三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血

目的探讨三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血的疗效,及三腔二囊管压迫止血后,内镜介入时机的选择。方法 87例食管胃底静脉曲张破裂出血患者,随机分为2组,观察组：三腔二囊管压迫后,胃管抽出胃液提示无明显活动性出血,患者生命体征平稳后,即行内镜下曲张静脉治疗;对照组：传统方法三腔二囊管压迫止血（即：三腔二囊管气囊压迫止血,每8~12 h放松气囊1次,出血停止24~48 h后,先放出气囊空气,再观察24 h,如无再出血则拔管）,再行内镜治疗。结果两组患者均顺利完成了内镜下治疗,未因活动性出血或胃腔积血影响内镜操作或治疗效果。但观察组缩短了既往三腔二囊管压迫至内镜治疗的间隙期,减轻了患者痛苦,减少了气囊压迫并发症,避免了观察期内反复出血而延误内镜治疗时机,乃至死亡的可能。结论三腔二囊管与内镜联合治疗食管胃底静脉曲张破裂出血疗效佳,观察组内镜治疗的时机,兼具了内镜急诊止血与择期治疗预防再出血的优点,值得推广。

Sengstaken-Blakemore tube combined with endoscopic therapy in treating esophageal and gastric varices bleeding

Objective To investigate the efficacy of Sengstaken-Blakemore tube combined with endoscopic therapy in treating esophageal and gastric varices bleeding and the appropriate time to use endoscopic therapy after the application of Sengstaken-Blakemore tube.Methods Eighty-seven patients with esophageal and gastric varices bleeding were randomly divided into treatment group and control group.In the treatment group,Sengstaken-Blakemore tube was used.Then gastric fluid was extracted from gastric tube.When no active bleeding was seen and patients had stable vital signs,endoscopic therapy was administrated.While in the control group,endoscopic therapy was employed after conventional use of Sengstaken-Blakemore tube（Air bag was slackened once every 8 to 12 hours and was completely released 24 to 48 hours after bleeding hemostasis. It was pulled out after another 24 hours of observation）.Results All patients of the two groups had successful endoscopic treatment.The endoscopic operation and therapeutic effect were not affected due to active bleeding or haematocele in stomach.However,the treatment group shortened the interval between compression of Sengstaken-blakemore tube and endoscopic therapy,therefore alleviated pains of patients,decreased complications of air bag compression,and avoided delaying therapeutic opportunity of endoscopy due to repeated bleeding,which might lead to death.Conclusion Sengstaken-Blakemore tube combined with endoscopic therapy is effective in treating esophageal and gastric varices bleeding.The endoscopic therapy can have faster haemastasis and prevent bleeding.Thus it is worthy of wider application.