上消化道出血358例急诊胃镜分析

目的了解上消化道出血的病因及急诊胃镜检查在上消化道出血的临床应用价值。方法358例上消化道出血患者来诊后或入院后立即进行胃镜检查，对生命体征不稳定及高龄患者建立静脉通道、补液、制酸、止血、输血、多功能心电监护，血压恢复后即行胃镜检查，用Forrest分类法作为判断出血依据。结果358例患者中消化性溃疡232例（65．0％），急性胃黏膜病变50例（14．0％），胃癌31例（8．6％），食管胃底静脉曲张破裂出血27例（7．5％），Dieulafoy病7例（1．9％），Mallory-Weiss综合征4例（1．2％），7例未找出明确的出血灶。无一例病情加重或死亡。结论上消化道出血常见病因为消化性溃疡、急性胃黏膜病变、胃癌、食管胃底静脉曲张破裂出血，Dieulafoy病，急诊胃镜检查可提高诊断阳性率，且安全。

Emergency gastroscopy for 358 case of upper Gastrointestinal hemorrhage

Objective To study the cause of the upper gastrointestinal hemorrhage and the clinical practice value of emergency gastroscopy in the upper gastrointestinal hemorrhage. Methods After visiting or admission, the 358 cause of upper gastrointestinal hemorrhage received the gastroscopy immediately. The patients with unstable life signs and the advanced age patient were given the establishement of the vein channel, the fluid infusion, the restraint acid, the hematischesis, the blood transfusion, the multi-purpose heart electricity guardianship, on the basis of patients condition and immediately the gastroscopy, after the blood pressure restored. The hemorrhage was judged on the basis of the Forrest classification. Results Of 358 cases digestive ulcer were found in 232 cases （65.0%）, the acute stomach mucous membrane pathological change in 50 cases （14.0%）, the stomach cancer in 31 cases （8.6%）, the esophageal and gastric fundus varices hemorrhage in 27 cases （7.5%）, Dieulafoy disense in 7 cases （ 1.9% ）, Mallory-Weiss syndrome in 4 cases （ 1.2% ） ,no definite bleeding focus in 7 cases. No worse or death case occurred during emergency gastroscopy. Conclusion The common causes of upper gastrointestinal hemorrhage are the digestive ulcer, the acute stomach mucous membrane pathological change, the stomach cancer, the esophageal and gastric fundus varices hemorrhage, the Dieulafoy disease. The emergency gastroscopy may enhance the diagnosis rate, and it is safe.