Although the incidence of gastrointestinal hemorrhage after cardiac surgery is low, the mortality rate is high. Early detection and diagnosis of gastrointestinal hemorrhage are difficult. The high risk phases including preoperation, intraoperation and postoperation. Preoperative high risk comorbidities include gastrointestinal ulcer, hypertension, coronary heart disease and chronic renal failure. Intraoperative high risk factors include decreased gastrointestinal blood perfusion due to cardiopulmonary bypass, inflammatory factors releasing, coagulation disorders, and thrombosis. Postoperative high risk factors include hypotension, low cardiac output, prolonged mechanical ventilation, etc. This article retrospectively summarized high-risk factors and pathogenesis of gastrointestinal hemorrhage after cardiac surgery, in order to improve prevention and treatment of gastrointestinal hemorrhage.
Objective To perform a systematic review on the safety (i.g. cardiovascular, mortality and gastrointestinal bleeding) of clopidogrel versus clopidogrel combined with proton pump inhibitors (PPIs) for the patients with coronary heart disease. Methods Such databases as The Cochrane Library, PubMed, EMbase, SSCI, VIP, CNKI, and CBM were searched from the date of their establishment to September 2010. The bibliographies of the retrieved articles were also checked. The data was extracted and evaluated by two reviewers independently. The RevMan 5.0 software was used for meta-analyses. Results A total of 29 studies were included. The results of meta-analyses showed that the use of clopidogrel combined with PPIs was associated with increasing the risk of cardiovascular events (RR=1.27, 95%CI 1.09 to 1.47), as well as myocardial infarction (RR=1.45, 95% CI 1.20 to 1.76), total mortality (RR=1.23, 95%CI 1.06 to 1.43), and rethrombosis (RR=1.37, 95%CI 1.01 to 1.86). However, there was no enough evidence to reach the conclusion that the combination use could benefit the situation of gastrointestinal bleeding (RR=0.84, 95%CI 0.47 to 1.50). Conclusion?Compared with clopidogrel, the combination use of clopidogrel and PPIs increases cardiovascular events, mortality, and the risks of myocardial infarction and rethrombosis. However, more clinical studies are required to assess the effect of reducing gastrointestinal bleeding.
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。
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。