APC联合内镜下靶控注射去甲肾上腺素对NVUGIB患者的止血效果及再出血因素分析  

作　　者：代波 

机构地区：[1]浙江省医疗健康集团杭州医院,310000

出　　处：《浙江临床医学》2025年第2期247-250,共4页Zhejiang Clinical Medical Journal

摘　　要：目的分析氩离子凝固术(APC)联合内镜下靶控注射去甲肾上腺素(NE)对非静脉曲张性上消化道出血(NVUGIB)患者的止血效果及再出血相关因素。方法采用前瞻性研究,纳入2021年3月至2023年3月医院收治的86例NVUGIB患者作为研究对象,随机分为对照组和观察组,每组各43例。对照组仅接受APC治疗,观察组在此基础上加用靶控注射NE治疗;比较两组止血效果及住院时间;对比治疗前、治疗后凝血指标(凝血酶原时间PT、活化部分凝血活酶时间APTT、纤维蛋白原FIB)和氧化应激指标(皮质醇Cor)、(肾上腺素E);记录患者止血后3 d内再出血情况,将再出血患者分为再出血组,未再出血患者分为未再出血组,通过二元Logistic回归分析影响NVUGIB患者止血后再出血的危险因素。结果治疗后,观察组止血及住院时间较短,出血量和输血量较低(P<0.05);观察组的PT、APTT较短,FIB较高(P<0.05);两组患者治疗后血清Cor、E水平低于治疗前,且观察组低于对照组(P<0.05);随访3 d,观察组再出血5例(11.63%),对照组再出血13例(30.23%)(χ2=4.497,P=0.034);再出血组出血病灶直径≥2 cm、合并低蛋白血症、便秘患者比例高于未再出血组(P<0.05);二元Logistic回归分析结果显示,出血病灶直径≥2cm、合并低蛋白血症及便秘是NVUGIB患者止血后再出血的危险因素(OR>1,P<0.05)。结论APC联合内镜下靶控注射NE能提高NVUGIB患者止血效果,改善凝血功能,降低机体氧化应激反应及再出血风险。止血后再出血与患者出血病灶直径、合并低蛋白血症及便秘相关,临床可针对这些风险因素进行干预,以降低再出血风险。Objective To analyze the hemostatic effect and related factors of rebleeding in patients with non-variceal upper gastrointestinal bleeding(NVUGIB)treated with argon plasma coagulation(APC)combined with endoscopic targeted injection of norepinephrine(NE).Methods A prospective study was conducted,including 86 NVUGIB patients admitted to the hospital from March 2021 to March 2023,randomly divided into two groups,each with 43 cases.The control group received APC treatment only,while the observation group received NE targeted injection treatment on this basis;the hemostatic effect(bleeding volume,blood transfusion volume,and hemostasis time)and hospital stay of the two groups were compared;pre-and posttreatment coagulation indicators(prothrombin time PT,activated partial thromboplastin time APTT,fibrinogen FIB)and oxidative stress indicators(cortisol Cor),(epinephrine E)were compared;the rebleeding situation within 3 days after hemostasis in patients was recorded,and patients with rebleeding were divided into the rebleeding group,and those without rebleeding were divided into the non-rebleeding group.Binary logistic regression analysis was used to analyze the risk factors affecting rebleeding after hemostasis in NVUGIB patients.Results After treatment,the observation group had shorter hemostasis and hospital stay,and lower bleeding and blood transfusion volumes(P<0.05);the PT and APTT in the observation group were shorter,and FIB was higher(P<0.05);the serum Cor and E levels after treatment in both groups were lower than before treatment,and the observation group was lower than the control group(P<0.05);within 3 days of follow-up,there were 5 cases of rebleeding in the observation group(11.63%)and 13 cases in the control group(30.23%)(χ2=4.497,P=0.034);the proportion of patients with a bleeding lesion diameter≥2 cm,combined hypoproteinemia,and constipation in the rebleeding group was higher than in the non-rebleeding group(P<0.05);binary logistic regression analysis showed that a bleeding lesion diameter≥2 cm,com

关 键 词：非静脉曲张性上消化道出血 氩离子凝固术 去甲肾上腺素 止血效果 再出血 

分 类 号：R47[医药卫生—护理学]