不同内镜下止血法对非静脉曲张性上消化道出血的疗效研究

Effect of different endoscopic hemostasis on non variceal upper gastrointestinal bleeding

目的观察注射肾上腺素止血、钛夹止血、电凝法止血及联合止血四种止血方法对非静脉曲张性上消化道出血的临床疗效。方法将80例非静脉曲张性上消化道出血患者(收治时间为2016年1月~2017年6月)作为此次研究对象,随机分为Ⅰ组、Ⅱ组、Ⅲ组及Ⅳ组,Ⅰ组患者采取注射肾上腺素溶液进行止血,Ⅱ组患者采取钛夹进行止血,Ⅲ组患者采取电凝法进行止血,Ⅳ组患者采取联合止血的方法,对其止血效果进行分析比较。结果Ⅰ组患者即刻止血、再出血及有效止血分别为80.0%、40.0%及60.0%;Ⅱ组患者即刻止血、再出血及有效止血分别为75.0%、30.0%及70.0%;Ⅲ组患者即刻止血、再出血及有效止血分别为65.0%、35.0%及65.0%;Ⅳ组患者即刻止血、再出血及有效止血分别为100.0%、5.0%及95.0%。Ⅳ组患者即刻止血率明显高于其他三个组(P<0.05),Ⅰ组、Ⅱ组及Ⅲ组患者即刻止血发生率差异无统计学意义(P>0.05);Ⅰ组、Ⅱ组及Ⅲ组患者再出血发生率差异无统计学意义(P>0.05);Ⅳ组患者再出血发生率明显低于其他三个组(P<0.05);Ⅰ组、Ⅱ组及Ⅲ组患者有效止血差异无统计学意义(P>0.05);Ⅳ组患者有效止血明显高于其他三个组(P<0.05)。结论非静脉曲张性上消化道出血患者采取内镜下止血方法效果均较为理想,内镜下止血具有稳定好、安全性高的优势,而联合止血的再出血率比较低。在临床实际应用时应根据患者的实际情况选择合适的止血手段。

Objective To observe the clinical effects of four hemostasis methods,including injection of adrenalin,hemostasis with titanium clip,electrocoagulation and hemostasis,combined hemostasis on non variceal upper gastrointestinal bleeding.Methods Eighty cases of non variceal upper gastrointestinal bleeding patients(treated from January 2016 to June 2017)were selected as the research object,and were randomly divided into groupⅠ,groupⅡ,groupⅢandⅣgroup.GroupⅠwas treated with injection of adrenalin solution,groupⅡwas treated with titanium clip,groupⅢwas treated with electrocoagulation and hemostasis,groupⅣwas treated with combined hemostasis,the hemostatic effect of four groups were compared.Results The immediate hemostasis,rebleeding and effective hemostasis were 80%,40%and 60%of GroupⅠ,groupⅡwere 75%,30%and 70%,groupⅢwere 65%,35%and 65%,group IV were 100%,5%and 95%.The immediate hemostasis rate in group IV was significantly higher than that of the other three groups(P<0.05),there were no difference in the rate of occurrence of immediate hemostasis of groupⅠ,groupⅡand groupⅢ(P>0.05).There were no difference in the rebleeding rate of groupⅠ,groupⅡand groupⅢ(P>0.05);The rebleeding rate in group IV was significantly higher than that of the other three groups(P<0.05).There were no difference in the effective hemostasis of groupⅠ,groupⅡand groupⅢ(P>0.05);The effective hemostasis in group IV was significantly higher than that of the other three groups(P<0.05).Conclusion The effect of endoscopic hemostasis is ideal for patients with non variceal upper gastrointestinal bleeding.Endoscopic hemostasis has the advantage of good stability and safety,while the rebleeding rate of combined hemostasis is low.In clinical practice,appropriate hemostatic means should be selected according to the actual situation of the patients.