中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
Chinese Journal of Clinicians (Electronic Edition)
2015年
17期
3206-3209
,共4页
王亚丽%林静%程艳丽%刘秀清%李玉红
王亞麗%林靜%程豔麗%劉秀清%李玉紅
왕아려%림정%정염려%류수청%리옥홍
消化性溃疡出血%质子泵抑制剂%内镜下止血治疗
消化性潰瘍齣血%質子泵抑製劑%內鏡下止血治療
소화성궤양출혈%질자빙억제제%내경하지혈치료
Peptic ulcer hemorrhage%Proton pump inhibitors%Endoscopic hemostasis
目的：探讨老年消化性溃疡出血的治疗方案。方法选取2014年1至12月于我院住院的85例老年消化性溃疡出血的患者，随机分为两组，观察A组（42例），入院后即给予内镜检查，如果为出血性溃疡，即给予内镜下止血治疗，后给予质子泵抑制剂（PPI）静脉滴注bid 5 d；观察B组（43例），入院后给予大剂量PPI（80 mg＋8 mg/h）泵入治疗24 h后，再行内镜检查，如果内镜发现为出血性溃疡，即给予内镜下止血治疗，后再予PPI泵入72 h，观察1周，比较两组的快速止血率、溃疡的内镜下分级、内镜下治疗率及溃疡再出血率。结果观察A组具有较高快速止血率（100%），内镜下 Forrest 分级多为Ⅰa～Ⅱb（76.2%），高危溃疡率及内镜下治疗率（76.2%）明显高于观察B组（P＜0.01），但两组再出血率无统计学差异。结论内镜下止血治疗对老年消化性溃疡出血疗效肯定，具有安全、快速止血、低再出血率的特点，提高了内科治疗效果；但首先给予大剂量、高效PPI 泵入也能得到良好的治疗效果，不仅可减少高危溃疡的发生率及内镜下治疗率，而且可以减少患者内镜下检查的时间、内镜带来的痛苦及检查的费用，也是一种理想的治疗方案。
目的：探討老年消化性潰瘍齣血的治療方案。方法選取2014年1至12月于我院住院的85例老年消化性潰瘍齣血的患者，隨機分為兩組，觀察A組（42例），入院後即給予內鏡檢查，如果為齣血性潰瘍，即給予內鏡下止血治療，後給予質子泵抑製劑（PPI）靜脈滴註bid 5 d；觀察B組（43例），入院後給予大劑量PPI（80 mg＋8 mg/h）泵入治療24 h後，再行內鏡檢查，如果內鏡髮現為齣血性潰瘍，即給予內鏡下止血治療，後再予PPI泵入72 h，觀察1週，比較兩組的快速止血率、潰瘍的內鏡下分級、內鏡下治療率及潰瘍再齣血率。結果觀察A組具有較高快速止血率（100%），內鏡下 Forrest 分級多為Ⅰa～Ⅱb（76.2%），高危潰瘍率及內鏡下治療率（76.2%）明顯高于觀察B組（P＜0.01），但兩組再齣血率無統計學差異。結論內鏡下止血治療對老年消化性潰瘍齣血療效肯定，具有安全、快速止血、低再齣血率的特點，提高瞭內科治療效果；但首先給予大劑量、高效PPI 泵入也能得到良好的治療效果，不僅可減少高危潰瘍的髮生率及內鏡下治療率，而且可以減少患者內鏡下檢查的時間、內鏡帶來的痛苦及檢查的費用，也是一種理想的治療方案。
목적：탐토노년소화성궤양출혈적치료방안。방법선취2014년1지12월우아원주원적85례노년소화성궤양출혈적환자，수궤분위량조，관찰A조（42례），입원후즉급여내경검사，여과위출혈성궤양，즉급여내경하지혈치료，후급여질자빙억제제（PPI）정맥적주bid 5 d；관찰B조（43례），입원후급여대제량PPI（80 mg＋8 mg/h）빙입치료24 h후，재행내경검사，여과내경발현위출혈성궤양，즉급여내경하지혈치료，후재여PPI빙입72 h，관찰1주，비교량조적쾌속지혈솔、궤양적내경하분급、내경하치료솔급궤양재출혈솔。결과관찰A조구유교고쾌속지혈솔（100%），내경하 Forrest 분급다위Ⅰa～Ⅱb（76.2%），고위궤양솔급내경하치료솔（76.2%）명현고우관찰B조（P＜0.01），단량조재출혈솔무통계학차이。결론내경하지혈치료대노년소화성궤양출혈료효긍정，구유안전、쾌속지혈、저재출혈솔적특점，제고료내과치료효과；단수선급여대제량、고효PPI 빙입야능득도량호적치료효과，불부가감소고위궤양적발생솔급내경하치료솔，이차가이감소환자내경하검사적시간、내경대래적통고급검사적비용，야시일충이상적치료방안。
Objective To investigate the treatment of elderly peptic ulcer bleeding.Methods As observed objects, 85 patients suffering from senile peptic ulcer bleeding were randomly divided into two groups, group A and group B. In group A, there were 42 patients who got endoscopy immediately after hospitalization. For some of them who were bleeding ulcers, the endoscopic hemostasis were put into use in first step, and then the intravenous proton pump inhibitors (PPI) bid 5days were next treatment. In group B, there were 43 patents who were given the large doses PPI pumped therapy for 24 hours after hospitalization. The following treatment was endoscopy, if there were some patients who were bleeding in ulcers, the endoscopic hemostasis were immediately given, and then gave the PPI pumped 72 hours. After one week observation, we compared the rapid hemostasis rate, endoscopic ulcer grading and ulcer rebleeding.Results In comparison, the patients in group A had high rate of rapid hemostasis (100%), endoscopic grading was ForrestⅠa-Ⅱb (76.2%), the high-risk ulcer rate and the endoscopic therapy (76.2%) were significantly higher than group B (P<0.01), in contrast, there were no noticeable difference in rebleeding between two groups.Conclusion The hemostasia treatment under the endoscope is effectual, safe and low rebleeding rate to the elderly peptic ulcer bleeding, which CAN rise the therapeutic efficacy in department of internal medicine. However, given large doses at beginning and efficiently PPI pumped can also get good treatment effect, which not only can reduce the incidence of high-risk ulcer and endoscopic treatment, but also can reduce the time of the patients with endoscopic examination, the pain of endoscopy and the cost of inspection. So it is also a reasonable treatment.
