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疗效比较.docVIP

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 　　[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%）（P0.05）。 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。 　　[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 　　[中图分类号] R573.2 [文献标识码] B [文章编号] 1673-9701（2017）14-0085-04 　　[Abstract] 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 rebleeding 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%） （P0.05）. Conclusion 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. 　　[Key words] ANVUGIB； Endoscopy； He-xie clip； Olympus metal clip 　　急性非?o脉曲张性上消化道出血（acute nonvariceal upper gastrointesti