聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血

Treatment of gastric fundus varices bleeding with sequential lauromacrogol injection of fibrinogen and thrombin

目的探讨聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血的临床价值。方法 152例胃底静脉曲张破裂出血患者随机分为两组,各76例。治疗组采取聚桂醇纤维蛋白原凝血酶序贯法治疗,对照组采取组织胶(α-氰基丙烯酸烷基酯)三明治法治疗,比较两组止血成功率及仪器损害、再出血、静脉改善、并发症等发生情况。结果治疗组与对照组的止血成功率分别为98.68%与93.42%,差异无统计学意义(P>0.05);再出血率分别为4.00%与25.35%,二者差异有统计学意义(P<0.01);两组发热、腹痛不良反应发生率相近(P>0.05),但对照组溃疡发生率高于治疗组(P<0.05);对照组堵针、粘镜发生率高于治疗组(P<0.01)。两组均未出现异位栓塞等严重并发症。结论聚桂醇纤维蛋白原凝血酶序贯法止血效果好,再出血率低,安全可靠。

Objective To explore the clinical value of sequential lauromacrogol injection of fibrinogen and thrombin in the treatment of gastric fundus varices bleeding. Methods A total of 152 patients with gastric fundus varices bleeding were randomly divided into two groups（n = 76, respectively）. The treatment group received sequential lauromacrogol injection of fibrinogen and thrombin and the control group received tissue adhesive（α-cyanoacrylates）（sandwich method）. The success rate of hemostasis, the damage from instruments, the rate of rebleeding, venous improvement, and the complications were compared. Results The success rate of hemostasis in the two groups was 98.68% and 93.42%, respectively, without significant difference（ P〉0.05）; the incidence of rebleeding was 4.00% and 25.35%, respectively, with a significant difference between the two groups（P〈0.01）. The incidences of fever, abdominal pain adverse reaction were similar between the two groups（P〈0.05）, but the incidence of ulcer in the control group was higher than that in the treatment group（P〈0.05）, so did the incidences of stuck needle and endoscope（P〈0.01）. There were no serious complications such as ectopic embolization in the two groups. Conclusion Sequential lauromacrogol injection of fibrinogen and thrombin has good hemostatic effects and low bleeding rate, is safe and reliable.