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目的 :研究内镜联合注射肾上腺素、纤维蛋白原、凝血酶法治疗上消化道溃疡大出血的疗效。资料与方法 :39例患者 ,胃溃疡 1 8例 (窦小弯 1 0角部 6体前后壁 2 )胃空肠吻合口溃疡 1例 ,幽门管溃疡 3例 ,1 2指肠球溃疡 9例、球后溃疡 2例。 39例中直径大于 2 .5cm分别为胃溃疡 3例 ,胃癌性溃疡 2例 ,(溃疡直径 4 .5～6cm)。溃疡面约 0 .8～ 5cm 38例中直径大于 2 .5cm分别为胃溃疡 3例 ,胃癌性溃疡 2例 ,内镜下有不同程度的血管喷血、渗血。先选择注射点分布紧邻血管和渗血的四周 (0 .1～ 0 .5cm)各注 1点 ,先用 1 /1 0 0 0 0肾上腺素注射病灶周围 ,待出血停止或明显减少 ,再将 1 /1 0 0 0 0肾上腺素与纤维蛋白原混合注射 (1∶5) ,每点各用纤维蛋白原 1～ 4ml注射 (总量 30ml) ,凝血酶 50～ 1 0 0u局部推注 (总量 80 0u)。内镜治疗后均禁食 1 2～ 1 4h ,继续静滴奥美拉唑 ,并加用抗生素 ,1～ 2d后 ,将奥美拉唑改为口服 ,加粘膜保护剂。结果全部病例均立即止血 ,即刻止血效率 1 0 0 % ,4周后 ,37例良性溃疡复查胃镜 ,见溃疡愈合 34例 ,变化缩小H2期 3例。8周后复查胃镜 37例溃疡全部愈合 (1 0 0 % ) ,并发症 :无过敏性休克或DIC发生。结论 :联合注射肾上腺素、纤维蛋白原、凝血酶法治疗上消化道溃疡大出血的
Objective: To study the effect of endoscopic injection of epinephrine, fibrinogen and thrombin in the treatment of hemorrhage of upper gastrointestinal ulcer. Materials and Methods: Thirty-nine patients, 18 cases of gastric ulcer (anterior and posterior wall of 6 bodies in 10 cases of sinus lesion), 1 case of gastrojejunostomy anastomosis, 3 cases of pyloric ulcer, 9 cases of 12 duodenal ulcer, 2 cases of ulcer after the ball. 39 cases of diameter greater than 2.5cm were 3 cases of gastric ulcer, gastric ulcer in 2 cases, (ulcer diameter of 4.5-6cm). Ulcer surface about 0 .8 ~ 5cm 38 cases of diameter greater than 2.5cm were 3 cases of gastric ulcer, gastric ulcer in 2 cases, there are different degrees of endoscopic splattering and bleeding. First select the distribution of injection points immediately adjacent to the blood vessels and oozing the four (0 .1 ~ 0 .5cm) each note 1 point, first with 1/10000 adrenaline injection around the lesion until the bleeding stopped or significantly reduced, and then 1/10000 Adrenaline and fibrinogen mixed injection (1: 5), each point with fibrin 1 ~ 4ml injection (total 30ml), thrombin 50 ~ 1000u local bolus injection Amount 80 0u). After endoscopic treatment were fasting 1 2 ~ 1 4h, continue intravenous omeprazole and antibiotics, 1 ~ 2d, the omeprazole to oral, plus mucosal protective agent. Results All the cases were hemostatic immediately, with an immediate hemostatic efficiency of 100%. After 4 weeks, 37 cases of benign ulcer were examined by gastroscope, 34 cases of ulcer healing were observed, and 3 cases were changed to reduce H2 phase. After 8 weeks, 37 cases of ulcer were completely healed by gastroscopy (100%). Complication: Anaphylactic shock or DIC occurred. Conclusion: Combined injection of epinephrine, fibrinogen and thrombin in the treatment of hemorrhage of upper gastrointestinal ulcer