钛夹止血联合尖吻蝮蛇血凝酶在急性非静脉曲张性上消化道出血中的应用  

Application of titanium clip hemostasis combined with hemocoagulase agkistrodonin acute non-variceal upper gastrointestinal bleeding

作　　者：苏翔 钟云川 颜韬 伯东 刘洪 SU Xiang;ZHONG Yunchuan;YAN Tao;BO Dong;LIU Hong(Department of Emergency Medicine,The First People's Hospital of Neijiang,Neijiang 641000,Sichuan,China)

机构地区：[1]内江市第一人民医院急诊科,四川内江641000

出　　处：《西部医学》2024年第7期1068-1072,共5页Medical Journal of West China

基　　金：四川省中医药管理局中医药科研专项课题(2021MS374)。

摘　　要：目的探讨肽夹止血联合尖吻蝮蛇血凝酶(HCA)在急性非静脉曲张性上消化道出血(ANVUGIB)中的应用效果。方法选取2020年1月—2022年7月我院收治的108例非静脉曲张性上消化道出血患者为研究对象,按照入院顺序编号,将其以单双号的方式分为对照组(n=54,单号)和观察组(n=54,双号)。对照组采用内镜下金属钛夹止血,观察组采用内镜下金属钛夹联合HCA止血。比较两组患者止血效果、临床症状改善时间、并发症情况、治疗前后凝血功能变化[纤维蛋白原(FBG)、凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板(PLT)水平]、氧化应激反应及术后3个月内再次出血率。结果观察组治疗后的总出血量低于对照组,止血总有效率(98.15%)高于对照组(87.04%)(均P<0.05);观察组粪便潜血转阴时间、呕血消失时间、恢复肠鸣音时间、止血时间、住院时间均显著短于对照组(均P<0.05);两组术后并发症发生率无明显差异(P>0.05);治疗后,两组FIB、PLT水平显著升高,且观察组高于对照组,两组APTT、PT、氧化应激水平均显著降低,且观察组低于对照组(均P<0.05);观察组术后3个月内再出血率(1.85%)显著低于对照组(12.96%)(P<0.05)。结论应用内镜下钛夹止血结合HCA进行止血,可提高止血效果,缩短临床症状缓解时间,优化氧化应激状态,改善凝血功能,降低并发症,降低术后出血率,具有临床推荐使用的意义。Objective To explore the application effect of titanium clip hemostasis combined with hemocoagulase agkistrodon on acute non-variceal upper gastrointestinal bleeding.Methods Totally 108 patients with non-variceal upper gastrointestinal bleeding admitted to the hospital from January 2020 to July 2022 were selected as the research subjects.The patients were numbered according to the order of admission and were divided into control group(n=54,odd number)and observation group(n=54,even number)by odd-even number method.The control group was given endoscopic metal titanium clip for hemostasis,and the observation group was given endoscopic metal titanium clip combined with hemocoagulase agkistrodon for hemostasis.The hemostatic effect,improvement time of each clinical symptom and complications were compared between the two groups.The coagulation function[fibrinogen(FBG),activated partial thromboplastin time(APTT),prothrombin time(PT),platelet(PLT)]and oxidative stress response before and after treatment and re-bleeding rate within 3 months after surgery were compared between the two groups.Results The total amount of bleeding in observation group was less than that in control group(P<0.05),and the total effective rate of hemostasis in observation group(98.15%)was higher than that in control group(87.04%)(P<0.05).The negative conversion time of fecal occult blood,disappearance time of hematemesis,recovery time of bowel sounds,hemostasis time,and hospital stay were significantly shorter in observation group than those in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications between the two groups(P>0.05).After treatment,the levels of FIB and PLT in the two groups were significantly increased(P<0.05),and the levels in observation group were higher than those in control group(P<0.05).APTT and PT in the two groups were significantly shortened(P<0.05),and the two indicators in observation group were shorter compared with those in control group(P<0.05).After treatment

关 键 词：急性非静脉曲张性上消化道出血 内镜 金属钛夹 尖吻蝮蛇血凝酶 止血效果 

分 类 号：R573.2[医药卫生—消化系统]