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

杨小云　陈燕萍　王群英　陈跃华　沈敏瑾　叶晓华　丁进

[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%）（P<0.05）。另外，和谐夹组的金属夹使用量少于对照组，且差异有统计学意义（P=0.025）。对照组3例患者转外科手术、1例行DSA下血管栓塞治疗。和谐夹组1例转外科手术治疗。两组手术治疗率与并发症发生率均无统计学差异（P>0.05）。 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%） （P<0.05）. Moreover， the amount of metal clips used in the He-xie clip group was significantly lower（P=0.025）. One patient treated with the He-xie clips needed additional surgery， whereas 3 patients and 1 patient in the control group were finally treated by surgery and DSA. There was no statistically significant difference between the two groups in the rate of surgical treatment and morbidity（P>0.05）. 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

急性非靜脉曲张性上消化道出血（acute nonvariceal upper gastrointestinal bleeding，ANVUGIB）为屈氏韧带以上的消化道非静脉曲张性疾病引起的出血。一项系统评价显示其病死率达8.6%[1]，因而如何安全、有效地止血成为治疗的关键。内镜下止血因起效迅速、疗效确切，已逐渐成为临床首选。研究证据表明，在局部注射药物的基础上，联合一种热凝或机械止血方法，可提高内镜下止血效果[2]。本研究拟通过比较内镜下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，分析两种不同金属夹的差异。

1 资料与方法

1.1一般资料

研究对象为2014年6月～2016年12月因呕血和（或）黑便在我院行内镜下止血治疗的ANVUGIB患者。……