食管出血

Objective To analyze the causation of short-term re-hemorrhage after the sclerotic therapy to esophagus varicose rupture hemorrhage in order to increase the curability of sclerotic therapy with endoscopes.Methˉods From January1995to June2004,this hospital has made sclerotic medicine to esophagus varicosis patients with the help of endoscopes for573person-times.

目的 分析食管静脉曲张破裂出血治疗后近期内再出血的主要原因，以提高内镜下硬化治疗的成功率方法我院消化内科从1995年1月～2004年6月，使用硬化剂对573例次食管静脉曲张患者行内镜下静脉注射。

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。

Methods: For 56 cases of arterial bleeding, performed angiography in the artery which was suspected to be the bleeding one, and then infused the embolus into the bleeding after super-selection to embolize it. For 17 cases of esophageal veins and fundic veins bleeding caused by the higher blood pressure in portal vein, we performed angiography in portal vein stem through puncturing the liver, found the bleeding spot, then infuse the embolus into the bleeding veins through super-selection to stop bleeding.

56例动脉性出血采用Seldinger氏法，经股动脉穿刺将导管选择插入可疑出血的动脉内先行DSA检查，明确诊断，再超选择插入出血动脉内注入栓塞材料，栓塞出血动脉。17例门静脉高压致食管胃底静脉曲张破裂出血，则采用经皮穿肝至门静脉主干行门静脉造影，明确出血部位，再超选择插管至出血静脉注入栓塞材料进行栓塞治疗。

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。

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.

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，退镜前于出血部位喷洒云南白药及凝血酶，防止再次出血。

Methods Emergency endoscope examination were carried out in 20 massive hemorrhage clients after gastrectomy and esophagectomy, after exposed and washed the bleeding part by cold 0.9% NS, 1:10000 adrenaline 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.

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lOOml＋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，退镜前于出血部位喷洒云南白药及凝血酶，防止再次出血。

ObjectiveTo explore the therapeutic effect of sandostatin for rebleeding of esophageal varicosis treated by endoscopic varical band ligation. Methods 82 patients with cirrhosis after hepatitis B complicated with esophageal variceal bleeding were divided into EVL group and EVL group + sandostatin group. The therapeutic effects of the two methods were compared for esophageal varicosis.

目的探讨善宁对食管静脉曲张套扎术后再出血的防治作用方法82例乙型病毒性肝炎后肝硬化并食管静脉曲张随机分套扎组和套扎+善宁组，比较两治疗方法对食管静脉曲张的治疗效果。

Clinical curative effect of hypophysin unite propranolol to healing esophagus fundus ventricularis variceal bleeding is similar with somatostatin, it is first elective method both economy and effective of healing esophagus fundus ventricularis variceal bleeding.

垂体后叶素联合心得安治疗食管胃底静脉曲张破裂出血的临床疗效与生长抑素基本相似，是治疗食管胃底静脉曲张破裂出血的既经济又实用有效的方法。

Clinical curative effect of hypophysin unite propranolol to healing esophagus fundus ventricularis variceal bleeding is similar with somatostatin, it is first elective method both economy and effective of healing esophagus fundus ventricularis variceal bleeding.

垂体后叶素联合心得安治疗食管胃底静脉曲张破裂出血的临床疗效与生长抑素基本相似，是治疗食管胃底静脉曲张破裂出血的既经济又实用有效的方法。中国论文联盟http：//www.lwlm.com

Clinical curative effect of hypophysin unite propranolol to healing esophagus fundus ventricularis variceal bleeding is similar with somatostatin, it is first elective method both economy and effective of healing esophagus fundus ventricularis variceal bleeding.

垂体后叶素联合心得安治疗食管胃底静脉曲张破裂出血的临床疗效与生长抑素基本相似，是治疗食管胃底静脉曲张破裂出血的既经济又实用有效的方法。转载于中国论文联盟 http：//www.lwlm.com

Fancy gold-plated dangling earrings with facetted White Opal crystals.

花式镀金悬垂耳环与facetted白欧泊水晶。

This essay chooses the study aim from biology teachers in middle school in Shi Jiazhuang which tells us that most of the middle school biology teachers in Shi Jiazhuang have the"burnout", lower successfulness, individualize.

本文选取石家庄市初中生物教师作为研究对象，运用问卷调查的方法对石家庄市初中生物教师职业倦怠的现状进行调查，调查结果发现，石家庄市初中生物教师这一群体普遍存在职业倦怠，情感枯竭程度偏高，成就感偏低，去个性化程度最为严重。