科技论文写作结课作业

Non-variceal gastrointestinal bleeding, endoscopic therapy clinical analysisAbstract: Objective: To study the observed endoscopic treatment of non-variceal gastrointestinal bleeding clinical effect.Methods: Our hospital in March 2010 to September 2011 were treated 100 cases of non-variceal gastrointestinal bleeding patients, all patients were diagnosed by endoscopy are endoscopic treatment, compared with before treatment. Results: 100 patients in the treatment of 94 patients immediately after bleeding, 6 patients unsuccessful retrobulbar bleeding ulcer bleeding, cure rate of 94%, including 4 patients in the treatment of bleeding again within two days after the implementation of the second treatment, 3 patients within 48 hours of successful hemostasis and no bleeding, one case of bleeding into the department receives an invalid continue treatment, and treatment than before, bleeding significantly reduced the number of cases, compared to P <0.05 was considered statistically significant, statistically significant. Conclusions: non-variceal gastrointestinal bleeding implementation of endoscopic therapy is a high safety and efficacy means, but it should be noted that the doctor according to the patients specific situation to choose the method of endoscopic hemostasis.Keywords:non-varice al,gastrointestinal bleeding, endoscopic therapy There are many causes of gastrointestinal bleeding, with the development of medical technology, endoscopic therapy has been widely used clinically, the author for further study of endoscopic treatment of non-variceal gastrointestinal bleeding clinical results, selected in our hospital 100 cases of non-variceal gastrointestinal bleeding, endoscopic therapy are used to obtain satisfactory results, are summarized as follows1.1 Materials and Methods 1.1 Clinical data in our hospital in March 2010 to September 2011 were treated 100 cases of non-variceal gastrointestinal bleeding patients, all patients were diagnosed by endoscopy. 61 patients were male, 39 female patients patients, aged 17 to 69 years, mean age 42 + -7.5 years old, of which three cases of anastomotic ulcer and 16 duodenal ulcer, 26 cases of gastric ulcer, 15 cases of complex ulcers, nine cases of acute gastric mucosal lesion with hemorrhage, 17 cases of esophagus, stomach bleeding after polypectomy, the other 14 cases. main clinical symptoms: black stools, vomiting, often accompanied with hypovolemia caused by acute peripheral circulatory failure2.1.2 Methods 1.2.1 hemostatic preparation for a serious condition and the fact that the amount of bleeding and hemodynamic changes caused patients to promptly give blood volume supplement to maintain blood pressure, at the same time care, when patients are in stable condition after endoscopy for the excessive bleeding caused by anemia patients should be given prompt corrective treatment until check the patients hemoglobin is not less than 70g / L, and then re-examination, in order to avoid damage to the digestive tract endoscopy tube inspection, so intuitive gastroscopy under local ice saline flush, suction and changes in position and other methods to avoid the impact of the observed bleeding more. 1.2.2 endoscopic treatment of patients before endoscopy were performed to determine the site of bleeding would needle inserted through the endoscope biopsy channel, then drug injection, bleeding around the site in the injection of the drug directly injected in the blood vessels When you feel resistance when the injection is stopped for non-injection treatment of varicose veins is not ideal for Patients can be hemoclipping. 1.3Statistical analysis All data in this study using SPSS18.0 statistical software, measurement data using t test, compared between groups using the X2 test, P <0.05 was considered statistically significant, with statistical significance.2 results in the treatment of 100 patients, 94 patients immediately after bleeding, 6 patients retrobulbar bleeding ulcer bleeding unsuccessful, the cure rate was 94%, of which there are Four patients in the treatment of bleeding again within two days after the implementation of the second treatment, 3 patients within 48 hours of successful hemostasis and no bleeding, one case of bleeding into the department receives an invalid continue treatment, compared with before treatment, the number of cases of bleeding significantly reduced, compared to P <0.05 was considered statistically significant, statistically significant, As shown in table I.3 refers to a discussion of the digestive tract between the esophagus to the anus pipeline, including through the esophagus, stomach, duodenum, jejunum, ileum, cecum, colon and rectum, while gastrointestinal bleeding is clinically more common diseases, light to take effective treatment can be cured, and might seriously damage the patients body. gastrointestinal bleeding main clinical symptoms are manifested as blood in the stool, black stools, vomiting 3. patients vomiting bright red color may be also possible that brown, bright red blood in the stool color can also be rendered, dark and tarry black. complex causes of gastrointestinal bleeding, clinical examination causes of morbidity in the moment consider the patients medical history, clinical signs and the main symptoms, but the location and cause of bleeding is required by mechanical instrument to determine at the time of diagnosis to pay special attention to upper gastrointestinal bleeding and some exclusion of lower gastrointestinal bleeding disorders 4. clinical study found that non-variceal gastrointestinal bleeding is the most common factors are tumor (endoscopic treatment, mucosal tear, mucosal lesions, inflammation and ulcers, the most important factor is the peptic ulcer bleeding. gastrointestinal bleeding with acute illness, is characterized by rapid change can be serious threats to the lives of patients, so it is important to clinical rescue 5 In the salvage therapy, anti-shock, quickly add volume is to treat basis. clinical bleeding according to the patients blood volume to determine the amount of the supplement, while the clinical treatment of gastrointestinal bleeding extinction there are many ways (conservative treatment , interventional radiology treatment, surgery, endoscopic therapy, comprehensive treatment, and with the development of medical technology, endoscopic therapy in clinical playing an increasingly important role, in this study the author selected 100 cases non-variceal gastrointestinal bleeding patients were treated with endoscopic therapy results show that 100 patients in the treatment of 94 patients immediately after bleeding, 6 patients with bleeding ulcer bleeding after the ball is unsuccessful, the cure rate was 94%. including four patients in the treatment of bleeding again within two days after the implementation of the second treatment, 3 patients within 48 hours of successful hemostasis and no bleeding, one case of bleeding into the department receives an invalid continue treatment, compared with before treatment, bleeding significantly reduced the number of cases, compared to P <0.05 was considered statistically significant, statistically significant, which shows that the implementation of non-variceal gastrointestinal bleeding endoscopic therapy is a high safety and efficacy of the means, but needs Note that the doctor according to the patients specific situation to choose the method of endoscopic hemostasis.References:1 Zhang, Xu Meidong, Chen Wei Feng.Endoscopic treatment of acute non-variceal upper gastrointestinal bleeding clinical value J. Chinese C2 Xumei Dong, Chen Wei Feng, Ma Lili.Endoscopic injection sclerotherapy metal clips and treatment of peptic ulcer bleeding J. Chinese Clinical Medicine, 2008,15 (06) :814-815.3 Journal of Internal Medicine Editorial Board.Acute non-variceal gastrointestinal bleeding treatment guidelines quotient J. Journal of Internal Medicine, 2009,08 (10): 891.4 Qiu Zan, Zhao Kui, Wang Bangmao.Endoscopic hemoclipping clinical value of high-risk peptic ulcer bleeding J. China Journal of Endoscopy, 2009.15 (02): 146.5 LO CC, HSU Pl, LO GH, et a1.Comparison of hemostatie efficacyFor Epinephrine Injection Alone And Injection Combined With Hemoclipthempy in treating hishrisk bleeding ulcers J.Gastronintest Endose, 2006,63 (06): 774. 非静脉曲张性消化道出血的内镜下治疗方法的临床分析摘要：目的：研究观察内镜下治疗非静脉曲张性消化道出血的临床效果。方法：选取我院于2010年3月至2011年9月收治的100例非静脉曲张性消化道出血患者，所有患者均经胃镜检查确诊，均在内镜下进行治疗，并与治疗前进行对比。结果：100例患者中在治疗后有94例患者即时止血，6例患者球后溃疡出血止血不成功，治愈率为94%。其中有4例患者在治疗后两天内再次出血，实施第二次治疗，3例患者止血成功且48小时内无出血情况，1例止血无效转入科室接受继续治疗，与治疗前相比，出血例数明显减少，对比P0.05为差异有显著性，有统计学意义。结论：非静脉曲张性消化道出血实施内镜下治疗是一种安全性与有效性较高的手段，但是需要注意的是医生要根据患者的具体情况来选择内镜下止血的方法。关键词：非静脉曲张性；消化道出血；内镜下治疗消化道出血的原因有很多，随着医学技术的发展，内镜治疗已被广泛应用于临床，笔者为进一步研究内镜下治疗非静脉曲张性消化道出血的临床效果，选取了我院收治的100例非静脉曲张性消化道出血患者，均采用内镜下治疗，取得满意效果，现作如下总结。1 资料与方法1.1 临床资料选取我院于2010年3月至2011年9月收治的100例非静脉曲张性消化道出血患者，所有患者均经胃镜检查确诊。其中男性患者61例，女性患者39例，年龄1769岁，平均年龄427.5岁。其中3例吻合口溃疡，16例十二指肠球部溃疡，26例胃窦溃疡，15例复合溃疡，9例急性胃黏膜病变伴出血，17例食管、胃息肉切除后出血，其他14例。主要临床症状：黑便、呕吐，多伴有血容量减少而引起的急性周围循环衰竭。1.2 方法1.2.1止血前准备对于病情严重及由于出血量多而引发血流动力学变化的患者要及时给予血容量补充，维持血压，同时进行监护，当患者病情稳定后即胃镜检查。对于由于失血过多而引起贫血的患者要及时给予纠正治疗，直到检查患者的血红蛋白不低于70gL，然后再行镜检，为了避免胃镜插管检查损伤消化道，所以在胃镜检查时直观下局部冰生理盐水冲洗、抽吸及改变体位等方法来避免出血较多对观察的影响1。1.2.2内镜治疗患者在治疗前均进行胃镜检查，从而确定出血部位。将注射针通过内镜活检通道插入，再进行药物注射，可在出血部位周围注射液可直接将药物注射在血管内。当注射时感觉到有阻力则停止。对于非曲张静脉性注射治疗后效果不理想的患者可进行止血夹治疗2。1.3 统计学分析本次研究所有数据均采用SPSS18.0统计学软件处理，计量资料采用t检验，组间对比采用X2检验，P0.05为差异有显著性，有统计学意义。2 结果100例患者中在治疗后有94例患者即时止血，6例患者球后溃疡出血止血不成功，治愈率为94%。其中有4例患者在治疗后两天内再次出血，实施第二次治疗，3例患者止血成功且48小时内无出血情况，1例止血无效转入科室接受继续治疗；与治疗前相比，出血例数明显减少，对比P0.05为差异有显著性，有统计学意义，如表一所示：3 讨论消化道指的是食管到肛门之间的管道，其中经过食管、胃、十二指肠、空肠、回肠、盲肠、结肠及直肠。而消化道出血则是临床上较为常见的疾病，轻者采取有效治疗即可痊愈，重者可严重损伤患者身体。消化道出血的临床主要症状多表现为便血，黑便、呕吐等3。患者呕吐的血色有可能是鲜红的也有可能的是咖啡色，便血颜色也可呈现鲜红、暗红及柏油样黑色。消化道出血的原因复杂，临床在检查发病原因时刻考虑患者的病史、体征及临床主要症状，但是出血的部位及原因则需要通过机械仪器来确定。在诊断时要特别注意上消化道出血和下消化道出血的一些排除症4。临床研究发现，非静脉曲张性消化道出血最常见的因素有肿瘤（内镜治疗后）、黏膜撕裂、黏膜病变、炎症及溃疡，其中最主要的因素是消化性溃疡出血。消化道出血具有病情急、变化快的特点，严重者可威胁患者的生命，所以，临床抢救是十分重要的5。在抢救治疗中，抗休克、迅速补充血容量是治疗的基础。临床上要根据患者的出血量来决定血容量的补充量。而临床治疗消道出血的方法有很多（保守治疗、放射介入治疗、外科手术治疗、内镜下治疗、综合治疗等），而随着医学技术的发展，内镜下治疗在临床发挥着越来越重要的作用，本次研究中笔者选取的100例非静脉曲张性消化道出血的患者均采用内镜下治疗其结果显示，100例患者中在治疗后有94例患者即时止血，6例患者球后溃疡出血止血不成功，治愈率为94%。其中有4例患者在治疗后两天内再次出血，实施第二次治疗，3例患者止血成功且48小时内无出血情况，1例止血无效转入科室接受继续治疗；与治疗前相比，出血例数明显减少，对比P0.05为差异有显著性，有统计学意义。这说明，非静脉曲张性消化道出血实施内镜下治疗是一种安全性与有效性较高的手段，但是需要注意的是医生要根据患者的具体情况来选择内镜下止血的方法。参考文献1张明，徐美东，陈巍峰.内镜治疗急性非静脉曲张性上消化道出血的临床价值J.中国临床医学，2010，17(05):679-680.2徐美东，陈巍峰，马丽黎.内镜下金属夹和注射硬化剂治疗消化性溃疡大出血J.中国临床医学，2008，15(06)：814-8153中华内科杂志编委会.急性非静脉曲张性商消化道出血诊治指南J.中华内科杂志，2009，08(10)：8914张秋瓒，赵魁，王邦茂.内镜下止血夹治疗高危消化性溃疡出血的临床价值J.中国内镜杂志，2009.15(02)：1465LO CC，HSU Pl，LO GH，et a1.Comparison of hemostatie efficacyfor epinephrine injection alone and injection combined with hemoclip 2006，63(06)：774. Ultrasound diagnosis of acute appendicitisAbstract: Objective: To investigate the ultrasound diagnosis of common appendicitis cases determined to further improve the compliance rate of ultrasound diagnosis against appendicitis diagnosed Methods: 85 patients with pathologically confirmed appendicitis ultrasound diagnosis of common analyzed. Results: Ultrasound diagnosis of each The appendicitis obvious discussion: B ultrasound in the differential diagnosis of acute appendicitis is different from other traditional means of diagnosis, has an important role in favor the auxiliary reasonable treatment options.Keywords: ultrasound diagnosis of acute appendicitis diagnostic criteriaAcute appendicitis is the most common disorders of the surgical abdomen, clinical manifestations although certain regularity, but sometimes changing, if not handled properly, serious complications can occur. Diagnosis of acute appendicitis usually rely mainly on clinical experience, traditional imaging techniques, such as X-ray is little clinical diagnosis of acute appendicitis effect, not easy to confirm the diagnosis of acute appendicitis. recent years, with the popularity and spread of ultrasound diagnosis, appendicitis difficult in the past due to many reasons due to interference of intestinal gas discovery caused by Lou Jane and misdiagnosed, is now gradually improving, especially with a high-frequency probe technology and better use of appendicitis sonographic characteristics, accurate diagnosis of appendicitis. proved by years of experience, ultrasonography in diagnosis of acute appendicitis and its complications, differential Diagnosis has important diagnostic value1 Our hospital from July 2009 to July 2011, diagnosed by ultrasound detected 85 cases of acute appendicitis, and in all cases confirmed by clinical diagnosis or surgery and get timely treatment are summarized as follows: 1 Materials And Methods1.1 GENERAL INFORMATION acute appendicitis in 85 cases, aged 7 to 58 years old, acute uncomplicated appendicitis, 58 cases, 20 cases of acute suppurative appendicitis, acute appendicitis with perforation three cases of acute appendicitis with abscess in four cases. Above both our hospital emergency patients The clinical manifestations of paroxysmal Cullen pain or metastatic right lower abdominal pain, some performance for lower abdominal tenderness, anti pain, white blood cells, Medium myeloid elevated symptoms2. 1.2 Instruments and Methods instruments with Germanys Siemens the G60S color Doppler ultrasonic diagnostic apparatus, the probe frequency 3.5MHZ, thinner using a combination of a 7 10MHZ high-frequency probe. Patient was supine or left Xiece supine maintain bladder filling and auxiliary routine inspection of the kidneys and ureters, female patients to be checked on the bladder, uterus, accessories, has been excluded urological, gynecological system disease factors, male patients with bladder, prostate All genitourinary examination related disease has been ruled out factors specified the pain of patients with a do focus on checking with partial pressure check, the probe flat right lower quadrant appendectomy pressure on both ends of the probe slowly pushed the surrounding tissue, abdominal and retroperitoneal lumbar major muscle, iliac artery, vein between the inflamed appendix can be seen with the cecum continuation. a.acute uncomplicated appendicitis in 58 cases, patients with symptoms for a short time of onset is generally between 12-36 hours, the ultrasound showed appendectomy tubular structure, mild swelling, was the earthworm-like fuzzy boundary wall thickening was bilateral was low and uniform shadow, internal or less homogeneous echo, not smooth serosal echo wall level is unclear. seen in liquid dark area appendectomy with cecum, breathing, moving down from the psoas muscle over dynamic observation of the ileocecal intestinal gas-liquid flow appendix cavity, no Gas-liquid flow panning.20 cases of acute suppurative appendicitis, acute suppurative appendicitis and acute gangrenous appendicitis both sonographic similar and difficult to distinguish, the positive rate of acute suppurative appendicitis ultrasound showed coarse swelling of the appendix, the long axis like a finger-like, the end of obtuse, wall thickening, the level is not clear, serosal echo slightly stronger, yet finishing heterogeneous internal echo, hypoechoic, the cavity was strong echo appendectomy cavity and surrounding exudate was sausage, slitting like, appendectomy varying wall thickness, strength of transverse section white ring echo, breathing appendectomy with cecum move up and down2. c.acute appendicitis with perforation of the three cases, the ultrasound showed the coarse appendectomy swelling, bowel wall thickening, the level is not clear, serosal echo slightly stronger, heterogeneous internal echo, hypoechoic intimal surface of the mucosa and submucosa strong Echo continuous interrupt to consider Perforated appendix after confined by surgery. Dacute appendicitis with abscess four cases of acute appendicitis with abscess is acute appendicitis suppurative gangrene, omental adhesions moved to the right lower quadrant wrapped inflammatory mass, the positive rate of 96.5%. above cases ultrasound showed: inflammatory mass in the lower right abdomen exploration and hypoechoic irregular echo area, appendectomy morphology unclear, heterogeneous internal echo, hypoechoic or cystic-solid mixed mass, the boundary is not clear, its normal appendix longer pan, abscess formation, internal liquefaction obvious sound through the poor, breathing activity disappeared, suspected appendiceal abscess after confirmed by surgery. 3 Discussion Acute appendicitis is a surgical common, ranking the first in a variety of acute abdomen, if the appendix in the normal anatomical position to rely on the characteristics of of metastatic abdominal pain and tenderness lower right abdomen positioning, combined with laboratory tests, can be confirmed, but if the position variation real-time ultrasound with no pain, subject to the influence of tranquilizers at the same time, the diagnosis becomes difficult. laboratory tests most acute appendicitis patients white blood cell count and neutrophil percentage increased, but the increase was not obvious nor deny the diagnosis. non-invasive, no side effects, easy and quick, can repeat the advantages of dynamic observation by exploratory appendectomy size and shape, internal echo and mobility combined with clinical data to make more accurate ultrasound diagnosis of appendicitis, clinical diagnosis rate the B super play an important role in the differential diagnosis of acute appendicitis and other acute abdomen but in some cases there are also false negative, so it should be combined with a detailed medical history, a comprehensive physical examination and laboratory tests, in order to make the right patients diagnosis so that patients receive timely treatment3.References1, Guo Xue editor << Ultrasound in Medicine >> (sixth edition), Peoples Medical Publishing House, 2011,2, Qian Yun Qiu, Zhou Xiaodong, Zhang Jun, editor << the practical ultrasonic diagnostic manual (second edition) Amendment, the Peoples Medical Publishing House, 2011,3, Wang Zhibin main translation << abdominal ultrasound diagnostic >>, Peoples Health Publishing House, 2005.急性阑尾炎的超声诊断摘要：目的：探讨超声诊断对常见阑尾炎进行的病例确定，进一步提高超声诊断作对阑尾炎确诊的符合率。方法：对85例经手术病理证实的阑尾炎超声诊断的共性进行总结分析。结果：超声诊断各型阑尾炎特征明显。讨论：B超在急性阑尾炎的鉴别诊断中有别于其他传统方式的诊断，具有重要作用，有利于辅助合理选择治疗方案。关键词：急性阑尾炎 超声诊断 诊断标准 急性阑尾炎是外科急腹症中最常见的疾患，临床表现虽有一定的规律性，但有时变化多端，如果处理不当，可出现严重的并发症。急性阑尾炎的诊断通常主要依靠临床经验，传统的影像技术，如X线等对临床诊断急性阑尾炎效果不大，不容易明确诊断急性阑尾炎。近年来，随着超声诊断的普及和蔓延，对过去因肠气干扰等诸多原因造成的发现阑尾炎困难而导致的娄珍和误诊，现已逐步得到了改善。尤其是采用了高频探头技术，更能利用阑尾炎的声像特点，准确无误的对阑尾炎进行诊断。经多年的的经验证明，超声检查在诊断急性阑尾炎及其合并症、鉴别诊断方面具有了重要的诊断价值1。 我院自2009年7月至2011年7月，经超声诊断检出急性阑尾炎85例，所有病例均经临床确诊或手术证实，并得到了及时的治疗。现总结如下：1资料与方法1.1一般资料 急性阑尾炎85例，年龄758岁，急性单纯性阑尾炎58例，急性化脓性阑尾炎20例，急性阑尾炎伴穿孔3例，急性阑尾炎伴脓肿4例。以上均为我院急诊患者，临床表现多为阵发性脐周痛或转移性右下腹痛，部分表现为下腹压痛、反条痛，白细胞、中型粒细胞升高等症状2。 1.2仪器与方法仪器采用德国西门子G60S彩色多普勒超声诊断仪，探头频率为3.5MHZ，比较瘦的人结合采用710MHZ高频探头。患者取仰卧位，或左斜侧卧位，膀胱保持充盈，并辅助常规进行双肾和输尿管的检查，女性患者对膀胱、子宫、附件进行检查，已排除泌尿、妇科系统疾病因素；男性患者对膀胱、前列腺等全部泌尿生殖系统检查，已排除相关疾病因素。对患者指定的疼痛出做重点检查，用局部加压检查法，将探头平放右下腹阑尾区，于探头两端缓缓加压将周围的组织推开，在腹壁与腹膜后的腰大肌，髂内动、静脉之间，可见到发炎的阑尾与盲肠相延续。 2结果a. 急性单纯性阑尾炎58例，患者多表现为发病时间短，一般在12-36小时之间，超声表现为阑尾呈管状结构，轻度肿胀，呈蚯蚓状，边界模糊、壁增厚呈双边影，内部呈低而均匀或欠均匀的回声，浆膜回声不光滑，管壁层次欠清晰。其内可见液性暗区，当呼吸时，阑尾随盲肠向下移动，从腰大肌滑过，动态观察，回盲部肠内有气液流动，而阑尾腔内未见气液流动声像3。b.急性化脓性阑尾炎20例，急性化脓性阑尾炎和急性坏疽性阑尾炎二者声像图相似，不易区别，阳性率高。急性化脓性阑尾炎超声表现为阑尾肿胀粗大，长轴似手指状，末端钝圆，肠壁增厚，层次不清晰，浆膜回声稍强，尚光整，内部回声不均匀，呈低回声，腔内呈强回声，阑尾腔及周围渗出液增多，纵切呈腊肠状，阑尾壁厚薄不一，横切面呈强弱相间的环形回声，呼吸时阑尾随盲肠上下移动。c.急性阑尾炎伴穿孔3例，超声表现为阑尾肿胀粗大，肠壁增厚，层次不清晰，浆膜回声稍强，内部回声不均匀，呈低回声，内膜面的粘膜与粘膜下层的强回声连续中断，考虑阑尾穿孔，后经手术证实。d.急性阑尾炎伴脓肿4例，急性阑尾炎伴脓肿是因急性阑尾炎化脓坏疽时，大网膜移至右下腹包裹粘连而形成的炎性肿块，其阳性率高96.5%。上述病例超声表现为：于右下腹部探及低回声炎性肿块，形态不规则的回