改良三腔管导丝插入牵引急诊硬化治疗食管静脉曲张大出血89例

Combined treatment of modified Sengstaken-Blakemore tube inserted by guide wire and EIS for 89 patients with severe esophagogastric variceal bleeding

目的:研究改良三腔管导丝插入牵引急诊硬化对食管静脉曲张大出血患者的治疗效果.方法:致死性食管静脉曲张破裂大出血患者89例,应用改良三腔管导丝插入法,并在改良三腔管牵引5min后牵引下行急诊内镜硬化治疗(EIS),于曲张静脉内注射5%鱼肝油酸钠6-10mL,平均用量约35mL.术后禁食24h,观察患者血压、呼吸、心率和再出血,常规静脉给予H2A或PPI和抗生素.结果:致死性食管静脉曲张破裂活动性大出血时改良三腔管插入成功率100%;首次牵引下EIS明确出血部位88例,首次急诊EIS止血成功87例(97.7%).其中17例为多次EIS后止血,并发症7例(7.86%),死亡1例(1.1%).结论:导丝引导插入法成功率高,改良三腔管牵引下急诊EIS是救治致死性食管静脉破裂大出血有效、安全和简便的方法.

AIM： To evaluate the efficacy of combined treatment of modified Sengstaken-Blakemore tube inserted by guide wire and EIS for patients with severe esophagogastric variceal bleeding. METHODS： Modified Sengstaken-Blakemore tube inserted by guide wire was performed on 89 patients with severe esophagogastric variceal bleeding, and 5min after the insertion, 35 mL on average EIS of 5% sodium morrhuate were injected into patients with esophagogastric vari- ces. Fasting for 24 h was advised to the patients, and blood pressure, respiratory rate, heart rate and bleeding recurrence were also observed. Besides, intravenous drop infusion of H2A, PPIand antibiotics were given to the patients RESULTS： The successful rate of modified Sengstaken-Blakemore tube insertion in patients with severe esophagogastric variceal bleeding was up to 100%. Bleeding site was confirmed in 88 patients in the first surgery. Severe esophagogastric variceal bleeding was alleviated in 87 patients by EIS administration （97.7%）, of which, 17 were relieved with repeated EIS, and complications occurred in 7 cases （7.86%） and I case died in the study （1.1%）. CONCLUSION： Combined treatment of modified Sengstaken-Blakemore tube inserted by guide wire and EIS shows relatively safe and effective performance for patients with severe esophagogastric variceal bleeding.