改良型三腔二囊管联合内镜序贯治疗肝硬化食管胃静脉曲张出血的疗效观察

Observation of clinical efficacy of modified Sengstaken-Blakemore tube combined with sequential endoscopic treatment for esophagogastric variceal bleeding in hepatic cirrhosis

目的探索改良型三腔二囊管联合内镜序贯治疗肝硬化食管胃静脉曲张出血的有效性。方法将食管胃静脉曲张破裂出血患者84例分为研究组和对照组(各42例),研究组加用改良型三腔二囊管止血,而对照组不用,观察2组患者在一般并发症、首次内镜前止血成功率、急诊胃镜率、无痛内镜治疗率、病死率方面的差异。结果研究组和对照组患者在性别构成比、年龄、肝功能分级比较差异均无统计学意义(P均>0.05)。2组的胸痛、发热、异位栓塞发生率比较差异均无统计学意义(P均>0.05)。研究组和对照组压迫性溃疡发生率(9.5%vs.0.0%)、误吸发生率(0.0%vs.11.9%)、首次内镜前止血成功率(95.2%vs.66.7%)、急诊胃镜率(4.8%vs.47.6%)、无痛内镜治疗率(100.0%vs.66.7%)、病死率(0.0%vs.9.5%)比较,差异均有统计学意义(P均<0.05)。结论改良型三腔二囊管联合内镜序贯治疗肝硬化食管胃静脉曲张出血能增加首次内镜前止血成功率,减少急诊胃镜率,增加无痛内镜治疗比例,降低误吸发生率和病死率。

Objective To evaluate the clinical efficacy of modified Sengstaken-Blakemore tube com-bined with sequential endoscopic treatment for esophagogastric variceal bleeding in hepatic cirrhosis. Methods Eighty-four patients suffering from ruptured esophagogastric variceal bleeding were divided into the study （n = 42） and control groups （ n = 42 ）. Modified Sengstaken-Blakemore tube was utilized for hemostasis in the study group rather than in the control group. Common complications, the hemostasis rate before the first endoscopy, the emergency endoscopy rate, the percentage of painless gastroscopic treatment and the mortality rate were ob-served and statistically compared between two groups. Results No significance differences were identified in the gender ratio, age and Child-Pugh score between two groups （all P 〉 0. 05 ） . The incidence rate of chest pain, fever and ectopic embolization did not significantly differ between two groups （all P 〉 0. 05 ） . Statistical significance was noted in terms of the incidence rate of pressure ulcer （9. 5% vs. 0 . 0 %） ,the aspiration rate （0. 0% vs. 11.9%） , the hemostasis rate before the first endoscopy （95.2% vs. 66.7% ） , the emergency en-doscopy rate （4. 8% vs. 47.6% ） , the percentage of painless gastroscopic treatment （100 .0% vs. 66 .1% ） and mortality rate （0. 0% vs. 9. 5%） between the study and control groups （all P 〈0 .05 ） . Conclusions Modified Sengstaken-Blakemore tube combined with sequential endoscopy is an efficacious treatment of esopha-gogastric variceal bleeding in hepatic cirrhosis, which increases the hemostasis rate before the first endoscopy and the percentage of painless gastroscopic treatment, whereas reduces the emergency endoscopy rate, aspira-tion rate and mortality rate.