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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 吳明賢(Ming-Shiang Wu) | |
dc.contributor.author | Chieh-Chang Chen | en |
dc.contributor.author | 陳介章 | zh_TW |
dc.date.accessioned | 2021-05-20T20:00:35Z | - |
dc.date.available | 2013-10-07 | |
dc.date.available | 2021-05-20T20:00:35Z | - |
dc.date.copyright | 2011-10-07 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-08-17 | |
dc.identifier.citation | (2002). 'Non-variceal upper gastrointestinal haemorrhage: guidelines.' Gut 51 Suppl 4: iv1-6.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/8747 | - |
dc.description.abstract | 背景
急性上消化道出血成因大多是急性消化性潰瘍出血。針對高危險性出血潰瘍病兆,內視鏡止血術,已被證實可預防潰瘍再出血、減低需緊急開刀手術的風險、降低住院日數。經內視鏡止血療法後,高劑量輔助性氫離子幫浦抑制劑治療已被證實可降低再出血率,然而氫離子幫浦抑制劑的劑量是否影響再出血率仍有爭議。此外氫離子幫浦抑制劑及內視鏡止血術廣泛的應用下,潰瘍再出血危險因子尚缺乏相關資料。 目的 評估內視鏡止血治療後,氫離子幫浦抑制劑的劑量是否會影響再出血率、手術比率、輸血量、住院日數、三十天死亡率,以及患者的臨床表現、內視鏡表現及既有疾病、非類固醇消炎止痛劑,幽門螺旋桿菌狀況、CYP2C19基因型是否和再出血相關。 方法 針對201位高風險出血性潰瘍患者,以內視鏡進行腎上腺素注射及熱探子熱凝止血治療後,依氫離子幫浦抑制劑劑量不同,隨機分派成高劑量組(pantoprazole八十毫克快速靜脈注射後,以每小時八毫克速率靜脈注射)或標準劑量組(每日pantoprazole靜脈注射四十毫克)共七十二小時。七十二小時後給予口服pantoprazole每天四十毫克,共二十七天。試驗期間給予必要之輸血及其他治療,並監測是否再出血。 結果 100位病患進入高劑量組,101位病患進入標準劑量。高劑量組組有6位(6.2%, 95% C.I: 1.3% ~ 11.1%),而標準劑量有5位(5.2%, 95% C.I: 0.6% ~ 11.1%) 在內視鏡治療後三十天內再出血 (p=0.77)。高劑量組平均輸血量為2.9 ± 6.2單位,標準劑量組平均輸血量為1.6 ± 2.1單位(P = 0.046)。住院天數在五天內的病患,高劑量組的病患有55位(56.7%),標準劑量組有57位(59.3%),p=0.70。高劑量組中有一位病患接受血管栓塞術止血 (0 vs. 1, p=0.32)。高劑量組中有3位(3.1%)在三十天內死亡,而標準劑量組有1位(1%)在三十天內死亡(p=0.32)。利用逐步Cox迴歸分析顯示透析、吐血、慢性阻塞性肺病為再出血的獨立危險因子(危險比:37.15、10.07、9.12,95% 信賴區間:6.76∼204.14、2.07∼49.01、1.66∼50.00)。幽門螺旋桿菌感染者較不容易發生再出血(危險比:0.20,95% 信賴區間:0.04∼0.94)。 結論 出血性潰瘍經合併兩種內視鏡止血術後,標準劑量pantoprazole靜脈輸注預防再出血的效果和高劑量pantoprazole靜脈輸注相當。透析、慢性阻塞性肺病、吐血以及幽門螺旋桿菌陰性的潰瘍為內視鏡治療後再出血之獨立危險因子。 | zh_TW |
dc.description.abstract | Background
Acute peptic ulcer bleeding remains the most common cause of acute upper gastrointestinal bleeding. Endoscopic hemostasis has been documented to be effective in decreasing rebleeding, need for surgery, and decreasing hospitalization days. Studies showed a high dose intravenous proton pump inhibitor infusion after endoscopic hemostasis reduced recurrent ulcer bleeding. It was controversial whether an adjuvantive use of standard-dose proton pump inhibitor therapy after endoscopic therapy had similar benefit. In addition, few literatures discussed risk factors of recurrent bleeding in the era of endoscopic therapy and proton pump inhibitors Methods Patients with actively bleeding ulcers or ulcers with non-bleeding visible vessel were treated with epinephrine injection and thermal coagulation, and randomized to receive intravenous PPIs according to a high-dose regimen (pantoprazole 80 mg bolus followed by 8 mg/h as continuous infusion for 72 h) or a standard-dose regimen (pantolprazole 40 mg bolus daily for 72 h). After 72 hours, all patients were given 40 mg pantoprazole daily orally for 27 days. The primary end point was recurrent bleeding within 30days after endoscopy. Results We enrolled 201 patients, 100 patients in the high-dose group and 101 patients in standard-dose group. Bleeding recurred within 30 days in 6 patients (6.2%, 95% CI 1.3% – 11.1%) in the high-dose group, as compared with 5 patients (5.2%, 95% CI 0.6% – 9.7%) in the standard-dose group (P=0.77). Mean units of blood transfused were 2.9 ± 6.2 in the high-dose and 1.6 ± 2.2 in the standard-dose group (P = 0.05). The duration of hospital stay was ≦ 5 days for 55 (56.7%) and 57 patients (59.3%) in the high- and standard-dose groups (P = 0.70). There were fewer surgical interventions or transcatheter arterial embolization in the standard- versus high-dose group (0 vs 1, P = 0.32). Three (3.1%) patients in the high-dose group and 1 (1%) patients died within 30 days after endoscopy (P = 0.32). The stepwise Cox regression analysis showed dialysis, hematemesis, chronic obstructive pulmonary disease (hazard ratio: 37.15, 10.07, 9.12, 95% confidence interval (CI): 6.76 - 204.14, 2.07 – 49.01, 1.66 – 50.00, respectively) were independent risk factors for recurrent bleeding and Helicobacter pylori (H. pylori) infection was associated with lower risk of recurrent bleeding (hazard ratio: 0.20, 95% CI: 0.04 – 0.94). Conclusions Following combined endoscopic hemostasis of bleeding ulcers, standard-dose pantoprazole infusion is as effective as a high-dose regimen in reducing the risk of recurrent bleeding. Dialysis, hematemesis, chronic obstructive pulmonary disease, and H. pylori negative ulcer, but no proton pump inhibitor dosage, are independent factors for recurrent bleeding. | en |
dc.description.provenance | Made available in DSpace on 2021-05-20T20:00:35Z (GMT). No. of bitstreams: 1 ntu-100-P98421006-1.pdf: 3500449 bytes, checksum: 437bf465255f70d2f8355987c6a62a3c (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 目錄
國立臺灣大學碩士學位論文 口試委員會審定書 I 誌謝 II 中文摘要 III ABSTRACT V 第一章 緒論 1 一、 消化性潰瘍及消化性潰瘍出血 1 二、 消化性潰瘍出血流行病學上的變遷 1 三、 消化性潰瘍出血的治療 3 (一) 內視鏡診斷及治療 3 (二) 藥物治療 5 四、 急性消化性潰瘍再出血之危險因子 7 五、 研究假說與特定目的 10 第二章 研究方法與材料 12 一、 研究對象與收入研究條件 12 二、 排除條件 12 三、 內視鏡治療止血 13 四、 幽門桿菌感染的判定 13 五、 CYTOCHROME P450 2C19基因型判定 13 (一) 萃取去氧核醣核酸 (DNA)之方式 13 (二) CYP2C19 第四及第五個表現序列的基因型 (Genotype) 之測定 15 六、 PANTOPRAZOLE的治療 17 七、 再出血之判定 18 八、 治療意願分析法(INTENTION-TO-TREAT ANALYSIS)和計劃性分析法(PER-PROTOCOL ANALYSIS) 18 九、 統計方法 19 (一) 統計模式設定 19 (二) 樣本數估計 19 (三) 資料分析方法 19 (四) 統計軟體 20 第三章 研究結果 21 一、 研究對像 21 二、 使用高劑量與低劑量靜脈輸注PANTOPRAZOLE對治療結果的影響 21 (一) 兩組患者的基本背景資料 21 (二) 兩組患者72小時內、7日內、30日內再 出血率的比較 22 (三) 兩組患者接受手術或血管栓塞術率的比較 22 (四) 兩組患者輸血量、住院天術的比較 22 (五) 兩組患者死亡率的比較 23 三、 內視鏡治療合併靜脈輸注PANTOPRAZOLE治療後30天內再出血之危險因子 23 第四章 討論 24 一、 討論 24 二、 研究限制 27 第五章 結論與未來展望 29 一、 結論 29 二、 展望 29 參考文獻 32 附錄 49 圖目錄 圖 一、消化性潰瘍出血徵兆的內視鏡分類及再出血機率 37 圖 二、血小板凝集與酸鹼值關係 38 圖 三、不同氫離子幫浦抑制劑劑量對胃內酸鹼值的影響 39 圖 四、STUDY FLOW DIAGRAM 40 圖 五、CYP2C19 GENOTYPING 41 圖 六、. KAPLAN-MEIER ESTIMATE OF THE CUMULATIVE PERCENTAGE OF PATIENTS FREE FROM RECURRENT BLEEDING WITHIN 30 DAYS AFTER ENDOSCOPIC TREATMENT. 42 表目錄 TABLE 1. BASELINE DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE INTENTION-TO-TREAT GROUPS 43 TABLE 2. ENDOSCOPIC FINDINGS AT BASELINE IN THE INTENTION-TO-TREAT GROUPS 45 TABLE 3 OUTCOMES AFTER ENDOSCOPIC THERAPY 46 TABLE 4. SUMMARY OF CASES WITH RECURRENT BLEEDING 47 TABLE 5. INDEPENDENT RISK FACTORS FOR 30-DAY RECURRENT BLEEDING IN PATIENTS WITH HIGH RISK BLEEDING PEPTIC ULCER, DETERMINED BY STEPWISE COX EGRESSION ANALYSIS 48 | |
dc.language.iso | zh-TW | |
dc.title | 高風險出血性潰瘍經內視鏡治療後再出血之危險因子分析 | zh_TW |
dc.title | Risk Factor Analysis for Recurrent Bleeding in High-risk Bleeding Peptic Ulcers after Endoscopic Therapy | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 王秀伯(Hsiu-Po Wang) | |
dc.contributor.oralexamcommittee | 劉俊人(Chun-Jen Liu),成佳憲(Chia-Hsien Cheng) | |
dc.subject.keyword | 消化性潰瘍出血,幽門螺旋桿菌,氫離子幫浦抑制劑,內視鏡止血術,再出血, | zh_TW |
dc.subject.keyword | Peptic ulcer bleeding,Helicobacter pylori,proton pump inhibitor,endoscopic hemostasis,recurrent bleeding, | en |
dc.relation.page | 49 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2011-08-18 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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