内镜下注射去氨加压素联合止血钛夹在治疗老年急性消化性溃疡出血中的应用价值  

Endoscopic injection of desmopressin combined with hemostatic titanium therapy for treatment of elderly patients with acute peptic ulcer bleeding

作　　者：陈克栋[1] 潘小红[1] 李其肯[2] 

机构地区：[1]浙江省余姚市人民医院急诊科,浙江省余姚市315400 [2]浙江省肿瘤医院胃肠肿瘤外科,浙江省杭州市310022

出　　处：《世界华人消化杂志》2018年第1期53-58,共6页World Chinese Journal of Digestology

摘　　要：目的探讨内镜下注射去氨加压素联合止血钛夹在老年急性消化性溃疡出血中的治疗价值.方法选取2012-05/2017-05浙江省余姚市人民医院收治的220例老年急性消化性溃疡患者,均使用内镜下注射药物联合止血钛夹进行治疗,其中行内镜下注射去氨加压素的患者共110例,将其作为观察组,再选择同期行内镜下注射肾上腺素的110例患者,将其作为对照组,然后将两组患者的临床疗效及心血管不良反应等指标进行比较.结果对照组患者的平均止血时间为12.9 h±1.3 h、平均输血量为1250 m L±210 m L、3例(2.72%)转外科手术、4例(3.63%)1 wk内再出血,观察组患者的平均止血时间为13.1 h±1.5 h、平均输血量为1190 m L±220 m L、3例(2.72%)转外科手术、5例(4.55%)1 wk内再出血,两组患者在止血时间、输血量、转外科手术、1 wk内再次出血等指标上无明显差异,无统计学意义(P>0.05);观察组患者的治疗总有效率为94.55%,对照组患者为93.64%,两组差异无统计学意义(P>0.05);观察组患者的心血管不良反应发生率显著低于对照组(1.82%vs 14.55%),差异有统计学意义(P<0.05).结论对于老年急性消化性溃疡出血患者给予内镜下注射去氨加压素的方案,减少患者治疗期间的心血管不良反应发生率,为其提供了新的治疗选择,有一定的临床借鉴意义.AIM To evaluate the value of endoscopic injection of desmopressin combined with titanium clip therapy in the treatment of elderly patients with acute peptic ulcer bleeding. METHODS Two hundred and twenty elderly patients with acute peptic ulcer bleeding treated at our hospital from May 2012 to May 2017 were divided into either an observation group or a control group （n = 110 each）. The observation group underwent endoscopic injection of desmopressin combined with titanium clip therapy, and the control group underwent endoscopic injection of epinephrine combined with titanium clip therapy. Clinical efficacy, cardiovascular adverse reactions, and other indicators were compared between the two groups. There was no significant difference between the control group and the observation group in the time to achieve hemostasis （12.9 h ± 1.3 h vs 13.1 h ± 1.5 h）, the amount of blood transfusion （1250 mL ±210 mL vs 1190 mL ± 220）, the percentage of cases undergoing transhepatic operation （2.72% vs 2.72%）, or the percentage of cases developing rebleeding within 1 wk （3.63% vs 4.55%） （P 〉 0.05）. The total effective rate was comparable between the observation group and the control group （94.55% vs 93.64%, P 〉 0.05）. The incidence of cardiovascular adverse events was significantly lower in the observation group than in the control group （1.82% vs 14.55%, P 〈 0.05）. CONCLUSION For elderly patients with acute peptic ulcer bleeding, endoscopic injection of desmopressin can reduce the incidence of cardiovascular adverse reactions.

关 键 词：消化性溃疡 急性出血 肾上腺素 去氨加压素 

分 类 号：R573.1[医药卫生—消化系统]