上消化道急性应激性黏膜病变出血的急诊内镜诊断和治疗

目的探讨上消化道急性应激性黏膜病变出血患者的急诊内镜诊断和治疗。方法对上消化道急性应激性黏膜病变出血患者60例进行急诊内镜检查,并行内镜下治疗及其他治疗的资料进行回顾性分析。结果60例患者内镜下病变表现为4种类型,其中充血水肿型36例、急性溃疡型22例、出血糜烂型20例、坏死剥脱型12例(有的各型并存)。单纯内镜下止血14例全部成功,内镜下止血加静脉给药止血20例亦全部成功;内镜下止血+胃管注药+静脉给药止血18例、成功15例;内镜下止血+胃管注药+静脉给药+手术止血8例、成功5例;有6例重症患者虽经内、外科综合治疗仍然病死。结论急诊内镜不仅是上消化道急性应激性黏膜病变出血准确可靠的诊断手段,而且也是一种快速有效的治疗方法。

Emergent endoscopic diagnosis and treatment of upper digestive hemorrhage from acute stress mucosal lesion

Objective To explore the emergent endoscopic diagnosis and treatment of upper digestive hemorrhage from acute stress mucosal lesion. Methods The 60 patients with upper digestive hemorrhage from acute stress mucosal lesion were checked by endoscope, the hemostasis under the endoscope and other therapeutic measures were performedtheir clinical data were analysed retrospectively.Results The 4 different patterns of mucosal lesion in above-mentioned patients could be seen under the endoscope, congestive edematous type in 36 cases, acute ulcerative type in 22 cases, hemorrhagic erosive type in 20 cases and necrotic exfoliative type in 12 cases.The hemostasis of 14 patients under simple endoscope was successful, and the hemostasis of 20 patients under the endoscope(①) plus phlebostasis(②) was successful 18 patients were subjected to the therapies of ①+②+drug given by nasogastric intubation(③), of them 15 were successed 8 patients subjected to ①+③+②+operation, of them 5 successed.The 6 patients with massive bleeding died after comprehensive treatment.Conclusion Emergent endoscopy not only offers correct diagnosis for upper digestive hemorrhage from acute stress mucosal lesion, but also is a rapid and effective therapeutic method.