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强化抑酸方案在行内镜止血术老年急性非静脉曲张性上消化道大出血患者中的效果
作者:郑泽辉 
单位:协和江南医院/武汉市江夏区第一人民医院, 湖北 武汉 430200
关键词:急性非静脉曲张性上消化道大出血 内镜 泮托拉唑 尿素氮 红细胞压积 
分类号:R459.9;R605.972
出版年·卷·期(页码):2019·38·第十一期(1319-1323)
摘要:

目的:探讨强化抑酸方案在行内镜止血术治疗的老年急性非静脉曲张性上消化道大出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)患者中的应用价值。方法:采用随机数字表法将2016年3月至2018年3月收治的106例老年ANVUGIB患者分为对照组(53例)和观察组(53例)。两组均行内镜止血术,对照组予以常规抑酸方案,观察组予以强化抑酸方案。观察两组临床效果,即治疗相关指标,治疗前、治疗72 h后血清尿素氮(BUN)、红细胞压积(Hct)水平变化及预后结局。结果:观察组治疗总有效率为98.11%,与对照组84.91%相比,差异有统计学意义(P<0.05);观察组止血时间、呕血停止时间、黑便消失时间及住院时间与对照组相比均明显较短,输血量较对照组明显少,差异均有统计学(P<0.05);治疗前两组血清BUN、Hct水平差异无统计学意义(P>0.05),治疗72 h后两组差异有统计学意义(P<0.05);观察组不良反应发生率为13.21%,死亡率为1.89%,与对照组的9.43%、7.55%相比,差异均无统计学意义(P>0.05);观察组再出血率为1.89%,明显低于对照组的13.21%(P<0.05)。结论:强化抑酸方案应用于行内镜止血术的老年ANVUGIB中,效果显著,再出血率低,可明显调节血清BUN和Hct水平。

Objective: To explore the value of intensive acid suppression in elderly patients with acute non-variceal upper gastrointestinal hemorrhage (ANVUGIB) treated by endoscopic hemostasis. Methods: 106 elderly patients with ANVUGIB admitted from March 2016 to March 2018 were randomly divided into a control group of 53 patients and an observation group of 53 patients, who all underwent endoscopic hemostasis treatment. The control group combined with conventional acid suppression program, the observation group combined with enhanced acid suppression program. The clinical effects of the two groups, treatment related indicators, serum urea nitrogen (BUN), hematocrit after treatment, 72 h after treatment (Hct) level changes and prognosis outcomes were observed. Results: The total effective rate of the observation group was 98.11%, which was statistically significant compared with the control group 84.91% (P<0.05).The hemostasis time, the time of hematemesis, the time of disappearance of melena and the length of hospital stay in the observation group were significantly shorter than those in the control group. The blood transfusion volume was significantly less than that of the control group, and the difference was statistically significant (P<0.05).There was no significant difference in serum BUN and Hct levels between the two groups before treatment (P>0.05).After 72 hours of treatment, the serum BUN and Hct levels in the observation group were compared with the control group (P<0.05).The incidence of adverse reactions in the observation group was 13.21%, and the mortality was 1.89%. Compared with the control group of 9.43% and 7.55%, the difference was not statistically significant (P>0.05).The rebleeding rate of the observation group was 1.89%, which was significantly higher than that of the control group 13.21% (P<0.05). Conclusion: The enhanced acid suppression program is applied to the elderly ANVUGIB for endoscopic hemostasis. The effect is significant, the rate of rebleeding is low, and the serum BUN and Hct levels can be significantly adjusted, and the safety is high, thus it is worthy of promotion.

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