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.
ObjectiveTo investigate the relationship between chronic obstructive pulmonary disease (COPD) and respiratory failure in patients with upper gastrointestinal bleeding and recent prognosis.
MethodsWe retrospectively analyzed the clinical data of 73 patients with COPD and respiratory failure treated from February 2009 to May 2011. The patients were assigned to the observing group (n=33) and control group (n=40). General characteristics, improvement rates, mortality rates, lengths of hospital stay, endotracheal tube rates and arrhythmia rates were compared between the two groups.
ResultsAge, sex, and medical history of the patients were similar in both groups (P>0.05). Compared with the control group, the improvement rate was lower (P<0.001), the mortality rate (P<0.001), length of hospital stay (P<0.001), endotracheal tube rate (P<0.05) and arrhythmia rate (P<0.05) were all higher in the observing group after treatment.
ConclusionUpper gastrointestinal bleeding is a high risk factor for short-term prognosis patients with COPD and respiratory failure.
Objective To investigate the effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. Methods Seventy-six patients who received traditional treatment between October 2020 and March 2021 were included in the traditional treatment group, and 82 patients who entered the emergency fast track for dangerous upper gastrointestinal bleeding between April 2021 and September 2021 were included in the fast-track treatment group. The patients in the traditional treatment group were treated with the traditional single-subject diagnosis and treatment mode, and the patients in the fast-track treatment group were treated according to the multidisciplinary diagnosis and treatment procedures of emergency fast track for dangerous upper gastrointestinal bleeding. The length of emergency stay, 24-hour endoscopic completion rate, effective rate, and length of hospital stay were compared between the two groups. Results The length of emergency stay [(3.75±3.19) vs. (6.51±4.72) h], the effective rate (96.3% vs. 85.5%) and the length of hospital stay [(8.26±2.51) vs. (11.07±2.79) d] were significantly better in the fast-track group than those in the traditional treatment group (P<0.05). There was no significant difference in the 24-hour endoscopic completion rate between the two groups (96.3% vs. 96.1%, P>0.05). Conclusion Compared with the traditional treatment mode, the fast-track treatment mode can significantly improve the treatment efficiency, and reduce the lengths of emergency stay and hospital stay.
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.
【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 explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.
