胃溃疡合并非静脉曲张性上消化道出血的循证治疗  

Evidence-based Treatment for Gastric Ulcer Complicated by Non-variceal Upper Gastrointestinal Bleeding

作　　者：蒋传林[1] 宋佳[1] 吕晓光[1] 董卫国[1] 

机构地区：[1]武汉大学人民医院消化内科,湖北省武汉市430060

出　　处：《中国全科医学》2013年第11期1263-1267,共5页Chinese General Practice

摘　　要：目的为1例胃溃疡合并非静脉曲张性上消化道出血患者制定循证治疗方案。方法根据患者情况提出临床问题,计算机检索Cochrane Library(网络版)、PubMed(1970—2012年)、EMBase(1970—2012年)、维普(1990—2012年)、中国知网(1990—2012年)数据库,获得与胃溃疡合并非静脉曲张性上消化道出血治疗相关的文献证据。结合文献证据及患者病情和需要制定治疗方案。结果共纳入10篇Meta分析和25篇随机对照试验,制定治疗方案如下:调整饮食习惯;适当补充血容量;给予奥美拉唑40 mg口服;内镜治疗并静脉注射奥美拉唑5 d,同时应用阿莫西林和甲硝唑三联疗法根除幽门螺杆菌。经过6个月门诊随访,患者行胃镜检查未见溃疡及出血病灶,制定的治疗方案有效。结论应用循证医学的方法,根据高质量的文献证据为胃溃疡合并非静脉曲张性上消化道出血患者制定合理的治疗方案,有助于提高治疗效果,改善患者预后。Objective To analyze the evidence -based treatment program for a case of gastric ulcer complicated by non -variceal upper gastrointestinal bleeding. Methods The clinical problems presented by the patient were retrieved in Co- chrane Library （online edition）, PubMed （1970--2012）, EMBase （1970--2012）, VIP （1990--2012）, CNKI to get literatures related to gastric ulcer complicated by non - variceal upper gastrointestinal bleeding. Treatment program was made based on literature evidence and the patient＇condition and requirement. Results A total of 10 articles on Meta - analysis and 25 on randomized controlled trials were enrolled. Treatment program was made as follow： adjusting eating habits, appropriate addition of blood volume ; Oral administration of omeprazole, 40 mg; Endoscopic therapy and intravenous omeprazole for 5 d, and amoxicil- lin, metronidazole triple therapy to root out helicobacter. After 6 months of follow - up, endoscopy did not find ulcers or bleeding lesions. The treatment program was effective. Conclusion By evidence - based method, rational treatment program made based on high - quality literatures for gastric ulcer complicated by non - variceal upper gastrointestinal bleeding contributes to im- provement of treatment effects and prognosis.

关 键 词：循证医学 胃溃疡 胃肠出血 消化性溃疡出血 

分 类 号：R573.11[医药卫生—消化系统] R573.2[医药卫生—内科学]