摘要
目的探讨抗栓治疗期间发生急性非静脉曲张性上消化道大出血患者的多学科治疗策略。方法回顾性分析2017年1月~2018年12月我院收治的抗栓治疗合并急性非静脉曲张性上消化道大出血24小时内行急诊内镜检查患者79例的临床资料。窦性心动过速48例,低收缩压15例,同时出现窦性心动过速和低收缩压16例。抗血小板治疗69例(肠溶阿司匹林35例,氯吡格雷8例,肠溶阿司匹林联合氯吡格雷21例,肠溶阿司匹林联合替格瑞洛5例),抗凝治疗10例(华法林7例,低分子肝素3例)。血红蛋白下降20~90 g/L,中位数40 g/L。19例合并循环衰竭,于手术室气管插管麻醉下行内镜检查及治疗,其余60例于心电监护、吸氧条件下行内镜检查及治疗。多学科共同会诊调整抗栓药物使用。结果内镜诊断消化性溃疡61例,食管贲门黏膜撕裂10例,急性糜烂性胃炎6例,十二指肠憩室1例,胃间质瘤1例。Rockall评分4~9分,中位数6分。8例追加介入止血治疗。均止血成功,未再出现活动性出血表现。结论抗栓治疗患者发生急性非静脉曲张性上消化道出血需制定个体化治疗方案,结合出血和栓塞风险,多学科共同会诊决定抗栓治疗药物调整策略。
Objective To explore the clinical strategy of multidisciplinary treatment of acute nonvariceal massive upper gastrointestinal bleeding in patients undergoing antithrombotic therapy. Methods Clinical data of 79 patients with acute nonvariceal massive upper gastrointestinal bleeding undergoing antithrombotic therapy received upper gastrointestinal endoscopy within 24 hour after bleeding in our hospital between January 2017 and December 2018. Sinus tachycardia occurred in 48 cases, low systolic blood pressure occured in 15 cases, and sinus tachycardia and low systolic blood pressure occurred in 16 patients. Antiplatelet therapy was given in 69 cases (35 cases taking enteric coated aspirin, 8 cases taking clopidogrel, 21 cases taking enteric coated aspirin and clopidogrel, and 5 cases taking enteric coated aspirin and tegrilol). Anticoagulant therapy was given in 10 cases (7 cases taking warfarin and 3 cases taking low molecular weight heparin). The median value of hemoglobin decrease was 40 g/L (range, 20-90 g/L). A total of 19 cases of circulatory failure were treated by endoscopy with anesthesia under tracheal intubation in the operating room, and the other 60 cases underwent endoscopy under ECG monitoring and oxygen inhalation. Multidisciplinary consultation was organized to regulate the use of antithrombotic drugs. Results There were 61 cases of peptic ulcer, 10 cases of Mallory-Weiss syndrome, 6 cases diagnosed acute erosive gastritis, 1 case of duodenal diverticulum and 1 case of gastric stromal tumor by endoscopy. The median Rockall score was 6 (range, 4-9) scores. Eight cases were also treated with interventional therapy. All of them had successful hemostasis and no further active bleeding appeared. Conclusion Individualized treating plan of regulating antithrombotic therapy should be developed by multidisciplinary consultation based on risk assessment of bleeding and embolization in patients with acute nonvariceal massive upper gastrointestinal bleeding undergoing antithrombotic therapy.
作者
郎海波
高峰
石进
陈雪
张杰
黄小勇
吴宪宏
Lang Haibo;Gao Feng;Shi Jin(Digestive Department,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第9期786-789,793,共5页
Chinese Journal of Minimally Invasive Surgery
基金
北京市医院管理中心消化内科学科协同发展中心专项经费资助(XXT15)
关键词
急性非静脉曲张性上消化道出血
抗栓治疗
多学科治疗经验
Acute nonvariceal upper gastrointestinal bleeding
Antithrombotic therapy
Multidisciplinary treatment experience
