Efficacy of endoscopic injection of snake venom hemocoagulase combined with intravenous drip of omeprazole in the treatment of ulcerative upper gastrointestinal bleeding
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摘要:
目的 分析内镜下注射蛇毒血凝酶联合静脉滴注奥美拉唑治疗溃疡性上消化道出血的疗效。 方法 选取2019年5月~2022年5月于本院接受治疗的溃疡性上消化道出血患者126例作为研究对象，依据入院先后顺序分为对照组和研究组，63例/组。对照组给予奥美拉唑静脉滴注治疗，40 mg/次，2次/d；研究组在此基础上于出血部位周围或断端血管内注射蛇毒血凝酶，1~2 U/d，两组均连续治疗5 d。比较两组止血时间、再出血率、转手术率、住院时间，比较两组治疗前后凝血功能指标[凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、D-二聚体（D-D）、纤维蛋白原（FIB）]水平、血流动力学指标[收缩压（SBP）、舒张压（DBP）、心率（HR）]变化，并分析临床疗效和安全性。 结果 研究组的止血时间、再出血率、转手术率、住院时间均较对照组降低（P < 0.05）；治疗后，两组的PT、APTT较治疗前均降低，D-D、FIB较治疗前均升高（P < 0.05），且研究组PT、APTT水平低于对照组，D-D、FIB水平高于对照组（P < 0.05）；治疗后，两组SBP、DBP、HR值较治疗前均降低（P < 0.05），且研究组SBP、DBP、HR值高于对照组（P < 0.05）。研究组的治疗总有效率为95.24%，高于对照组的79.36%（P < 0.05）；研究组的不良反应总发生率为6.35%，与对照组的（12.70%）差异无统计学意义（P > 0.05）。 结论 应用内镜下注射蛇毒血凝酶联合静脉滴注奥美拉唑治疗溃疡性上消化道出血的止血效果显著，能明显降低患者再出血率、转手术率，有效改善患者凝血功能指标，维持患者血压及心率稳定，安全性高。 Abstract:Objective To analyze the efficacy of endoscopic injection of snake venom hemocoagulase combined with intravenous drip of omeprazole in the treatment of ulcerative upper gastrointestinal bleeding. Methods A total of 126 patients with ulcerative upper gastrointestinal bleeding who were treated in our hospital from May 2019 to May 2022 were selected. They were divided into the control group (n=63) and the research group (n=63) according to the order of admission. The control group was given omeprazole intravenous drip treatment, 40 mg/time, 2 times per day. The research group was given intravascular injection of snake venom hemocoagulase around the bleeding site or the broken end on this basis, 1-2 U/d, both groups received continuous treatment for 5 d. Hemostasis time, rebleeding rate, the rate of transfer to surgery and hospitalization time between the two groups were compared, the coagulation function indexes [prothrombin time (PT), partially activated prothrombin time (APTT), D-dimer (D-D), fibrinogen (FIB)] levels, hemodynamic indexes [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)] changes were compared between the two groups before and after treatment, and the clinical efficacy and safety were analyzed. Results The hemostasis time, rebleeding rate, rate of transfer to surgery, and hospital stay in the research group were significantly lower than those in the control group (P < 0.05). After treatment, the PT and APTT of the two groups were lower than those before treatment, and the D-D and FIB were higher than those before treatment (P < 0.05). The levels of PT and APTT in the research group were lower than those in the control group, while the levels of D-D and FIB were higher than those in the control group (P < 0.05). After treatment, the SBP, DBP and HR values of the two groups were all lower than those before treatment (P < 0.05). The SBP, DBP and HR values of the research group were significantly higher than those of the control group (P < 0.05). The total effective rate of the research group was significantly higher than that of the control group (P < 0.05). The total incidence of adverse reactions in the research group was not significantly different from the control group (P > 0.05). Conclusion Endoscopic injection of snake venom hemocoagulase combined with intravenous infusion of omeprazole has a significant hemostatic effect in the treatment of ulcerative upper gastrointestinal bleeding. It can significantly reduce the rate of rebleeding and transfer to surgery, effectively improve the coagulation function indexes of patients, and maintain the stability of blood pressure and heart rate of patients. -
图 1 不同部位溃疡性上消化道出血的内镜检查结果
A: 十二指肠; B: 胃窦; C: 胃体上部.
Figure 1. Endoscopy results of ulcerative upper gastrointestinal bleeding at different sites.
表 1 两组止血时间、输血量、住院时间、再出血率比较
Table 1. Comparison of hemostasis time, transfusion volume, hospital stay, and rebleeding rate between the two groups (n=63)
组别 止血时间（h, Mean±SD） 住院时间（d, Mean±SD） 再出血率[n(%)] 转手术率[n(%)] 研究组 23.16±4.26 4.35±1.08 2（3.17） 1（1.59） 对照组 31.77±6.24 5.47±1.27 9（14.29） 8（12.70） t/χ2 9.045 5.332 4.881 5.862 P < 0.001 < 0.001 0.027 0.015 
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表 2 两组凝血功能指标比较
Table 2. Comparison of coagulation function indexes between the two groups (n=63, Mean±SD)
组别 PT（s） APTT（s） D-D（µg/mL） FIB（g/L） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组 12.33±2.51 8.33±1.53α 30.25±6.59 27.17±2.26α 2.67±0.51 4.08±0.48α 3.22±0.75 3.96±0.26α 对照组 12.45±2.36 10.22±2.01α 31.06±5.77 29.32±3.54α 2.78±0.56 3.26±0.52α 3.31±0.47 3.76±0.31α t 0.276 5.939 0.734 4.063 1.153 9.197 0.807 3.924 P 0.783 < 0.001 0.464 < 0.001 0.251 < 0.001 0.421 < 0.001 αP < 0.05 vs同组治疗前. PT: 凝血酶原时间; APTT: 部分活化凝血酶原时间; D-D: D-二聚体; FIB: 纤维蛋白原.
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表 3 两组血流动力学指标比较
Table 3. Comparison of hemodynamic indexes between the two groups (n=63, Mean±SD)
组别 SBP（mmHg） DBP（mmHg） HR（次/min） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组 107.48±5.47 100.37±3.51α 81.25±4.34 67.69±3.35α 101.26±3.64 94.24±3.34α 对照组 106.86±5.49 91.44±3.43α 80.57±4.81 60.67±2.29α 101.58±3.74 85.77±3.01α t 0.635 14.443 0.816 13.731 0.487 14.952 P 0.527 < 0.001 0.416 < 0.001 0.627 < 0.001 αP < 0.05 vs同组治疗前. SBP: 收缩压; DBP: 舒张压; HR: 心率.
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表 4 两组临床疗效比较
Table 4. Comparison of the clinical efficacy between the two groups [n=63, n(%)]
组别 显效 有效 无效 总有效率 研究组 37（58.73） 23（36.51） 3（4.76） 60（95.24） 对照组 29（46.03） 21（33.33） 13（20.63） 50（79.36） χ2 7.719 P 0.007
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