ObjectivesTo systematically review the efficacy and safety of esomeprazole versus omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of esomeprazole versus omeprazole in the treatment of ANVUGIB from inception to January, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 17 RCTs involving 2 086 patients were included. The results of meta-analysis showed that, the total effective rate of esomeprazole group was higher than omeprazole group (RR=1.09, 95%CI 1.04 to 1.14, P=0.000 6), the incidence of adverse reactions was lower than omeprazole group (OR=0.27, 95%CI 0.18 to 0.40, P<0.000 01), the average hemostasis time was shorter than omeprazole group (MD=?0.64, 95%CI ?0.94 to ?0.34, P<0.0001), and the difference were statistically significant.ConclusionsCurrent evidence shows that in the treatment of ANVUGIB, esomeprazole has rapid hemostasis, significant effect and fewer adverse reactions, which is worthy of wide application and promotion. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
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.
ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning. MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores. ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05). ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.
目的：探討DSA診斷小腸血管畸形的價值。方法：本文分析21例小腸血管畸形患者的臨床及DSA特征，其中男性14例，女性7例，所有患者均行腸系膜上、下動脈造影。結果：臨床特征：①急性消化道出血為主癥狀；②常規檢查一般為陰性；③血紅蛋白含量短期內降至4～6 g/mL。DSA特征：①動靜脈瘺；②局部腸壁染色增濃；③局部血管異常增多，結構紊亂。其中12例進行了動脈導絲栓塞，2例栓塞后出血，進行外科手術切除。結論：DSA是診斷血管畸形所致小腸出血的最有效的方法，動脈導絲栓塞是安全，有效的治療方法，同時為外科手術切除提供的正確部位。
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.