动脉性上消化道出血的急症介入诊疗价值和影响因素  

Acute interventional diagnosis and treatment of upper gastrointestinal arterial hemorrhage:its clinical value and influence factors

作　　者：王永利[1] 崔世涛[1] 张家兴[1] 汝复明[1] 徐家华[1] 徐霁充[1] 

机构地区：[1]同济大学附属第十人民医院脑外科(神经介入组),上海200072

出　　处：《介入放射学杂志》2009年第6期409-413,共5页Journal of Interventional Radiology

摘　　要：目的分析急症介入在动脉性上消化道出血诊断中的影响因素,探讨其治疗价值。方法回顾性分析56例动脉性上消化道出血资料。分析导管在2级动脉和3～4级动脉开口造影时出血阳性率差异;经导管灌注缩血管药、止血剂和经导管栓塞治疗的技术成功率、临床成功率。结果导管在2级和3～4级动脉开口处出血的阳性诊断率分别为21.4%(12/56)和100%(56/56),两者差异有统计学意义(P<0.05)。介入治疗前、后(24h内)平均收缩压分别为(93.14±18.63)mmHg和(116.84±13.61)mmHg,两者差异有统计学意义(P=0.023)。经导管灌注垂体后叶素和血凝酶20例,技术成功率80%(16/20),临床成功率55%(11/20)。再出血9例行微导管超选择栓塞,7例成功,2例失败,接受手术治疗。经导管灌注血凝酶和明胶海绵条栓塞共45例(36例+9例灌注后再出血),技术成功率93%(42/45),临床成功率89%(40/45)。2种介入治疗方法比较,止血的技术成功率无显著差异(P=0.058),临床成功率差异有统计学意义(P=0.001)。2例患者栓塞后因酗酒再出血,血管造影显示原出血动脉闭塞;1例患者仅行胃、十二指肠动脉灌注和栓塞,死于动脉性门脉高压所致食管胃底静脉曲张大出血(肝动脉-门静脉瘘)。结论急症介入能快速发现出血部位并有效控制出血,是急性上消化道动脉性出血的有效诊疗手段;出血的诊断率、止血的技术成功率和临床成功率受多重因素影响。Objective To evaluate emergent angiography and interventional management in treating massive upper gastrointestinal （GI） arterial hemorrhage, and to discuss the factors influencing the angiographic bleeding signs and the interventional therapeutic results. Methods The clinical data of 56 patients with massive upper GI arterial hemorrhage, who underwent diagnostic arteriography and interventional management with trans-catheter vasopressin infusion and embolization, were retrospectively analyzed. Systolic blood pressure of both pre- and post-interventional therapy was recorded and statistically analyzed. The arteriographic positive rates were separately calculated according to the catheter tip＇s location, being placed at the 2nd grade branch or at the 3 rd - 4 th grade branch of the artery, and the relation of the positive rate with the tip＇ s location was analyzed. A comparison of the hemostatic effect between trans-eatheter vasopressin infusion and trans-catheter embolization was made. Results The average systolic blood pressure of pre- and post-procedure was （93.14 ±18.63） mmHg and （11.64±13.61） mmHg respectively, with a significant difference （P = 0.023）. The angiographic bleeding signs were demonstrated in 12 cases （21.4%） with the catheter＇s tip at the 2nd grade branch and in 56 cases （100%） with the eatheter＇s tip at the 3 rd - 4 th grade branch, the difference between the two was of statistically significance （P 〈 0.05）. The technical success rate and the clinical hemostasis rate of via catheter vasopressin infusion was 80% （16/20） and 55% （11/20） respectively. Of nine re-bleeding cases, seven were successfully controlled with embolization therapy by using microcatheter and two had to receive surgery because of arterial rupture which was proved by angiography. The technical and the clinical rates of success for trans-catheter embolization therapy were 93% （42/45） and 89% （40/45） respectively. Recurrence of bleeding was seen in two patients who got drun

关 键 词：上消化道出血 血管造影 介入治疗 

分 类 号：R573.2[医药卫生—消化系统]