经内镜透明帽下注射联合止血夹治疗非静脉曲张性上消化道大出血的临床研究

Clinical study on treatment of non-variceal upper gastrointestinal bleeding by endoscopic transparent cap injection combined with hemostatic clip

目的观察经内镜透明帽下注射联合止血夹治疗非静脉曲张性上消化道大出血患者的临床疗效。方法抽取本院2012年6月至2016年11月期间收治的224例非静脉曲张性上消化道大出血患者作为研究对象,将224例患者分为A组、B组、C组,A组72例,B组78例,C组74例。A组实施1/10 000肾上腺素粘膜下注射止血,B组实施止血夹止血,C组经内镜透明帽下注射联合止血夹治疗。比较三组患者的止血治疗效果、生活质量和术后并发症情况。结果 A组、B组患者的即时止血率、有效止血率比较均无明显差异(P>0.05),C组患者的即时止血率、有效止血率均较A组和B组患者高(P<0.05)。A组患者一周后再出血率、外科手术率与B组患者比较无明显差异(P>0.05),与C组患者比较存在明显差异(P<0.05)。治疗前,三组患者的生活质量综合评定问卷(GQOLI-74)评分比较无明显差异(P>0.05),治疗后C组患者的生活质量综合评定问卷评分明显高于A组和B组患者(P<0.01),A组和B组患者治疗前后的GQOLI-74评分比较均无明显差异(P>0.05)。结论经内镜透明帽下注射联合止血夹治疗非静脉曲张性上消化道大出血患者,止血效果确切,安全性高,可有效改善患者生活质量,值得临床推广应用。

Objective To observe the treatment effect of non-variceal upper gastrointestinal bleeding by endoscopic transparent cap injection combined with hemostatic clip. Methods 224 cases of patients from July2014 to June 2015 was selected,in chronological order,divided into groups A,B,C,group A of 72 cases,group B of 78 cases,group C of 74 cases,the A group of patients received 1/10000 adrenaline mucosal bleeding treatment,the B group of patients received Hemostat bleeding treatment,the C group of patients received endoscopic injection combined with transparent cap Hemostat treatment,compared the hemostasis effect,quality of life and postoperative complications among the three groups of patients. Results There was no significant difference between group A and group B in immediate hemostasis rate and effective hemostasis rate（ P〉0. 05）.The immediate hemostasis rate and effective hemostasis rate of group C were higher than those of group A and group B（ P〈0. 05）. Before the treatment,life quality evaluation questionnaire of three groups of patients（ GQOLI-74） had no significant difference score（ P〉0. 05）,group C after treatment in patients with a comprehensive assessment of quality of life questionnaire score was significantly higher than that of A group and B group（ P〈0.01）,A group and B group before and after treatment in patients with GQOLI-74 scores showed no significant difference（ P〉0. 05）. Conclusions The treatment effect of non-variceal upper gastrointestinal bleeding by endoscopic transparent cap injection combined with hemostatic clip has good hemostatic effect and high safety,can effectively improve the quality of life of patients,worthy of clinical application.