目的分析高血压脑出血手术治疗后并发胃应激出血的因素,以探寻有效的预防措施。方法以我院行手术治疗的120例高血压脑出血患者为研究对象,其中有38例患者术后并发胃应激出血(并发组),82例未并发胃应激出血(未并发组),收集两组患者的临...目的分析高血压脑出血手术治疗后并发胃应激出血的因素,以探寻有效的预防措施。方法以我院行手术治疗的120例高血压脑出血患者为研究对象,其中有38例患者术后并发胃应激出血(并发组),82例未并发胃应激出血(未并发组),收集两组患者的临床资料,并对其进行回顾性分析。结果两组年龄、性别、血压比较,差异无统计学意义(P>0.05);两组基底核出血、GCS评分≤8分、出血量≥30m L、基底核出血破入脑室、意识丧失与中线结构移位患者例数比较,差异具有统计学意义(P<0.05)。对本研究结果行多因素Logistic回归分析,结果显示:基底核出血、GCS评分≤8分、出血量≥30 m L、基底核出血破入脑室、意识丧失与中线结构移位是高血压脑出血手术治疗后并发胃应激出血的危险因素,其中以出血量≥30 m L为首要危险因素。结论基底核出血、GCS评分≤8分、出血量≥30 m L、基底核出血破入脑室、意识丧失与中线结构移位是导致高血压脑出血患者术后并发胃应激出血的主要因素,其中以出血量≥30 m L为首要危险因素。因此,提高术者操作技能、做好脑室引流工作、术后对患者预防性使用H2受体拮抗剂等对预防胃应激出血具有重要意义。展开更多
AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 200...AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workers evacuated to Golmud (2808 m) and Xining (2261 m). The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13 502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia, and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery. CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.展开更多
文摘目的分析高血压脑出血手术治疗后并发胃应激出血的因素,以探寻有效的预防措施。方法以我院行手术治疗的120例高血压脑出血患者为研究对象,其中有38例患者术后并发胃应激出血(并发组),82例未并发胃应激出血(未并发组),收集两组患者的临床资料,并对其进行回顾性分析。结果两组年龄、性别、血压比较,差异无统计学意义(P>0.05);两组基底核出血、GCS评分≤8分、出血量≥30m L、基底核出血破入脑室、意识丧失与中线结构移位患者例数比较,差异具有统计学意义(P<0.05)。对本研究结果行多因素Logistic回归分析,结果显示:基底核出血、GCS评分≤8分、出血量≥30 m L、基底核出血破入脑室、意识丧失与中线结构移位是高血压脑出血手术治疗后并发胃应激出血的危险因素,其中以出血量≥30 m L为首要危险因素。结论基底核出血、GCS评分≤8分、出血量≥30 m L、基底核出血破入脑室、意识丧失与中线结构移位是导致高血压脑出血患者术后并发胃应激出血的主要因素,其中以出血量≥30 m L为首要危险因素。因此,提高术者操作技能、做好脑室引流工作、术后对患者预防性使用H2受体拮抗剂等对预防胃应激出血具有重要意义。
基金Supported by the grant LS-CNNSF-30393130, and 973 Program 2006 CB 504100, CB708514, China
文摘AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workers evacuated to Golmud (2808 m) and Xining (2261 m). The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13 502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia, and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery. CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.
