急诊结肠镜检查在急性下消化道出血诊治中的价值  

The role of emergency colonoscopy in diagnosis and treatment of acute lower digestive tract hemorrhage

作　　者：刘涵[1] 陈磊[2] 徐世伟[1] 陈翔宇[1] 刘明华[1] 

机构地区：[1]第三军医大学西南医院急救部,重庆400038 [2]第三军医大学西南医院消化科

出　　处：《临床急诊杂志》2016年第8期628-630,共3页Journal of Clinical Emergency

摘　　要：目的:探讨急诊结肠镜检查在急性下消化道出血诊治中的价值。方法:回顾性总结2010-01-2015-12间在我院行急诊肠镜检查的下消化道出血的329例患者的临床资料,分析病因、出血程度、肠道准备情况以及结肠镜完成情况。结果:329例中轻度出血168例,中度出血97例,重度出血64例,出血原因以结肠息肉和结肠癌最为常见;256例检查前进行了肠道准备,肠道准备过程中再出血或出血加重情况如下:聚乙二醇散组5例(9.3%),磷酸钠口服液组3例(7.0%),甘露醇组5例(7.5%),灌肠组2例(2.2%),灌肠组诱发再出血或出血加重的发生率低于其余3组(P<0.05);急诊结肠镜检查到达回盲部318例(96.7%),在充分冲洗的情况下,常规口服泻药与清洁灌肠做肠道准备后结肠镜检查完成率和病灶发现率差异均无统计学意义,在完成检查的耗时方面,口服泻药所需时间少于灌肠和不做肠道清洁,但差异无统计学意义;内镜下实时止血成功179例,成功率达83.3%。结论:急诊肠镜对下消化道出血的诊治意义重大,安全有效。清洁灌肠也可以达到口服泻药相同的结肠镜检查完成率和病灶发现率。Objective：To explore the role of emergency colonoscopy in diagnosis and treatment of acute lower digestive tract hemorrhage.Method：Retrospectively study clinical data of 329 acute lower digestive tract hemorrhage patients who received emergency colonoscopy in Southwest hospital during Jan 2010 to Dec 2015.Etiology,degree of bleeding,the intestinal cleaning preparation and completion rate of colonoscopy were analyzed.Result：Among 329 patients,168were with mild hemorrhage,97 were with moderate hemorrhage and 64 were with severe hemorrhage.The most common causes of bleeding were colonic polyp and tumor.Two hundred and fifty-six patients received intestinal cleaning preparation before endoscopy.Rebleeding and increased bleeding occured in 5of polyethyleneglycol intake patients（9.3%）,3of sodium phosphates oral solution intake patients（7.0%）,5of mannitol intake patients（7.5%）and 2of patients receiving coloclysis（2.2%）.The rebleeding rate of coloclysis group was lower than that of other three groups（P〈0.05）.Ileocecus were reached during colonoscopy in 318patients（96.7%）.Completion rate and positve finding rate had no significant difference between oral cleansing group and coloclysis group.One hundred and seventy-nine patients were successful treated by endoscopic hemostasis（83.3%）.Conclusion：Emergency colonoscopy has important clinical value in diagnosis and treatment of acute lower digestive tract hemorrhage.Coloclysis can achieve the same completion rate of colonoscopy and positve finding rate as oral cleansing.

关 键 词：下消化道出血 急诊肠镜检查 肠道准备 再出血 

分 类 号：R573[医药卫生—消化系统]