摘要
目的探讨内镜下不同止血措施在非静脉曲张性上消化道出血中的应用,评价其可行性、成功率及临床疗效。方法根据出血病因及内镜下改良Forrest分级,对112例非静脉曲张性上消化道出血患者选择性使用:注射药物、氩离子凝固术(APC)、血管夹及注射联合氩离子凝固术等4种内镜下止血措施,观察其临床疗效并进行统计分析。结果 112例非静脉曲张性出血患者,总的即时止血率98.2%(110/112),再出血率12.7%(14/112),未见明显并发症者,无死亡病例。注射组23例,即时止血率100%,有效止血率73.9%(17/23),再出血率26.1%(6/23);APC组29例,即时止血率100%,有效止血率86.2%(25/29),再出血率13.8%(4/29);血管夹组27例,即时止血率96.3%(26/27),有效止血率92.6%(25/27),再出血率3.8%(1/26),明显低于注射组及APC组(P<O.05);联合组33例,即时止血率96.97%(32/33),有效止血率87.9%(29/33),再出血率9.4%(3/32),低于单纯注射组(P<0.05)。各组即时止血成功率差异无统计学意义(P>0.05)。结论急诊内镜下止血起效迅速,疗效肯定,可成为非静脉曲张性出血的一线治疗方法,根据不同的出血病因选择合理的止血措施可提高止血成功率,降低再出血率。
Objective To explore the applications of several endoscopic hemostasis therapies on non-variceal bleeding, and evaluate the feasibility, success rate and clinical effects. Methods 112 cases with non-variceal upper gastrointestinal bleeding were treated with different endoscopic hemostasis therapies according to different causes and endoscopic modified forrest grades, and divided into 4 groups according to 4 different endoscopic hemostasis in the treatments （ injection, argon plasma coagulation, hemoclip, combination of hemoelip and argon plasma coagulation）. The clinical efficacy was analyzed. Results In the 112 cases with non-variceal upper gastrointestinal bleeding, the total of immediate hemostasis rate was 98,2% （110/112）, rehleeding rate was 12.7% （14/110）, no apparent complication and death. Injection group had 23 cases, the immediate hemostasis rate was 100%, effective hemostasis rate was 73.9% （ 17/23 ）, rebleeding rate was 26.1% （6/23）. Argon plasma coagulatiou group had 29 cases,the immediate hemostasis rate was also 100% , effective hemostasis rate was 86.2% （25/29） , rebleeding rate was 13.8% （4/29） ; 27 cases in hemoclip group, the immediate hemostasis rate and effective hemostasis rate were 96.3 % （ 26/27 ） and 92.6 % （25/27） respectively, rebleeding rate 3.8 % （ 1/26） was lower than the two previous groups （ P 〈 0. 05）. Combined group was 33 cases, the immediate hemostasis rate was 96.97% （32/33） ,effective hemostasis rate was 87.9% （29/33）, rebleeding rate was 9.4% （93/32）, differed from simplex injection group （P 〈 0.05 ）. The successful hemostasis rate was not difference amone every group. Conclusion The emergent endoscopic hemostasis effect quickly and curative effect affirmation. It could be first-line treatment for non-variceal bleeding. Choosing reasonable hemostasis treatment according to different causes of bleeding may improve successful hemostasis rate,reduce rebleeding.
出处
《临床消化病杂志》
2011年第3期175-179,共5页
Chinese Journal of Clinical Gastroenterology
关键词
上消化道出血
非静脉曲张
内窥镜检查
止血措施
Upper gastrointestinal bleeding
Non- variceal
Endoscopy
Hemostasis treatment
