發(fā)布時間：2018-04-26 08:09

  本文選題：非靜脈曲張性上消化道出血 + 生肌止血散　； 參考：《廣州中醫(yī)藥大學》2016年碩士論文

【摘要】：目的：本研究擬對急性非靜脈曲張性上消化道出血(ANVUGIB)患者進行內鏡下噴灑生肌止血散治療,觀察其止血療效及臨床安全性,以期為本病的治療提供一種新的止血方法。同時通過觀察生肌止血散對胃出血大鼠模型的作用,探討其止血機制,為該方臨床應用提供藥理依據。方法：一、臨床研究：選取2014年3月到2016年1月期間廣東省第二中醫(yī)院住院患者中符合納入標準的熱盛迫血型ANVUGIB患者60例,隨機分為試驗組(胃鏡下噴灑生肌止血散)和對照組(胃鏡下噴灑去甲腎上腺素),每組30例,兩組患者術前均予泮托拉唑制酸及營養(yǎng)支持等常規(guī)治療,待患者生命體征平穩(wěn)后,于出血24小時內給予胃鏡下藥物噴灑治療,內鏡下治療后兩組患者均繼續(xù)采用與治療前相同的治療方案。觀察記錄兩組患者內鏡下止血治療后5min內即時止血情況,對兩組治療后的即時止血率、大便潛血轉陰率、平均止血時間、平均住院時間、總有效率等數據觀察比較,并對資料進行統(tǒng)計學分析。二、實驗研究：將40只大鼠隨機分為空白組(10只)和模型組(30只),模型組采用吲哚美辛灌胃復制胃出血大鼠模型,將造模后的大鼠隨機分為模型組(10只)、陽性對照組(10只)、實驗組(10只),實驗組給予生肌止血散溶液灌胃,陽性對照組給予云南白藥溶液灌胃,空白組、模型組給予等量生理鹽水灌胃,分別于造模后0.5h和3h各灌胃1次。14h后腹主動脈取血,并摘除大鼠全胃。比較各組活化部分凝血活酶時間(APTT)、凝血酶原時間(PT)、凝血酶時間(TT)及胃黏膜出血點情況,結果進行統(tǒng)計學分析,以探討生肌止血散的止血機制。結果：一、臨床研究：即時止血率方面,試驗組的即時止血率為96.67%,試驗組優(yōu)于對照組(76.67%)(P0.05)。再出血率方面：試驗組的再出血率3.33%,試驗組的顯著低于對照組(20%)(P0.05)。大便潛血轉陰率方面：試驗組的大便潛血轉陰率為90%,試驗組顯著高于對照組(60%)(P0.05)。平均止血時間方面：試驗組的平均止血時間為31.43±7.67h,試驗組顯著低于對照組(44.20±17.15h)(P0.01)。住院時間方面：試驗組平均住院時間為6.400±1.482 d,試驗組明顯短于對照組(7.267±1.680 d)(P0.05)�？傆行史矫妫涸囼灲M的總有效率96.67%,試驗組明顯高于對照組(83.33%)(P0.05)。二、動物實驗方面：PT:空白組的平均PT為11.020±1.698秒,模型組的為12.650±0.642秒,對照組的為10.860±1.318秒,實驗組為9.600±0.804秒,與模型組比較,空白組、陽性對照組、試驗組均顯著性降低(P0.01)；與陽性對照組比較,試驗組顯著性降低(P0.05)。APTT:空白組的平均APTT為21.850±3.101秒,模型組的為25.980±3.602秒,對照組的為20.900±2.428秒,實驗組為20.540±2.208秒,與模型組比較,空白組、陽性對照組、試驗組均顯著性降低(P0.01)。TT:空白組的TT為58.650±4.880秒,模型組的為64.810±3.704秒,對照組的為54.190±3.990秒,實驗組為52.730±5.865秒,與模型組比較,空白組、陽性對照組、試驗組均顯著性降低(P0.01)。胃粘膜出血點：空白組的胃粘膜無出血點,模型組的為30.400±4.858個,對照組的為16.200±3.615個,實驗組為10.800±2.378個,與模型組胃粘膜出血點水平比較,空白組、陽性對照組、試驗組均顯著性降低(P0.01)；與陽性對照組胃粘膜出血點水平比較,試驗組顯著性降低(P0.01)。結論：臨床試驗表明：1.生肌止血散治療能迅速止血,提高ANVUGIB患者的止血率、大便的轉陰率及治療的總有效率。2.生肌止血散治療能縮短ANVUGIB患者的止血時間及住院時間。3.在本試驗中生肌止血散治療后未出現(xiàn)不良反應。動物實驗表明：1.生肌止血散可能啟動大鼠的內源性凝血及外源性凝血,改善大鼠的凝血功能。2.生肌止血散能促進損傷粘膜的愈合,降低大鼠的胃粘膜出血點。綜合上所述,生肌止血散內鏡下噴灑止血臨床療效好,無不良反應,可以在臨床上推廣應用。
[Abstract]:Objective: To investigate the efficacy and safety of the treatment of acute non variceal upper gastrointestinal bleeding (ANVUGIB) patients with endoscopically sprayed Shengji hemostat, in order to provide a new method of hemostasis for the treatment of this disease, and to explore the effect of Shengji Zhi Xue powder on the rat model of gastric hemorrhage. Blood mechanism provides pharmacological basis for the clinical application of this prescription. Methods: 1. Clinical study: 60 cases of ANVUGIB patients with hot and forced blood type ANVUGIB were selected from March 2014 to January 2016. The patients were randomly divided into the experimental group (gastroscope spraying Shengji Shengxue powder) and the control group (gastroscope spraying normethylene kidney under the gastroscope). There were 30 cases in each group. The two groups were given pantoprazole acid and nutritional support before the operation. After the patient's life signs were stable, the treatment was given under the gastroscope within 24 hours of bleeding. After endoscopic treatment, the two groups continued to use the same treatment as before the treatment. Observe and record the hemostasis of the two groups of patients under endoscopy. The immediate hemostatic situation in 5min after treatment, the two groups after the treatment of immediate hemostasis rate, fecal occult blood turn negative rate, the mean time of hemostasis, the average time of hospitalization, the total efficiency and other data were observed and compared. Two, the experimental study: 40 rats were randomly divided into blank group (10) and model group (30), model group adopted INDEN The rat model of gastric hemorrhage was replicated by gavage, and the rats were randomly divided into model group (10 rats), positive control group (10 rats), experimental group (10 rats), the experimental group was given Shengji hemostatic powder solution irrigation, the positive control group was given the Yunnan Baiyao solution gavage, the blank group, the model group was given the same amount of physiological saline irrigation, respectively, after the model 0.5h and 3H respectively. Blood was taken from the abdominal aorta after 1.14h intragastric perfusion and the whole stomach was removed. The activation time (APTT), prothrombin time (PT), thrombin time (TT) and gastric mucosa bleeding point were compared in each group. The results were statistically analyzed to explore the hemostatic mechanism of Shengji hemostatic powder. Results: 1, clinical study: immediate hemostasis rate, The immediate hemostasis rate in the experimental group was 96.67%, and the experimental group was superior to the control group (76.67%) (P0.05). The rebleeding rate of the experimental group was 3.33%, the experimental group was significantly lower than the control group (20%) (P0.05). The rate of fecal occult blood conversion was 90%, the test group was significantly higher than the control group (60%) (60%) (P0.05). Time: the average time of hemostasis in the experimental group was 31.43 + 7.67h, the experimental group was significantly lower than the control group (44.20 17.15h) (P0.01). The time of hospitalization was 6.400 + 1.482 D in the experimental group, and the experimental group was significantly shorter than the control group (7.267 + 1.680 D) (P0.05). The total effective rate was 96.67% in the experimental group and the experimental group was clear. Significantly higher than the control group (83.33%) (P0.05) (two), animal experiment: the average PT in the PT: blank group was 11.020 + 1.698 seconds, the model group was 12.650 + 0.642 seconds, the control group was 10.860 + 1.318 seconds, the experimental group was 9.600 + 0.804 seconds, compared with the model group, the blank group, the positive group, and the test group were significantly lower (P0.01); compared with the positive control group, the comparison was compared with the positive control group. The average APTT of the test group was 21.850 + 3.101 seconds, the model group was 25.980 + 3.101 seconds, the model group was 25.980 + 3.602 seconds, the control group was 20.900 + 2.428 seconds, the experimental group was 20.540 + 2.208 seconds. Compared with the model group, the blank group, the positive control group and the test group were significantly reduced (P0.01).TT: blank group TT for 58.650 + 4.880 seconds, the model was 58.650 + 4.880 seconds. The group was 64.810 + 3.704 seconds, the control group was 54.190 + 3.990 seconds, the experimental group was 52.730 + 5.865 seconds. Compared with the model group, the blank group, the positive control group and the test group were all significantly decreased (P0.01). The gastric mucosa bleeding point: the gastric mucosa of the blank group had no bleeding point, 30.400 + 4.858 in the model group, 16.200 + 3.615 in the control group, and 1 in the experimental group. 0.800 + 2.378, compared with the level of gastric mucosal bleeding point in the model group, the blank group, the positive control group and the test group decreased significantly (P0.01). Compared with the level of gastric mucosal bleeding in the positive control group, the experimental group was significantly lower (P0.01). Conclusion: the clinical trial showed that 1. raw muscle hemostasis powder can quickly stop bleeding and improve the stop of ANVUGIB patients. The blood rate, the conversion rate of stool and the total effective rate of treatment.2. Shengji hemostasis powder can shorten the time of hemostasis in ANVUGIB patients and the time of hospitalization,.3. has no adverse reaction after the treatment of Shengji Shengxue powder in this experiment. Animal experiments show that 1. raw muscle hemostasis powder may start the endogenous coagulation and exogenous coagulation in rats, and improve the rat The coagulant function.2. Shengji hemostasis powder can promote the healing of damaged mucosa and reduce the bleeding point of gastric mucosa in rats.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R573.2

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