金属钛夹联合肾上腺素和立止血内镜下局部注药对消化性溃疡出血的疗效观察

Efficacy of local injection of epinephrine and reptilase in the treatment of peptic ulcer bleeding with metal titanium clips

目的探讨内镜下金属钛夹联合肾上腺素和立止血治疗消化性溃疡合并上消化道出血的治疗效果。方法选取108例确诊消化性溃疡合并上消化道出血患者为受试对象,采用随机数字表法将患者均分为A、B、C三组,各36例。A组予以内镜下金属钛夹止血方案;B组在A组治疗基础上联合局部喷洒、注射肾上腺素方案;C组在B组治疗基础上联合局部喷洒、注射立止血方案。对比三组患者止血效果,记录治疗后1周内呕血次数及黑便次数,分析治疗前后血压、脉搏等体征变化情况,记录不良反应及并发症发生情况。结果 1C组立即止血率、48 h内止血率分别为83.3%和94.4%,均显著高于A、B组;手术率、治疗1周内再出血率则为0.0%和5.6%,均显著低于A、B组(P<0.05);治疗1周后,C组呕血次数、黑便次数分别为(0.5±0.2)次和(0.6±0.3)次,均显著低于A、B组(P<0.05);A、B组上述指标对比无统计学意义(P>0.05)。2治疗3 d后,三组患者脉搏次数均较治疗前显著降低,且血压较治疗前显著提升(P<0.05);其中A组血压显著低于B、C组,脉搏次数则显著高于B、C组(P<0.05),B、C组在上述指标对比上无统计学意义(P>0.05)。3三组患者治疗后均无不良反应及并发症发生。结论将内镜下金属钛夹联合局部喷洒、注射肾上腺素+立止血的方案应用于消化性溃疡合并上消化道出血患者的临床治疗中,止血效果确切,安全性理想。

Objective To investigate the effect of metal titanic clips combined with local injection of epinephrine and reptilase in the treatment of peptic ulcer complicated with bleeding.Methods A total of 108 patients with peptic ulcer bleeding were selected.According to the random number table,they were divided into A,B and C,groups on average.Group A was treated with endoscopic metal titanic clip,group B was treated with additional local spraying and injection of epinephrine,while group C was treated with local spraying and injection of reptilase based on the treatment in group B.The hemostasis effects in the three groups were compared.The times of haematemesis and melena one week after treatment were recorded.The signs such as blood pressure and pulse rate before and after treatment were analyzed,and the occurrence of adverse reactions and complications was recorded.Results 1 The immediate hemostasis rate and 48-hour hemostasis rate in group C（83.3%,94.4%） were significantly higher than those in group A and B; the rate of operation and rebleeding one week after treatment were 0.0%,5.6% which were significantly lower than those in group A and B（P〈0.05）; after one week of treatment,times of haematemesis and melena in group C were 0.5 ± 0.2 days and 0.6 ± 0.3 days which were significantly lower than those in group A and B（P〈0.05）.There was no significant difference between group A and B in above indicators（P〈0.05）.2After 3 days of treatment,the pulse rate in three groups was significantly lower than those before treatment,while blood pressure levels were significantly higher than those before treatment（P〈0.05）.The blood pressure level in group A was significantly lower than that in group B and C,while pulse level was significantly higher than that in group B and C（P〈0.05）.There was no significant difference in the above indicators between group B and C（P〈0.05）.3There were no adverse reactions and complications in three groups after treatment.Conclusions Endoscopic metal titanic clip combined with local spraying and injection of epinephrine and reptilase in the treatment of peptic ulcer bleeding effective and safe.