of low-dose aspirin- induced peptic ulcer,similar to the effects of PPIs, while cytoprotective anti-ulcer drugs were ineffective in preventing ulceration.

Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

AIM:To establish the prevalence of Helicobacter pylori (H. pylori ) infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflamma- tory drugs (NSAIDs). METHODS:A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease (CLO) test, histological examination, and bacterial culture. IgG anti-CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections. RESULTS:Eighty patients, 61 males (76.3%), mean age 61.2 ± 15.9 years, were consecutively enrolled. Forty-seven (58.8%) patients occasionally consumed NSAIDs, while 33 (41.3%) were on chronic treatment with low-dose aspirin (LD ASA). Forty-four (55.0%) patients were considered infected by H. pylori . The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The highest accuracy (92.5%) was obtained with the culture of biopsy specimens.CONCLUSION:Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

奥美拉唑联合白眉蛇毒血凝酶对消化性溃疡并出血患者凝血指标及血小板参数变化的影响

目的探讨奥美拉唑联合白眉蛇毒血凝酶的治疗消化性溃疡并出血患者的临床疗效。方法选取2020年4月至2022年3月瑞金市总医院/瑞金市人民医院收治的80例消化性溃疡并出血患者作为研究对象,采用单双号法分为对照组与研究组,每组40例。对照组采用奥美拉唑治疗,研究组采用奥美拉唑联合白眉蛇毒血凝酶治疗,比较两组凝血功能指标、血小板参数、临床疗效、临床指标及不良反应发生情况。结果治疗后,两组凝血酶时间(TT)、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均短于治疗前,且研究组短于对照组,差异有统计学意义(P<0.05)。治疗后,两组血小板计数(PLT)均高于治疗前,血小板比容(PCT)均大于治疗前,血小板体积(MPV)均小于治疗前,且研究组PLT高于对照组,PCT大于对照组,MPV小于对照组,差异有统计学意义(P<0.05)。研究组治疗总有效率为97.50%,高于对照组的77.50%,差异有统计学意义(P<0.05)。研究组止血时间、住院时间均短于对照组,复发率低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论奥美拉唑联合白眉蛇毒血凝酶治疗消化性溃疡并出血疗效更佳,可有效改善患者凝血指标及血小板参数,缩短止血时间、住院时间,降低复发率,且安全性较高。

艾司奥美拉唑钠持续泵入与静脉滴注给药方式在消化性溃疡合并出血患者中的应用效果

目的 比较艾司奥美拉唑钠持续泵入与静脉滴注给药方式在消化性溃疡合并出血患者中的应用效果。方法 选择2018年4月至2021年4月收治的90例消化性溃疡合并出血患者作为研究对象,按红绿双色球法将其分为对照组和研究组,各45例。对照组给予艾司奥美拉唑钠静脉滴注治疗,研究组给予艾司奥美拉唑钠持续泵入治疗。比较两组的治疗效果。结果 研究组的出血、呕血、黑便停止时间和腹痛缓解时间短于对照组(P<0.05)。研究组的治疗总有效率为95.56%,显著高于对照组的80.00%(P<0.05)。治疗后,研究组的纤维蛋白原、D-二聚体水平低于对照组,血小板计数(PLT)、红细胞比容(HCT)高于对照组(P<0.05)。治疗后,研究组的表皮生长因子(EGF)、前列腺素E2(PGE2)水平高于对照组,基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-3(MMP-3)水平低于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 相比于艾司奥美拉唑钠静脉滴注给药,持续泵入效果会更好,能够缩短消化性溃疡合并出血患者临床症状消失时间,提高治疗效果,改善凝血功能及血清指标。

消化性溃疡患者并发上消化道出血的危险因素分析

目的分析探讨消化性溃疡(PU)患者并发上消化道出血(UGH)的危险因素。方法选取2021年4月至2022年4月郑州市第九人民医院收治的90例PU患者作为研究对象,收集患者性别、年龄、溃疡长径、溃疡病程、溃疡部位、职业、有无吸烟史、有无饮酒史、是否合并幽门螺杆菌感染、入院时血清单核细胞趋化蛋白-1(MCP-1)水平、入院时CD4+水平、入院时CD8+水平、有无高血压病史、有无糖尿病病史、是否长时间应用非甾体抗炎药、是否合并UGH等资料,并根据患者是否合并UGH将其分为并发UGH组和未并发UGH组,多因素Logistic回归分析PU患者并发UGH的危险因素。结果90例PU患者中22例(24.44%)患者合并UGH,设为并发UGH组;68例(75.56%)患者未合并UGH,设为未并发UGH组。单因素分析结果显示,并发UGH组有饮酒史、长时间应用非甾体抗炎药患者比例明显高于未并发UGH组(χ^(2)=17.113、10.399,P<0.001、P=0.001),血清MCP-1水平、CD4+水平明显高于未并发UGH组(t=18.595、4.757,P均<0.001);多因素Logistic回归分析结果显示,有饮酒史、长时间应用非甾体抗炎药、血清MCP-1高水平、CD4+高水平是PU患者并发UGH的独立危险因素(95%CI为3.386~30.422、1.805~14.281、1.047~1.131、1.098~1.349,P<0.001、P=0.002、P<0.001、P<0.001)。结论PU患者并发UGH与饮酒史、非甾体抗炎药应用史以及MCP-1与CD4+水平密切相关,临床应予以重点关注,及时根据患者具体情况采取针对性干预措施,以预防UGH的发生。

Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child

Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.

Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia?A pilot study

AIM:Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open,pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.METHODS:We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive blood transfusions.One day alter the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100mg im, on days 1-6, (G1) or iron only (G2). Haematocrit was measured on days 0, 6, 14,30, 45, and 60, respectively.R.ESULTS: One patient from G1 and two from G2 were lost to follow-up. Therefore, 14 and 13 patients from G1 and G2 respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study.Median reticulocyte counts were significantly different between groups on day six (G1: 4.0,3.0-6.4 vs G2:3.5,2.1-4.4%,P=0.03) and median haematocrit on day fourteen [G1:35.9,30.7-41.0 vs G2:32.5,29.5-37.0% (median, range), P=0.04].CONCLUSION:Erythropoietin administration significantly accelerates correction of anemia alter acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfused blood two weeks alter the bleeding episode.

雷贝拉唑联合法莫替丁对Hp阳性消化性溃疡并出血患者的疗效及对VEGF、IL-6水平的影响

目的探讨雷贝拉唑联合法莫替丁对幽门螺杆菌(Hp)阳性消化性溃疡病并出血患者的疗效及对血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)水平的影响。方法选取2021年1月至2022年1月南阳市中心医院收治的80例Hp阳性消化性溃疡并出血患者为研究对象,按照数字表法随机将其分为观察组和对照组,每组各40例。对照组给予法莫替丁治疗,观察组给予雷贝拉唑联合法莫替丁治疗。对比两组疗效、出血停止时间、住院时间、治疗前后VEGF、IL-6水平、不良反应发生率、Hp根除率、Hp再感染率。结果观察组临床有效率(92.50%)高于对照组(75.00%),差异有统计学意义(P<0.05)。观察组患者出血停止时间和住院时间均短于对照组,差异有统计学意义(P<0.05)。两组患者治疗后VEGF水平高于治疗前,且观察组高于对照组;两组IL-6水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率(25.00%)、Hp根除率(90.00%)、Hp再感染率(5.00%)与对照组(17.50%、85.00%、7.50%)比较差异无统计学意义(P>0.05)。结论Hp阳性消化性溃疡病并出血患者采用雷贝拉唑联合法莫替丁治疗,其疗效较佳,可缩短患者康复时间,改善VEGF、IL-6水平,且安全性较好。

脑出血术后并发应激性溃疡的危险因素

【目的】探讨脑出血术后并发应激性溃疡(SU)的危险因素。【方法】回顾性分析2018年1月至2022年1月郑州大学第一附属医院收治374例接受手术治疗的脑出血患者的临床资料,根据术后是否并发SU将其分为SU组(n=42)和非SU组(n=332)。比较两组患者基线资料,采用Logistic多因素回归模型分析影响脑出血术后并发SU的危险因素。受试者工作特征(ROC)曲线分析Logistic多因素回归模型评估脑出血术后并发SU的价值。【结果】两组患者年龄及血清钾、胃泌素、乳酸水平比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄(≥60岁)及血清钾(≤3.84 mmol/L)、胃泌素(>73.17 ng/L)、乳酸(>2.70 mmol/L)是脑出血术后并发SU的危险因素(P<0.05)。Logistic回归模型评估脑出血术后并发SU的AUC为0.878(95%CI:0.824~0.936),敏感度为82.13%,特异度为83.66%。【结论】年龄及血清钾、胃泌素及乳酸水平为脑出血术后并发SU的重要影响因素,临床医师可针对性制定相应的干预措施,从而降低术后SU发生风险。

分期饮食护理联合人文关怀护理对消化性溃疡合并出血患者治疗效果和生活质量的影响

目的探讨分期饮食护理联合人文关怀护理对消化性溃疡合并出血患者治疗效果和生活质量的影响。方法根据随机数字表法将200例消化性溃疡合并出血患者分为对照组(n=100,常规护理干预)和观察组(n=100,分期饮食护理联合人文关怀护理)。比较两组的干预效果。结果观察组的出血停止时间、住院时间短于对照组,随访结束时的疾病知识认知度、健康促进生活方式量表-Ⅱ(HPLP-Ⅱ)评分、治疗总依从率、护理优良率及消化系统疾病生存质量指数(GIQLI)各维度评分高于对照组(P<0.05)。结论分期饮食护理联合人文关怀护理能有效提高消化性溃疡合并出血患者的健康行为,促进溃疡愈合,提高护理效果和患者的生活质量。

新型OTSC吻合夹止血术治疗溃疡性上消化急性出血的疗效及并发症分析

目的分析新型OTSC吻合夹止血术治疗溃疡性上消化急性出血的疗效及并发症。方法选择2019年1月-2021年1月经徐州医科大学附属淮海医院收治的溃疡性上消化急性出血患者113例,根据患者意愿将其分为观察组(n=63)与对照组(n=50),观察组行新型OTSC吻合夹止血术治疗,对照组行传统TTSC内镜夹止血术治疗。收集患者一般资料:性别、平均年龄、出血部位、Forrest分级、平均Rockall评分。比较两组患者临床疗效、临床指标:患者输血量、止血时间、住院时间、术后再出血率、并发症等。结果观察组患者有效率高于对照组,差异有统计学意义(P<0.05)。观察组患者输血量、止血时间、住院时间、术后再出血率均低于对照组患者,且止血成功率高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后均未出现消化道瘘、穿孔等严重并发症。结论新型OTSC吻合夹止血术可提高溃疡性上消化急性出血患者临床疗效,且安全性较高。

云南白药辅佐治疗出血性消化性溃疡的meta分析

目的评价云南白药辅佐治疗出血性消化性溃疡的临床有效性和安全性,从而为临床提供更多循证依据。方法检索中国知网、维普、万方、中国生物医学文献、PubMed、Embase等数据库,从建库到2022年4月发表的云南白药辅佐治疗消化性溃疡出血的临床随机对照试验和相关研究,采用Cochrane偏倚风险评估准则对纳入研究进行质量评价,使用Review Manager 5.4软件进行合并分析。结果最终有18篇文献符合纳入标准并进行合并分析,总计1509例患者,结果显示在对照组西药治疗的基础上,联合云南白药治疗的治疗组患者临床有效率[合并风险比(RR)=1.19,95%置信区间(95%CI)(1.14,1.24),P<0.00001]显著提高;止血时间[均数差(MD)=-2.12,95%CI(-2.35,-1.89),P<0.00001]和住院时间[MD=-2.25,95%CI(-2.69,-1.181),P<0.00001]显著缩短;且并未增加不良反应发生率[RR=0.66,95%CI(0.34,1.28),P=0.22]。结论加用云南白药较单纯西药治疗出血性消化性溃疡的临床疗效改善更显著,且能缩短止血时间和住院时间,具有较好的安全性。

内镜下电凝与钛夹治疗消化性溃疡出血患者的效果比较

目的比较内镜下电凝与钛夹治疗消化性溃疡出血患者的效果。方法选取2018年1月至2020年12月我院收治的78例消化性溃疡出血患者作为研究对象,根据治疗方案不同将其分为电凝组(39例,内镜下电凝治疗)和钛夹组(39例,内镜下钛夹治疗)。比较两组的治疗效果。结果两组的治疗总有效率比较,差异无统计学意义(P>0.05)。钛夹组的手术中转率、再出血率低于电凝组(P<0.05);两组的输血量比较,差异无统计学意义(P>0.05)。术后3 d,两组的应激反应指标及炎症因子水平均升高,但钛夹组低于电凝组(P<0.05)。结论内镜下电凝与钛夹治疗消化性溃疡出血均具有较好的效果,但内镜下电凝更易出现再出血和手术中转,且应激反应和炎症反应更重。

消化性溃疡患者外周血细胞免疫及体液免疫功能变化分析

目的探讨消化性溃疡患者外周血细胞免疫及体液免疫功能的变化及临床意义。方法选择2014年1月—2015年1月杭州师范大学附属医院门诊及住院的连续经胃镜确诊的消化性溃疡患者122例为溃疡组,另选择同期体检中心体检健康者70例为对照组,溃疡组患者根据是否感染幽门螺杆菌分为幽门螺杆菌阳性亚组(Hp+亚组)85例和幽门螺杆菌阴性亚组(Hp-亚组)37例,根据是否出血分为出血亚组58例和未出血亚组64例。检测外周血细胞免疫指标(包括CD_3、CD_4、CD_8、CD_4/CD_8、CD_(19)、CD_(56))及体液免疫指标(IgG、IgA、IgM、IgE、C_3、C_4)水平,出血亚组中30例大便隐血试验阳性患者大便隐血试验转阴后复查外周血细胞免疫指标及体液免疫指标。结果溃疡组患者外周血CD_3、CD_4、CD_4/CD_8、CD_(19)、CD_(56)、C_3、C_4水平较对照组降低,IgG水平较对照组升高(P<0.05);Hp+亚组患者外周血CD_3、CD_4、CD_8、CD_(19)、IgM、IgE水平较Hp-亚组升高,CD_4/CD_8较Hp-亚组降低(P<0.05);出血亚组患者外周血CD_3、CD_4水平、CD_4/CD_8较未出血亚组降低(P<0.05)。大便隐血试验阳性患者转阴后外周血CD_3、CD_4、CD_8、CD_(19)、CD_(56)、C_3、C_4水平较治疗前升高,IgG、IgM水平较治疗前降低(P<0.05)。结论消化性溃疡患者存在免疫功能调节紊乱,幽门螺杆菌感染可促使机体产生强烈的免疫反应,急性出血后免疫功能处于抑制状态,止血后免疫功能有所恢复。