内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血疗效分析

Clinical effect of endoscopic titanium clip combined with injection of epinephrine in the treatment of peptic ulcer hemorrhage

目的探讨内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效。方法选取2014年1月至2015年12月期间青海省人民医院消化内科收治的168例消化性溃疡出血患者作为研究对象,根据患者入院顺序进行编号,将其随机分为A、B、C 3组,每组各56例。A组患者接受内镜下金属钛夹夹闭止血治疗,B组患者接受内镜下注射止血治疗,C组患者接受内镜下金属钛夹联合注射止血治疗。治疗完成后,比较3组的临床疗效、即时止血率、再出血率、外科手术率以及术后并发症发生情况。结果治疗前,3组患者的一般资料、病例分布及病情分级等方面比较差异无统计学意义(P>0.05)。治疗后,C组治疗总有效率为94.6%,显著高于A组和B组的82.1%、75.0%(P=0.017);A组与C组的即时止血率均为100%,显著高于B组的92.9%(P=0.017);C组的再次出血发生率为1.8%,显著低于A组和B组的10.7%、16.1%(P=0.034);但在转外科手术率及术后并发症发生率方面,3组比较差异无统计学意义(P>0.05)。结论内镜下金属钛夹联合注射肾上腺素治疗消化性溃疡出血近期疗效确切,具有较好的止血效果,可降低再出血发生率,具有一定的临床价值。

Objective To discuss the clinical effect of endoscopic titanium clip combined with injection of epinephrine in the treatment of acute peptic ulcer hemorrhage. Methods A total of 168 patients with acute peptic ulcer hemorrhage who accepted treatment in qmghai People＇s Hospital from January 2014 to December 2015 were selected, and they were randomly divided into group A, group B and group C according to the order of admission, 56 patients in each group. Patients in group A were treated with endoscopic metal titanium clips and patients in group B were treated with endoscopic injection of epinephrine, while patients in group C were treated with endoscopic metal titanium clips combined with injection of epinephrine. Compare the clinical efficacy3 immediate hemostasis rate, re-bleeding rate, surgical intervention rate and postoperative complications after the treatment. Results There were no significant difference in patients＇ general data, the distribution of cases or the staging among the three groups before the treatment （P〉0.05）. After finishing the treatment, the total effective rate of group C was 94.6%, which was significantly higher than 82.1% of group A and 75.0% of group B （P= 0.017）; the immediate hemostasis rate of group A and group C were both 100%, significantly higher than 92.9% of group B （P=0.017）; the re-bleeding incidence of group C was 1.8% which was significantly lower than 10.7% of group A and 16.1% of group B （P=0.034）. There was no significant difference in the incidence of surgical intervention rate or postoperative complications among the three groups （P〉0.05）. Conclusion Endoscopic metal titanium clip combined with injection of epinephrine has accurate recent curative effect in the treatment of peptic ulcer bleeding and it can obviously reduce the re-bleeding incidence rate, which is of some clinical value.