内镜下四种方法治疗消化性溃疡出血的疗效  

Efficacy of four kinds of endoscopic therapy on peptic ulcer bleeding

作　　者：姜英杰[1] 聂玉强[1] 李瑜元[1] 张龙[1] 

机构地区：[1]广州医学院附属广州市第一人民医院消化内科,510180

出　　处：《中华生物医学工程杂志》2009年第5期383-386,共4页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨4种内镜下治疗方法对上消化道溃疡出血的疗效。方法将349例内镜下有活动出血的溃疡患者分为4组：肾上腺素注射组、金属钛夹组、氩离子凝固组及联合治疗组。肾上腺素注射组157例接受内镜下。肾上腺素注射止血；金属钛夹组46例接受金属钛夹止血；氩离子凝固组51例接受氩离子凝固止血；联合治疗组95例接受肾上腺素注射联合氩离子凝固止血治疗。对比各组间止血效果。结果4种方法的即时止血率均为100％，有效止血率在肾上腺素注射组为87．9％，在金属钛夹、氩离子凝固及联合治疗组分别为89．1％、86．3％、91．6％，各组间差异均无统计学意义（P〉O．05）。肾上腺素注射组中，Forrest I a患者的有效止血率为55．0％，明显低于其余3组患者（P〈0．01）。结论4种内镜下治疗均能有效、安全止血。药物注射对Forrest I a患者的止血效果差。Objective To evaluate the efficacy of 4 kinds of endoscopic therapy on peptic ulcer bleeding. Methods Three hundred and forty-nine patients with active ulcer bleeding or non-bleeding visible vessels were respectively divided into 4 groups according to endoscopic therapies （adrenaline injection group, titanic clip placement group, argon beam coagulation group and combined treatment group）. One hundred and fifty- seven patients were treated to stop bleeding with injection of adrenaline in adrenaline injection group, 46 with titanic clips in titanic clip placement group, 51 with argon beam coagulation in argon beam coagulation group, and 95 patients with combination of injection and argon beam coagulation in combined treatment group. The hemostasis effects were compared among four groups. Results In all the groups, the immediate hemostasis rate was 100%, and effective hemostasis was achieved in 87.9%, 89.1%, 86.3% and 91.6% of the patients who underwent adrenaline injection, titanic clip placement, argon beam coagulation and combined treatment respectively, with no statistical difference among the groups （P〉0.05）. For patients with Forrest I a lesions, the effective hemostasis rate with adrenaline injection （55.0%） was significantly lower as compared with other treatment options （P〈O.01）. Conclusions Four kinds of endoscopic therapy are effective and safe in patients with peptic ulcer bleeding. Adrenaline injection seems to be a poor solution for Forrest I a lesions.

关 键 词：消化性溃疡出血 止血 内窥镜 肾上腺素 氩离子 钛夹 

分 类 号：R573.1[医药卫生—消化系统] R768.32[医药卫生—内科学]