普通与无痛胃镜套扎治疗急性食管静脉曲张性出血的效果比较  

Comparison of effects between common and painless gastroscopic ligation in treating acute esophageal varices bleeding

作　　者：沈文拥[1] 易志强 刘爱民[1] 魏莎[1] 唐静[1] 吴涛[1] SHEN Wenyong;YI Zhiqiang;LIU Aimin;WEI Sha;TANG Jing;WU Tao(Department of Gastroenterology,Chongqing Fuling Central Hospital,Chongqing 408099,China)

机构地区：[1]重庆市涪陵中心医院消化内科,408099

出　　处：《检验医学与临床》2018年第20期3103-3106,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨普通与无痛胃镜套扎治疗急性食管静脉曲张破裂出血的效果。方法选择符合纳入标准的112例行急诊胃镜下套扎术患者,其中68例选择了普通胃镜下套扎术(A组),44例选择了气管插管无痛胃镜下套扎术(B组)。记录术前血压、手术时间、悬浮红细胞用量、食管内视野评分、肝性脑病发生率、术后再次出血率、病死率和窒息发生率。结果套扎术开始前A组收缩压较B高,手术时间较B组短,悬浮红细胞用量较B组少,食管内视野清晰度评分较B组低,差异均有统计学意义(P<0.05)。A组肝性脑病发生率较B组低(P<0.05)。A组3例套扎后再次出血,1例经第2次套扎后成功止血,2例放弃治疗死亡;B组5例套扎后仍出血,1例经保守治疗治愈,4例未经第2次套扎放弃治疗或死亡。A组共死亡2例,B组共死亡5例。两组再出血率、死亡或放弃治疗者比例比较,差异无统计学意义(P>0.05)。两组均无窒息病例发生。结论两种方法均可完成急性食管静脉曲张破裂出血套扎手术,且有效、可行。经充分术前准备后,普通胃镜下患者适当呕吐反应更有利于急诊套扎手术完成。Objective To investigate the effects of common and painless gastroscopic ligation in treating acute esophageal varices bleeding. Methods One hundred and twelve patients conforming to the inclusion criteria undergoing emergency gastroscopic ligation were selected,among them 68 cases selected the common gastroscopic ligation （group A） and 44 cases selected painless gastroscopic ligation （group B）.Preoperative blood pressure,operation time,dosage of suspended red blood cells,intra-esophagus view score,incidence rate of hepatic encephalopathy,postoperative rebleeding rate,mortality rate and incidence rate of asphyxia were recorded. Results The systolic blood pressure before operation in the group A was higher than that in the group B,the operative time was shorter than that in the group B,the amount of suspended red blood cells was less than that in the group B,intra-esophagus view definition score was lower than that in the group B,and the differences were statistically significant （ P 〈0.05）.The incidence rate of hepatic encephalopathy in the group A was lower than that in the group B （ P 〈0.05）.In the group A,3 cases had re-bleeding after ligation,1 case succeeded in stopping bleeding after the second ligation,and 2 cases died after giving up treatment;5 cases remained bleeding after ligation in group B,1 case was cured by conservative treatment,4 cases were not treated by the second time ligation to give up treatment or death.Two cases of death in the group A and 5 cases of death in group B occurred.There was no statistically significant difference in the re-bleeding rate,and the proportion of death or giving up treatment between the two groups （ P 〉0.05）.No cases of asphyxia occurred in both groups. Conclusion Both methods can complete the ligation operation of acute esophageal variceal bleeding,which are effective and feasible.After full preoperative preparation,under ordinary gastroscopy,the patient′s appropriate vomiting response is more conducive to complete the emergency liga

关 键 词：急诊 胃镜 食管静脉曲张破裂出血 套扎 

分 类 号：R571.3[医药卫生—消化系统]