摘要
目的探讨对消化性溃疡出血患者进行内镜下Forrest分级的临床意义。方法将2006年10月～2009年12月因呕血和(或)黑便入院,经急诊内镜检查确诊为消化性溃疡出血患者168例分成2组,第1组(行Forrest分级)81例,第2组(未行Forrest分级)87例。对两组患者在内科治疗无差别的基础上,根据内镜下表现选择镜下局部喷洒药物、黏膜下注射和(或)止血夹治疗。结果两组即时止血率为100%。第1组48h内再出血率4.94%(4/81),4例再出血患者中Ⅰa级1例,Ⅰb级2例,Ⅱa级1例;第2组48h内再出血率14.94%(13/87),13例再出血患者中活动性出血8例,近期出血5例;两组再出血率比较差异有显著性(P<0.05)。第1组手术率2.47%(2/81),第2组手术率5.75%(5/87),两组手术率比较差异无显著性(P>0.05)。结论对消化性溃疡出血患者结合内镜下表现进行Forrest分级,可指导内镜下治疗,达到快速有效的止血目的,同时再出血率较低。对镜下表现为Ⅰ级患者予止血夹治疗,Ⅱa级予局部黏膜下注射加喷洒药物或止血夹治疗加喷洒药物,Ⅱb级以局部喷洒药物为主,如有新鲜大血凝块则加用局部黏膜下注射或止血夹治疗;Ⅱc级和Ⅲ级无需作内镜下局部特殊治疗,对部分Ⅱc级可予局部喷洒药物治疗。
[Objective] To study the clinical significance of Forrest graded peptic ulcer bleeding under emergency endoscopy.[Methods] From October 2006 to December 2009,168 patients with haematemesis and/or hematochezia diagnosed as peptic ulcer by immediate endoscopy were divided into two groups based on Forrest grading,the first group （to Forrest graded） 81 cases,the second group （not to Forrest graded） of 87 cases.Two groups based on conservative treatment without discrimination were treated with sprayed drugs,injection therapy and （or） hemoclip therapy.[Results] Initial hemostasis was all achieved in 168 patients.Bleeding recurred in 4 patients in the first group within 48 h,and 13 patients in the second group （4.94% vs 14.94%,P〈0.05）.2 patients in the first group and 5 patients in the second group underwent emergency surgery to arrest bleeding （2.47% vs 5.75%,P〉0.05）.[Conclusions] Combination with peptic ulcer bleeding on Forrest graded can guide endoscopic therapy to achieve rapid and effective hemostasis purposes,while the low rate of recurrent bleeding.The patients of grade Ⅰ were given hemoclip therapy,Ⅱa was given injection therapy and spraying of drugs or hemoclip therapy with sprayed drugs,Ⅱb spraying of drug-based,large blood clots if it is used fresh local submucosal injection or hemoclipping;Ⅱc and Ⅲ without any endoscopic therapy,some of Ⅱc may be spraying of drugs.
出处
《中国内镜杂志》
CSCD
北大核心
2011年第3期247-250,254,共5页
China Journal of Endoscopy
