内镜下不同止血方案治疗上消化道出血的疗效对比

Comparison of therapeutic effect of different endoscopic hemostatic procedures on upper gastrointestinal bleeding

目的探讨内镜下不同止血方案对上消化道出血(UGIB)的治疗效果。方法回顾性分析85例UGIB患者的资料,根据治疗方案的不同分为A组(30例,行内镜下注射药物止血)、B组(27例,行内镜下喷洒药物止血)、C组(28例,行内镜下金属钛夹止血)。比较三组患者的止血效果、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]与氧化应激指标[皮质醇(Cor)、丙二醛(MDA)]、并发症发生情况。结果A、B组首次止血成功率分别为73.33%、55.56%,均低于C组的92.86%(χ^(2)=3.869、10.079,P=0.049、0.001<0.05);A组与B组止血成功率对比无显著差异(χ^(2)=1.972,P=0.160>0.05)。治疗后,A组、B组、C组的PT分别为(11.43±1.27)、(12.75±1.14)、(10.19±1.07)s,APTT分别为(30.14±1.26)、(31.26±1.38)、(28.32±1.47)s。C组PT、APTT短于A组及B组,A组PT、APTT短于B组(P<0.05)。治疗后,A组、B组、C组的Cor分别为(295.54±24.35)、(319.58±23.47)、(276.89±23.18)ng/ml,MDA分别为(8.25±0.93)、(9.36±0.91)、(7.28±0.82)μmol/L。C组Cor、MDA水平低于A组及B组,A组Cor、MDA水平低于B组(P<0.05)。三组并发症发生率对比无显著差异(P>0.05)。结论内镜下注射药物、喷洒药物及金属钛夹止血对UGIB的治疗效果存在一定差异,其中,金属钛夹的首次止血率远高于其他两种方法,且对患者的凝血功能与应激反应的改善效果更好,同时不会增加并发症发生率。

Objective To explore the therapeutic effect of different endoscopic hemostatic procedures on upper gastrointestinal bleeding(UGIB).Methods The data of 85 patients with UGIB were retrospectively analyzed,and they were divided into group A(30 cases undergoing endoscopic injection for hemostasis),group B(27 cases undergoing endoscopic spray for hemostasis),and group C(28 cases undergoing endoscopic hemoclip for hemostasis)according to the different treatment plans.Comparison was made on hemostatic effect,coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT)]and oxidative stress indexes[cortisol(Cor)and malondialdehyde(MDA)],and the occurrence of complications among the three groups.Results The success rates of first hemostasis in group A and group B were 73.33%and 55.56%,which was lower than 92.86%in group C(χ^(2)=3.869,10.079,P=0.049,0.001<0.05).There was no significant difference in the comparison of hemostatic success rate between group A and group B(χ^(2)=1.972,P=0.160>0.05).After treatment,the PT of group A,group B and group C were(11.43±1.27),(12.75±1.14)and(10.19±1.07)s,and the APTT were(30.14±1.26),(31.26±1.38)and(28.32±1.47)s,respectively.PT and APTT in group C were shorter than thhose in group A and group B;PT and APTT in group A were shorter than those in group B(P<0.05).After treatment,Cor in group A,group B and group C were(295.54±24.35),(319.58±23.47),(276.89±23.18)ng/ml,and MDA were(8.25±0.93),(9.36±0.91),and(7.28±0.82)μmol/L,respectively.The levels of Cor and MDA in group C were lower than those in group A and group B;the levels of Cor and MDA in group A were lower than those in group B(P<0.05).There was no significant difference in the comparison of complication rates among the three groups(P>0.05).Conclusion There are some differences in the therapeutic effects of endoscopic injection,spraying of drugs and hemoclip for hemostasis of UGIB.Among them,the initial hemostasis rate of hemoclip is much higher than that of the other two methods,and it has a better effect on the improvement of coagulation function and stress response of patients,without increasing the incidence of complications.