急性非静脉曲张性上消化道出血常规内镜下止血后再出血的血管栓塞术治疗价值

2017年4月—2020年6月,因急性非静脉曲张性上消化道出血（acute non?variceal upper gastrointestinal bleeding,ANVUGIB）行内镜下止血治疗（包括局部注射药物、电凝、止血夹和套扎等）后再出血,于中国科学技术大学附属第一医院消化内科接受内镜下血管栓塞术（endoscopic vascular embolization,EVE）治疗的病例共46例。46例经EVE治疗后均即刻止血,即刻止血有效率为100.0%。术后出现腹痛13例（28.3%）,腹胀3例（6.5%）,发热2例（4.3%）。术后3、12个月复查胃镜,黏膜逐渐愈合。随访至2021年6月,无一例消化道再出血发生。由此可见,EVE对于初次内镜止血失败的ANVUGIB患者是一种安全、高效的方法,值得临床进一步研究和推广应用。     

内镜止血术治疗老年急性非静脉曲张性上消化道大出血的效果及再出血影响因素

目的探究内镜止血治疗老年急性非静脉曲张性上消化道出血(ANVUGIB)患者的效果及再出血的影响因素。方法老年ANVUGIB患者182例,根据治疗方案不同分为研究组(93例,内镜下钛夹止血)、对照组(89例,内镜下注射药物止血)。比较两组治疗效果,根据内镜止血有效后是否发生再出血分为再出血组、非再出血组,采用Logistic回归分析老年ANVUGIB患者内镜止血成功后发生再出血的影响因素。结果研究组引流变清、呕血消失、潜血转阴时间均显著短于对照组(P0.05)。研究组即时止血93例(100.00%)、有效止血92例(98.92%),分别高于对照组的83例(93.26%)、79例(88.76%);止血有效后再出血6例(6.45%),明显低于对照组的26例(29.21%),差异均有统计学意义(P0.05)。Logistic结果显示,年龄≥75岁、有重要器官并发症、Blatchford评分≥6分、Rockall评分≥5分、Forrest分级Ⅰa级、休克指数增高是内镜止血有效后发生再出血的危险因素(P0.05),而HGB增高是保护性因素(P0.05)。结论内镜下钛夹止血可加快老年ANVUGIB患者临床症状的改善,提高止血效果;年龄≥75岁、有重要器官并发症、Blatchford评分≥6分、Rockall评分≥5分、Forrest分级Ia级、休克指数增高是再出血危险因素,临床应加强监测和干预。     

动脉栓塞治疗上消化道动脉性大出血

临床上惯用的处理上消化道非静脉曲张出血的模式是药物治疗-内镜治疗-手术治疗。但经药物及内镜治疗后仍不能止血的患者病情均较严重，快速止血是迫切的问题。我们将19例经药物治疗、内镜治疗无效的上消化道动脉性大出血患者行经股动脉插管腹腔动脉造影和栓塞治疗的结果报告如下。     

金属夹治疗上消化道非静脉曲张性大出血

１９９７年～１９９９年我们对２９例上消化道非静脉曲张急性出血患者应用Olympus内镜金属夹治疗取得了满意的疗效。１．一般资料：２９例患者中男１６例，女１３例；年龄１４～７８岁，平均４０．６岁。均有上消化道急性出血史，２４h内行急诊内镜检查。检查结果：胃溃疡１１例，十二指肠球部溃疡７例，胃癌３例，食管贲门粘膜撕裂症２例，胃息肉３例，Dieu－lafoy病１例，胃息肉内镜切除术后出血２例。出血按Forrest分类法：喷射性活动性出血（Ⅰa）１０例，渗出性活动出血（Ⅰb）１２例，血管显露（Ⅱa）７例。２．器械：Olympus－EVI…     

上消化道非静脉曲张性急性出血内镜止血夹治疗的护理体会

随着内镜技术及其它相关技术的发展，内镜止血已成为目前消化道出血的首选方法。特别对于急性活动性出血和内镜下可见血管残端裸露的消化道出血，内镜下金属夹止血更具快速而有效的特点，深受广大消化内镜医师的青睐。我们自2001～01／2003～11，共对23例上消化道非静脉曲张性急性出血的病人行胃镜下金属夹止血，疗效确切。现将其治疗和护理体会总结如下。     

非静脉曲张性上消化道出血

介绍非静脉曲张上消化道出血的诊断、处理,特别是内镜下的诊断、处理及预后的新进展。     

生长抑素联合泮托拉唑治疗老年急性非静脉曲张性上消化道大出血观察

目的 观察生长抑素联合泮托拉唑治疗老年急性非静脉曲张性上消化道大出血的治疗效果.方法 将80例老年急性非静脉曲张性上消化道大出血患者随机分成对照组(40例)和观察组(40例).两组均给予泮托拉唑静脉注射,治疗组加用生长抑素.两组持续用药72 h后,分别观察两组治疗后12 h、24 h、48h内的止血效果.结果 治疗组与对照组12 h止血率分别为75.0%和52.5%;24 h止血率分别为87.5%、67.5%;48 h止血率分别为97.5%、80.0%.两组12 h、24 h及48 h的有效率比较有统计学差异(均P＜0.05).结论 生长抑素联合泮托拉唑治疗老年非静脉曲张性上消化道大出血疗效肯定,止血速度快,止血成功率高,可降低急诊手术率和病死率.     

国产与进口生长抑素治疗非静脉曲张性上消化道大出血的对比研究

非静脉曲张性上消化道出血主要包括胃、十二指肠溃疡出血及急性胃黏膜病变,是临床常见的急症之一,进口生长抑素在治疗此类出血效果较好,但在基层医院因价格昂贵,临床使用受到一定限制.     

内镜治疗在急性非静脉曲张上消化道出血中的应用

急性非静脉曲张上消化道出血是临床常见的急危重症。内镜技术在急性非静脉曲张上消化道出血的治疗中有重要价值。近年此领域有了持续的新进展。本文即就内镜治疗对急性非静脉曲张上消化道出血的适宜治疗患者、治疗时机以及治疗方法和策略等方面给予简述。     

射频治疗在上消化道非静脉曲张出血的应用体会

上消化道非静脉曲张出血是消化内科常见急症之一，我院近2年采用射频治疗仪行内镜下止血治疗，取得了较好的疗效，现报道如下。     

Primary and secondary nonvariceal upper gastrointestinal bleeding

BACKGROUND: Upper gastrointestinal (UGI) bleeding is associated with a mortality rate of up to 14% in emergency hospital admissions (primary bleeding), and up to 28% in hospitalized patients (secondary bleeding). AIM: To characterize and compare the clinical pictures and outcome of primary and secondary nonvariceal UGI bleeding. STUDY: A retrospective, case-control design was used. The files of all consecutive patients admitted to our tertiary academic center between January 1, 2001 and December 31, 2002 for UGI bleeding were reviewed for demographic and clinical data, treatment details, number of blood transfusions, endoscopic procedures, surgical procedures, and mortality. RESULTS: Compared to primary UGI bleeding, secondary bleeding was associated with female sex, older age, more chronic diseases, intake of more drugs, hospitalization in internal medicine departments, longer hospital stay, fewer endoscopic procedures, and less Helicobacter pylori-related peptic ulcer disease. Total mortality rate in the secondary bleeders was 30.3% versus 4.6% in the primary bleeders (P<0.0001). There was no significant difference between primary and secondary bleeders in treatment with nonsteroidal anti-inflammatory agents or aspirin, severity of bleeding, or death related to gastrointestinal bleeding. CONCLUSIONS: Despite the significant differences in the clinical picture of primary and secondary bleeders, the severity of bleeding appear to be similar in both groups. Although there was a trend towards a higher gastrointestinal-related mortality in secondary bleeders, it was not statistically significant.     

急性非静脉曲张性上消化道出血诊治指南(2009,杭州)

一、定义 急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)系指屈氏韧带以上消化道非静脉曲张性疾患引起的出血,包括胰管或胆管的出血和胃空肠吻合术后吻合口附近疾患引起的出血,年发病率为50/10万～150/10万,病死率为6%～10%~([1-2]).     

Patient-reported outcomes after acute nonvariceal upper gastrointestinal hemorrhage

Abstract

Objective. Nonvariceal acute upper gastrointestinal bleeding (AUGIB) is often associated with significant blood loss and anemia. Both the bleeding episode itself and the subsequent anemia are likely to significantly impact a patient’s health-related quality of life (HRQoL). Treating the anemia is essential to increase the hemoglobin levels. The HRQoL impact has not been investigated. This longitudinal study aimed to determine the relationship between anemia, HRQoL, and fatigue in patients after nonvariceal AUGIB. Materials and methods. A total of 97 patients (51 males and 46 females; mean age 70 years) were followed in a longitudinal study with a 6-month follow-up. All patients had AUGIB and were anemic at inclusion. Anemia, HRQoL (EQ-5D-3L), and fatigue (using the Multidimensional Fatigue Inventory) were assessed at baseline, and at 1, 3, and 6 months. The patients were initially included in an iron supplementation study. Results. The patients’ HRQoL increased and their fatigue levels decreased from baseline to month 3 and month 6. Approximately half of the patients had full health at month 3; similar results were observed in the general population. Three and six months after the bleeding episodes, neither the HRQoL nor fatigue was affected by the anemia. Conclusion. This study did not uncover relationships between anemia and HRQoL or anemia and fatigue after nonvariceal AUGIB.     

急性非静脉曲张上消化道出血风险评估的临床研究

目的 探讨Rockall(RS)和Blatchford(BRS)评分系统对急性非静脉曲张上消化道出血(ANVUGIB)预后风险评估的准确性和临床实用性.方法 记录我院2009年1月至2009年12月间收治的195例符合研究标准及资料完整的ANVUGIB患者的临床资料,分别计算各患者RS和BRS分值进行危险分层,出院后随访30 d,并将死亡或出院后30 d的疾病转归作为临床研究终点.检验两评分系统对预后的预测能力.结果 195例患者中男150例,女45例,男女比例2.3:1.年龄15～85岁,平均(53.97±18.34)岁.年龄≥60岁患者(老年组)90例,年龄<60岁患者(非老年组)105例.生存182例(93.3%),死亡13例(6.7%),生存患者中再出血11例(5.6%).老年组患者病死率[12.2%(11/90)]、合并基础疾病率[43.3%(39/90)]及服阿司匹林[24.4%(22/90)]均高于非老年组患者[1.9%(2/105)、16.2%(17/105)和11.4%(12/105),P值均<0.05].RS预测死亡风险的曲线下面积(AUC)=0.742(P=0.004),预测再出血风险的AUC=0.469(P=0.101);BRS评分系统预测死亡风险AUC=0.493(P=0.067),预测再出血风险AUC=0.341(P=0.092).RS分值与住院天数呈正相关性,而BRS与住院天数关系无统计学意义.结论 RS评分系统对死亡预测能力良好,其分值高低与住院天数长短呈正相关,但对再出血预测能力较差.BRS对住院患者死亡和再出血预测能力均不理想,不适用于住院患者不良预后的风险预测.     

Diagnosis and management of nonvariceal upper gastrointestinal bleeding

Nonvariceal upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality worldwide. Despite the improvements in the management of this condition in western countries, mortality rates have remained at 5-10% over the past decade. This article presents the main recommendations for the management of UGIB. Pre-endoscopic management (including use of scoring scales, nasogastric tube placement and blood pressure stabilization) is crucial for triage and optimal resuscitation of patients, and should include a multidisciplinary approach at an early stage. Unless the patient has specific comorbidities, transfusion should only be considered if their hemoglobin level is ≤70 g/l. Endoscopic therapy, the cornerstone of therapeutic management of high-risk lesions, should not be delayed for more than 24 h following admission. Several endoscopic techniques, mostly using clips or thermal methods, are available and new approaches are emerging. When endoscopy fails, surgery or arterial embolization should be considered. Although the efficacy of prokinetics and high-dose intravenous PPI prior to endoscopy is controversial, the use of an intravenous PPI following endoscopy is strongly recommended. Antiplatelet therapy should be suspended and resumed in 3-5 days. Finally, all patients should be tested for Helicobacter pylori by serology in the acute setting.     

急性非静脉曲张性上消化道出血内镜止血成功后再出血的危险因素分析

目的探讨急性非静脉曲张性上消化道出血（ANVUGIB）首次内镜止血成功后再出血的危险因素。方法回顾ANVUGIB首次内镜止血成功患者316例,按3d内是否再出血分为再出血组（n=80）和无再出血组（n=236）,对比两组患者临床及辅助检查资料、内镜下表现、内镜治疗及后续治疗等变量的差异。单因素X^2检验选出差异有统计学意义的因素,并以之为自变量,是否再出血为因变量,行多因素Logistic回归分析,寻找再出血的危险因素。结果两组患者恶性肿瘤出血、抑酸药使用、血红蛋白、入院时休克、病灶喷射样出血、支持治疗情况、内镜治疗方法等差异有统计学意义（P〈0．05）。经向后删除法Logistic回归分析,保留在模型中的变量有单一方法内镜治疗（OR=5．383）、恶性肿瘤出血（OR=4．812）、无后续PPIs（OR=4．351）、HGB〈90g／L（OR=4．342）、病灶喷射样出血（OR=4．320）、支持治疗不足（OR=3．271）,其95％CI下限均大于1。结论单一方法内镜治疗、恶性肿瘤出血、无后续PPIs、血色素低、病灶喷射样出血、支持治疗不足是ANVUGIB首次内镜止血成功后再出血的危险因素。     

老年急性非静脉曲张性上消化道出血临床特点分析

目的总结分析急性非静脉曲张性上消化道出血≥75岁老年患者的临床特点,以便进一步了解该类患者的特殊性,为更好的临床诊治提供参考。方法回顾性分析165例于2006～2007年收住消化内科的非静脉曲张性上消化道出血患者的临床病历资料,其中老年组（≥75岁）96例,非老年组（〈60岁）59例,详细记录其临床表现、实验室检查、内镜下表现及伴随的其他系统疾病,并进行对比和分类分析。结果老年组与非老年组急性非静脉曲张性上消化道出血的首要原因均为溃疡病,老年组胃溃疡发病率（20.8%）高于非老年组（8.5%）（P〈0.05）,而非老年组十二指肠球部溃疡（57.6%）及复合性溃疡（15.3%）发病率高于老年组（39.6%及5.2%）（P〈0.05）,老年组急性糜烂出血性胃炎发病率（13.5%）明显高于非老年组（3.4%）（P〈0.05）,老年组有上腹痛和（或）上腹部压痛者（49%）低于非老年组（66.1%）（P〈0.05）。与非老年组比较,老年组伴随的其他系统疾病明显增高（P〈0.01）;应用阿司匹林/非甾体类抗炎药（NSAIDs）明显增多（P〈0.01）;血尿素氮数值明显增高（P〈0.01）;住院时间明显延长（P〈0.05）。2组幽门螺杆菌感染情况比较无显著性差异（P〉0.05）。结论≥75岁老年患者非静脉曲张性上消化道出血病情较非老年组重,住院时间长,治疗也较为复杂。对于老年组急诊内镜下诊治可以明确诊断,并可同时进行镜下止血治疗。     

急性非静脉曲张性上消化道出血临床分析

目的分析非静脉曲张性上消化道出血的临床特征。方法回顾分析我院消化内科2009年1月-2011年12月期间收治的经胃镜证实的301例非静脉曲张性上消化道出血病例,分析总结非静脉曲张性上消化道出血的常见病因及临床诊治情况。结果非静脉曲张性上消化道出血的常见病因依次为消化性溃疡、消化道肿瘤、急性胃黏膜病变,内科保守治疗的有效率为96.35%(290/301),内镜下止血成功率93.55%(58/62)。结论消化性溃疡是非静脉曲张性上消化道出血最常见的病因。在消化道出血的救治中,急诊内镜、选择性血管造影以及内外科的紧密配合与协作发挥着重要作用。     

Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspectives

Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata.