【摘要】 目的　比较溃疡病合并非喷射性出血患者不同内镜征象者临床表现、内镜治疗效果及转归的差异。方法　参考Forrest分级将143 例患者分为3 组:单纯渗血(Ⅰb)、渗血伴血管裸露(Ⅰb+ Ⅱa)和渗血伴血凝块(Ⅰb+ Ⅱb)。所有患者均接受内镜药物喷洒治疗,未止血者继续予内镜下注射治疗,反复大出血者外科手术。结果　内镜喷洒的即时止血率为Ⅰb 50.0% ,Ⅰb+ Ⅱa 0.0% ,Ⅰb+ Ⅱb 25.4% ;注射的即刻止血率均为100.0% 。3种不同征象的患者治疗后的再出血率为15.0% ～23.5% ,差异无显著性意义;注射治疗的再出血率低于喷洒治疗(13.7% 与37.5% ,P< 0.01)。4.0%～9.0% 的病例需要手术治疗,各组之间手术率差异无显著性意义。结论　Ⅰb+ Ⅱa、Ⅰb+ Ⅱb 者临床表现较重。内镜下注射治疗的即时效果优于喷洒治疗,且再出血的发生率较低。经内镜成功治疗的患者,尤其是接受注射者再出血和手术率与内镜征象无关更多还原

【Abstract】 Objective The endoscopic stigmas of non pulsatile bleeding from peptic ulcer were studied , the efficacy and outcome following interventional treatments compared.Methods 143 patients with bleeding foci were enrolled and categorized with reference to Forrest classification into Ib, Ib+II a and Ib+II b groups. Each had endoscopic hemostatic spray ± injection therapy. The failures underwent surgery.Results Immediate stop of bleeding was achieved with injection in all cases , while that with spray did in 50% for Ib, in 25.4% for Ib+II b and 0% for Ib+II a . Bleeding recurred later less frequently after injection than spray ( 13.7% and 37.5% ,P<0.01 ) . The overall recurrence rated ranged 15~23.5% with no significance . Hemostasis was finally resorted to surgery in 4.0~9.0% of cases without difference among groups.Conclusion In general patient having ulcer and visible bleeder ( Ib+II a, Ib+II b ) complained more. Injection was likely to be more effective to check the bleeder with lower incidence of recurrence. Rebleeding seen some time after initial hemostasis or alteration to operation for control of blood loss did not relate with endoscopic stigmas更多还原