药物联合钛夹治疗十二指肠球后溃疡出血疗效观察  

Clinical efficacy of drug combined with titanium clips in the treatment of postbulbar duodenal ulcer with bleeding

作　　者：温彪[1] 赵奎[1] 

机构地区：[1]成都医学院第一附属医院消化内科,四川成都610500

出　　处：《海南医学》2015年第24期3677-3679,共3页Hainan Medical Journal

摘　　要：目的探讨药物联合内镜下金属钛夹治疗十二指肠球后溃疡出血的临床效果。方法收集我院2010年7月至2015年1月十二指肠球后溃疡出血患者38例。按入院时间顺序,以2010年7月至2012年1月收治的13例患者为对照组,以2012年2月至2015年1月收治的25例患者为观察组。对照组仅给予药物治疗,观察组给予药物及内镜下金属钛夹治疗。药物采用生长抑素联合埃索美拉唑,埃索美拉唑40 mg静脉滴注,生长抑素首剂予250μg加入生理盐水20 ml静脉推注,继而以250μg/h的速度连续静脉滴注;内镜治疗时在内镜直视下明确出血部位,用金属钛夹置放器对准出血部位的两端钳夹止血。比较两组患者的即刻止血率、再出血率、输血量、平均住院时间和并发症等。结果两组患者经过治疗后即刻止血率均为100%;对照组再出血率为15.38%,明显高于观察组的4.00%,差异有统计学意义(P<0.05);观察组患者的输血量为(0.4±0.1)L,平均住院时间为(5.6±1.9)d,均明显低于对照组的(0.6±0.3)L和(8.7±2.0)d,差异均有统计学意义(P<0.05);两组患者治疗期间及治疗后随访3个月均未发生相关并发症。结论药物联合内镜下金属钛夹治疗十二指肠球后溃疡出血是一种疗效高、创伤低、止血效果明显、并发症少的治疗方法,具有一定的临床价值。Objective To investigate the clinical efficacy of drug combined with titanium clips in the treatment of postbulbar duodenal ulcer with bleeding. Methods The clinical data of 38 patients of postbulbar duodenal ulcer with bleeding in our hospital from Jul. 2010 to Jan. 2015 were collected. According to the admission time, the patients were divide into the control group（Jul. 2010 to Jan. 2012） and the observation group（Feb. 2012 to Jan. 2015）.The control group received drug treatment, while the observation group received drug and endoscopic treatment with titanium clips. Drug treatment applied somatostatin and esomeprazole, with intravenous infusion of 40 mg esomeprazole, intravenous injecting of 250 μg somatostatin added to 20 ml normal saline, followed by continuous intravenous infusion of somatostatin at 250 μg/h. In endoscopic treatment, endoscope was applied to find the bleeding site under direct vision, and a titanium clip placer was used to control bleeding. The immediate hemostasis rate after treatment, rebleeding rate, volume of blood transfusion, average length of hospital stay, complications were observed and compared between the two groups. Results The immediate hemostasis rate after treatment was 100% in both the two groups, while the rebleeding rate in the control group（15.38%） was significantly higher than that in the observation group（4.00%）, P〈0.05. The volume of blood transfusion and average length of hospital stay were（0.4±0.1） L and（5.6±1.9） d in the observation group, significantly lower than（0.6±0.3） L and（8.7±2.0） d in the control group（P〈0.05）. During treatment and follow-up of 3 months after treatment, there was no related complications in two groups.Conclusion In the treatment of postbulbar duodenal ulcer with bleeding, drugs combined with titanium clips results in high efficacy, low trauma, obvious hemostasis effect, few complications, which is of certain clinical value.

关 键 词：药物 内镜 钛夹 十二指肠球后溃疡 出血 

分 类 号：R574.1[医药卫生—消化系统]