急性非静脉曲张性上消化道出血治疗进展

急性非静脉曲张性上消化道出血治疗进展

摘要】急性非静脉曲张性上消化道出血（acute nonvariceal upper gastroinstinal bleeding ANVUGIB）包括胰管出血、胆管出血和胃空肠吻合术后吻合口附近疾患引起的出血,其临床表现与出血量大小有关，出血量小时，可表现为黑便，出血量较大时表现为呕血或血便，严重者可出现周围循环衰竭的表现。主要危险因素包括：（1）饮食习惯:饮食不规律或进食刺激性食物可削弱胃黏膜保护屏障，增加胃酸分泌导致胃粘膜产生炎症，炎症进一步加重导致溃疡形成进而出血。（2）幽门螺杆菌（Hp）感染：Hp生存于胃及十二指肠的各区域内会引起胃肠黏膜的慢性炎症，甚或导致胃及十二指肠溃疡与胃癌。（3）药物刺激：抗血小板聚集药物、抗凝药物、类固醇及非甾体抗炎药等，长期服用可损伤胃粘膜保护屏障，导致胃粘膜防御功能下降，使粘膜发生糜烂、溃疡甚至出血。出血量＞5～10ml 大便潜血试验出现阳性；当动脉或静脉血管受损时可由于出血量和速度增加表现出呕血、黑便等症状。

【关键词】急性非静脉曲张性上消化道出血；药物治疗；内镜治疗；血管造影栓塞治疗；外科手术治疗

【中图分类号】R573.2 【文献标识码】A 【文章编号】2095-1752（2019）05-0012-02

Progress in treatment of acute non-varicose upper gastrointestinal bleeding

Hou Jing.

Department of Gastroenterology, Suqian Hospital affiliated to Xuzhou Medical University,Suqian,Jiangsu 223800,China

【Abstract】Acute non-varicose upper gastrointestinal hemorrhage (acute nonvariceal upper gastroinstinal bleeding ANVUGIB) included pancreatic duct hemorrhage, bile duct hemorrhage and bleeding caused by diseases near the anastomotic site after gastrojejunostomy. The clinical manifestations were related to the amount of bleeding and the amount of bleeding was small. It can be manifested as black stool, hematemesis or blood stool when the amount of bleeding is larger, and peripheral circulation failure can be seen in severe cases. The main risk factors include: (1) eating habits: eating irregularly or eating irritant food can weaken the protective barrier of gastric mucosa and increase gastric acid secretion, which leads to inflammation of gastric mucosa. Inflammation further exacerbates the formation of ulcers and leads to bleeding. (2) Helicobacter pylori (Hp) infection: Hp exists in various regions of the stomach and duodenum, causing chronic inflammation of the gastrointestinal mucosa. Even leading to gastric and duodenal ulcers and gastric cancer.(3) drug stimulation: antiplatelet aggregation drugs, anticoagulants, steroids and non-steroidal anti-inflammatory drugs, long-term use can damage the gastric mucosal protective barrier, resulting in gastric mucosal defense function decline, Causes mucosal erosion, ulcers and even bleeding. Haemorrhage > 5-10ml stool occult blood test was positive, when the artery or vein blood vessel was damaged, hematemesis and black stool could be showed due to the increase of bleeding volume and speed.

【Key words】Acute non-varicose upper gastrointestinal bleeding; Drug therapy; Endoscopic therapy; Angiographic embolization; Surgical treatment

急性上消化道出血（Acute upper gastrointestinal hemorrhage，AUGIH）是指屈氏韧带以上的消化道出血，临床上根据AUGIH的病因，将其分为静脉曲张性