目的 探讨内镜止血治疗在急性非静脉曲张性上消化道出血中的疗效及对症护理。方法 173例急性非静脉曲张性上消化道出血患者,根据出血病因及内镜下改良Forrest分级选择不同治疗方法:注射药物、氩离子凝固术(APC)、血管夹及联合止血治疗等4 种内镜下止血措施,观察其疗效并采取对症护理。结果 173例非静脉曲张性出血患者,总的即时止血率为98.27%(170/173),再出血率为8.09% (14/173)。其中注射组69例,即时止血率92.75%(64/69),有效止血率85.51% (59/69),再出血率11.59%(8/69),转外科手术7例,发生率10.14%(7/69); APC组8例,即时止血率87.50%(7/8),有效止血率75.00% (6/8),再出血率25.00%(2/8); 钛夹组91例,即时止血率100%(91/91),有效止血率96.70%(88/91),再出血率3.30%(3/91),转外科手术2例,发生率2.20%(2/91)再出血率明显低于注射组及APC 组(P＜0.05); 联合组5例,即时止血率100%(5/5),有效止血率80.00%(4/5),再出血率20.00%(1/5)转外科手术1例,发生率20.00%(1/5)。全部内镜止血病例无明显并发症,无死亡病例。结论 内镜下止血治疗起效迅速、疗效确切,是急性非静脉曲张性上消化道出血患者的首选急救治疗方法,准确评估患者病情、迅速恢复有效循环、针对不同的出血病因选择更为合理的止血方法、医护间的密切配合是抢救成功的关键。

Objective To investigate the effect of endoscopic hemostasis on acute non-varicose upper gastrointestinal bleeding and its symptomatic nursing.Methods Based on the etiology and endoscopic improved Forrest classification,173 cases of acute non-varicose upper gastrointestinal bleeding received different treatments,including injection of drugs,argon ion coagulation (APC),vascular clamp,and combined hemostatic therapy.Their curative effects and symptomatic nursing were observed.Results In the 173 patients with non-varicose upper gastrointestinal bleeding,the total immediate hemostasis rate was 98.27% (170/173),and the rebleeding rate was 8.09% (14/173).Among them,69 patients in the injection group had the immediate hemostasis rate of 92.75% (64/69),effective hemostasis rate of 85.51% (59/69),rebleeding rate of 11.59%(8/69),and surgical operation rate of 10.14% (7/69); 8 cases in the APC group had the immediate hemostasis rate of 87.50% (7/8),effective hemostasis rate of 75.00% (6/8),and rebleeding rate of 25.00%(2/8); 91 patients in the vascular clamp group had the immediate hemostasis rate of 100% (91/91),effective hemostasis rate of 96.70% (88/91),rebleeding rate of 3.30% (3/91),which was significantly lower than those of the injection group and the APC group (P<0.05),and surgical operation rate of 2.2% (2/91); 5 patients in the combined group showed the immediate hemostasis rate of 100% (5/5),effective hemostasis rate of 80.00%(4/5),rebleeding rate of 20.00%(1/5),and surgical operation rate of 20.00%(1/5).Neither significant complications nor deaths occurred.Conclusion Endoscopic hemostasis exhibits a quick and precise effect; therefore,it should be the preferred first-aid treatment for acute non-varicose upper gastrointestinal bleeding patients.The key to successful rescue of the disease includes accurate assessment,fast recovery of effective circulation,endoscopic hemostatic treatment appropriate for bleeding etiologies,and close cooperation between doctors and nurses.