内镜下金属钛夹联合去甲肾上腺素喷洒对消化性溃疡出血患者凝血状态、炎症因子及并发症的临床观察

Clinical effects of endoscopic titanium clip combined with norepinephrine spray on coagulation status,inflammatory factors,and complications in patients with peptic ulcer bleeding

目的:探讨内镜下金属钛夹联合去甲肾上腺素喷洒对消化性溃疡出血患者凝血状态、炎症因子及并发症的临床观察。方法:选取2022年12月至2024年3月在我院确诊的60例消化性溃疡出血患者,随机分为基础组和联合组(n=30),分别采用内镜下金属钛夹治疗以及内镜下金属钛夹联合去甲肾上腺素喷洒治疗均持续治疗12 w。分别于治疗前、治疗3 d后,采用自动血凝仪测定联合组和基础组凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)、纤维蛋白原(Fibrinogen,Fbg)及凝血酶时间(Thrombin time,TT)等凝血指标;以酶联免疫吸附试验法测定血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子(Tumor necrosis factor,TNF)-α及白细胞介素(Interleukin,IL)-6水平。对比联合组和基础组止血效果,随访1 m,比较联合组和基础组患者生活质量,记录两组并发症发生情况。结果:治疗3 d后,联合组和基础组APTT、PT、TT、CRP、TNF-α及IL-6水平均降低,Fbg水平升高,且联合组优于基础组(P<0.05);联合组患者立即止血率、72 h止血率均高于基础组(P<0.05);随访1m,联合组的生活质量明显优于基础组(P<0.05);联合组并发症发生率为6.67%,基础组并发症发生率为13.33%,两组对比无明显差异(P>0.05)。结论:内镜下金属钛夹联合去甲肾上腺素喷洒治疗能改善消化性溃疡出血患者凝血状态,降低炎症因子水平,且安全性好。

Objective:To explore the clinical effects of endoscopic titanium clip combined with norepinephrine spray on coagulation status,inflammatory factors,and complications in patients with peptic ulcer bleeding.Methods:A total of 60 patients with peptic ulcer bleeding confirmed in the hospital were enrolled and randomly divided into a basic group(n=30,endoscopic titanium clip)and a combination group(n=30,endoscopic titanium clip combined with norepinephrine spray)between December 2022 and March 2024.All patients were treated for 12 weeks.Before and at 3 days after treatment,the levels of activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fbg),and thrombin time(TT)were detected by automatic coagulometer,the levels of serum C-reactive protein(CRP),tumor necrosis factor(TNF)-α,and interleukin(IL)-6 were detected by enzyme-linked immunosorbent assay.The hemostatic effect in the two groups was compared.After 1 month of follow-up,the quality of life in the two groups was compared,and the occurrence of complications in the two groups was recorded.Results:After 3 days of treatment,APTT,PT,TT,CRP,TNF-α,and IL-6 were decreased,while Fbg was increased in both groups,and the above indexes were better in the combination group than the basic group(P<0.05).The immediate hemostasis rate and 72 hours hemostasis rate in the combination group were higher than those in the basic group(P<0.05).After 1 month of follow-up,the quality of life in the combination group was significantly better(P<0.05).There was no significant difference in the incidence of complications between the combination group and the basic group(6.67%vs 13.33%,P>0.05).Conclusion:Endoscopic titanium clip combined with norepinephrine spray can improve coagulation status and reduce levels of inflammatory factors in patients with peptic ulcer bleeding,which has good safety.