何远琴+梁若玲+王丽萍+赖敏莉

摘 要 目的：探讨胃镜下注射联合钛夹在降低急性非静脉曲张上消化道出血风险中的应用价值。方法：回顾性分析201例急性非静脉曲张上消化道出血患者的临床资料，根据治疗方法的不同分为对照组96例和研究组105例。对照组患者采用胃镜下注射肾上腺素治疗，研究组采用胃镜下注射肾上腺素联合金属钛夹止血治疗。比较两组患者治疗后的即时止血率、有效止血率、72 h再出血率及外科手术率。记录两组患者的出血量、输血量、住院时间及并发症发生情况。结果：治疗后，研究组患者的即时止血率、有效止血率、72 h再出血率和外科手术率均优于对照组（P<0.05）；研究组患者的出血量、输血量和住院时间显著低于对照组（P<0.05）。结论：胃镜下注射肾上腺素联合钛夹治疗急性上消化道出血可有效缩短出血时间和住院时间，降低再发出血的风险。

关键词 胃镜 肾上腺素 金属钛夹 上消化道出血

中图分类号：R573.2 文献标识码：B 文章编号：1006-1533（2017）11-0035-04

Application of epinephrine injection combined with titanium clip hemostasis under gastroscopy in 105 patients with acute upper gastrointestinal bleeding*

HE Yuanqin1**， LIANG Ruoling1， WANG liping1， LAI Minli2（1. Department of Gastroenterology， the Second Peoples Hospital of Foshan City， Foshan 528000， China；

2. Endoscopy Center， the Second Peoples Hospital of Foshan City， Foshan 528000， China）

ABSTRACT Objective： To investigate the value of epinephrine injection combined with titanium clip under gastroscopy in reducing the risk of acute non-variceal upper gastrointestinal bleeding. Methods： The clinical data from 201 patients with acute non-variceal upper gastrointestinal bleeding were retrospectively analyzed and all the patients were divided into a control group with 96 cases and a study group with 105 cases based on the different treatment methods. All the patients underwent epinephrine injection under gastroscopy while the patients in the study group underwent titanium clip hemostasis additionally. The immediate hemostasis rate， effective hemostasis rate， 72 h rebleeding rate and surgical rate were compared between the two groups after treatment. The amount of bleeding and blood transfusion， the time for hospital stay and the incidence of complications were recorded. Results： After treatment， the immediate hemostasis rate， effective hemostatic rate， 72 h rebleeding rate and surgical rate were better and the amount of bleeding and blood transfusion， the time for hospital stay and the incidence of complications were significantly less in the study group than in the control group （P<0.05）. Conclusion： The therapy of epinephrine injection combined with titanium clip hemostasis under gastroscopy for the acute upper gastrointestinal bleeding can effectively shorten the bleeding time and hospitalization time and reduce the risk of recurrent bleeding.

KEY WORDS gastroscopy； epinephrine； titanium clip； upper gastrointestinal bleeding

急性非靜脉曲张上消化道出血是消化内科常见的急症之一，是指除静脉曲张之外所致的上消化道出血，临床表现为呕血、黑便等出血症状，常伴有因血容量减少而引起的急性周围循环障碍，如不进行及时有效的治疗，可危及患者的生命[1]。内镜治疗急性非静脉曲张上消化道出血具有快速、准确、对机体损伤小等特点，现已广泛应用于临床[2]。常见的内镜下治疗手段有结扎止血、钛夹止血、药物喷洒及局部注射等，均具有较好的治疗效果[3]。为了进一步改善患者抢救过程中止血的有效性，降低患者再出血风险，本研究采用胃镜下注射肾上腺素联合钛夹治疗急性上消化道出血。……