急诊应用药物治疗急性上消化道出血的疗效

Medication Treatment for Acute Upper Gastrointestinal Hemorrhage in Emergency Department

目的探讨急诊应用药物治疗急性上消化道出血的方法及疗效。方法对2008年6月至2010年6月收治的86例急性上消化道出血患者采用内科方法治疗,采用生长抑素(善宁)0.1 mg稀释于生理盐水20 mL中缓慢静脉注射,继之以25～50μg·h-1的剂量持续静脉滴注;垂体后叶素0.2～0.4 U·min-1持续静脉滴注24 h后,半量维持,至血止后24 h停用。消化性溃疡的患者加用质子泵抑制剂奥美拉唑肠溶胶囊40 mg,1次.d-1静脉滴注;收缩压低于8.00～12.00 kPa者予多巴胺升压治疗;有凝血功能障碍者采用凝血酶治疗。观察患者临床症状的改善情况。结果 86例患者平均住院时间为(11.6±0.5)d,无一例死亡。其中显效23例,有效46例,无效17例,总有效率为80.2%。内科治疗无效的患者均转往外科或行内镜下止血治疗。结论生长抑素、垂体后叶素、奥美拉唑联合应用,对于急诊治疗上消化道出血有重要意义。

Objective gastrointestinal hemorrhage To explore the method and efficacy of medication treatment for acute upper （UGIH） in the department of emergency. Methods A retrospective analysis was performed in 86 patients with acute UGIH treated between June 2008 and June 2010. Patients were treated with intravenous injection of 0.1 mg octreotide diluted 20 mL normal saline, followed by continuous intravenous infusion of octreotide （25-50 μg.h-1）. After continuous intravenous infusion of pituitrin （0.2-0.4 U .min-1）for 24 hours, patients were given a maintenance of half dose of pituitrin, which was discontinued 24 hours after hemostasis. Patients with peptic ulcer were additionally given in- travenous infusion of proton pump inhibitor omeprazole （40 mg-d-t）. Patients with systolic blood pressure lower than 8.00-12.00 kPa were additionally treated with dopamine. Patients with coagulation dysfunction were additionally treated with thrombin. The improvement in clinical symptoms was observed. Results Average length of stay was （ 11.6＋0.5 ）days and no patients died. Among the 86 patients, the treatment was markedly effective in 23, effective in 46 and ineffective in 17, with a total effective rate of 80.2%. Patients who underwent failed medical therapy were converted to surgical or endoscopic hemostasis. Conclusion Combined application of octreotide,pituitrin and omeprazole is effective in the treatment of acute UGIH.