【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.
Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.
目的总结外科手术后应激性溃疡大出血的临床特点和治疗经验。方法回顾分析1997~2003年期间我院治疗的32例应激性溃疡大出血患者的临床资料。结果28例患者采用非手术治疗，其中12例患者接受急诊胃镜检查; 手术治疗4例。本组患者总的治愈率为87.50%，死亡率为15.62%。结论急诊胃镜检查有助于明确诊断及止血治疗，应激性溃疡大出血首选非手术治疗，无效者可选择手术治疗。
目的:探索上消化道出血患者焦虑发生情况和相关因素分析。方法:采用问卷调查法对70 例上消化道出血患者发生情况进行研究,分析焦虑发生与患者性别、年龄、文化程度、医疗费用支付方式、出血次数、临床症状、疾病了解程度及合并疾病的相关性。结果:上消化道出血患者焦虑发生率为58.6 %。女性患者焦虑发生率明显高于男性患者,出血量多的患者焦虑发生率明显高于出血量少的患者,出血次数、有无合并症与焦虑有明显相关性。结论:正确认识焦虑是开展负性情绪干预的前提,针对上消化道出血患者焦虑发生相关因素,积极开展心理疏导,是保障手术顺利进行的重要环节。
Objective To systematically evaluate the effectiveness and safety of China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding. Methods Such databases as PubMed, MEDLINE, Springer, The Cochrane Library, CNKI, VIP, CBM and WanFang data were searched to collect the randomized controlled trials (RCTs) about China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding, and the references of included studies were also retrieved. The retrieval time was from inception to December 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.1 software. Results A total of 11 RCTs were included. Among all 1 075 patients, 544 were in the treatment group, while the other 531 were in the control group. The results of meta-analysis showed that, there were no significant differences in the total effective rate (OR=0.68, 95%CI 0.35 to 1.33, P=0.26) and safety (RR=1.33, 95%CI 0.45 to 3.91, P=0.96) between the China-made omeprazole and imported omeprazole. Conclusion China-made omeprazole is effective and safe in treating acute non-variceal upper gastrointestinal bleeding in comparison with the imported omeprazole.
目的:比较国产生长抑素与进口生长抑素治疗消化性溃疡出血的经济效果。方法:将120例消化性溃疡伴出血的患者随机分成国产生长抑素及进口生长抑素组,分别给予国产生长抑素、进口生长抑素治疗3天,观察疗效,并进行药物经济学评价。 结果: 国产生长抑素、进口生长抑素治疗上消化道出血成本分别为558元和4116元,有统计学差异(P＜005);有效率分别为925%和968%,无统计学差异 (Pgt;005),成本—效果比分别为60324和425207,有统计学差异(P＜005)。结论: 从药物经济学角度分析,国产生长抑素治疗消化性溃疡出血较进口生长抑素更为经济。