张秀莲 关聪聪 陈飞旭

【摘要】 目的：探讨急性非静脉曲张性上消化道出血（ANVUGIB）患者开展内镜止血的临床效果及对住院时间、止血时间的影响。方法：开展回顾性分析，病历资料选取于2019年1月—2022年12月，对象为北京市健宫医院收治的80例ANVUGIB患者，根据治疗方法的不同分为对照组（予以常规内科止血治疗）与观察组（实行内镜止血），各40例。观察对比两组治疗效果、止血成功率和再出血率、治疗指标、凝血功能指标、血红蛋白、血氧饱和度、动脉血氧分压、急性生理和慢性健康状况评价Ⅱ（APACHEⅡ）评分。结果：相比于对照组，观察组总有效率高（95.00% vs 77.50%）（P<0.05）。与对照组相比，观察组止血时间、住院时间均明显短，出血量显著少（P<0.05）。相比于对照组，观察组止血成功率高，再出血率低（P<0.05）。治疗后，观察组PT、TT水平均短于对照组（P<0.05）。治疗后，两组血红蛋白、血氧饱和度、动脉血氧分压均较治疗前升高，APACHEⅡ评分均较治疗前下降，且观察组均优于对照组（P<0.05）。结论：ANVUGIB患者实施内镜止血，可取得确切疗效，止血速度快，且降低再出血风险，有利于维持患者生命体征稳定，加快疾病康复进程，缩短住院时间，取得良好预后。

【关键词】 急性非静脉曲张性上消化道出血 内镜止血 住院时间

Effect of Endoscopic Hemostasis in the Treatment of Acute Nonvariceal Upper Gastrointestinal Bleeding/ZHANG Xiulian， GUAN Congcong， CHEN Feixu. //Medical Innovation of China， 2024， 21（14）： 005-009

[Abstract] Objective： To explore the clinical effect of endoscopic hemostasis in patients with acute nonvariceal upper gastrointestinal bleeding （ANVUGIB） and its influence on hospitalization time and hemostasis time. Method： Retrospective analysis was carried out， the medical records were selected from January 2019 to December 2022， 80 patients admitted to Beijing Jiangong Hospital were selected as suljects， they were divided into control group （given routine internal hemostasis） and observation group （given endoscopic hemostasis） by different treatment methods， with 40 cases in each group. The treatment effects， the success rate of hemostasis and the incidence of rebleeding， therapeutic indexes， coagulation indexes， hemoglobin， blood oxygen saturation， arterial oxygen partial pressure， acute physiological and chronic health evaluation Ⅱ （APACHEⅡ） score were observed and compared between the two groups. Result： Compared with control group， the total effective rate of observation group was higher （95.00% vs 77.50%） （P<0.05）. Compared with the control group， the time of hemostasis， the hospital stay in the observation group were significantly shorter， and the amount of blood loss was significantly less （P<0.05）. Compared with control group， hemostasis success rate in the observation group was higher， rebleeding rate was lower （P<0.05）. After treatment， the levels of PT and TT in the observation group were significantly shorter than those in the control group （P<0.05）. After treatment， hemoglobin， blood oxygen saturation and arterial oxygen partial pressure were increased compared to those before treatment， APACHEⅡ scores were decreased， and those in observation group were better than those in the control group （P<0.05）. Conclusion： Endoscopic hemostasis in patients with ANVUGIB can achieve exact efficacy， fast hemostasis， and reduce the risk of rebleeding， which is conducive to maintaining the stability of patients' vital signs， accelerating the process of disease recovery， shortening the length of hospital stay， and achieving a good prognosis.

[Key words] Acute nonvariceal upper gastrointestinal bleeding Endoscopic hemostasis Hospital stay

First-author's address： Department of Gastroenterology， Beijing Jiangong Hospital， Beijing 100054， China

doi：10.3969/j.issn.1674-4985.2024.14.002

急性非静脉曲张性上消化道出血（acute nonvariceal upper gastrointestinal bleeding，ANVUGIB）主要为屈氏韧带以上的消化道出血，包括胃、十二指肠、食管等部位。多种疾病均可导致ANVUGIB，常见有消化性溃疡、胃肠道肿瘤、血管畸形、食管贲门黏膜撕裂等[1]。ANVUGIB主要症状表现有呕血、黑便、头晕等，或伴有心率异常、血压下降等情况，发病突然、进展迅速，几小时内出血可达总循环血量的20%，病情危重，如果未能及时开展治疗，对患者生命构成巨大威胁。因此，该类疾病及时止血是对患者生命安全的有效保障。既往对于本病的止血治疗措施以保守方法为主，在一定程度上可实现有效止血，但治疗后再次出血的问题较为突出[2]。内镜技术用于消化系统疾病诊疗中，不仅止血成功率明显提升，同时后期再出血风险大大下降，内镜技术下的止血措施常见的有内镜出血点喷洒药物、药物注射、机械止血、热凝止血等[3]。……