内镜下血管钳夹加止血合剂注射治疗消化性溃疡并出血的临床观察  

CLINICAL OBSERVATION OF ENDOSCOPIC HEMOCLIP PLACEMENT PLUS INJECTION WITH STYTIC MIXTURE FOR CESSATION OF BLEADING FROM PEPTIC ULCERS

作　　者：朱惠明 黄勋 易朝晖 

机构地区：[1]深圳市人民医院消化内科,518020

出　　处：《现代消化及介入诊疗》1999年第3期16-18,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：本研究旨在探索治疗溃疡病并出血的新方法。20例溃疡并出血病人采用内镜下钛夹钳夹血管加止血合剂注射治疗(内镜治疗组)。20侧病人中胃溃疡3例。十二指肠球部溃疡17例。重度出血15人,占 75％,中度出血5人,占25％。注射用止血合剂由3％高渗盐水、立止血、肾上腺素组成。另20例溃疡并出血病人采用静脉内药物注射怍为对照(药物治疗组)。药物治疗组20例病人胃溃疡2例,十二指肠球部溃疡18例,重度出血12例,占60％,中度出血8例,占40％,质子泵抑制剂选用奥美拉唑40mg,每日二次静脉注射止血。内镜治疗组人院后12小时内止血19例(占95％),输血量600-1500ml(平均800ml),转外科手术1人(占5％),奥美拉唑治疗组人院后12小时内止血9例(占45％,输血量600-3000ml(平均1500ml),转外科手术5人(占25％)。两组有非常显著性差异。本研究表明,内镜下应用钛血管夹直接钳夹破裂或显露在溃疡面的血管,主要优点是靶向性强.对血破裂所致的喷血、涌血以及血凝块复盖下潜行性出血病灶止血效果确切。在钳夹血管后,自血管夹周围环状多点注射血合剂。可引起组织水肿、血管收缩和凝血而达到止血的目的。血管夹和止血合剂联合应用具有互补和加强疗效的作用,不仅对明显喷血、涌血或显露的血管有效,对溃疡面渗血或钳夹不可靠的病例也有较好的效果。内镜下血管钳夹加上血合剂注射治疗溃疡病并出血,其效果优于应用质子泵抑制剂静脉注射。The prupese of this study was to evaluate a new endoscopic hemostasis in the treatment of bleeding peptic ulcers. The endoscopic hewoclip placement plus injection with stytic mixture(3% NaCl,1:10,000 epinephrine and Reptialse) were performed for 20 patients with peptic ulcers(gastric ulcer 3, duodenal 1,sever bleeding 15, 75%,moderate bleeding 5,25%).As a control group, pharmaco-therapeutic approach,omeprazole,40mg, twice a day,was administered intravenously for other patientswith peptic ulers(gastric ulcer2, duodenal ulcer 18, severe bleeding 12, 60% , moderate bleeding 8,40%). The results showed that hemostasis in 12 hours after admission. Blood transfusion of 600～1500ml(mean 800ml) was needed in the endoscopic hemostasis group. Recurrent bleeding was reveale d in one (5%) of 20 patients treated with therapeutic endoscopy,and the patient underwent surgery.In the Pharmaco-therapeutic approach,bleeding was stopped in 9(45%) of 20 patients in 12 hours after admission. Blood replacement of 600～3000ml(mean 1500ml) was required. Surgical management was needed in 5 of 20 patients (25%). It is concluded that endoscopic hemoclip placement plus injection with stytic mixture is superior to intravenous omeprazle in cessation of bleeding from peptic ulcers.

关 键 词：止血 钳夹 出血 内镜下 溃疡 合剂 注射治疗 病人 血管夹 血管钳 

分 类 号：R573[医药卫生—消化系统] R657[医药卫生—内科学]