消化内镜下不同止血夹治疗上消化道出血的疗效及对白蛋白、血红蛋白和血小板水平的影响

Efficacy of different hemostatic clips under digestive endoscopy on upper gastrointestinal hemorrhage and effects on levels of ALB, HGB and PLT

摘要:

目的 比较消化内镜下可旋转重复开闭软组织夹（和谐夹）与金属钛夹止血治疗上消化道出血的应用效果及对患者白蛋白（ALB）、血红蛋白（HGB）和血小板（PLT）水平的影响。方法 回顾性分析2018年1月－2019年12月该院167例上消化道出血患者的临床资料，根据内镜下使用的止血夹不同，分为观察组（和谐夹，n = 74）与对照组（Olympus金属钛夹，n = 93）。经倾向评分匹配，得到观察组与对照组各48例，比较两组即时止血率、止血有效率、再出血率、钛夹使用数量、住院期间平均输血量、术后住院时间、止血夹开始脱落时间和治疗前后ALB、HGB、PLT的变化，记录两组外科再手术率、并发症发生率和病死率。结果 观察组即时止血率为100.00%，与对照组93.75%比较，差异无统计学意义（P > 0.05）；止血有效率为97.92%，高于对照组85.42%（P < 0.05）；再出血率为4.17%，低于对照组18.75%（P < 0.05）；观察组止血夹使用数量和输血量均较对照组少，住院时间较对照组短，止血夹开始脱落时间晚于对照组，两组比较，差异均有统计学意义（P < 0.05）；两组ALB和HGB水平治疗后7 d均较治疗前高（P < 0.05），且观察组HGB水平高于对照组，两组比较，差异有统计学意义（P < 0.05）；两组PLT水平与治疗前比较，差异无统计学意义（P > 0.05）；两组外科再手术率、并发症发生率和病死率比较，差异均无统计学意义（P > 0.05）。结论 消化内镜下和谐夹止血用于上消化道出血治疗，较常规金属钛夹可提高患者止血有效率、降低再出血率，具有良好的应用前景。

Abstract:

Objective To compare the application effects of rotating and repeatedly opening-closing soft tissue clip (SureClip) and metal titanium hemostatic clip under digestive endoscopy on upper gastrointestinal hemorrhage and effects on levels of patients albumin (ALB), hemoglobin (HGB) and platelet (PLT).Methods The clinical data of 167 patients with upper gastrointestinal hemorrhage from January 2018 to December 2019 were retrospectively analyzed. According to the different hemostatic clips under endoscopy, the patients were divided into observation group (Sure Clip, n = 74) and control group (Olympus metal titanium clip, n = 93). By propensity score matching, each 48 cases were obtained in the two groups. The immediate hemostasis rate, hemostasis effective rate, re-bleeding rate, the number of titanium clip use, average blood transfusion during hospitalization, postoperative hospital stay, start time of falling of hemostatic clips and changes of ALB, HGB and PLT before and after treatment were compared between the two groups, and the surgical re-operation rate, incidence rates of complications and mortality rate were recorded in the two groups.Results The immediate hemostasis rate in observation group was not significantly different than that in control group (100.00% vs 93.75%) (P > 0.05). The hemostasis effective rate was higher than that in control group (97.92% vs 85.42%) (P < 0.05), and the rebleeding rate was lower than that in control group (4.17% vs 18.75%) (P < 0.05). The number of use of hemostatic clips, blood transfusion and hospital stay in observation group were less or shorter than those in control group, and the start time of falling of hemostatic clips was later than that in control group (P < 0.05). At 7 d after treatment, the levels of ALB and HGB in the two groups were higher than those before treatment (P < 0.05), and the HGB level in observation group was higher than that in control group (P < 0.05). There was no statistically significant difference in the PLT level compared with that before treatment (P > 0.05). There were no statistically significant differences between the two groups in the surgical reoperation rate, incidence rates of complications and mortality rate (P > 0.05).Conclusion Compared with conventional metal titanium clip, SureClip hemostasis under digestive endoscopy for upper gastrointestinal hemorrhage can improve the hemostasis effective rate and reduce the rebleeding rate, with good application prospects.