内镜下组织胶联合药物注射治疗急性非静脉曲张性上消化道出血的疗效及安全性研究

Tissue adhesive combined with medication injection via endoscopy in the treatment of acute non-variceal upper gastrointestinal bleeding: a research of the efficacy and safety

目的分析内镜下组织胶联合药物注射治疗急性非静脉曲张性上消化道出血(ANVUGIB)的临床效果与安全性。方法选取ANVUGIB患者82例,根据治疗方案分为研究组和对照组,各41例。在常规治疗基础上,对照组给予内镜下金属钛夹治疗或出血病灶黏膜下注射1∶10000的肾上腺素治疗,研究组予内镜下组织胶联合药物注射裸露血管治疗。比较两组的手术指标(输血量、止血时间、住院时间)、临床疗效、止血成功率、再出血率及并发症情况。结果研究组的输血量少于对照组,止血时间及住院时间短于对照组;研究组的总有效率明显高于对照组(97.56%vs.78.05%,均P<0.05);两组患者的止血成功率、迟发性再出血率比较,差异无统计学意义(均P>0.05);研究组的术后早期再出血率明显低于对照组(P<0.05);治疗后1~2个月,两组患者均未出现消化道穿孔以及感染等并发症,预后效果较好。结论内镜下组织胶联合药物注射治疗ANVUGIB的效果显著,可有效减少输血量、缩短止血时间及住院时间,降低患者再出血发生率,且安全性高,值得临床推广应用。

Objective To analyze the clinical effect and safety of tissue adhesive combined with medication injection via endoscopy in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods A total of 82 patients with ANVUGIB were selected,and they were divided into study group and control group according to the treatment options,with 41 cases in each group.On the basis of routine treatment,the control group was given metal titanium clips or submucosal injection of 1∶10000 adrenaline in bleeding lesions via endoscopy,while the study group received tissue adhesive combined with medication injection of exposed blood vessels via endoscopy.The surgical indicators(blood transfusion volume,hemostasis time,hospitalization time),clinical efficacy,success rate of hemostasis,rebleeding rate and complications were compared between the two groups.Results Compared with the control group,the study group yielded less volume of blood transfusion,shorter time of hemostasis and hospitalization,and higher total effective rate(97.56%vs.78.05%,all P<0.05).There were no statistically significant differences in hemostasis success rate and delayed rebleeding rate(all P>0.05).The study group yielded lower rate of early postoperative rebleeding as compared with the control group(P<0.05).After 1 to 2 months of treatment,no complications including gastrointestinal perforation and infection occurred in both groups,with a preferable effect of prognosis.Conclusion Tissue adhesive combined with medication injection via endoscopy has a significant effect in the treatment of ANVUGIB,which can effectively reduce the volume of blood transfusion,shorten the time of hemostasis and hospitalization,decrease the incidence of rebleeding,with high safety,and thus it is worthy of clinical promotion and application.