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.

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).

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.

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.

Study on relationship between acute gastrointestinal disease and Helicobacter pylori infections

Objective: To assess the relation between acute gastrointestinal disease and Helicobacter pylori (H. pylori) infections. Methods: Over the 18-month period, a total of 323 patients referred to three hospitals in Babol (north of Iran) were enrolled in this cross-sectional study. H. pylori status (rapid urease test), endoscopic findings in the patients, personal habits (smoking or alcohol intake) and administration of drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs) were analyzed using standard Chi-square test and multinomial logistic regression analysis. Results: Results showed that acute gastric ulcer patients had a significant association with alcohol (P=0.001, OR=6.183), opium (P=0.022, OR=2.823), smoking (P=0.016, OR=2.579) and NSAIDs (P=0.046, OR=2.071). However, patients with in acute duodenal ulcer have a significant association with opium (P=0.023, OR=2.326) and alcohol (P=0.003, OR=3.888). As well as, gastric cancer had significant association with alcohol (P<0.05, OR=6.937), smoking (P=0.012, OR=2.738), family history (P=0.005, OR=4.380) and gender (P≤0.05, OR=5.103). Conclusions: Current investigation shows that H. pylori infection, alcoholism, male gender, age and family history have an additive impact on the incidence of gastric cancer. In addition, alcoholism, opium usage, NSAIDs and family history have more impact on the incidence of acute gastric ulcer and acute duodenal ulcer in patients.

Visibility of the bleeding point in acute rectal hemorrhagic ulcer using red dichromatic imaging:A case report

BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.

紫地合剂联合质子泵抑制剂治疗消化性溃疡出血的临床疗效观察

【目的】观察具有收敛止血、清热凉血功效的紫地合剂联合质子泵抑制剂(proton pump inhibitions,PPIs)治疗消化性溃疡出血(peptic ulcer bleeding,PUB)的临床效果。【方法】回顾性收集2019年12月至2023年5月在广州中医药大学第一附属医院急诊病区住院的281例PUB患者,根据治疗方案的不同将其分为对照组143例和观察组138例。对照组患者在一般治疗基础上给予PPIs治疗,观察组在对照组的基础上给予紫地合剂口服治疗,疗程为3 d。观察2组患者治疗前后格拉斯哥-布拉奇福德出血评分(GBS)、血红蛋白量(HGB)、血小板总数(PLT)、血尿素氮(BUN)、血肌酐(Cr)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平的变化情况,并比较2组患者的平均住院时间和临床疗效。【结果】(1)治疗3 d后,观察组的总有效率为97.10%(134/138),对照组为91.61%(131/143),组间比较(χ^(2)检验),观察组的疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的GBS评分均较治疗前降低(P<0.05),且观察组对GBS评分的降低作用优于对照组,差异有统计学意义(P<0.05)。(3)观察组的平均住院时间为(5.81±1.02)d,较对照组的(6.13±1.12)d有所缩短,差异有统计学意义(P<0.05)。(4)治疗后,2组患者外周血HGB、PLT水平较治疗前升高(P<0.05),BUN水平较治疗前降低(P<0.05),且观察组对外周血HGB、PLT水平的升高作用及对BUN水平的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。(5)治疗过程中,2组患者的外周血AST、ALT、Cr水平均未见升高,差异均无统计学意义(P>0.05)。【结论】紫地合剂联合PPIs治疗PUB效果显著,有助于改善相关血常规和生化指标,缩短住院时间,其疗效优于单纯使用PPIs治疗。

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。

Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis

AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P < 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.

Endoscopic management and outcome of non-variceal bleeding in patients with liver cirrhosis:A systematic review

BACKGROUND Acute non-variceal bleeding accounts for approximately 20%of all-cause bleeding episodes in patients with liver cirrhosis.It is associated with high morbidity and mortality therefore prompt diagnosis and endoscopic management are crucial.AIM To evaluate available data on the efficacy of endoscopic treatment modalities used to control acute non-variceal gastrointestinal bleeding(GIB)in cirrhotic patients as well as to assess treatment outcomes.METHODS Employing PRISMA methodology,the MEDLINE was searched through PubMed using appropriate MeSH terms.Data are reported in a summative manner and separately for each major non-variceal cause of bleeding.RESULTS Overall,23 studies were identified with a total of 1288 cirrhotic patients of whom 958/1288 underwent endoscopic therapy for acute non-variceal GIB.Peptic ulcer bleeding was the most common cause of acute non-variceal bleeding,followed by portal hypertensive gastropathy,gastric antral vascular ectasia,Mallory-Weiss syndrome,Dieaulafoy lesions,portal hypertensive colopathy,and hemorrhoids.Failure to control bleeding from all-causes of non-variceal GIB accounted for less than 3.5%of cirrhotic patients.Rebleeding(range 2%-25%)and mortality(range 3%-40%)rates varied,presumably due to study heterogeneity.Rebleeding was usually managed endoscopically and salvage therapy using arterial embolisation or surgery was undertaken in very few cases.Mortality was usually associated with liver function deterioration and other organ failure or infections rather than uncontrolled bleeding.Endoscopic treatment-related complications were extremely rare.Lower acute non-variceal bleeding was examined in two studies(197/1288 patients)achieving initial hemostasis in all patients using argon plasma coagulation for portal hypertensive colopathy and endoscopic band ligation or sclerotherapy for bleeding hemorrhoids(rebleeding range 10%-13%).Data on the efficacy of endoscopic therapy of cirrhotic patients vs non-cirrhotic controls with acute GIB are very scarce.CONCLUSION Endotherapy seems to be efficient as a means to control non-variceal hemorrhage in cirrhosis,although published data are very limited,particularly those comparing cirrhotics with noncirrhotics and those regarding acute bleeding from the lower gastrointestinal tract.Rebleeding and mortality rates appear to be relatively high,although firm conclusions may not be drawn due to study heterogeneity.Hopefully this review may stimulate further research on this subject and help clinicians administer optimal endoscopic therapy for cirrhotic patients.

Endoscopic clipping in the lower gastrointestinal tract

Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.

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 after the endoscopic confirmation of cessation of bleeding,they were randomised either to erythropoietin(20 000 IU Epoetin alfa subcutaneously,on days 0,4 and 6)plus iron(100 mg im,on days 1-6,(G_1)or iron only(G_2).Haematocdt was measured on days 0,6,14, 30,45,and 60,respectively. RESULTS:One patient from G_1 and two from G_2 were lost to follow-up.Therefore,14 and 13 patients from G_1 and G_2 respectively were analysed.Demographic characteristics,serum iron,ferritin,total iron binding capacity,reticulocytes,and haernatoait were not significantly different at entry to the study. Median reticulocyte counts were significantly different between groups on day six(G_1:4.0,3.0-6.4 vs G_2:3.5,2.1-4.4%, P=0.03)and median haematocrit on day fourteen [G_1:35.9, 30.7-41.0 vs G_2:32.5,29.5-37.0%(median,range),P=0.04]. CONCLUSION:Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding. The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.

急性消化性溃疡患者反复上消化道出血的危险因素研究

目的 检测和分析急性消化性溃疡出血患者在内窥镜治疗成功后上消化道再出血的危险因素。方法 通过纳入标准和排除标准选取北京市大兴区人民医院104名患者作为研究对象,接受过内镜治疗后发生再次上消化道出血的患者52名作为观察组,52名内镜治疗后上消化道未发生再次出血患者作为对照组。收集患者入院时的一般资料、相关临床检测指标以及再出血情况进行统计分析,所有指标进行组间比较,具有差异的指标进行Logistic回归分析。结果 在溃疡大小方面,对照组溃疡大小≥2 cm的患者占44.23%,而观察组溃疡大小≥2 cm的患者占86.54%,观察组患者的溃疡面积普遍更大。在Forrest分类方面,观察组的患者入院时出血情况更严重。在使用非甾体抗炎药方面,对照组相比于观察组有更多的患者使用了非甾体抗炎药。对照组和观察组患者在血红蛋白、血小板计数和血尿素氮方面两组相互比较,观察组患者在该三个指标方面均显著低于对照组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示溃疡大小和非甾体抗炎药使用情况的P<0.05。结论急性消化性溃疡患者的溃疡大小和非甾体抗炎药使用情况是急性消化性溃疡病患者反复上消化道出血的独立危险因素。

止血粉治疗急性上消化道出血的研究进展

急性上消化道出血是临床常见的急危重症之一.最常见的病因是消化性溃疡和食管胃底静脉曲张破裂出血.尽管内镜下止血技术不断改进,但仍有5%-15%的患者内镜下止血治疗失败.止血粉是内镜下止血的新兴药物,呈白色粉末状,在气泵的辅助下喷洒至出血部位,通过吸收水分以促进凝血物质的聚集和粘附在病变上方形成机械屏障等途径达到止血效果.该技术操作简单、无需精确定位并具有较高的即刻止血率,可作为常规止血无效的补救措施.然而,国内尚未推荐止血粉用于治疗急性消化道出血.本文旨在总结现有研究证据,阐述常见的五种止血粉的作用机制、临床应用及不良事件,以期加强内镜医生对止血粉的认识.

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。

胃镜下止血治疗消化性溃疡合并急性上消化道出血的临床效果分析

目的:探究胃镜下止血治疗消化性溃疡合并急性上消化道出血的临床效果。方法:选取2022年1—12月赤水市人民医院消化性溃疡合并急性上消化道出血患者56例为观察对象,根据抽签分为观察组与对照组,各28例。对照组采用常规内科治疗,观察组在对照组基础上采用胃镜下止血治疗。比较两组治疗效果、临床指标、空腹胃液pH值。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=0.043);观察组止血时间、住院时间短于对照组,差异有统计学意义(P<0.001);观察组空腹胃液pH值低于对照组,差异有统计学意义(P<0.001)。结论:在常规内科治疗基础上结合胃镜下止血治疗消化性溃疡伴急性上消化道出血有确切效果,能缩短止血时间、住院时间,提高空腹胃液pH值,提高治疗效果。

泮托拉唑静脉滴注治疗急性上消化道出血的疗效

目的 :观察静脉滴注泮托拉唑治疗急性上消化道出血的疗效。方法 :将 70例病人分为 2组 :泮托拉唑治疗组 4 0例 ,静脉滴注泮托拉唑 4 0mg ,q 12h ,持续 2～ 3d ,出血停止后均予泮托拉唑胶囊4 0mg ,po ,qd维持。雷尼替丁对照组 30例 ,静脉滴注雷尼替丁 15 0～ 2 0 0mg ,q 12h ,持续 2～ 3d ,出血停止后均予以雷尼替丁 30 0mg ,po ,qd维持。结果 :泮托拉唑治疗组有效率 92 % ,止血时间 (1.6±0 .5 )d ,再出血率 3% ,明显优于雷尼替丁对照组[分别为 6 7% ,(2 .5± 0 .6 )d和 2 0 % ],均P <0 .0 5。结论 :静脉滴注泮托拉唑是治疗急性上消化道出血有效、安全的药物 ,尤其适用于中。

胃溃疡合并非静脉曲张性上消化道出血的循证治疗

目的为1例胃溃疡合并非静脉曲张性上消化道出血患者制定循证治疗方案。方法根据患者情况提出临床问题,计算机检索Cochrane Library(网络版)、PubMed(1970—2012年)、EMBase(1970—2012年)、维普(1990—2012年)、中国知网(1990—2012年)数据库,获得与胃溃疡合并非静脉曲张性上消化道出血治疗相关的文献证据。结合文献证据及患者病情和需要制定治疗方案。结果共纳入10篇Meta分析和25篇随机对照试验,制定治疗方案如下:调整饮食习惯;适当补充血容量;给予奥美拉唑40 mg口服;内镜治疗并静脉注射奥美拉唑5 d,同时应用阿莫西林和甲硝唑三联疗法根除幽门螺杆菌。经过6个月门诊随访,患者行胃镜检查未见溃疡及出血病灶,制定的治疗方案有效。结论应用循证医学的方法,根据高质量的文献证据为胃溃疡合并非静脉曲张性上消化道出血患者制定合理的治疗方案,有助于提高治疗效果,改善患者预后。

老年人急性非静脉曲张性上消化道出血病因分析

目的分析老年急性非静脉曲张性上消化道出血（ANVUGIB）的病因。方法对解放军总医院消化内科2011年1月至2015年12月期间收治的233例老年ANVUGIB患者的临床资料进行回顾性分析。结果233例老年ANVUGIB患者，年龄60-96（74．38±8．86）岁。最常见的病因为消化性溃疡（111例，占47．6％），内胃溃疡49例，十二指肠溃疡43例，复合溃疡19例。排在第二、三位的病因分别为消化系恶性肿瘤（74例，占31．8％）、急性胃黏膜病变出血（20例，占8．6％）。老年ANVUGIB的危险因素中，非甾体抗炎药（NSAIDs）及抗凝药物相关消化道出血占28．8％。性别亦是危险因素之一。结论消化性溃疡是老年ANVUGIB最常见的病因，NSAIDs及抗凝药物相关消化道出血是其最常见的危险因素。

三七通舒胶囊治疗急性脑梗死合并消化道溃疡的疗效观察

目的评价三七通舒胶囊对存在消化道溃疡病史的急性脑梗死患者的临床疗效和安全性。方法既往存在消化道溃疡病史的73例脑梗死患者随机分为两组,对照组为常规治疗或其他治疗方案,实验组在常规治疗基础上加三七通舒胶囊。治疗30 d后,观察两组治疗前后欧洲卒中评分(Europe Stroke Score,ESS)、巴塞尔指数评分(Barthel Index,BI)及消化道不良反应。结果治疗前两组患者的ESS评分和BI评分均数无显著差异(P>0.05),治疗后实验组患者的ESS评分和BI评分均高于治疗前,且高于对照组(P<0.05)。两组患者治疗后血小板聚集率、血清血栓素B2(TXB2)以及白介素-6(IL-6)的水平均有减低,但二者之间比较存在明显差异(P<0.05)。两组消化道出血的发生率未见明显差异(P>0.05)。结论三七通舒胶囊可通过抑制血小板聚集、减轻炎性反应治疗有消化道溃疡病史的急性脑梗死疗效确切。且不增加消化道出血风险。