内镜下注射去甲肾上腺素治疗脑梗死合并应激性消化道出血75例效果观察  

Effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding

作　　者：汤静雯 杨芮 沈慧芸 王恩[3] Tang Jingwen;Yang Rui;Shen Huiyun;Wang En(Intensive Care Unit,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Orthopedics,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Neurosurgery,Taizhou Hospital of Zhejiang Province,Taizhou 318000,Zhejiang Province,China)

机构地区：[1]丽水市人民医院重症监护室,丽水323000 [2]丽水市人民医院骨科,丽水323000 [3]浙江省台州医院神经外科,台州318000

出　　处：《中国基层医药》2024年第1期40-44,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察内镜下注射去甲肾上腺素治疗脑梗死合并应激性消化道出血临床效果。方法选择2020年10月至2021年10月丽水市人民医院重症监护室接收的脑梗死合并应激性消化道出血患者150例为研究对象,采用随机对照研究方法,按照随机数字表法分为对照组(n=75)和观察组(n=75)。对照组给予常规临床治疗,观察组在此基础上予以内镜下注射去甲肾上腺素治疗。比较两组止血时间、输血量、住院时间,比较两组治疗前后的应激指标及炎症指标,评价两组止血效果及不良反应情况。结果观察组的止血时间、输血量、住院时间分别为(16.16±4.36)h、(385.35±41.28)mL、(5.35±1.28)d,均短于、少于对照组的(27.27±6.34)h、(447.07±32.07)mL、(7.07±2.07)d(t=12.50、10.22、6.12,均P<0.001);治疗后,观察组的皮质醇(Cor)、去甲肾上腺素(NE)、抗利尿激素(ADH)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平分别为(288.33±19.53)mmol/L、(29.17±4.26)μg/L、(4.08±1.08)mU/L、(38.27±8.72)ng/L、(6.69±1.35)μg/L、(6.37±1.51)mg/L,均低于对照组的(327.22±22.01)mmol/L、(39.32±5.54)μg/L、(5.36±1.22)mU/L、(51.24±13.23)ng/L、(8.67±2.29)μg/L、(11.44±3.13)mg/L(t=11.44、12.57、6.80、7.08、6.45、12.63,均P<0.001)。观察组的止血总有效率为94.67%(71/75),优于对照组的82.67%(62/75)(χ^(2)=5.37,P<0.05);观察组的不良反应发生率8.00%(6/75),略低于对照组的14.67%(11/75),但两组差异无统计学意义(χ^(2)=1.66,P>0.05)。结论应用内镜下注射去甲肾上腺素治疗脑梗死合并应激性消化道出血,可快速止血,且可有效改善患者的炎症及应激指标,安全性高。Objective To investigate the clinical effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding.Methods A total of 150 patients with cerebral infarction complicated by stress-induced gastrointestinal bleeding who were admitted to the Intensive Care Unit of Lishui City People's Hospital from October 2020 to October 2021 were included in this study.These patients were randomly divided into a control group and an observation group using the random number table method,with 75 patients in each group.Patients in the control group received routine clinical treatment,while those in the observation group received endoscopic injection of norepinephrine in addition to routine clinical treatment.The hemostatic time,blood transfusion volume,and length of hospital stay were compared between the two groups.The stress index and inflammatory index were compared between the two groups before and after treatment.The hemostatic effect and adverse reactions were evaluated in each group.Results The hemostatic time,blood transfusion volume,and length of hospital stay in the observation group were(16.16±4.36)hours,(385.35±41.28)mL,and(5.35±1.28)days,respectively,which were significantly shorter or less than(27.27±6.34)hours,(447.07±32.07)mL,and(7.07±2.07)days in the control group(t=12.50,10.22,6.12,all P<0.001).After treatment,the levels of cortisol,norepinephrine,antidiuretic hormone,high-sensitivity C-reactive protein,interleukin-6,and tumor necrosis factor-αin the observation group were(288.33±19.53)mmol/L,(29.17±4.26)μg/L,(4.08±1.08)mU/L,(38.27±8.72)ng/L,(6.69±1.35)μg/L,and(6.37±1.51)mg/L,respectively,which were significantly lower than(327.22±22.01)mmol/L,(39.32±5.54)μg/L,(5.36±1.22)mU/L,(51.24±13.23)ng/L,(8.67±2.29)μg/L,and(11.44±3.13)mg/L in the control group(t=11.44,12.57,6.80,7.08,6.45,12.63,all P<0.001).The overall response rate of hemostasis in the observation group was 94.67%(71/75),which was significantly higher than 82.67%(62/75)in

关 键 词：脑梗死 消化性溃疡出血 止血 内窥镜 去甲肾上腺素 四氢皮质醇 C反应蛋白质 白细胞介素6 肿瘤坏死因子α 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R573.2[医药卫生—临床医学]