緊急氣管插管術輔助急診胃鏡檢查搶救急性上消化道大出血7例臨床分析

【摘 要】 目的評估緊急氣管插管術下輔助急診胃鏡檢查搶救上消化道大出血的臨床價值。方法針對急性上消化道大出血時病人呈休克狀態并易嘔血誤吸，無法進行急診胃鏡檢查而病情急需查明病因及時搶救時，采用上述方法搶救上消化道大出血7例，均給予相應鏡下治療措施。結果本組7例病人均安全順利通過上述方法檢查，確診了病因并進行了內鏡下治療，2例手術，6例治愈出院，搶救成功率為85.71%。1例術后24小時死于循環衰竭。結論該方法確實對急性上消化道大出血有最大可能保證了病人的安全，保持氣道通暢，使病人得到及時查明病因，及時診斷和治療，提高了搶救成功率，確實有明顯的臨床實用價值，在基層醫院有推廣的應用價值。

【關鍵詞】 緊急氣管插管術；急診胃鏡檢查；急性上消化道大出血

【中圖分類號】 R573.2【文獻標識碼】 BThe Clinical Vaule of Emergency Endoscopy with Endotracheal Intubation in the Salvage of Massive Upper Gastrointestinal Hemorrhage

Liu HaiZhu WeimeiXiong JunguangSun HaiyanHuang Hong

(Department of Digestive Diseases，Yunnan The third People's Hospital，Kunming，650011)【Abstract】 ObjectiveTo evaluate the clinical vaule of emergency endoscopy with endotracheal intubation in the salvage of massive upper gastrointestinal hemorrhage.MethodsWe chosed 7 cases.They were all hospitalized for massive upper gastrointestinal hemorrhage，and were in shock at the same time.They were more likely to aspirat spitting blood Because of being in shock-state.We salvaged and treated the 7 patients through emergency endoscopy with endotracheal intubation. Results2 of them were operated，6 of them left hospital recurred，only 1 case died for circulatory failure 24 hours later.The success rates of salvage was 85.71%.ConclusionEmergency endoscopy with endotracheal intubation indeed plays important role in the salvage of massive upper gastrointestinal hemorrhage.It can keep airway opened，and ensure patients have more chose to be diagnosed and treated.This method ensures maximal safety，and elevates the rate of salvage.So emergency endoscopy with endotracheal intubation in the salvage of massive upper gastrointestinal hemorrhage should be popularized in basic hospital.

【Keywords】 emergency endotracheal intubation;emergency endoscopy;massive upper gastrointestinal hemorrhage急性上消化道大出血是消化系統疾病的急危重癥，死亡率可達8-13.7%[1]，早期行急診胃鏡檢查是病因診斷的關鍵檢查[2，3]，但病人為休克狀態，大量嘔血，過早行胃鏡檢查容易發生誤吸，出血期間進胃鏡影響視野，而且血壓過低，增加術中猝死[4]，行急診胃鏡風險很大，為了解決臨床難題，從2008年1月-2010年12月筆者采用了緊急氣管插管術輔助急診胃鏡檢查方法對7例搶救上消化道大出血的病人進行檢查治療取得良好效果，報告如下。

1資料與方法

1.1一般資料2008年1月-2010年12月本科收治上消化道出血病人324例，本組患者為7例，占同期病例的2.16%本組患者7例，男5例，女2例。……