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目的分析急性上消化道大出血的急诊治疗方法,以提高治疗水平。方法回顾近10年来我院收治的急性上消化道大出血患者276例急诊治疗方法及结果。276例患者均急诊输液、输血及药物(生长抑素/奥曲肽,质子泵抑制剂/洛赛克等)治疗,部分患者胃镜下喷洒止血药物。41例食管胃底静脉曲张破裂出血患者加用三腔二囊管压迫止血,4例患者进行内镜下静脉曲张套扎术,1例患者行经颈静脉肝内门体支架分流术(TIPS),9例患者内镜下止血夹治疗,1例患者进行血管造影动脉灌注垂体后叶素,6例进行明胶海绵栓塞治疗,18例手术治疗。结果 276急性上消化道大出血止血率93.12%(257/276),药物治疗在48h 内止血率69.93%(193/276),生长抑素加三腔二囊管压迫止血率75.61%(31/41),内镜下套扎止血率75%(3/4),止血夹止血率88.89%(8/9),TIPS 及血管造影灌注或栓塞出血血管止血率100%(1/1,6/6);死亡组中第一个24 h 补液量均大于3 000ml 者占89.47%(17/19),应用多巴胺和阿拉明者占94.74%(18/19),均显著高于止血组的14.40%(37/257,P<0.01)和21.79%(56/257,P<0.01)。结论药物生长抑素治疗急性上消化道大出血是有效的,生长抑素加三腔二囊管压迫止血,内镜下套扎、止血夹、TIPS 及血管造影灌注或栓塞出血血管等止血方法均取得满意效果,而大量补液和升压药物可能加重大出血。
Objective To analyze the emergency treatment of acute upper gastrointestinal bleeding in order to improve the treatment level. Methods A retrospective review of the past 10 years in our hospital admitted to patients with acute upper gastrointestinal bleeding in 276 cases of emergency treatment and results. 276 patients were treated with emergency transfusion, blood transfusion and drugs (somatostatin / octreotide, proton pump inhibitor / Losec, etc.), and some patients underwent endoscopy with hemostatic drugs. 41 patients with esophageal and gastric variceal hemorrhage were treated with three-chamber two-balloon compression and hemostasis. Four patients underwent endoscopic varicose vein ligation. One patient underwent transjugular intrahepatic portosystemic shunt (TIPS) Nine patients underwent endoscopic hemostatic clip treatment, one underwent angiographic arterial infusion of pituitrin, six received gelatin sponge embolization, and 18 received surgical treatment. Results The hemostasis rate of acute upper gastrointestinal hemorrhage was 93.12% (257/276) in 276 patients. The rate of hemostasis was 69.93% (193/276) within 48 hours after drug treatment. The rate of hemostatin plus three - ), Hemostasis rate of endoscopic ligation was 75% (3/4), hemostatic clip hemostasis rate was 88.89% (8/9), TIPS and angiography perfusion or embolization bleeding bleeding rate of 100% (1 / 1,6 / 6 ). In the death group, the volume of fluid rehydration in the first 24 h was more than 3 000 ml, accounting for 89.47% (17/19), and 94.74% (18/19) in the group receiving dopamine and alendronate, all of which were significantly higher than the 14.40% (37/257, P <0.01) and 21.79% (56/257, P <0.01). Conclusion Somatostatin is effective in treating acute upper gastrointestinal hemorrhage. Somatostatin plus three-cavity two-capsule compression hemostasis, endoscopic ligation, hemostatic clip, TIPS and angiography perfusion or embolization bleeding hemostasis are all achieved Satisfactory results, and a large number of rehydration and booster drugs may aggravate bleeding.