摘要
目的探讨血液透析过程中并发急性上消化道出血患者急诊内镜下的表现及止血措施。方法对48例血液透析过程中并发急性上消化道出血患者进行急诊内镜检查及治疗,总结消化道出血原因、内镜下表现、内镜下治疗方法及疗效。结果急诊胃镜检查发现上消化道出血病因以胃黏膜糜烂出血为主20例(41.7%),其次为十二指肠球部溃疡12例(25.0%)、胃溃疡8例(16.7%)。幽门螺旋杆菌阳性36例(75.0%)。上消化道出血内镜下改良Forrest分级:ForrestⅠa 6例,ForrestⅠb 18例,ForrestⅡa 8例,ForrestⅡb 8例,ForrestⅡc 4例,ForrestⅢ4例。对分级为ForrestⅠa至ForrestⅡb的38例患者进行内镜下止血,包括喷洒止血药止血6例,注射止血药止血4例,高频电凝止血8例,氩离子凝固术10例,钛夹止血6例,多种方法联合应用4例。48例患者中上消化道出血治愈46例,死亡2例,总体即时止血率为63.2%,有效止血率31.6%,再发出血率5.3%。结论血液透析中并发急性上消化道出血以急性胃黏膜糜烂为主,内镜下表现以ForrestⅠb及ForrestⅡb为主,急诊内镜下止血效果显著。
Objective To explore the emergency endoscopic manifestations and hemostasis measures in compli- cating upper gastrointestinal hemorrhage during hemodialysis process. Methods 48 patients with complicating upper gastrointestinal hemorrhage during hemodialysis were detected and treatment under emergency endoscopic examina- tion. The hemorrhage causes, endoscopic manifestations, treatment method under endoscopy and therapeutic effects were summarized. Results The emergency endoscopic examination found that the main causes of upper gastrointesti- nal hemorrhage during hemodialysis were gastric mucosal erosion（41.7 %） ,followed hy duodenal ulcer （25.0%）and gastric ulcer（ 16.7 % ）. 36 cases （75.0%） were the positive helicobacter pylori. The modified Forrest grade I a was in 6 cases,Forrest grade Ⅰ b in 18 cases,Forrest grade Ⅱ a in 8 cases,Forrest grade Ⅱ b in 8 cases,Forrest grade II c in 4 cases and Forrest grade Ⅲ in 4 cases. The 38 patients with Forrest grade Ⅰ a-- Ⅱb were treated by endoscopic he- mostasis,including spraying hemostatic drugs in 6 cases, hemostatics injection in 4 cases, high frequency electric coag- ulation in 8 patients,argon ion coagulation in 10 cases,titanium clamp hemostasis in 6 cases and combined application of multiple hemostatic methods in 4 cases. 46 cases were cured,and 2 cases died. The immediate hemostasis rate was 63.20%, the effective hemostasis rate was 31. 6 %, and the relapsed hemorrhage rate was 5. 3 %. Conclusion The complicating upper gastrointestinal hemorrhage during hemodialysis is dominated by gastric mucosal erosion,and the endoscopic manifestations mainly are Forrest grade Ⅰb and Forrest grade Ⅱb. The emergency endoscopic hemostasis has significant effect.
出处
《检验医学与临床》
CAS
2015年第16期2391-2392,2395,共3页
Laboratory Medicine and Clinic
关键词
血液透析
上消化道出血
急诊内镜
内镜下治疗
hemodialysis
upper gastrointestinal hemorrhage
emergency endoscopy
endoscopic treat- ment
