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    浅析非静脉曲张性上消化道出血临床治疗效果观察

    出处:论文网
    时间:2019-09-11

    浅析非静脉曲张性上消化道出血临床治疗效果观察

      【中图分类号】R573.2 【文献标识码】A 【文章编号】1005-0019(2019)15--01

      消化道出血在临床中是较为常见的一种疾病, 分为上消化道出血及下消化道出血两种类型, 上消化道出血患者出血点在屈氏韧带以上的整个消化道, 主要有胃、十二指肠溃疡和食管位置出血。临床中上消化道出血症状较为常见, 大约占消化道出血的30%, 非静脉曲张性上消化道出血则是由屈氏韧带以上消化道非静脉曲张而导致的出血症状, 导致非静脉曲张性上消化道出血症状因素为溃疡及私膜糜烂、静脉曲张破裂、血管疾病等, 若患者发病则会出血不止, 引发急性周围循环衰竭, 因此由于缺氧、代谢产物发生蓄积导致毛细血管遭受损伤, 对心、脑等器官血液供应造成极为不利的影响, 由此引发休克及死亡。有研究发现, 每10万人中50~150例出现非静脉曲张性上消化道出血症状, 死亡率达到10%。本文选取184例非静脉曲张性上消化道出血患者, 分析治疗方法及效果, 现报告如下。

      1 资料与方法

      1. 1 一般资料 选取本院 2015年3月~2018年2月收治的184例非静脉曲张性上消化道出血患者, 按照数字抽取分为研究组与对照组, 每组92例, 患者均符合非静脉曲张性上消化道出血诊断标准, 入院时无便血、呕血现象, 最近2周均未接受H2受体拮抗剂和质子泵抑制剂治疗。其中男98例, 女86例, 年龄20~75岁, 平均年龄(41.6±3.6)岁。两组患者在年龄、性别、病症等一般资料方面, 差异无统计学意义(P>0.05), 具有可比性。

      1. 2 方法 两组患者均应用常规治疗措施, 主要有吸氧、补液、血压平衡、消除氧耗自由基、预防感染、平衡水电解质、对症治疗等。研究组在常规治疗基础上予以泮托拉唑, 40 mg泮托拉唑放置到100 ml 0.9%氯化钠注射液内混合, 静脉滴注, 1次/d, 持续4 d。对照组常规治疗基础上予以法莫替丁20 mg, 静脉滴注, 2次/d, 持续4 d。

      1. 3 疗效判定标准[1] 治愈:临床呕血、黑便症状均消除, 7 d内大便潜血试验3次(-);显效:临床呕血、黑便症状均消除, 7 d内大便潜血试验3次(+~++);好转:临床呕血、黑便症状均停止, 大便潜血试验自强阳性转为(+~+++);无效:经7 d治疗临床呕血或黑便症状未完全消失或得到缓解。总有效率=治愈率+显效率+好转率。

      1. 4 统计学方法 所有数据均采用 SPSS17.0软件进行统计分析。计量资料以均数±标准差()表示, 采用t检验;计数资料以率(%)表示, 采用χ2检验。P<0.05表示差异具有统计学意义。

      2 结果

      经治疗, 研究组总有效率明显高于对照组, 差异有统计学意义(P<0.05);研究组患者平均止血时间(30.5±2.6)h, 对照组则为(53.6±8.4)h, 两组差异有统计学意义(P<0.05)。两组患者均未产生恶心、呕吐等不良反应。

      3 讨论

      上消化道出血疾病具有极高发生率, 大约85%消化性溃疡患者由于一些诱因有出血现象, 为了能够使得病情及早发现、及早预防, 发生溃疡或胃出血等情况时需及时就医检查, 传统X线钡餐检查、内镜检查等在临床中得到较为广泛应用。非静脉曲张性上消化道出血患者因为失血量过大, 若未及时予以止血处理往往会使得细胞出现缺氧症状, 甚至死亡[2], 患者往往从前期头昏、恶心症状发展到疲乏无力、休克死亡情况, 尤其老年人往往伴有大量疾病出现, 若未予以紧急处理, 即使患者未大量出血也会导致器官功能发生衰竭现象, 从而出现死亡病例。所以及早发现与合理治疗对于患者具有重要作用。

      对照组患者应用法莫替丁, 经研究分析其为一种H2-受体拮抗剂, 其中5肽胃泌素会对胃酸分泌产生一定影响却无法达到合理控制, 尤其是无法避免白天饮食后胃泌素对胃酸形成影响, 因此抑酸作用具有一定局限性, 效果并不理想。泮托拉唑属于一种胃壁细胞质子泵抑制劑, 处于中性和弱酸性环境时具有一定稳定性, 强酸性环境中会快速活化, 其pH依赖的活化特性, 导致其对H+/K+-ATP酶具有更明显选择性[3]。此药物可以特异性阻滞壁细胞顶端膜构成分泌性微管和胞浆内管状泡上的H+/K+-ATP 酶, 使得此酶具有不可逆抑制作用, 由此可以有效避免胃酸大量分泌。因为H+/K+-ATP酶属于壁细胞泌酸过程最后一个环节, 所以此药物具有较为强效抑酸作用。其可以非竞争性抑制促胃泌素、组胺、胆碱所导致的胃酸分泌, 还可以抑制不受胆碱或H2受体阻断剂影响的部分基础胃酸分泌。在临床中主要特点为:具有明显抑酸效果, 呈现持久性、递增性, 经3~5 d即可达到稳定状态, 胃内pH保持较高平稳性, 持续用药并无明显耐受性[4]。研究表明, 非静脉曲张性上消化道出血临床治疗中予以泮托拉唑效果显著, 临床价值较高。

    浅析非静脉曲张性上消化道出血临床治疗效果观察

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