消化性溃疡出血的Forrest分级与内镜治疗

上消化道出血是临床常见的急症之一,在全球范围内,其年患病率为（48～160）／10……6,病死率高达10％～14％。上消化道出血中以急性非静脉曲张性上消化道出血（nonva—riceal upper gastrointestinal bleeding,NVUGIB）最为常见,而消化性溃疡出血又是NVUGIB中最主要的一种。     

内镜下注射结合静注法莫替丁治疗消化性溃疡活动性出血疗效观察

20 0 0年 1～ 1 2月 ,我们采用随即对照的研究方法 ,对内镜注射结合静注抑酸药法莫替丁与单用法莫替丁治疗溃疡活动性出血进行疗效对照观察。现报告如下。1　资料与方法1 . 1　一般资料　同期收治 48例消化性溃疡活动性出血患者 ,均经急症胃镜检查确诊。胃镜下可见动脉喷血、活动性渗血和血管暴露等表现 ,合并有严重并发症如心力衰竭、呼吸衰竭、脑血管意外、尿毒症及肝性脑病者除外。随机分为两组 :1 组 :2 4例。男1 8例 ,女 6例 ;年龄 2 8～ 62岁。 2 组 :2 4例。男 1 9例 ,女 5例 ,年龄 2 4～ 65岁。两组患者的病情、伴随病及内镜表现…     

内镜下注射治疗消化性溃疡并出血的临床应用评价

目的探讨内镜下注射止血的临床意义。方法2001年7月至2002年8月因呕血和(或)黑便入院，经紧急内镜检查确诊为消化性溃疡并出血患81例．分成内科保守治疗和内镜注射止血治疗二组，内镜组在内科保守治疗的基础上，内镜下于出血灶注射HLGE液。结果内镜组42例，止血成功率95．24％，对照组39例，止血成功率79．49％，二组有显性差异。结论内镜注射止血治疗简单有效，降低手术率和再出血率。     

内镜治疗血凝块附着消化性溃疡的探讨

目前对活动性及可见血管残端的消化性溃疡出血内镜治疗是很有效的，然而对血凝块附着的消化性溃疡是否需内镜治疗尚有争议。我们对此类没有活动性出血患者进行内镜治疗，并与内科药物治疗进行对照分析，现总结如下。     

内镜下注射治疗消化性溃疡出血的护理

内镜下注射肾上腺素或鱼肝油酸钠已成为消化性溃疡出血的主要治疗方法。1995—06／2004—09，我们共有98例消化性溃疡出血病人应用内镜注射治疗，取得了满意的疗效。现将护理体会总结报告如下。     

内镜下注射肾上腺素治疗老年消化性溃疡出血21例

老年性消化性溃疡,临床表现不典型,尤其以上消化道出血表现为主发生率很高,出血量大,不易止血,并复发出血机会多,死亡率高。本院1996年10月—1999年2月间,共发现60岁以上溃疡病28例,其中以出血表现为主21例,在内镜下用肾上腺素注射治疗取得成功,现报告如下。     

内镜局部注射治疗消化性溃疡出血的临床观察

探讨一种疗效好,可靠,副作用少,操作简单的内镜下止血方法。以高渗盐水立止血内下注射治疗消化性溃疡出血患者７７例为治疗组,立即止血率９７．９％,再出血率２．５％。     

内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察

目的 观察内镜电凝止血术与内镜组织胶注射术治疗对消化性溃疡伴出血患者的临床疗效。方法 回顾性分析2021年1月至2023年1月亳州市人民医院收治的因消化性溃疡所致上消化道出血的86例患者的临床资料,根据治疗方案的不同,将患者分为对照组(内镜组织胶注射)46例和观察组(内镜电凝止血)40例。统计并比较两组患者的一般基线资料(年龄、性别、体重指数、病程、Forrest分级、溃疡类型、血红蛋白水平)、疗效、术中内镜下止血率、术后1周内再出血率和异位栓塞率、病情康复相关指标(呕血消失时间、住院时间、潜血转阴时间)及不良反应发生率。结果 两组患者的一般基线资料比较差异无统计学意义(P> 0.05)。观察组的治疗总有效率高于对照组(P <0.05)。观察组的术中内镜下止血率显著高于对照组(P <0.05),术后1周内再出血率显著低于对照组(P <0.05),两组术后1周内异位栓塞率比较差异无统计学意义(P>0.05)。观察组的病情康复相关指标显著优于对照组(P <0.001)。两组患者的不良反应总发生率差异无统计学意义(P> 0.05)。结论 内镜电凝止血...     

Current endoscopic and pharmacological therapy of peptic ulcer bleeding

Peptic ulcer bleeding is the most significant complication of ulcer disease, remaining the most important reason for upper gastrointestinal bleeding even in the era of Helicobacter eradication. Endoscopic triage and management plays a vital role in the handling of these patients, albeit in close collaboration with radiological and surgical expertise. Injection therapy, preferably with large volume epinephrine remains a core technology. Histoacryl and fibrin glue are more costly and less widely adopted alternatives. Mechanical measures are attractive and clips offer an excellent solution, particularly in soft tissues, and in combination with initial injection. Thermal methods with coagulation and coaptive axial force have similar performance characteristics. Increasingly, the combination of injection therapy with either a mechanical or thermal method appears the best option to achieve permanent haemostasis. PPIs for potent acid inhibition improves the clotting regardless of other treatment modalities. In the setting of rebleeding, patient and ulcer factors determine whether repeat endoscopy should be attempted, but the surgeon should be close at hand in this situation.     

Large-volume endoscopic injection of epinephrine plus normal saline for peptic ulcer bleeding

BACKGROUND AND AIM: Large-volume endoscopic injection of epinephrine has been proven to significantly reduce rates of recurrent peptic ulcer bleeding. Injection of normal saline may be equally effective for the similar hemostatic effect of local tamponade. The aim of our study was to compare the therapeutic effects of large-volume (40 mL) endoscopic injections of epinephrine, normal saline and a combination of the two in patients with active bleeding ulcers. METHOD: A total of 216 patients with actively bleeding ulcers (spurting or oozing) were randomly assigned to three groups (1:10,000 epinephrine, normal saline or diluted epinephrine plus normal saline). The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS: The initial hemostatic rate was significantly lower in the normal saline group (P < 0.05). The volume of injected solution required for the arrest of bleeding was significantly larger in the normal saline group (P < 0.01). Mean duration for arrest of bleeding was significantly longer in the normal saline group (P < 0.01). There were no significant differences between the three groups with respect to the rates of recurrent bleeding, surgical intervention, 30-day mortality, amount of transfusion and duration of hospitalization. Significant elevation of systolic blood pressure (P < 0.05) and persistent high pulse rate after endoscopic injection were observed in the epinephrine group. CONCLUSIONS: For patients with active bleeding ulcers (spurting or oozing), we recommend a large-volume (40 mL) combination injection using diluted epinephrine to cease bleeding, followed by injection of normal saline to achieve sustained hemostasis.     

Limitations of endoscopic haemostasis by ethanol injection and surgical management for bleeding peptic ulcer

Abstract Two hundred and fifty-three patients with bleeding peptic ulcer underwent therapeutic endoscopy using local ethanol injection and were evaluated to determine the need for surgery and outcome. Permanent endoscopic haemostasis was achieved in 178 (70.4%) cases. Pulsatile arterial bleeding in ulcers and shock on admission (respectively, P < 0.01, P < 0.05) were significantly more frequent in patients with unsuccessful endoscopic treatment. Postoperative stay was significantly longer ( P < 0.05) for patients with bleeding peptic ulcer than for patients requiring surgery for intractable ulcer without bleeding. Surgery was recommended if three attempts at endoscopic treatment did not achieve permanent haemostasis. The need for more than three such treatment sessions and the presence of a large excavated ulcer with an exposed vessel in an elderly patient were considered to indicate the necessity for surgery. Surgical procedures to which the operator is accustomed and intensive management were recommended for emergency cases to optimize the likelihood of survival.     

消化性溃疡出血急诊内镜检查220例分析

１９９０年１月～１９９５年２月．对２２０例消化性溃疡出血病人进行了急诊内镜检查。急诊内镜检查在 ２４～４８ ｈ内完成。内镜所见的出血类型参照Ｆｏｒｒｅｓｔ所建议的分类标准，其中ＦⅠａ４例（１．８％）．ＦⅠｂ２８例（１２．７％），ＦⅡａ２８例（１２．７％）．ＦⅡｂ１２０例（５４．５％）和ＦⅢ ４０例（１８．２％）。结果显示，球部溃疡出血明显多于胃溃疡（６１８％比２９．１％， Ｐ ＜０． ００５）；出血发生率与年龄有明显关系，以中年组发生率最高，占６０％．依次为青年组（２９．１％），老年组（１０．９％）。出血征象ＦⅠａ以老年组居多．其他各型均以中年组占多数。     

Endoscopic hemoclip treatment for bleeding peptic ulcer

AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.     

药物注射联合氩离子凝固对消化性溃疡出血的疗效分析

目的 比较内镜下药物注射联合氩离子凝固治疗及单一治疗对上消化道溃疡出血的疗效.方法 将303例内镜下有活动出血的溃疡患者分为3组.157例接受内镜下药物注射止血治疗,51例接受氩离子凝固止血治疗,95例接受药物注射联合氩离子凝固治疗.结果 三种方法的即时止血率均为100%,有效止血率在药物注射组、氩离子及联合治疗组分别为为87.9%、86.3%、91.6%,三组比较无统计学差异(P>0.05).所有病例无穿孔及其它术后并发症.结论 药物注射联合氩离子凝同治疗为安全有效的止血方法,但并没有显著提高止血率.     

内镜下注射结合静脉注射奥美拉唑对消化性溃疡活动性出血的疗效

目的观察内镜注射治疗联用不同剂量的奥美拉唑(OME)及单用OME对消化性溃疡活动性出血患者的疗效。方法采用随机对照的方法。把101例内镜下有活动性出血的消化性溃疡出血患者,随机分为3组,分别接受①内镜注射止血治疗联用每天2次静脉注射OME40mg,疗程5d;②内镜注射止血治疗联用每天1次静脉注射OME40mg,疗程5d;③单用每天2次静脉注射OME40mg,疗程5d。治疗期间观察患者的止血时间、输血量、再出血情况及住院时间。结果3组患者的再出血率为3/35(8.6％),9/32(28.1％),15/34(44.1％),差异有显著性(P＜0.05);手术率1/35(2.9％),2/32(6.3％),7/34(20.6％),差异有显著性(P＜0.05);死亡率0/34(0％),1/32(3.1％),1/34(2.9％),差异无显著性(P＞0.05);输血量(3.7±2.7)单位(每单位=200m1),(5±2.5)单位,(2.5±2.4)单位,差异无显著性(P＞0.05);止血时间分别为(1.8±1.5)d,(3.8±1.9)d,(5.5±2.1)d,差异有显著性(P＜0.05);住院时间(8.7±2.5)d,(15.7±6.9)d,(17.1±8.3)d,差异有显著性(P＜0.05)。结论内镜注射治疗联用每天2次静脉注射40mgOME疗效最好o     

内镜下注射治疗消化性溃疡出血

目的 探讨内镜下注射止血的临床应用及意义。方法 2001年7月至2002年8月因呕血和（或）黑便入院，经紧急内镜检查确诊为消化性溃疡并出血患者81例，分成内科保守治疗和内镜注射止血治疗二组，内镜组在内科保守治疗的基础上于出血灶注射HLGE液。结果 内镜组42例，止血成功率95.24％，对照组39例，止血成功率79．49％，二组有显著性差异。结论 内镜注射止血治疗简单有效，可降低手术率和再出血率。