内镜下治疗非静脉曲张性消化道血管破裂出血86例疗效分析

目的探讨内镜下治疗对非静脉曲张性消化道血管破裂性出血的疗效。方法内镜下对非静脉曲张性血管破裂性出血灶周围注射肾上腺素立止血高渗氯化钠注射液，如出血停止，则不再另行处理；如出血量减少，则在出血灶上行微波烧灼治疗；对注射后出血无明显变化及微波治疗后未止血者于出血灶上注射无水酒精硬化治疗。结果该组86例经注射肾上腺素立止血高渗氯化钠注射液后止血70例，止血率为81．4％；注射后出血量减少者10例联合微波治疗后止血8例，止血率提高到90．7％；注射后出血量无变化者及微波治疗后未止血者共8例联合无水酒精注射，止血3例，止血率提高到94.2％。结论内镜下注射肾上腺素立止血高渗氯化钠液对非静脉曲张性消化道血管破裂出血是一种安全、有效的止血方法，联合微波和／或无水酒精注射可提高疗效，降低急诊手术率。     

两种方式注射治疗非静脉曲张性上消化道大出血的疗效研究

目的探讨胃镜下去甲肾上腺素药物喷洒与肾上腺素注射治疗非静脉曲张性上消化道大出血的疗效。方法 160例符合纳入标准的非静脉曲张性上消化道大出血患者按治疗方案分为药物喷洒组(80例)和药物注射组(80例)。所有患者均给予上消化道大出血的常规治疗。药物喷洒组患者在胃镜下给予去甲肾上腺素喷洒治疗,而药物注射组在胃镜下给予肾上腺素注射治疗。观察两组患者治疗疗效、止血时间、再出血率及不良反应发生情况。结果药物注射组的治疗总有效率为95.0%,明显高于药物喷洒组的80.0%(P0.05)。与药物喷洒组相比,药物注射组的止血时间明显缩短,再出血率明显降低(均P0.05)。治疗过程中,两组均未发生严重不良反应,其不良反应发生率在两组间比较差异无统计学意义(P0.05)。结论胃镜下肾上腺素注射是非静脉曲张性上消化道大出血的有效治疗方案,可以提高治疗有效率,缩短止血时间,且不良反应轻,疗效优于去甲肾上腺素喷洒治疗,临床上值得进一步研究。     

急诊胃镜治疗非静脉曲张上消化道出血30例分析

目的：探讨急诊胃镜诊断非静脉曲张上消化道出血的临床特点及止血治疗效果。方法：对30例非静脉曲张上消化道出血行急诊胃镜检查后，立即行胃镜下止血治疗，按出血情况予喷洒止血、黏膜下注射止血。结果：采用局部喷药18例黏膜下注射止血2例，29例均止血，1例3d后再出血转外科手术治疗，有效率96．7％。结论：急诊胃镜是检查上消化道出血病因及止血治疗的重要方法，具有出血灶检出率高、止血治疗快速安全有效的特点，值得临床推广应用。     

盐酸利多卡因注射液在上消化道内镜下注射止血中的价值

目的研究盐酸利多卡因注射液在上消化道内镜下注射止血中的价值。方法选择该院2003年10月～2010年10月共158例非静脉曲张性上消化道出血需行急诊内镜下注射止血的患者,其中,男93例,女65例;年龄25～88岁,平均(54.2±11.3)岁。随机分为两组,Ⅰ组73例为单纯注射高渗钠-肾上腺素溶液(HSE),Ⅱ组85例添加盐酸利多卡因注射液,比较两组的急诊止血率、不良反应率、疼痛感知率。结果两组患者一般资料差异无显著性(P>0.05)。Ⅰ组急诊止血率达90.41%,不良反应率5.47%,疼痛感知率84.93%;Ⅱ组急诊止血率达98.82%,不良反应率为2.35%,疼痛感知率为38.82%;两组急性出血止血率及并发症发生率差异无显著性(P>0.05)。两组的疼痛感知率差异有显著性(P<0.05)。结论在非静脉性上消化道出血急诊内镜下注射止血中添加盐酸利多卡因能减轻患者痛苦,是安全、有效的。     

胃镜下喷洒医用生物蛋白胶治疗非静脉曲张性上消化道出血64例

非静脉曲张性上消化道出血是消化内科的常见急症，特别是上消化道大出血病情凶险，死亡率高，人们都在寻找更有效的止血方法。目前，除了药物及手术等止血方法外。胃镜下亦有多种止血方法。我们自2000年6月-2002年9月应用胃镜下喷洒医用生物蛋白胶(又称纤维蛋白胶Fibrin Glue，FG)治疗非静脉曲张性上消化道出血64例，取得满意疗效。     

胃镜下重酒石酸去甲肾上腺素喷洒与注射治疗急性非静脉曲张性上消化道出血的效果比较

目的比较胃镜下重酒石酸去甲肾上腺素喷洒与注射治疗急性非静脉曲张性上消化道出血的效果。方法选取2016年5月至2020年5月在我院接受治疗的108例急性非静脉曲张性上消化道出血患者作为研究对象,根据用药方法的不同将其分为对照组和观察组,各54例。对照组给予胃镜下重酒石酸去甲肾上腺素喷洒治疗,观察组给予胃镜下重酒石酸去甲肾上腺素注射治疗。比较两组的治疗效果。结果观察组治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。观察组止血成功率高于对照组,再出血率低于对照组,差异具有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组生理功能、社会功能、情感职能、活力评分均高于对照组,差异具有统计学意义(P<0.05)。观察组成功止血时间短于对照组,差异具有统计学意义(P<0.05)。结论胃镜下重酒石酸去甲肾上腺素注射治疗急性非静脉曲张性上消化道出血效果优于胃镜下重酒石酸去甲肾上腺素喷洒治疗,可有效改善患者的出血症状,提高生活质量,且不良反应少。     

急诊胃镜在上消化道急症的临床应用

目的 评估急诊胃镜在上消化道急症中的临床应用。方法对587例上消化道急症分4组进行急诊胃镜检查，并用相应的器械及方法进行镜下治疗。结果上消化道异物组155例全部病例诊断明确，镜下一次去除成功148例，成功率为95．5％。食管静脉曲张出血(EVB)69例，其中并胃底静脉曲张11例，急诊止血率为loo％，2例再出血死亡。非静脉曲张性上消化道出血组(NVB)256例，诊断明确24l例(94．1％)，无结论者15例(5．9％)，镜下治疗197例，止血成功率为94．9％，术后7天内再出血14例，近期再出血率7．1％。24例胆道蛔虫，23例成功取出虫体，l例断裂。结论急诊胃镜在上消化道急症的应用安全有效。     

急诊胃镜诊治上消化道大出血126例分析

目的:探讨急诊胃镜诊断上消化道大出血的临床特点及止血治疗效果。方法:对126例上消化道大出血行急诊胃镜常规检查后,立即进行胃镜下止血治疗,按不同病因、病变部位,使用喷药、粘膜下注射、套扎、血管栓塞、硬化剂治疗不同止血治疗方法。结果:采用局部喷药45例,粘膜下注射及电灼电凝30例均止血,血管出血行注射止血26例,出血停止,其中2例5～7天后再次临床少量出血,用药物加强治疗后出血停止。食管胃静脉曲张25例行套扎、DTH栓塞及硬化剂治疗,出血停止24例。本组总有效止血率99.2％(125/126)。结论:急诊胃镜是检查上消化道大出血病因及止血治疗的重要方法,具有出血灶检出率高,止血治疗快速有效的特点,值得临床大力推广应用。     

局部注射肾上腺素高渗氯化钠治疗上消化道出血的护理

上消化道出血是消化内科最常见的急诊之一，尽快进行有效的止血是治疗本病的关键。目前对上消化道出血除传统内科保守及外科手术治疗外，急诊内镜下止血因其疗效肯定、设备简单、费用低廉而被广泛应用于临床。2002年8月-2004年12月，我院行胃镜下局部注射肾上腺素高渗氯化钠治疗上消化道出血53例，取得满意疗效，现报道如下。     

经内镜金属夹钳夹术治疗非静脉曲张性上消化道出血

目的 探讨经内镜金属钛夹止血治疗非静脉曲张性上消化道出血的治疗效果。方法2000年7月-2004年3月应用OlympusGIFl30电子胃镜、Olympus钛夹（MD850型）及推进器（HX-5LR-I）止血治疗非静脉曲张性上消化道出血41例。结果 41例非静脉曲张性上消化道出血患者应用经内镜金属钛夹止血治疗，即时止血率达100％。41例患者共用金属夹92枚，平均每例2．24枚。结论 应用经内镜金属钛夹止血是治疗非静脉曲张性上消化道出血的有效方法。     

63例非静脉曲张性上消化道出血的内镜治疗分析

目的探讨内镜治疗急性非静脉曲张性上消化道出血的疗效。方法回顾性分析2008年9月—2011年5月行内镜治疗的63例急性非静脉曲张性上消化道出血患者的临床资料。内镜治疗包括药物喷洒、注射、氩气等离子体电凝、金属钛夹等方法。结果 63例患者中,注射治疗31例,联合氩气治疗17例,联合钛夹15例。63例患者中即时止血成功60例(96.3%),48 h内再出血4例,再次内镜下止血成功3例。共4例治疗无效,均转外科手术治疗,内镜治疗总有效率为93.65%(59/63)。结论内镜治疗急性非静脉曲张性上消化道出血是一种安全、有效的方法。     

内镜下紧急止血治疗上消化道出血

目的：探讨内镜下治疗上消化道出血的临床疗效。方法：2000年3月至2002年5月人院的36例非门脉高压上消化道大出血患者，人院后24h行紧急内镜下止血。结果：36例上消化道出血患者中，首次出血者10例(27．8％)，多次反复出血者26例(72．2％)。15例采用内镜直视下局部喷射5％碱性硫酸铁溶液(Monseli液)止血，21例采用内镜直视下注射复方硬化剂止血。20例(55．6％)患者在上述处理后即时止血，另15例加用止血剂后在3天内止血。本组胃镜均顺利完成．无严重并发症。结论：内镜下紧急止血治疗是上消化道大出血非常有效的诊断与治疗手段，值得在基层医院推广使用。     

组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的临床观察

【目的】观察组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的临床疗效及安全性。【方法】对32例食管胃底静脉曲张破裂出血患者进行内镜下治疗,胃底曲张静脉采用“三明治夹心法”行组织黏合剂注射,对合并的食管曲张静脉同时行套扎治疗。术后观察不良反应、并发症和近期疗效。【结果】组织黏合剂注射量1．0～3．5mL,平均1．8mL,套扎5～12点,平均8．2点。治疗成功率100％。6例出现胸痛（18．8％）,2例出现上腹不适（6．3％）,全组未有异位栓塞的发生,追踪3个月未有再出血病例,28例3个月后复查胃镜,见胃底曲张静脉消失或明显减轻,食管曲张静脉减轻与红色征消失。【结论】组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血安全、有效。     

内镜下钛夹治疗上消化道非静脉曲张出血60例的护理配合

摘要：目的通过对60例上消化道非静脉曲张出血患者采用金属钛夹在内镜下直接止血,总结护理配合技巧和要点。方法用金属钛夹推送器安装钛夹,对准出血部位释放金属钛夹达到止血目的。结果60例非静脉曲张上消化道出血,根据Forrest分级标准,Ⅰa6例,Ⅰb38例,Ⅱa9例,Ⅱb7例。共用金属钛夹125枚,所有病例内镜下首次止血成功率100％,术后无不良反应及并发症。结论掌握内镜性能,正确使用金属钛夹推送器,可确保内镜下金属钛夹治疗消化道出血的成功。     

高频小探头超声辅助内镜下治疗上消化道黏膜下肿瘤

目的探讨高频小探头超声辅助内镜下高频电凝电切圈套切除术治疗上消化道黏膜下肿瘤的安全性和疗效。方法治疗前经高频小探头超声评估和未经评估的分别为84例和110例，采用高频电凝电切圈套切除术治疗直径0．5～3．0cm上消化道黏膜下肿瘤，严密观察有无出血、穿孔等并发症，切除组织全部送组织病理学检查，术后定期门诊随访。结果经高频小探头超声评估后内镜下高频电凝电切圈套切除术治疗成功率100％（84／84），无1例出现大出血、穿孔等严重并发症；而未经超声内镜评估的治疗成功率85．69％（101／110），3例出现大出血，4例穿孔，两组病例随访2～60个月均未见肿瘤复发。结论高频小探头超声辅助内镜下高频电凝电切圈套切除术治疗上消化道黏膜下肿瘤是一项安全、有效的方法。     

Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS: Various methods of endoscopic hemostasis have been described. However, few reports have investigated the efficacy of argon plasma coagulation (APC) in the treatment of upper gastrointestinal bleeding. The aim of this study was to evaluate the efficacy of APC in various types of upper gastrointestinal bleeding. PATIENTS AND METHODS: The present study was designed as a prospective and observational study. A total of 254 consecutive patients with upper gastrointestinal bleeding (excluding variceal bleeding) were primarily treated using APC. If it was difficult to achieve complete hemostasis with APC alone, injection of a hypertonic saline-epinephrine solution and clipping were carried out. The initial hemostasis rate, rate of recurrent bleeding after APC, permanent hemostasis rate, and mean procedure time were evaluated. RESULTS: Initial hemostasis with APC alone was achieved in 193 of the 254 patients (75.9 %). With the assistance of other methods as well, initial hemostasis was achieved in 253 patients (99.6 %). Among the 193 patients treated with APC alone, recurrent bleeding was observed in 11 cases (11 of 193, 5.7 %). With one exception, these cases of recurrent bleeding were controlled with APC alone again; permanent hemostasis was thus ultimately achieved with APC alone in 192 of the 254 patients (75.5 %). The mean procedure time was 8 min. No complications (such as perforation) were observed with the APC treatment. CONCLUSIONS: These data indicate that APC is a safe, quick, and effective method of treating various types of nonvariceal upper gastrointestinal bleeding and that it can be a powerful tool for endoscopic hemostasis.     

Upper GI bleeding requires prompt investigation

Upper GI bleeding is a common medical emergency with an incidence in the UK of 103 cases per 100,000 adults per year and is much more common in the elderly. The most common presenting signs are haematemesis (bright red or 'coffee ground') and melaena. About 30% of patients with bleeding ulcers present with haematemesis, 20% with melaena, and 50% with both. Up to 5% of patients with bleeding ulcers have haematochezia and this indicates heavy bleeding into the upper GI tract. An upper GI bleeding source should be considered when haematochezia presents with signs and symptoms of haemodynamic compromise. Peptic ulcer disease, both gastric and duodenal, accounts for the majority of admissions for upper GI bleeding. Other causes of bleeding include mucosal (Mallory-Weiss) tear of the gastro-oesophageal junction secondary to vomiting, and multiple types of vascular abnormalities. Clinical risk factors for mortality in upper GI bleeding are age, comorbidity, tachycardia and a low systolic blood pressure. Given the high mortality rate associated with upper GI bleeding nearly all patients with symptoms described above should be referred to secondary care for emergency admission and endoscopic assessment. This should also be the default position in borderline cases. Early endoscopy in upper GI bleeding: allows early diagnosis; provides the opportunity for endoscopic haemostasis; enables complete risk stratification of non-variceal bleeding and allows early discharge of patients with low-risk findings.     

Prevalence and incidence of NSAID-induced gastrointestinal ulcers and bleeding

Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAID) have been accepted as major causes of upper gastrointestinal (GI) ulcers and bleeding. As patients with Helicobacter pylori infection have decreased, upper GI disorders related to NSAID have been relatively increasing. Among patients taking low-dose aspirin, the prevalence of upper GI ulcers is 10-40% and aspirin increases the risk of upper GI bleeding up to 2-fold. Among patients taking nonaspirin NSAID, the prevalence of upper GI ulcers is around 20% and nonaspirin NSAID increases the risk of upper GI bleeding up to 4- to 6-fold. Since the prevalence of GI disorders related to NSAID is very high, endoscopic examination might be considered to monitor GI lesions for patients taking NSAID.     

Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract

In a prospective series 102 non-variceal upper GI bleeders were studied. An indication for endoscopic injection therapy was seen in 63 patients. In accordance with bleeding intensity, 27 patients were grouped as Forrest Ia, 37 as Forrest Ib, 8 as Forrest II with a "visible vessel" and 13 as Forrest II without one. Definitive hemostasis was achieved in almost 100% of the cases. Within the Forrest Ia group mortality was lowered to 11% as compared with 20% within the emergency surgery group. More than 80% of patients had at least one severe coexistent illness. The aim of endoscopic injection is to avoid surgery in high-risk patients.     

The effect of endoscopic hemostasis with alcohol on the mortality rate of nonvariceal upper gastrointestinal hemorrhage. A randomized prospective study

One hundred and forty-five patients with nonvariceal upper GI hemorrhage, active or with stigmata (Forrest I and II) were divided into two groups according to the day of the week on which emergency endoscopy was performed: group A (78 patients) in which conventional treatment was applied (blood transfusions, antacids, cimetidine, pirenzepine), and group B (65 patients) in which endoscopic hemostasis with absolute alcohol (Asaki's method) was performed. The two groups were comparable as regards age, sex distribution and type of hemorrhage (after Forrest). Emergency surgery was performed in both groups if the bleeding did not stop or if it recurred. Twenty patients (11 in group A and 9 in group B) were operated on some time after the bleeding episode (5-18 days) to prevent new episodes. Absolute alcohol injection achieved hemostasis in all the cases of active hemorrhage (Forrest I) and prevented recurrence in 24 out of 25 cases with a clot or visible vessels (Forrest II), so that emergency surgery was not necessary in any of the patients of group B. Mortality rate was significantly lower in group B than in group A (10 deaths in group A, 2 in group B, p less than 0.05) being explained mainly by the reduced post-operative mortality (18% in group B), due to the small number of the operated patients (28 in groups A, 10 in B; p less than 0.02), especially of those operated on as an emergency (one in the endoscopic hemostasis group as compared with 17 in the conventional treatment group; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)