出血

Objective:to investigate the cesarean section of the reasons for the bleeding, and lower the rate of obstetric hysterectomy possibility.methods: 30 cases in our hospital cesarean section in the clinical data of patients with hemorrhage were retrospectively analyzed.results: in 30 cases of bleeding, placental factors accounted for 53.33%, 36.67% of the uterine atony, uterine incision bleeding laceration of 6.67%, 3.33% of the amniotic fluid embolism, hysterectomy three cases.conclusion:placenta, uterine atony cesarean section is the main reason for the bleeding.

目的：探讨剖宫产术中大出血的原因及降低产科子宫切除率的可能性。方法：对我院30例剖宫产术中大出血患者的临床资料进行回顾性分析。结果：30例大出血中，胎盘因素占53.33%，宫缩乏力占36.67%，子宫切口裂伤出血占6.67%，羊水栓塞占3.33%。治疗结果中，子宫切除3例，占剖宫产术的0.076%（3/3 935）。结论：胎盘因素、宫缩乏力是剖宫产术中大出血的主要原因。

Results Nine cases were not exactly diagnosed and got proper treatment before admission in the total 12 cases,accounting for 75 perc...

结果12例患者中，有9例(75.0%)入院前未得到明确诊断和正确处理。12例(100.0%)均有伤口局部出血不止，全身多处大片皮下出血瘀斑；10例(83.3%)出现血尿、牙龈渗血症状；1例(8.35%)继发脑出血；2例(16.67%)出现出血性休克，其中1例并发急性肾功能衰竭：1例(8.35%)出现严重肺出血。

Brainstem hemorrhage most frequently occurs in pons, secondly in middle brain and rare in medulla.

脑干出血的好发部位在桥脑，本组资料中桥脑出血占脑干出血的75%，其次是中脑出血，延髓出血少见。

Ranutudune not only can decrease the ratal of upper gastroinrestinal which is the complication of cerebral hemorrhage but also in proving the progrosis significantly during the acute time.www.lwf

雷尼替丁不仅可明显降低脑出血并发上消化道出血的发生率，而且可以改善急性期的预后。关键词：雷尼替丁；脑出血；上消化道出血

And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%、27.39%、20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54,low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively. Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding.

结果：①术后一过性发热62例(84.9%)，腹痛腹胀48例(65.8%)是介入断流术常见的并发症，未发生严重并发症；②门静脉造影显示胃冠状静脉、胃短静脉和胃后静脉的曲张分流的出现率是100%、65.26%和38.34%；显示食管静脉曲张主要由胃冠状静脉供血，胃静脉曲张主要由胃短静脉和胃后静脉供血；胃冠状静脉大多数为单支，少数为双支，其双支的出现率分别为30.57%；胃冠状静脉开口于门静脉主干的为52.06%，开口于脾静脉主干的为27.39%和开口于门脾静脉交汇处的为20.55%；③发现胃肾分流3例，脾肾分流7例、腹膜后门腔静脉分流2例，以及CTA检查发现脐静脉开放者2例；④73例患者介入断流术前和术后平均自由门静脉压力分别为3.87±1.82kpa和3.64±1.14kpa，前后比较存在显著性差异；11例再次介入手术患者的术前、术后和复发后的自由门静脉压力分别为4.02±0.24kpa、3.82±0.25kpa和3.93±0.23kpa ，前后比较发现首次术前与术后存在显著性差异，首次术前和复发出血术前门静脉压力比较无显著性差异；⑤介入术后复查曲张静脉转归基本消失54例，轻度19例；⑥Spearman相关分析和Logistic多因素回归分析，肝功能分级、静脉曲张程度、门脉血流方向和残存小侧支四个因素对曲张静脉转归有影响；Spearman相关分析和Logistic多因素回归分析门脉高压性胃病和出血量等因素对复发出血时间有影响；⑦COX回归分析，门体分流和曲张静脉转归两个因素对术后生存有影响；⑧术后随访6-70月，1、2、3、4、5年的累计复发出血率和累计生存率分别为17.81%、28.77%、38.36%、43.84%、47.95%和93.15%、91.78%、86.30%、83.56%、80.82%；结论：介入断流术治疗门脉高压食管胃底静脉曲张有独特的优点，可以快速直接控制曲张静脉出血而门静脉压力无显著增高，保证了肝脏灌注；与外科分流术相比适应证广、损伤轻、术后恢复快，不易遗漏曲张静脉；肝功能分级、曲张静脉程度、门脉血流方向和残存侧支血管对食管胃曲张静脉转归有影响；门脉高压性胃病对复发出血时间有影响；门体分流和曲张静脉转归对生存时间有影响。

RESULTS Duodenal ulcer was the first cause of upper gastrointestinal hemorrhage. Gastric ulcer, cirrhosis, Mallory-Weiss syndrome or acute gastric mucous lesion was the second cause of the illness alternatively. The rate of endoscopy and emergent endoscopy has been going up year after year and got up to 80% in 1998. Bleeding and active hemorrhage, respectively were found in 24.3% and 14.9% of the patients underwent endoscopy before medication. Endoscopic hemostasis was performed in 108 patients by spraying hemostatics and a good response was achieved subsequently. Hemostatics were mainly cimetidine and yunnan baiyao before 1994. Reptilase, pPI, famotidine and ranitidine were used increasingly while cimetidine and yunnan baiyao were used decreasingly. Octreotide was used in patients with cirrhosis commonly. The length of hospital stay and the period from admission to bleeding cease tended to be shorter year by year, but the reduction rate was small. The uses of ranitidine, famotidine, pPI, reptilase, octreotide, early endoscopy and endoscopic therapy may play a role in improving the therapeutic effect of hemostasis, reducing the hospitalization and the mortality.

结果 十二指肠球部溃疡是历年上消化道出血的首要原因，胃溃疡、肝硬变、Mallory -Weiss综合征、急性胃粘膜病变则交替成为第2位出血原因；内镜诊断率和急诊内镜率逐年提高，1998年达到80%，内镜下见出血者占内镜检查的24.3%，而见到活动性出血者仅占内镜检查者的14.9%；内镜下止血108例次，成功率100%；1994年前治疗药物主要为云南白药和甲氰咪胍，之后，随着立止血、质子泵抑制剂、法莫替丁、雷尼替丁等药物使用的逐渐增多，前二者的使用逐渐减少，善得定多用于肝硬变出血；住院天数和止血天数呈逐年下降的趋势，但幅度微小；雷尼替丁、法莫替丁、PPI、立止血、善得定的使用以及及时的内镜检查和内镜下治疗在提高止血效果、缩短住院天数、降低死亡率方面可能起到了一定作用。

There were three types of bleeding, i.e. bleeding of superficial trauma, of deep trauma and of parenchymatous organs according to bleeding character.

(1)临床观察350例急诊创伤和手术出血病人，根据出血性质分为浅表创面出血、深部创面出血和实质脏器出血3类。

Methods In clinic, 350 patients who suffered bleeding from trauma and surgical operation were studied. There were three types of bleeding, i.e. bleeding of superficial trauma, of deep trauma and of parenchymatous organs according to bleeding character.

(1)临床观察350例急诊创伤和手术出血病人，根据出血性质分为浅表创面出血、深部创面出血和实质脏器出血3类。

Resalt In these cases, the positions of hemorrhage of 64 patients were in lobe of brain; that of 33 patients was in basal ganglia; that of 29 patients was in cerebral ventricle and that of 9 patients was in cerebellum.

结果脑叶出血64例，基底节区出血33例，脑室出血29例，小脑出血9例DSA正常55例（占40.7％），异常80例（占59.3％），其中烟雾病43例、动-静脉畸形29例、动脉瘤6例、动-静脉瘘2例。8例复发性脑出血中DSA正常5例。

Objective To discuss the methods and effects of the treatment under endoscope and the courses of massive hemorrhage of upper digestive tract after gastrectomy and esophagectomy.Methods Emergency endoscope ex-amination were carried out in20massive hemorrhage clients after gastrectomy and esophagectomy,after exposed and washed the bleeding part by cold0.9%NS,1∶10000adrenaline and hypertonic saline were injected in perifocal sub-mucosa.After stop bleeding and before move back the endoscope,spray some YunNanBaiYao and thrombase in the bleeding part to prevent secondary hemoorahge.

目的 探讨食管、胃切除术后上消化道出血的原因及内镜下治疗的方法、效果方法对食管、胃切除术后引起大出血的患者行急症内镜检查，用冰冻生理盐水100ml+去甲肾上腺素8mg反复冲洗，暴露出血部位后在病灶周围黏膜下注射1∶10000肾上腺素及高渗盐水，无出血后，退镜于出血部位喷洒云南白药及凝血酶，防止再次出血。

According to the clear water experiment, aeration performance of the new equipment is good with high total oxygen transfer coefficient and oxygen utilization ratio.

曝气设备的动力效率在叶轮转速为120rpm～150rpm时取得最大值，此时氧利用率和充氧能力也具有较高值。

The environmental stability of that world - including its crushing pressures and icy darkness - means that some of its most famous inhabitants have survived for eons as evolutionary throwbacks, their bodies undergoing little change.

稳定的海底环境─包括能把人压扁的压力和冰冷的黑暗─意谓海底某些最知名的栖居生物已以演化返祖的样态活了万世，形体几无变化。