胃镜下注射肾上腺素联合生物胶喷洒治疗消化性溃疡活动性出血的临床研究

Clinical study on the treatment of active bleeding of peptic ulcer with adrenaline injection combined with bioglue under gastroscope

摘要:

目的 探讨胃镜下注射肾上腺素联合生物胶喷洒治疗消化性溃疡活动性出血的疗效。方法 回顾性分析2019年2月－2020年1月自贡市第一人民医院收治的143例消化性溃疡活动性出血患者的临床资料，按不同治疗方法分为3组。其中，A组（n = 44）采用胃镜下注射肾上腺素 + 静脉注射奥美拉唑治疗，B组（n = 48）采用胃镜下生物胶喷洒 + 静脉注射奥美拉唑治疗，C组（n = 51）采用胃镜下注射肾上腺素 + 生物胶喷洒 + 静脉注射奥美拉唑治疗。对比3组患者临床疗效、止血时间、住院时间、治疗7 d内呕血次数、黑便次数、再出血率和不良反应发生情况。结果 按照显效、有效和无效的顺序，A组分别为15、17和12例，B组分别为17、19和12例，C组分别为22、27和2例，3组患者临床疗效比较，差异有统计学意义（P < 0.05）；C组总有效率明显高于A组和B组（96.08%、72.73%和75.00%，P < 0.01），3组患者总有效率比较，差异有统计学意义（P < 0.05）；治疗第7天，A组、B组和C组的血红蛋白含量分别为（92.56±10.25）、（94.02±11.37）和（118.31±12.48）g/L，血细胞比容分别为（38.71±5.36）%、（37.08±5.19）%和（45.06±5.26）%，3组患者血红蛋白和血细胞比容水平较入院时均升高（P < 0.05），治疗第7天时，A组和B组的血红蛋白和血细胞比容水平比较，差异均无统计学意义（P > 0.05），C组血红蛋白和血细胞比容高于A组和B组（P < 0.05）；A组、B组和C组组的止血时间分别为（4.34±0.75）、（4.29±0.84）和（1.68±0.29）d，住院时间分别为（14.85±3.30）、（15.02±3.27）和（9.24±2.98）d，治疗7 d内呕血次数分别为（2.66±0.46）、（2.57±0.42）和（1.65±0.44）次，治疗7 d内黑便次数分别为（3.21±0.52）、（3.08±0.49）和（1.96±0.46）次，A组和B组的止血时间、住院时间、治疗7 d内呕血次数、黑便次数及再出血率比较，差异均无统计学意义（P > 0.05），C组止血时间和住院时间明显短于A组和B组（P < 0.05），治疗7 d内呕血次数和黑便次数明显少于A组和B组（P < 0.05），再出血率明显低于A组和B组（9.80%、45.45%和33.33%，P < 0.01），3组患者不良反应发生率比较，差异无统计学意义（P > 0.05）。结论 胃镜下注射肾上腺素联合生物胶喷洒治疗消化性溃疡活动性出血，能够提高治疗效果，加快止血，改善呕血和黑便状况，降低再出血率，缩短住院时间，安全性高，值得临床推广应用。

Abstract:

Objective To explore the effect of epinephrine injection combined with bioglue spraying under gastroscope in the treatment of active bleeding of peptic ulcer.Methods The clinical data of 143 patients with peptic ulcer active bleeding from February 2019 to January 2020 were retrospectively analyzed. Among them, group A (n = 44) were treated with epinephrine injection under gastroscope and omeprazole intravenous injection, group B (n = 48) were treated with biogel spraying under gastroscope and omeprazole intravenous injection, group C (n = 51) were treated with epinephrine injection under gastroscope and biogel spraying and omeprazole intravenous injection. The clinical efficacy, hemostasis time, hospitalization time, the times of hematemesis and melena within 7 days after treatment, rebleeding rates and the incidences of adverse reactions were compared among the three groups.Results The proportion of significant effect, effective and invalid in group A was 15, 17 and 12 cases respectively. The proportion of significant effect, effective and invalid in group B was 17, 19 and 12 cases respectively. The significant, effective and invalid proportion in group C was 22, 27 and 2 case, respectively. There was a significant difference in clinical efficacy distribution among the three groups (P < 0.05). The difference in the total effective rates of the three groups was statistically significant (P < 0.05). The total effective rates of group C was significantly higher than those of group A and group B (96.08%, 72.73% and 75.00%, P < 0.01). On the 7th day of treatment, the hemoglobin levels of group A, B and C were (92.56 ± 10.25) g/L, (94.02 ± 11.37) g/L and (118.31 ± 12.48) g/L, respectively. And hematocrit of group A, B and C were (38.71 ± 5.36)%, (37.08 ± 5.19) %, and (45.06 ± 5.26) %, respectively. There was no statistical difference in the levels of hemoglobin and hematocrit between group A and group B (P > 0.05), and the levels of hemoglobin and hematocrit in group C were higher than those in group A and group B (P < 0.05). The hemostasis time of group A, group B and group C were (4.34 ± 0.75) d, (4.29 ± 0.84) d and (1.68 ± 0.29) d, respectively, the length of stay were (14.85 ± 3.30) d, (15.02 ± 3.27) d and (9.24 ± 2.98) d, respectively, the haematemesis times within 7 days of treatment were (2.66 ± 0.46) times, (2.57 ± 0.42) times and (1.65 ± 0.44) times, respectively, the times of black stool within 7 days were (3.21 ± 0.52) times, (3.08 ± 0.49) times and (1.96 ± 0.46) times, respectively. There were no statistical difference in the hemostasis time, hospitalization time, hematemesis times within 7 days after treatment, frequency of black stool and rebleeding rates between the group A and B (P > 0.05). The hemostasis time and hospitalization time in group C were markedly shorter than those in group A and group B (P < 0.05). The times of hematemesis and melena within 7 days after treatment were significantly less than those in group A and group B (P < 0.05), and the rebleeding rate of group C was significantly lower than those in group A and group B (9.80%, 45.45% and 33.33%, P < 0.01). There was no significant difference in the incidences of adverse reactions among the three groups (P > 0.05).Conclusion The treatment of peptic ulcer active bleeding by injecting adrenaline under gastroscope combined with spraying biological glue can improve the therapeutic effect, speed up hemostasis, improve the condition of hematemesis and melena, reduce the rate of rebleeding, shorten the length of hospital stay, which is safe, it is worthy of clinical application.