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两种不同金属夹联合局部注射肾上腺素治疗急性非静脉曲张性上消化道出血的疗效比较

ISSN号：1009-3044
期刊名称：《电脑知识与技术：经验技巧》
时间：0
分类：R573.2[医药卫生—消化系统;医药卫生—临床医学;医药卫生—内科学]
作者机构：浙江大学金华医院消化内科,浙江金华321000
相关基金：浙江省金华市科技局重点项目（2013-3-010）;浙江省科技厅实验动物科技计划项目（2015C37120）

关键词：急性非静脉曲张性上消化道出血, 内镜, 和谐夹, 奥林帕斯金属夹, ANVUGIB, Endoscopy, He-xie clip, Olympus metal clip

中文摘要：

目的探讨内镜下应用可旋转重复开闭软组织夹（和谐夹）与奥林帕斯金属夹联合局部注射肾上腺素治疗ANVUGIB的疗效差异。方法选择2014年6月~2016年12月确诊为ANVUGIB并符合入组条件患者121例,随机分成两组,其中奥林帕斯金属夹组（对照组）54例,和谐夹组67例。分析两组患者止血率、再出血率、手术率、并发症等差异。结果和谐夹组即时止血率（94.0%）高于对照组（88.9%）,但无统计学差异（P=0.307）。和谐夹组72 h再出血率（4.5%）显著低于对照组（16.7%）（P=0.026）。和谐夹组有效止血率（95.5%）也显著高于对照组（83.3%）（P〈0.05）。另外,和谐夹组的金属夹使用量少于对照组,且差异有统计学意义（P=0.025）。对照组3例患者转外科手术、1例行DSA下血管栓塞治疗。和谐夹组1例转外科手术治疗。两组手术治疗率与并发症发生率均无统计学差异（P〉0.05）。结论内镜下金属夹联合局部注射肾上腺素治疗ANVUGIB时,和谐夹比奥林帕斯金属夹的有效止血率更高,再出血发生率更低,金属夹使用量也更少。

英文摘要：

Objective To compare the efficacy of rotating, repeatedly opening and closing of soft tissue clip（He-xie clip） with the Olympus metal clip combined with local epinephrine injection for the treatment of ANVUGIB （acute nonvariceal upper gastrointestinal bleeding）. Methods From June 2014 to December 2016, 121 patients diagnosed as ANVUGIB were enrolled. The subjects were randomly divided into two groups： 67 patients treated with He-xie clips and 54 patients treated with Olympus metal clips （control group）, respectively. The hemostatic rates, rebleeding rates, surgical rates, and complications between two groups were analyzed. Results The immediate hemostasis rate （94.0%） in the He-xie clip group was higher than that of the control group （88.9%）, but with no statistical significance （P=0.307）. However, the re- bleeding rate during the first 72 hours of the patients treated with the He-xie clip （4.5%） was significantly lower than that of the control group （16.7%）（P=0.026）. Similarly, the effective hemostasis rate in the He-xie clip group （95.5%） was significantly higher than that of the control group（83.3%）（P〈O.05）. Moreover, the amount of metal clips used in the He-xie clip group was significantly lower （P=0.025）： One patient treated with the He-xie clips needed additional surgery, whereas 3 patients and 1 patient in the control group were finally treated by surgery and DSA. There was no statistically significant difference between the two groups in the rate of surgical treatment and morbidity（P〉0.05）. Con- clusion He-xie clip appears to have higher effective hemostasis rate, lower rebleeding rate, and could be used in less amount than the Olympus metal clip when combined with local epinephrine injection to treat ANVUGIB.

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