急诊内镜在急性心肌梗死合并上消化道出血诊治中的应用

摘要

目的 探讨急诊内镜在急性心肌梗死(AMI)合并上消化道出血(UGIB)诊治中的疗效与安全性.方法 对15例AMI并发急性上消化道出血的患者行急诊胃镜检查并给于内镜下止血治疗,评价治疗效果及安全性.结果 15例AMI合并急性上消化道出血患者均顺利完成了急诊胃镜检查及止血治疗,其中消化性溃疡6例(35.3%),食管贲门黏膜撕裂综合征(MWS)5例(29.4%),急性糜烂出血性胃炎1例(5.9%),应激性溃疡2例(11.7%),食道胃底静脉曲张1例(5.9%),没有严重并发症发生,有2例出现了一过性低血压和心动过缓.结论 基于本研究人群,急诊内镜检查可用于AMI合并UGIB,对5例MWS镜下止血安全有效,未发生严重并发症,但本研究样本量很少,依赖于大样本研究验证.%Objective To discuss the curative effect and safety of emergency endoscope in treatment of acute myocardial infarction (AMI) complicated by upper gastrointestinal bleeding (UGIB).Methods The patients with AMI complicated by UGIB (n=15) were given examination of emergency endoscope and endoscopic hemostasis treatment. The curative effect and safety were reviewed.Results The examination of emergency endoscope and endoscopic hemostasis treatment were succeed in all patients. Among 15 patients, there were 6 (35.3%) with peptic ulcer, 5 (29.4%) with mallory-weiss syndrome (MWS), 1 (5.9%) with acute erosive hemorrhagic gastritis, 2 (11.7%) with stress ulcer, and 1 (5.9%) with esophageal and gastric varices. There were no severe complications observed and 2 patients had transient hypotension and bradyarrhythmia.Conclusion Based on this studied population, emergency endoscope can be applied in patients with AMI complicated by UGIB, and endoscopic hemostasis is safe and effective in 5 patients with MWS without severe complications. As the size of sample is small in this study, the conclusion needs further verification depends on larger size of sample.