【摘要】 目的探讨应激性溃疡大出血的数字减影血管造影(digital subtraction angiography,DSA)表现和介入治疗的临床价值。方法 2006-06-2011-09,12例手术或创伤后出现应激性溃疡并消化道大出血的患者接受了DSA造影检查和介入治疗。回顾性分析应激性溃疡并发消化道大出血的DSA表现和介入治疗方法,比较介入术前和术后第3天血红蛋白、红细胞压积、血压和心率变化。结果 DSA表现为局部血管网状增多、走形紊乱、肠壁或胃壁异常染色7例;局部异常染色伴对比剂渗出3例;2例患者未见异常血管。其中11例进行介入治疗后出血即刻停止,1例术后大出血复发行外科手术治疗。所有患者未出现消化道穿孔、腹膜炎等严重并发症。术后第3天患者血红蛋白、红细胞压积、收缩压和舒张压增高,心率降低(均P<0.05)。结论介入治疗应激性溃疡大出血操作简单、安全性高、止血迅速、效果好,是一种有效的治疗措施,值得临床推广应用。更多还原

【Abstract】 Objective To review the imaging signs of digital substraction angiography(DSA) and clinical value of interventional therapy in massive hemorrhage induced by stress ulcer.Methods Twelve patients with massive hemorrhage induced by stress ulcer underwent DSA examination and interventional therapy from June 2006 to September 2011.The imaging signs of DSA and the efficacy of interventional therapy were retrospectively analyzed.The hemoglobin,hematocrit,blood pressure and heart rate before and 3d after interventional therapy were compared.The data were analyzed with paired-samples T test using SPSS 12.0 statistical software.Results The DSA demonstrated local vessel increasing with disordered appearance and increased stains of the gastrointestinal wall in 7 patients,locally increased stains with contrast medium effusion in 3 and no vessel changes in 2.The massive hemorrhage ceased immediately after interventional therapy in 11 patients,and 1 patients had re-hemorrhage at d4.Severe complication such as gastrointestinal perforation and necrosis did not happen in the patients.Compared with pre-procedure levels the hemoglobin,hematocrit,systolic and diastolic pressure were elevated(t=7.564,P=0.000;t=6.616,P=0.000;(=6.051,P=0.000;t=8.579,P=0.000),and the heart rate was decreased(t=11.050,P=0.000) at d3 after intervention.Conclusion Interventional therapy is a simple,safe,effective and rapid method for massive hemorrhage induced by stress ulcer.更多还原