重型闭合性颅脑损伤高压氧治疗中并发上消化道出血的原因和预防措施  

Causes and preventive measures of upper gastrointestinal bleeding in hyperbaric oxygen therapy for patients with severe closed craniocerebral injury

作　　者：陈彬 裘申忠 张汶 CHEN Bin QIU Shen-zhong ZHANG Wen(Department of Neurosurgery, the First People＇s Hospital of Fuyang District Hangzhou, Hangzhou 311400, China Department of Hyperbaric Oxygen Therapy Center, the First People＇s Hospital of Fuyang District Hangzhou, Hangzhou 311400, China)

机构地区：[1]杭州市富阳区第一人民医院神经外科,浙江杭州311400 [2]杭州市富阳区第一人民医院高压氧治疗中心,浙江杭州311400

出　　处：《中国生化药物杂志》2017年第6期380-382,共3页Chinese Journal of Biochemical Pharmaceutics

基　　金：杭州市卫生科技计划项目(2015B36)

摘　　要：目的 探讨重型闭合性颅脑损伤高压氧治疗中并发上消化道出血的原因和预防措施.方法 对杭州市富阳区第一人民医院2011年5月-2016年5月收治的重型闭合性颅脑损伤高压氧治疗中并发上消化道出血患者24例的临床资料进行分析,对患者的上消化道出血发生时间、临床疗效进行分析.结果24例患者中,首次治疗即发现显性出血14例,其中2例患者有出血性液体从胃管流出,2例患者有鲜血从胃管流出,2例患者出血治愈后再次接受高压氧治疗3次再次显性出血;高压氧治疗第3、7、10次有咖啡色液体或血性液体从胃管流出6例;高压氧治疗第2、3个疗程有咖啡色液体从胃管流出4例,分别占总数的58.3%、25.0%、16.7%;恢复良好8例,中度残疾10例,严重残疾4例,植物状态2例,死亡0例,恢复良好率为33.3%.结论 重型闭合性颅脑损伤高压氧治疗未正确掌握时机会使患者并发上消化道出血,对H2受体结抗剂进行正确应用、将有针对性的治疗方案制定出来能够对上消化道出血进行有效预防和治疗,值得临床充分重视.Objective To investigate the causes and preventive measures of upper gastrointestinal bleeding in hyperbaric oxygen therapy for patients with severe closed head injury.MethodsThe clinical data of 24 cases of patients with upper gastrointestinal hemorrhage treated by hyperbaric oxygen therapy in the first people＆#39;s Hospital of Fuyang District Hangzhou from May 2011 to May 2016 were analyzed, the occurrence time and clinical effect of upper gastrointestinal bleeding were analyzed.ResultsAmong the 24 cases of patients, 14 cases were treated for the first time that overt bleeding, including bleeding from the stomach liquid outflow of blood from 2 cases, gastric outflow 2 cases, hemorrhage after cure again received hyperbaric oxygen therapy 3 times again dominant bleeding 2 cases;6 cases hyperbaric oxygen treatment for third, 7, 10 times brown liquid or bloody fluid from the stomach outflow;4 cases hyperbaric oxygen treatment in patients with second and 3 courses of coffee liquid from the outflow tube, which accounted for 58.3%, 25.0%, 16.7% of the total, retrospectively;8 cases were with good recovery, 10 cases moderate disability, 4 cases severe disability, 2 cases vegetative state, 0 case died, the good recovery rate was 33.3%.ConclusionNot correctly grasp the time of hyperbaric oxygen therapy in the treatment of patients with severe closed craniocerebral injury will cause upper gastrointestinal hemorrhage, correct application of H2 receptor binding agent, developing targeted therapy programme can effectively prevent and treat upper gastrointestinal bleeding, so is worthy of the clinical＆#39;s full attention.

关 键 词：重型闭合性颅脑损伤 高压氧 上消化道出血 

分 类 号：R651.1[医药卫生—外科学]