内镜止血治疗急性非静脉曲张性上消化道出血的临床观察

Clinical observation on endoscopic hemostasis in the treatment of acute nonvariceal upper gastrointestinal bleeding

目的:分析急性非静脉曲张上消化道出血(ANVUGIB)内镜治疗的临床效果。方法:回顾性分析我院收治的86例接受内镜止血治疗的ANVUGIB患者的临床资料,内镜止血方法包括注射、喷洒药物、机械止血、热凝及联合止血,且所有患者均完成Rockall再出血风险评估,分析内镜止血治疗ANVUGIB的可行性。结果:(1)86例患者首次内镜止血成功成功率为94.19%,再出血率为13.95%;(2)低危组肾上腺素注射止血、联合止血成功率为100.00%;中危组机械止血、热凝止血成功率为100.00%;高危组联合止血成功率较高,为91.67%;(3)Forrest分级为Ⅱ级的患者止血成功率较高,病变直径≥2cm患者内镜止血成功率降低,机械止血及热凝止血再出血率为0,联合止血再出血率高(16.67%),其次为喷洒药物止血(14.29%)。结论:对ANVUGIB患者作内镜下止血处理,微创,且止血成功率高,患者术后恢复速度快,再出血发生率低。

Objective To analyze the clinical effect of endoscopic treatment for acute non-variceal upper gastrointestinal bleeding(ANVUGIB). Methods The clinical data of 86 patients with ANVUGIB who received endoscopic hemostasis in our hospital were retrospectively analyzed. Endoscopic hemostasis methods included injection, spraying drugs, mechanical hemostasis, thermocoagulation and combined hemostasis, and all patients completed the Rockall rebleeding risk assessment. The feasibility of endoscopic hemostasis in the treatment of ANVUGIB was analyzed. Results The success rate of endoscopic hemostasis in 86 patients was 94.19%, and the rebleeding rate was 13.95%. The success rate of epinephrine injection hemostasis and combined hemostasis in the low-risk group was 100.00%. The success rate of mechanical hemostasis and thermocoagulation hemostasis in the middle-risk group was 100.00%. The success rate of combined hemostasis in the high-risk group was 91.67%. The success rate of hemostasis was high in patients with Forrest grade II, and the success rate of endoscopic hemostasis was low in patients with lesions ≥ 2 cm. The rebleeding rate after mechanical hemostasis and thermocoagulation hemostasis was 0 while the rebleeding rate after combined hemostasis was high(16.67%), followed by spraying drugs(14.29%). Conclusion The application of endoscopic hemostasis in patients with ANVUGIB is minimally invasive, and the success rate of hemostasis is high. Patients can recover quickly after surgery, and the incidence of bleeding is low.