目的系统评价肝硬化患者消化道出血风险预测模型,为临床医护人员开发或应用适合的风险评估工具提供依据。方法检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL、中国知网、万方、维普和中国生物医学文献数据库中发表的...目的系统评价肝硬化患者消化道出血风险预测模型,为临床医护人员开发或应用适合的风险评估工具提供依据。方法检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL、中国知网、万方、维普和中国生物医学文献数据库中发表的与肝硬化患者消化道出血风险预测模型相关的文献,检索时限为建库至2022年8月31日。由2名研究人员按照纳入及排除标准独立筛选文献,按照CHARMS清单进行数据提取,并采用PROBAST工具进行文献质量评价。结果共纳入8篇文献,7项研究的适用性高,5项研究存在一定偏倚,模型的受试者特征下曲线面积或C指数范围为0.662~0.930,门静脉直径、终末期肝病预后模型(model for end-stage liver disease,MELD)评分、白蛋白、腹水、血小板计数、凝血酶原时间是进入模型次数最多的预测因子。结论纳入研究的质量一般,纳入模型的预测效能较好,可帮助医护人员早期识别肝硬化并发消化道出血的高危人群,但未来有待开展研究对模型进行优化与外推。展开更多
AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines. METHODS: A questionnaire on the management of digestive bleeding was completed ...AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines. METHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals. RESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers forearly vasoactive drug administration (87% of cases), association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04), differed among centers. CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus. Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.展开更多
Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known ...Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.展开更多
目的:系统评价桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的疗效和安全性。方法:运用计算机检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、The Cochrane Library、The Web of ...目的:系统评价桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的疗效和安全性。方法:运用计算机检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、The Cochrane Library、The Web of Science、Springer等中英文数据库从建库至2020年5月关于桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的随机对照试验和临床对照试验。应用Revman5.3软件进行Meta分析。结果:经筛选,纳入12篇文献,共1206例患者。Meta分析结果显示:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病临床总有效率更高(OR=3.31,95%Cl为2.12~5.18,P<0.00001),并能减轻痛经程度:慢性疼痛分级问卷法评分方法(MD=-0.46,95%CI为-0.62~-0.29,P<0.00001)和VAS评分方法(MD=-1.75,95%CI为-2.01~-1.49,P<0.00001),减少月经量(MD=-15.47,95%CI为-20.20~-10.73,P<0.00001),使子宫内膜厚度变薄(MD=-15.47,95%CI为-2.14~-2.38,P<0.00001),子宫体积缩小(MD=-16.23,95%CI为-19.45~-13.02,P<0.00001),降低血清促卵泡素(FSH)(MD=-1.30,95%CI为-1.86~-0.74,P<0.00001)、黄体生成素(LH)(MD=-1.18,95%CI为-1.37~-1.00,P<0.00001)和血清CA125水平(MD=-9.68,95%CI为-12.83~-6.54,P<0.00001),降低不良反应发生率(OR=0.53,95%CI为0.29~0.94,P=0.03)。结论:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病疗效优于单用曼月乐组,不良反应发生率低于单用曼月乐组。受纳入文献的数量和质量的限制,将来需要更大样本和高质量的研究文献,对二者联合治疗子宫腺肌病有更精确的评估。展开更多
文摘目的系统评价肝硬化患者消化道出血风险预测模型,为临床医护人员开发或应用适合的风险评估工具提供依据。方法检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL、中国知网、万方、维普和中国生物医学文献数据库中发表的与肝硬化患者消化道出血风险预测模型相关的文献,检索时限为建库至2022年8月31日。由2名研究人员按照纳入及排除标准独立筛选文献,按照CHARMS清单进行数据提取,并采用PROBAST工具进行文献质量评价。结果共纳入8篇文献,7项研究的适用性高,5项研究存在一定偏倚,模型的受试者特征下曲线面积或C指数范围为0.662~0.930,门静脉直径、终末期肝病预后模型(model for end-stage liver disease,MELD)评分、白蛋白、腹水、血小板计数、凝血酶原时间是进入模型次数最多的预测因子。结论纳入研究的质量一般,纳入模型的预测效能较好,可帮助医护人员早期识别肝硬化并发消化道出血的高危人群,但未来有待开展研究对模型进行优化与外推。
基金Supported by grants from the French Society of Gastroenterology
文摘AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines. METHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals. RESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers forearly vasoactive drug administration (87% of cases), association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04), differed among centers. CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus. Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.
文摘Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.
文摘目的:系统评价桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的疗效和安全性。方法:运用计算机检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、The Cochrane Library、The Web of Science、Springer等中英文数据库从建库至2020年5月关于桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的随机对照试验和临床对照试验。应用Revman5.3软件进行Meta分析。结果:经筛选,纳入12篇文献,共1206例患者。Meta分析结果显示:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病临床总有效率更高(OR=3.31,95%Cl为2.12~5.18,P<0.00001),并能减轻痛经程度:慢性疼痛分级问卷法评分方法(MD=-0.46,95%CI为-0.62~-0.29,P<0.00001)和VAS评分方法(MD=-1.75,95%CI为-2.01~-1.49,P<0.00001),减少月经量(MD=-15.47,95%CI为-20.20~-10.73,P<0.00001),使子宫内膜厚度变薄(MD=-15.47,95%CI为-2.14~-2.38,P<0.00001),子宫体积缩小(MD=-16.23,95%CI为-19.45~-13.02,P<0.00001),降低血清促卵泡素(FSH)(MD=-1.30,95%CI为-1.86~-0.74,P<0.00001)、黄体生成素(LH)(MD=-1.18,95%CI为-1.37~-1.00,P<0.00001)和血清CA125水平(MD=-9.68,95%CI为-12.83~-6.54,P<0.00001),降低不良反应发生率(OR=0.53,95%CI为0.29~0.94,P=0.03)。结论:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病疗效优于单用曼月乐组,不良反应发生率低于单用曼月乐组。受纳入文献的数量和质量的限制,将来需要更大样本和高质量的研究文献,对二者联合治疗子宫腺肌病有更精确的评估。
