急诊内镜检查对活动性上消化道出血的诊治评价

急诊内镜检查对活动性上消化道出血的诊治评价满桂琴，张志斌，罗晓赫我院自１９８８年以来急诊行内镜检查对活动性上消化道出血诊治２３例，获得很好效果，现将其价值评价如下。临床资料病人选自门诊就诊的出血后２４小时内行内镜检查２３例，给予局部止血治疗。男性２０...     

内镜下消化性溃疡并出血治疗的临床分析

目的探讨内镜下治疗消化性溃疡并出血的治疗效果及价值。方法对46例消化性溃疡并出血急诊内镜检查Forrest分级为Ⅰ级及Ⅱ级患者，初次均行内镜下局部注射1：10000肾上腺素盐水止血治疗，24h内再出血患者予再次注射治疗并联合电凝或止血夹治疗。结果46例患者初次内镜下治疗均立即止血，24h内再出血6例，再次内镜下治疗3例失败转外科手术治疗。初次止血率为86．9％，总止血率为93．5％。结论内镜下止血治疗对消化性溃疡并出血疗效肯定，安全，提高了内科治疗效果，减少了外科手术率。     

内镜诊治上消化道出血320例临床分析

目的探讨上消化道出血在48h内、外进行内镜直视下止血的疗效,并对其进行分析总结。方法选取2001年1月~2002年7月经内镜检查确诊的消化道出血患者320例,分为研究组和对照组。其中研究组228例在出血48h内进行内镜检查及镜下治疗;对照组92例在48h后进行内镜检查及治疗。并评价止血效果。结果研究组228例,成功止血有224例,成功止血率是98.24%;对照组92例,成功止血有78例,成功止血率是84.78%,两者相比,差异有统计意义(P<0.05)。结论上消化道出血患者,在积极改善一般情况血压稳定后,尽快行急诊内镜检查;治疗时间越早,成功止血率越高,对明确病因及成功止血十分重要。     

上消化道大出血急诊胃镜检查和治疗

1997～1998年我院对18例上消化道大出血患者行急诊胃镜检查和治疗。现报道如下,并对其应用价值进行评价。1 一般资料 患者均为本院住院患者,共18例,其中男13例,女5例,年龄19～87岁,平均45岁。病程最短48小时,最长19年。18例均有呕血和大量黑便,24小时内出血量都在1000ml以上,并同时伴有心率加快,血压下降,或24小时内输血800ml左右血压仍不稳定者。2 设备与方法 Olympus GIF-P_(10)。纤维胃镜,50ml注射器,急诊胃镜检查前给予冰盐水清洁洗胃。检查时发现活动出血灶立即行内镜下止血治疗,止血治疗包括通过活检钳通道内局部喷洒100:8的等渗盐水-去甲肾上腺素溶液,或喷洒凝血酶溶液,观察无活动出     

内窥镜在急症上消化道大出血中的应用

目的：探讨急症内窥镜（内镜）介入对上消化道大出血的诊断及治疗的意义。方法：对急症上消化道大出血患者在１２～４８小时内进行胃镜检查，检查前用０．００８％去甲肾上腺素冰盐水洗胃。急症内镜检查组３９４例，非内镜检查１０５例为对照组。结果：诊断符合率内镜检查组为９８．４８％，对照组为６３．８１％；病死率内镜检查组为４．５７％，对照组为２８．５７％，Ｐ均＜０．０１。结论：急症内镜检查可以及时明确诊断，又可介入进行直接治疗；急症上消化道大出血时内镜介入可明显提高诊断率，降低病死率。     

内镜下治疗上消化道出血62例临床护理

目的：探讨内镜下治疗上消化道出血的临床护理措施。方法：对62例上消化道出血患者于入院12～48h内行内镜下止血治疗，介入前后给予严密的护理配合。结果：61例患者经内镜治疗止血成功，1例静脉曲张破裂出血患者转外科手术止血，内镜止血成功率达98．4％，再出血率为3．22％。所有患者介入后均未见穿孔、狭窄、脾栓塞等严重并发症。结论：介入前针对性的心理护理与全面的准备工作、介入中治疗的密切配合与仔细观察生命体征、介入后严格的生活护理与饮食管理等全过程护理措施，是上消化道出血内镜治疗成功的重要保证。     

急诊内镜在肝硬化上消化道出血中的应用价值(附116例报道)

目的：分析门静脉高压时上消化道出血原因，了解胃粘膜的改变，评价急诊内镜检查的价值。方法：回顾性分析了116例肝硬化门静脉高压合并急性上消化道出血患者行急诊内镜检查的临床资料。结果：116例患者中，Ⅲ度食管静脉曲张76例，合并反流性食管炎15例(12．4％)，胃十二指肠溃疡24例(19．0％)．急性胃粘膜病变29例(25％)。102例(87．9％)镜下见到出血灶，其中见静脉曲张破裂出血84例(82．3％)。非静脉曲张破裂出血18例(17．7％)。14例(12．1％)未发现明确出血原因。40例行胃粘膜活检，病理结果均提示门静脉高压性胃病。结论：肝硬化门静脉高压患者出现上消化道出血时，行急诊内镜检查是安全的，应积极行急诊内镜检查以明确出血原因。指导临床治疗。     

急诊内镜治疗消化道肿瘤并上消化道出血的护理体会

目的探讨急诊内镜治疗消化道肿瘤并上消化道出血的护理方法。方法选择本院急诊科收治的消化道肿瘤并上消化道出血患者160例,以随机数字表将其平分为研究组与对照组,每组各80例。对照组采取对症支持治疗联合常规护理干预。研究组于出血24 h内给予急诊内镜诊疗与围术期护理干预。结果研究组止血成功率高于对照组,再出血率、输血率低于对照组(P0.05);研究组止血时间少于对照组(P0.05);2组治疗不良反应发生率比较差异无统计学意义(P0.05)。结论急诊内镜治疗方案与护理干预可以有效缩短消化道肿瘤并上消化道出血患者的止血时间,降低再出血率,保证救治效果,安全可靠,适于临床推广。     

床边急诊胃镜诊治致死性非静脉曲张性上消化道大出血

目的探讨床边急诊胃镜在急性重症非静脉曲张性上消化道大出血诊治中的作用。方法154例致死性非静脉曲张性上消化道大出血病人，入院后即刻行床边急诊胃镜明确病因、部位及出血情况后胃镜下注射肾上腺素-利多卡因-高渗盐水止血。结果急诊诊断率94．2％，总有效率92．9％，再出血率9．0％，无不良反应。结论床边急诊胃镜能有效诊断急性致死性非静脉曲张性上消化道大出血，内镜下注射肾上腺素-利多卡因-高渗盐水能有效止血，安全、简便。     

急诊内镜检查在上消化道出血的诊断和治疗中的应用(附81例报告)

目的　探讨急诊内镜检查在上消化道出血诊断和治疗中的价值。方法　对 81例急性上消化道出血病例 4 8h内作紧急内镜检查 ,对 2 4例活动性出血在内镜直视下根据出血状况采取相应措施止血 ,9例局部喷酒凝血酶或去甲肾上腺素 ,8例用微波或电凝热探头止血、3例息肉伴出血作高频电切除术 ,4例食道静脉曲张伴出血作硬化剂注射 ,2例不明原因作外科急诊手术。结果　不同时间活动性检出率不尽相同 ,急诊内镜 <12h与 12～ 14h相比活动性病灶检出率无显著异性 (P >0 .0 5 ) ;<2 4h与 2 4～ 4 8h相比有显著差异性(P <0 .0 1) ,内镜检查时间愈早 ,活动性病灶检出率越高。活动性内镜下止血成功率 10 0 %。结果　急诊内镜检查对上消化出血的价值 ,已不仅限于诊断 ,而且在治疗上增加了一项有效手段。只要病情许可 ,镜检时间越早越好。     

急诊上消化道出血186例临床分析

目的:探讨急诊科上消化道出血的病因构成及特点.方法:回顾性分析我科2010年1月至2012年1月诊治的186例上消化道出血患者的临床资料.结果:(1)上消化道出血主要病因为消化性溃疡46.9％、急性胃黏膜病变12.7％、肝硬化9.0％、胃癌7.2％,贲门撕裂症6.0％.(2)急诊内镜诊断明确的阳性率(95.6％)显著高于非急诊内镜(81.3％),P＜0.01.(3)服用非甾体消炎药(NSAIDs)患者急性胃黏膜病变发生率(39.5％)明显高于未服用者(4.1％),P＜ 0.01;服用NSAIDs患者消化性溃疡发生率(52.6％)虽高于未服用者(39.2％),但差异无统计学意义,P＞ 0.05.结论:服用NSAIDs是上消化道出血的重要原因,急性胃黏膜病变发生率较前有所增加,急诊内镜检查有助于上消化道出血的诊断.     

Significance of emergency endoscopy in severe upper gastrointestinal hemorrhage

312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.     

纤维胃镜在小儿上消化道出血诊治中的应用

目的探讨纤维胃镜在小儿上消化道出血诊治中的应用价值。方法采用日本产OLYMPUS GIF-XP20型纤维胃镜检查对2007年12月至2011年5月收治的102例上消化道出血患儿行胃镜检查及幽门螺杆菌(Hp)定性检查。结果上消化道出血病因中以消化性溃疡为主(其中胃溃疡20例,十二指肠球部溃疡39例);其次是急性胃黏膜病变。24 h内行胃镜检查者定位诊断率100%;24～48 h内检查者定位诊断率为90.6%;超过48 h以上检查者诊断率为85.5%。Hp阳性60例,阳性率58.8%。本组102例上消化道出血患儿,成功插镜率100%。结论小儿上消化道出血多由于消化性溃疡所致,与Hp感染相关。早期纤维胃镜可明确出血病因,简单易行,安全可靠,是小儿上消化道出血诊断的首选方法。     

Low utility of endoscopy for suspected upper gastrointestinal bleeding occurring in hospitalized patients

OBJECTIVES: To determine the clinical utility of upper endoscopy in patients who have upper gastrointestinal bleeding after hospitalization. METHODS: Patients were studied who underwent upper endoscopy for an indication of suspected upper gastrointestinal bleeding that developed more than 48 hours after hospitalization. Demographic, clinical, and endoscopic data were extracted by chart review. Bleeding was characterized as clinically important (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion) or non-clinically important. RESULTS: Eighty-six patients met inclusion criteria. Clinically important bleeding occurred in 17%. Peptic ulcer disease and gastritis were the most common sources of bleeding in the clinically important and non-clinically important groups, respectively. The bleeding source was not found in 24% of patients. Endoscopic therapy was required in 11% (all of whom had clinically important bleeding). Upper endoscopy prompted no treatment changes in the non-clinically important bleeding group. CONCLUSIONS: Endoscopic therapy was needed only in the few patients with clinically important bleeding. Nonendoscopic treatment can be recommended for upper gastrointestinal bleeding developing in hospitalized patients who do not meet established criteria for a clinically important bleed.     

High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

OBJECTIVES: The optimal timing of interventional endoscopy within the initial 24 hours remains controversial. We designed a retrospective study to compare the outcomes between emergency endoscopy (EE) and urgent endoscopy (UE) for high-risk patients with nonvariceal upper gastrointestinal hemorrhage presenting to the emergency department (ED). METHODS: The medical records of 189 patients with nonvariceal upper gastrointestinal hemorrhage who underwent endoscopy within 24 hours of admission to the ED were reviewed. Patients were divided into 2 groups: EE group (<8 hours) or UE group (8-24 hours). We compared the endoscopic findings, hemostatic procedures, rate of hemostasis, rebleeding, need for transfusion, length of hospitalization, and mortality between the 2 groups. RESULTS: There were 88 patients (47%) in the EE group and 101 patients (53%) in the UE group. Ulcers with active bleeding or exposed vessel were found more frequently in the EE group than in the UE group (19% vs 8%, P = .03; 34% vs 12%, P < .001). Fifty patients had blood retention in the stomach, especially in the EE group (40% vs 15%, P < .001). Forty-four (50%) patients in the EE group and 21 (21%) patients in the UE group received endoscopic interventions. Combination modalities of endoscopic hemostasis were more commonly used in the EE group than in the UE group (40% vs 15%, P < .001). Primary hemostasis was achieved at a rate of 95% in both groups. There was no statistical difference regarding the rate of recurrent bleeding, total amount of transfusion, length of hospital stay, and mortality rate in both groups. CONCLUSIONS: Although more active lesions were detected and more therapeutic attempts were performed in the EE group, the outcome showed no difference in both groups. Emergency endoscopy performed less than 8 hours after arrival to the ED showed no definite benefit in comparison with UE performed within 8 to 24 hours.     

Causes and clinical outcome of acute upper gastrointestinal bleeding: a prospective analysis of 1534 cases

Despite considerable improvement in the diagnostic and therapeutic approach to patients with acute upper gastrointestinal (GI) bleeding, several studies suggest there has been no overall change in mortality. The aim of this study was to evaluate prospectively the effect of early emergency diagnostic and therapeutic endoscopy and medico-surgical collaboration in the clinical outcome of 1534 patients with acute upper GI bleeding treated in our hospital over the past five years. Emergency endoscopy and injection haemostasis were performed within 24 hours of admission, or immediately after resuscitation, in patients with massive bleeding; patients were then treated with close co-operation between surgeons and gastroenterologists. We observed an increase in the incidence of peptic ulcer (67%) with a simultaneous decrease in the incidence of gastroduodenitis (13.5%) as a cause of bleeding compared with the previous decade. In peptic ulcer bleeding, emergency surgical haemostasis was required in 92 patients (8.9%), while none of the patients with erosive gastroduodenitis required surgical intervention. Overall mortality was 2.9%, and in peptic ulcer bleeding patients 2.1% with a postsurgical mortality of 8.7%. Peptic ulcer remains the main cause of upper GI bleeding. Improved clinical outcome and low mortality can be achieved with early diagnostic and therapeutic endoscopy and medico-surgical collaboration.     

Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS: Excessive blood covering the examination field is a frequent cause of diagnostic failure in emergency endoscopy for acute upper gastrointestinal bleeding. The implications and outcome in these patients have not been well described. PATIENTS AND METHODS: The records for 1459 consecutive patients who presented at our medical center with acute nonvariceal upper gastrointestinal bleeding during a 15-month period were reviewed. All of the patients underwent emergency endoscopy within 24 h of initial presentation. Patients in whom an identifiable bleeding source was not found in spite of an overtly bloody lumen were designated as having a failure of diagnosis, and these cases were analyzed further. RESULTS: Diagnosis failed in 25 patients (1.7 %), 16 of whom underwent repeat endoscopy or surgical intervention. Bleeding vessels were identified in 13 of these patients. Gastric and duodenal ulcers were the most commonly overlooked lesions, with locations in the cardia (n = 3), fundus (n = 2), posterior wall of the antrum (n = 1), duodenal bulb (n = 3), second part of the duodenum (n = 2), and in the stoma of a Billroth II gastrectomy (n = 2). The rates for endoscopic complications, recurrent bleeding, surgery, and mortality were significantly higher in the group with diagnostic failure than in patients with acute upper gastrointestinal bleeding in whom diagnosis did not fail (8 % vs. 0.4 %; 20 % vs. 3.1 %; 16 % vs. 2.9 %; and 20 % vs. 3.6 %, respectively). CONCLUSIONS: In acute nonvariceal upper gastrointestinal bleeding, diagnostic failure is associated with higher morbidity and mortality. The data from this study emphasize the importance of good preparation before the procedure and adequate removal of blood during emergency endoscopy procedures.     

107例小儿消化道出血胃镜检查结果分析

目的：了解不同年龄组消化道出血的病因和合理的胃镜检查时间。方法：对107例临床疑似上消化道出血的患儿进行纤维胃镜检查。结果：确诊为上消化道出血的79例（十二指肠溃疡61例,胃溃疡7例,食道静脉曲张3例,食管炎1例,贲门粘膜撕裂症3例,十二指肠憩室2例,脑疝2例）,小肠出血6例（3例小肠憩室、2例克隆氏病,1例小肠结核） ,咽血综合症3例,未检查出病因19例。结论：十二指肠球部溃疡、胃溃疡是年龄较大儿童消化道出血最常见的原因,先天性消化道畸形是婴幼儿消化道出血的另一个重要原因,患儿在出血48h内纤维胃镜检查阳性率最高,小儿上消化道出血急症胃镜检查是一种快速、准确、较安全的检查方法。     

术中内镜在急性消化道大出血急诊剖腹探查术中的应用价值

目的 探讨术中内镜在急性消化道大出血患者行急诊剖腹探查术中的应用价值及其安全性。方法对25例急性消化道大出血行急诊剖腹探查的患者进行术中内镜检查，评价其应用价值。结果25例术中内镜检查有24例明确了出血原因，检出率达96．0％。术中内镜平均用时13min，无一例术中内镜受检者发生术中内镜相关性并发症。所有患者均根据术中内镜诊断进行了相关手术治疗，术后无一例再出血。结论急性消化道大出血患者术中内镜的应用，不仅提高了病变的检出率，而且能对病灶进行准确定位与定性，可提高剖腹探查的成功率。