内镜治疗并发胃肠道出血的预防与处理

Risk factors for death of hospitalized patients with gastrointestinal ulcer bleeding

AIM: To identify risk factors for death of hospitalized patients with gastrointestinal ulcer bleeding.

METHODS: The clinical data for 785 patients with gastrointestinal ulcer bleeding hospitalized from June 2008 to June 2014 were analyzed retrospectively. The risk factors for death of gastrointestinal ulcer bleeding were analyzed by univariate and multivariate analyses.

RESULTS: The mortality rate was 4.84% (38/785) during hospitalization. Age > 60 years, re-bleeding, complications, blood clotting abnormalities, titanium clip endoscopic hemostasis, surgical bleeding, endoscopic spraying for hemostasis, Forrest classification ≤ Ⅰb, history of non-steroidal anti-inflammatory drug (NSAID) usage, shock, Helicobacter pylori (H. pylori) positivity, and history of alcohol abuse differed significantly between the death group and cured group (P < 0.05). The levels of serum proteins, thromboxane A₂ (TXA₂), and rate of H. pylori infection were significantly higher, and the levels of prostaglandin E₂ (PGE₂) and cyclooxygenase-2 (COX-2) were significantly lower in the death group than in the cured group (P < 0.05). Re-bleeding (OR = 4.223; 95%CI: 1.269-6.425), history of NSAID usage (OR = 4.112; 95%CI: 1.326-6.986), Forrest classification ≤Ⅱb (OR = 4.692; 95%CI: 1.485-7.021), TXA₂ (OR = 4.623; 95%CI: 1.239-6.963), and COX-2 (OR = 4.265; 95%CI: 1.208-8.006) were independent risk factors for death with gastrointestinal ulcer bleeding. PGE₂ (OR = 4.772; 95%CI: 1.277-7.236) was a protective factor for death with gastrointestinal ulcer bleeding.

CONCLUSION: Re-bleeding, history of NSAID usage, Forrest classification ≤Ⅰb, TXA₂, and COX-2 are independent risk factors for death in patients with gastrointestinal ulcer bleeding, and PGE₂ is a protective factor.

Diagnostic and therapeutic value of emergency colonoscopy in delayed hemorrhage following colonic electrocoagulation resection of colorectal polyps

AIM: To assess the value of emergency colonoscopy in the diagnosis and therapy of delayed hemorrhage following colonic electrocoagulation resection of colorectal polyps.

METHODS: Three of 972 patients who underwent colonic electrocoagulation resection for colorectal polyps developed delayed hemorrhage and underwent emergency colonoscopy.

RESULTS: Immediately after bleeding sites were identified by emergency endoscopy, colonoscopic electrocoagulation, injection therapy and titanium clip ligation treatment were given. Bleeding was stopped in all patients, and no complications developed.

CONCLUSION: Emergency colonoscopy is a safe, effective method for the diagnosis and treatment of delayed hemorrhage following high-frequency electrocoagulation resection of colorectal polyps.

Blood loss from tests in patients with gastrointestinal diseases: An analysis of 218 cases

AIM: To investigate the reasons for blood loss from tests in patients with gastrointestinal diseases and to explore countermeasures against such condition.

METHODS: Data were obtained from hospital LIS, including hospital stay, total blood loss, average daily blood loss, blood loss ratio between different tests, average volume collected for blood gas analysis.

RESULTS: The average daily blood loss in our patients was 7.63 mL. The average daily blood loss was 8.57 mL in the blood culture group and 5.58 mL in the non-blood culture group, with a significant difference between the two groups.

CONCLUSION: Attention should be paid to blood loss in patients undergoing a blood culture test. Improvement of the functions of LIS, standard operation, and reasonable use of ordinary syringe for blood collection could help reduce blood loss from tests.