非静脉曲张性上消化道出血急诊胃镜金属夹止血病例的特点分析  

Analysis of the Characteristics of Hemostasis with Metal Clip Under Emergency Gastroscope in Patients with Nonvariceal Upper Gastrointestinal Bleeding

作　　者：张鹏[1] ZHANG Peng(Gastroenterology Department,The First Hospital of Fangshan District,Beijing,102400,China)

机构地区：[1]北京市房山区第一医院消化内科,北京102400

出　　处：《黑龙江医学》2020年第10期1336-1339,共4页Heilongjiang Medical Journal

摘　　要：目的分析非静脉曲张性上消化道出血急诊胃镜下金属夹止血病例的特点。方法选取于2016年1月-2019年12月间北京市房山区第一医院收治的非静脉曲张性上消化道出血急诊内镜检查患者300例,胃镜下金属夹止血组26例,非金属夹组274例,分析两组患者的一般情况、病因、Forrest分型情况、血红蛋白和尿素氮水平及治疗效果。结果金属夹组与非金属夹组相比,男女比例(22∶4和152∶122),平均出血时间(1.02±0.25)d和(3.61±1.33)d,差异有统计学意义(P<0.05);平均年龄(59.71±9.03)岁和(56.02±12.06)岁,血红蛋白水平(96.46±27.05)g/L和(94.61±24.20)g/L,尿素氮(16.05±6.96)mmol/L和(16.53±7.42)mmol/L,差异无统计学意义(P>0.05)。金属夹组呕血、便血、腹痛、心悸、出汗、晕厥的发生率高于非金属夹组,差异有统计学意义(P<0.05)。金属夹组内镜诊断以消化性溃疡、贲门撕裂最多见,十二指肠憩室、Dieulafoy’s病少见。溃疡患者Forrest分型为Ⅰa型5例,Ⅰb型7例,Ⅱa型6例,Ⅱb型1例。金属夹止血即刻止血率26/26(100%),术后72 h内再出血2例(2/26,7.7%),与非金属夹组相比无显著差异。结论非静脉曲张性上消化道出血急诊胃镜检查患者中男性较多,并以中老年为主,多伴有血红蛋白下降、尿素氮升高。胃镜下金属夹止血患者病情较重,病因以消化性溃疡、贲门黏膜撕裂最常见,内镜表现以正在大量出血或血管断端为主。金属夹止血具有止血率高、再出血率低的特点。Objective To explore the characteristics of hemostasis with metal clip under emergency gastroscope in patients with nonvariceal upper gastrointestinal bleeding.Methods 300 patients with nonvariceal upper gastrointestinal bleeding underwent emergency endoscopy in the hospital from January, 2016 to December, 2019 were selected. There were 26 cases in metal clip hemostasis group, and 274 cases were in non-metal clip group. The general condition, etiology, Forrest classification, hemoglobin and urea nitrogen levels and therapeutic effect of the two groups were analyzed.Results The ratio of men to women in the metal clip group and non-metal clip group was 22:4 vs 152:122. The mean bleeding time was(1.02 ±0.25)vs(3.61±1.33)days, and there was significant difference(P<0.05). The mean age was(59.71±9.03)vs(56.02±12.06)years, the hemoglobin level was(96.46±27.05)vs(94.61±24.20) g/l, the urea nitrogen was(16.05±6.96)vs(16.53±7.42)mmol/l, and there was no significant difference(P>0.05). The incidence of hematemesis, hematochezia, abdominal pain, palpitation, sweating and syncope in metal clip group was higher than that in non-metal clip group(P<0.05). The most common endoscopic diagnosis in the metal clip group was peptic ulcer and cardiac avulsion, while duodenal diverticulum and Dieulafoy’s disease were rare. Forrest clasification was type Ⅰa(5 cases), type Ⅰb(7 cases), type Ⅱa(6 cases)and type Ⅱb(1 case). The immediate hemostasis rate was 26/26(100%), and the rebleeding rate was 2 cases(2/26, 7.7%)within 72 hours after operation,and there was no significant difference between the two groups.Conclusion Patients with nonvariceal upper gastrointestinal bleeding underwent emergency gastroscopy are more male,mostly accompanied by decreased hemoglobin and elevated urea nitrogen. Patients with metal clips under gastroscope for hemostasis are more serious. The most common causes are peptic ulcer and cardia laceration, and the endoscopic presentation is characterized by massive bleeding or broken ends of blood v

关 键 词：非静脉曲张性上消化道出血 急诊胃镜 金属夹止血 病例特点 

分 类 号：R573.2[医药卫生—消化系统]