红霉素输注在急性非静脉曲张性上消化道出血内镜治疗中的临床应用

摘要

Objective To investigate the clinical application of erythromycin infusion before endoscopy therapy for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). Methods A prospective randomized study was preformed in this study. One hundred and fifty ANVUGIB patients were enrolled from Mar. 2015 to Jun. 2016 in Department of Gastroenterology,Baoji Central Hospital. Five patients were lost in follow-up,the other 145 patients were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin +gastric lavage group (both erythromycin infusion and gastric lavage). All patients were conducted to endoscopic hemostasis therapy after above intervening. The primary endpoint was satisfactory visualization. Secondary endpoints included identification of a bleeding source, the success rate of hemostasis,adverse effects related to erythromycin infusion or gastric lavage,the number of transfused blood,rebleeding rate,and bleeding-related mortality.Results All bleeding source in ANVUGIB patients were identified. There were no significant difference in duration of endoscopy, endoscopic finding, hemostatic treatment and methods among three groups (P>0.05). There was significantly difference of the number of satisfactory visualization (visualization score>6) patients among three groups(χ2=21.202,P<0.001). Visualization score,the bleeding source,the success rate of hemostasis, adverse effects, the number of transfused blood, rebleeding rate, and bleeding-related mortality had no significantly differences among three groups (P > 0. 05). Conclusion Intravenous erythromycin infusion before emergency endoscopy hemostatic therapy for ANVUGIB seems to improve satisfactory endoscopic visualization.%目的 探讨红霉素输注在急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding, ANVUGIB)内镜治疗中的临床应用价值.方法 采用前瞻性随机对照试验,选取2015年3月至2016年6月宝鸡市中心医院消化内科收治的ANVUGIB患者150例,随访1个月,失访5例,其他145例ANVUGIB患者随机分为三组:红霉素组(红霉素静脉滴注)、洗胃组(经鼻胃管洗胃)、红霉素+洗胃组(同时红霉素静脉滴注和经鼻胃管洗胃).三组患者干预后内镜止血治疗.主要研究终点:可视化评分;次要研究终点:识别出血位点、止血率与红霉素输注或洗胃相关的不良反应、输血数、再出血率和与出血有关的死亡率.结果 三组患者经内镜检查均明确出血点.三组患者内镜使用时间、内镜检查结果、内镜止血治疗及止血方法差异均无统计学意义(P>0.05).三组可视化评分≥6分的患者例数差异有统计学意义(χ2=21.202,P<0.001).三组可视化评分和出血点、止血率、不良反应、输血率、再出血率、死亡率差异均无统计学意义(P>0.05).结论 ANVUGIB患者内镜止血治疗前采用红霉素输注能有效改善内镜可视化质量.