急诊内镜硬化术治疗食管静脉曲张破裂出血患者的疗效观察

Evaluation of emergent endoscopic injection sclerotherapy in treatment of patients with esophageal variceal bleeding

目的探讨对食管静脉曲张破裂出血患者行急诊内镜下硬化术治疗的疗效及安全性。方法回顾性分析山西煤炭中心医院62例食管静脉曲张破裂出血患者病历资料，患者均保持2条静脉通路，保持收缩压不低于90mmHg，胃镜插入后，明确出血位点，足量推注硬化剂（聚桂醇），推注完毕每点加注蛇毒血凝酶注射液（速乐涓）0．5ml，每次注射3-4点，每点推注硬化剂6～10ml，平均用量35ml，最大量40mI，硬化治疗后在食管下段内镜下喷洒凝血酶冻干粉溶液2000U，观察术中、术后并发症。结果61例患者急诊止血成功，1例止血失败，术后24h内出现呕血，三腔二囊管压迫后止血。术后1周复查胃镜，23例（37％）静脉曲张好转，27例（44％）有食管溃疡形成，39例（63％）仍有重度静脉曲张。术后常见并发症有发热和胸骨后疼痛，未发生严重并发症。结论急诊硬化术治疗食管静脉曲张破裂出血，止血效果可靠，安全性高。

Objective To evaluate the clinical efficacy and safety of emergent endoscopic injection sclerotherapy （EIS） in patients with esophageal variceal bleeding （EVB）. Methods the present study retrospectively analyzed 62 cases of esophageal variceal bleeding with two venous access remained and systolic blood pressure of not less than 90 mmHg. The patients accepted sufficient amount of bolus hardening and then each point of 0.Sml Hemocoagulase injection with three or four points one time and 6- 10ml hardening each point, the average hardening amount of 35ml, the maximum amount of 40ml. We sprayed 2000U of the thrombin lyophilized soulution after sclerotherapy, and observed Intraoperative and postoperative complications. Results Bleeding was controlled in 61 patients, while one patient suffered haematemesis during post-treatment of 24 hours, and the bleeding was controlled by Sengstaken-Blackmore tube .Gastroendoscopy 1 week later showed that the varicosis of 23 patients （37%） were improved, esophageal ulcer occurred in 27 patients （44%）, and the varicosis of 39 patients （63%） was still severe. Fever and retrosternal pain were the common postoperative complications And there was no serious complications. Conclusion Emergent endoscopic injection sclerotherapy is safe and effective in controlling acute esophageal variceal bleeding.