非静脉曲张上消化道出血内镜急诊止血297例临床分析

近年来，由于开展急诊内镜检查，非静脉曲张上消化道出血的病因诊断率大为提高，并在内镜直视下采取各种止血措施，对改善预后、降低病死率、减少输血量、缩短疗程等都起到积极的作用。我们对我院自2001年1月至2002年7月因上消化道出血进行内镜检查排除静脉曲张297例的治疗进行回顾分析。根据内镜检查时间的不同分为急诊内镜检查组和非急诊内镜检查组，其中急诊内镜组有215例，非急诊检查的有82例，根据资料现总结如下。     

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。     

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。     

非静脉曲张性上消化道出血行急诊内镜止血患者病情严重且预后较差

目的：比较分析非静脉曲张性上消化道出血(NVUGIB)床边急诊内镜与择期内镜治疗的临床特点和疗效。方法：回顾性收集304例NVUGIB并接受内镜止血治疗患者的病例资料,其中接受床边急诊内镜的152例患者纳入急诊内镜组,接受择期内镜止血的152例患者纳入择期内镜组,比较分析2组患者的一般情况、病情严重程度、疗效等。结果：2组患者的一般情况、病因构成、止血方式无明显差异(P均>0.05),与择期内镜组比较,急诊内镜组患者血红蛋白量和血小板计数低,凝血时间延长,AIMS65评分及内镜前Rockall(pRS)评分较高(P均<0.01),输血率高(60.4% vs 47.4%,P<0.01),输血量多(P<0.01),再出血率高(12.2% vs 3.9%,P<0.01),住院时间更长(P<0.01)。2组患者止血成功率都在80%以上,并发症发生率和死亡率无明显统计学差异(P>0.05)。结论：对于NVUGIB患者,需行床边急诊内镜止血者失血情况严重,凝血功能差,其输血量、再出血率、住院时间均较高或较长,但死亡率与择期内镜止血治疗者相近。     

内镜下止血夹治疗在急性非静脉曲张性消化道出血中的应用

目的 观察内镜下金属止血夹治疗急性非静脉曲张消化道出血的治疗效果.方法 收集我院2004年7月至2009年7月收治的急性非静脉曲张消化道出血患者79例,在内镜下明确出血部位,使用止血夹钳夹止血.结果 79例急性非静脉曲张消化道出血患者应用内镜下金属止血夹止血治疗,共用金属夹238枚,平均每例3.01枚,即时止血率97.47%(77/79),20例止血夹止血失败病例中1例Dieulafoy病患者改用内镜下套扎治疗止血成功,另1例转外科手术治疗.1周内再出血率3.80%(3/79),其中2例患者转手术治疗.所有患者内镜术后均未出现内镜治疗相关并发症,全组无死亡病例.结论 内镜下金属止血夹是一种治疗急性非静脉曲张消化道出血的有效方法,具有操作简单,止血效率高及无明显并发症等优点,值得临床推广应用.     

非门脉高压上消化道出血的内镜下紧急止血治疗

非门脉高压上消化道出血的内镜下紧急止血治疗陈隆典牛桂军甸阝东华徐肇敏非门脉高压性上消化道出血为消化科常见病，大多为消化性溃疡。绝大多数出血为自限性，但约５％为持续性出血，２０％～２５％可有再出血，且大多发生于起病４８小时内。１９９４～１９９６年我们经...     

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。     

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。     

内镜下不同方法治疗非静脉曲张性上消化道出血的疗效比较

目的比较内镜下不同方法治疗非静脉曲张性上消化道出血的临床效果。方法将176例非静脉曲张性上消化道出血患者随机分成喷洒组、注射组、钛夹组和微波组,使用电子胃镜检查和治疗,喷洒组向出血部位喷洒8%去甲肾上腺素溶液,注射组向出血部位注射1∶10 000的肾上腺素溶液,钛夹组用金属钛夹止血,微波组使用微波反复熨烙止血。结果钛夹组即时有效率为100%,治疗有效率为97.73%,均明显优于其他三组（P〈0.05）;注射组即时有效率为90.91%,治疗有效率为81.82%;喷洒组及微波组治疗效果欠佳。结论在非静脉曲张性上消化道出血治疗中,钛夹止血法和注射止血法效果确切,优势明显,值得临床推广。     

非静脉曲张性急性上消化道出血血清胃泌素检测及其临床意义

目的:了解非静脉曲张性急性上消化道出血血清胃泌素变化及其临床意义。方法:A组:急性非静脉曲张性上消化道出血34例;B组:活动期消化性溃疡29例;C组:慢性胃炎30例。采用放免法检测血清胃泌素。结果:A组血清胄泌素为97.94±22.75ng/L,95％可信限(95％CI)为92.08～103.80ng/L;B组胃泌素52.31±9.94ng/L,95％CI 48.70～55.94ng/L;C组胃泌素35.15±11.95ng/L,95％ CI 30.88～39.42ng/L。A组胃泌素显著高于B、C组(P<0.01),B组胃泌素也明显高于C组(P<0.05)。结论:胃泌素增多与消化道出血相关。     

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.     

Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods

Upper non-variceal gastrointestinal bleeding is a conditionthat requires immediate medical intervention and has a high associated mortality rate(exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the firstline treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy(within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.     

Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate

AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal upper gastrointestinal bleeding(NV-UGIB).METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding.RESULTS Of the 45 patients treated endoscopically without initialhemostasis or with early rebleeding, 33(76.7%) were treated with modified cyanoacrylate glue, 16(37.2%) underwent surgery, and 3(7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS(23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients(78.8%): 19 out of 24(79.2%) during the first endoscopy and in 7 out of 9(77.8%) among early rebleeders. Two patients(22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.     

上消化道大出血的分析研究

本文论述了上消化道大出血病因、诊断方法、止血措施等,重点阐述了三腔二囊管压迫止血、内镜下止血、经静脉肝内门体静脉分流术等止血的措施和方法,为消化道大出血临床实践提供了一定的理论指导.     

内镜下喷洒过氧化氢对急性上消化道出血部位影响的临床研究

目的 :本研究旨在证明过氧化氢在急诊内镜时是否可以作为一种溶剂以改变血凝块的性质 ,使内镜下出血部位视野较清晰。方法 :急性上消化道出血患者 2 0例 ,急诊内镜对可疑出血部位先用 2 0 0ml生理盐水喷洒 ,再用 2 5～ 1 75ml 3%过氧化氢喷洒。分别在生理盐水和过氧化氢冲洗前后照相 ,然后将这些照片送给 3名消化病专家运用视野清晰度评分系统进行评分。为了评价 3 %过氧化氢的安全性 ,分别在喷洒前和喷洒后胃窦和十二指肠球部钳取组织并送病理。结果 :单独用生理盐水冲洗与用过氧化氢冲洗的视野清晰度评分 (2 .41∶0 .37)差异有显著性 (P <0 .0 5)。过氧化氢冲洗后的胃窦和十二指肠球部组织学检查均未发现有临床意义的变化。结论 :急诊内镜治疗急性上消化道出血时 ,过氧化氢可以清晰视野 ,明确出血部位 ,是一种安全、有效的方法 ,仅有轻微的不良反应。     

洛赛克治疗上消化道出血的止血效果及与胃酸抑制的关系

75例上消化道出血病人,随机分为两组:洛赛克(20mgqd)组41例,雷尼替丁(100mg iv bid)组34例。洛赛克组止血的显效率和总有效率分别为78.1％和97.6％,雷尼替丁组则分别为41.2％和82.4％。洛赛克组治疗3天和5天后胃内pH分别升为6.10±1.03和6.34±1.01,雷尼替丁组分别为2.88±0.57和3.10±0.48。洛赛克组的BAO抑制率在3天和5天后分别为93.3％与94.1％,雷尼替丁组分别为51.5％与60.4％。当胃内pH>6时,止血效果增加。洛赛克对上消化道出血的止血效果和胃酸抑制均优于雷尼替丁。     

Clarifying the Relationship Between ABO/Rhesus Blood Group Antigens and Upper Gastrointestinal Bleeding

Background and Aim The relationship between blood group antigens and peptic ulcer disease has been widely evaluated in the past. Data concerning the same association with upper gastrointestinal bleeding are very limited. We aimed to evaluate this association and we thought it was worthwhile to try to determine whether these components take some part in this complication. Methods The study population consisted of 1,098 adults (364 patients and 734 volunteer blood donors as controls). Demographic features, comorbid illnesses, and use of aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) were recorded. Blood groups were examined by gel centrifugation method. We included only patients with bleeding from peptic ulcer disease and erosive gastropathy. Ulcers were classified by using Forrest’s classification system in terms of rebleeding risk. Helicobacter pylori was examined by histology. Results The gender distribution was similar in both groups. The ABO blood group phenotype distribution in patients and controls (respectively) was as follows: 46.2% versus 34.9% for group O, 32.4% versus 39.5% for group A, 15.7% versus 18.4% for group B, and 5.8% versus 7.2% for group AB. Blood group O was found to have higher frequency in the patient group than in the control group (P = 0.004). Rh positivity was also higher in patients than in controls (P = 0.007). H. pylori positivity was similar between blood groups among patients. The rebleeding and mortality rates between blood groups were also similar. Conclusion ABO blood group O had an important role in patients with upper gastrointestinal bleeding. The impact of blood group on rebleeding and mortality may be a focus for further studies.