老年上消化道出血210例

Omeprazole for prevention of upper gastrointestinal bleeding in uremia patients with hemofiltration: Clinical efficacy and nursing

AIM: To assess the clinical efficacy of omeprazole to prevent upper gastrointestinal bleeding in uremia patients with hemofiltration and determine appropriate nursing measures.

METHODS: One hundred and twelve patients with uremia treated at our hospital were divided into either a control group or a treatment group, both of which received hemofiltration and targeted nursing. The treatment group was additionally given omeprazole treatment. Clinical efficacy was observed and compared for the two groups.

RESULTS: The gastric pH, incidence rate of upper gastrointestinal bleeding and mortality rate of the control group were 5.22 ± 1.43, 12.5% and 7.1%, respectively; the corresponding values in the treatment group were 6.54 ± 1.54, 1.8% and 0.0%. The gastric pH was significantly higher in the treatment group that in the control group (P < 0.05), while the incidence rate of upper gastrointestinal bleeding and mortality rate were significantly lower in the treatment group (P < 0.05). The rates of nausea and vomiting, headache, anemia and diarrhea did not differ significantly between the control group and treatment group (5.4% vs 3.6%, 3.6% vs 1.8%, 0.0% vs 0.0%, 3.6% vs 0.0%, P > 0.05).

CONCLUSION: Using omeprazole to prevent upper gastrointestinal bleeding in uremia patients with hemofiltration is effective.

Clinical effects of endoscopic clipping in management of peptic ulcer bleeding

AIM: To explore the clinical effects of endoscopic clipping in the management of peptic ulcer bleeding.

METHODS: Eighty-six patients with peptic ulcer bleeding were divided into either an observation group (n = 43) or a control group (n = 43) based on the treatment method. The observation group was treated by endoscopic clipping, and the control group was treated by endoscopic local injection. The clinical effects and hemostatic effects on 1 and 3 d were compared between the two groups.

RESULTS: The improvement rate and total effective rate were significantly higher in the observation group than in the control group (62.79% vs 37.21%, 95.35% vs 76.74%, P < 0.05). The hemostatic rates on 1 and 3 d were significantly higher in the observation group than in the control group (90.70% vs 69.77%, 100.00% vs 74.42%, P < 0.05).

CONCLUSION: Endoscopic clipping for peptic ulcer bleeding is simple and easy to use, and is associated with a better hemostatic effect, a higher cure rate, and improved patient prognosis.

Risk factors associated with failure of endoscopic therapy for acute non-variceal upper gastrointestinal bleeding

AIM: To determine risk factors associated with failure of endoscopic therapy for acute non-variceal upper gastrointcstinal bleeding (ANVUGIB).

METHODS: This was a retrospective cohort study of 52 patients with acute ANVUGIB who were admitted to the Affiliated Hospital of Guiyang Medical College from January 2010 to October 2013. Based on the therapeutic effect after first endoscopic therapy, the patients were divided into either a success or a failure group. Data including age, sex, bleeding history, chronic disorder history, non-steroidal anti-inflammatory drug history, time from bleeding to endoscope examination, blood transfusion, shock index, hemoglobin, blood routine examination, liver and renal function examination, parameter of anticoagulative system, causes and type of bleeding, lesion size, Rockall and Blatchford grade were compared between the two groups to find the variables with a significant difference. Risk factors for treatment failure were identified using multivariable logistic regression.

RESULTS: Therapeutic failure rate was 23.7% (12/52). The two groups had significant differences in age, blood transfusion, BUN, CHE, ALB, and PT. Logistic regression analysis revealed that age (OR = 1.076, 95%CI: 1.009-1.147) and PT (OR = 1.684, 95%CI: 1.053-2.693) were independent risk factors.

CONCLUSION: ANVUGIB patients with old age or long PT have a higher risk of failure of endoscopic therapy and should be given interventional therapy or surgery when necessary.

Efficacy of emergency endoscopic drug spraying vs injection in treatment of non-variceal upper gastrointestinal bleeding

AIM: To compare the clinical efficacy of emergency endoscopic drug spraying versus injection in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB).

METHODS: Clinical data for ANVUGIB patients treated at our hospital from January 2010 to January 2013 were retrospectively analyzed. These patients were randomly and equally divided into two groups: a control group and an observation group. The observation group underwent emergency endoscopic injection of adrenalin, while the control group underwent emergency endoscopic spraying of adrenalin. The hemostatic effect and side effects were compared between the two groups.

RESULTS: The total hemostasis rate was significantly higher in the observation group than in the control group (88.0% vs 78.0%, P < 0.05). The rate of adverse reactions was significantly lower in the observation group than in the control group (9.0% vs 32.0%, P < 0.05). Compared with pre-treatment values, hemoglobin levels rose in both groups, and the rise was more significant in the observation group (P < 0.05).

CONCLUSION: Emergency endoscopic injection of adrenalin is associated with a better hemostatic effect and fewer side effects in the treatment of ANVUGIB.