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wcjd@wjgnet.com世界华人消化杂志2009年5月8日;17(13):1363-1365ISSN1009-3079CN14-1260/R临床经验CLINICALPRACTICE改良三腔管导丝插入牵引急诊硬化治疗食管静脉曲张大出血89例陈炳芳,沈云志,汪良芝,王扬,孙克文,周燕春,秦怡陈炳芳,沈云志,汪良芝,王扬,孙克文,周燕春,秦怡,常州市第一人民医院消化科江苏省常州市213003作者贡献分布:陈炳芳与沈云志对此文所作贡献均等;此课题由陈炳芳与沈云志设计;研究过程由陈炳芳、沈云志、汪良芝、王扬、孙克文、周燕春及秦怡操作完成;数据分析由陈炳芳完成;本论文写作由陈炳芳与沈云志完成.通讯作者:陈炳芳,213003,江苏省常州市,江苏省常州市第一人民医院消化科.s_y__1@163.com电话:0519-86181102收稿日期:2008-12-10修回日期:2009-03-02接受日期:2009-03-09在线出版日期:2009-05-08CombinedtreatmentofmodifiedSengstaken-BlakemoretubeinsertedbyguidewireandEISfor89patientswithsevereesophagogastricvaricealbleedingBing-FangChen,Yun-ZhiShen,Liang-ZhiWang,YangWang,Ke-WenSun,Yan-ChunZhou,YiQinBing-FangChen,Yun-ZhiShen,Liang-ZhiWang,YangWang,Ke-WenSun,Yan-ChunZhou,YiQin,theFirstHos-pitalofChangzhou,Changzhou213003,JiangsuProvince,ChinaCorrespondenceto:Dr.Bing-fangChen,DepartmentofGastroenterology,theFirstHospitalofChangzhou,Chang-zhou213003,JiangsuProvince,China.s_y__1@163.comReceived:2008-12-10Revised:2009-03-02Accepted:2009-03-09Publishedonline:2009-05-08AbstractAIM:ToevaluatetheefficacyofcombinedtreatmentofmodifiedSengstaken-BlakemoretubeinsertedbyguidewireandEISforpatientswithsevereesophagogastricvaricealbleeding.METHODS:ModifiedSengstaken-Blakemoretubeinsertedbyguidewirewasperformedon89patientswithsevereesophagogastricvaricealbleeding,and5minaftertheinsertion,35mLonaverageEISof5%sodiummorrhuatewereinjectedintopatientswithesophagogastricvari-ces.Fastingfor24hwasadvisedtothepatients,andbloodpressure,respiratoryrate,heartrateandbleedingrecurrencewerealsoobserved.Besides,intravenousdropinfusionofH2A,PPIandantibioticsweregiventothepatients.RESULTS:ThesuccessfulrateofmodifiedSengstaken-Blakemoretubeinsertioninpatientswithsevereesophagogastricvaricealbleedingwasupto100%.Bleedingsitewasconfirmedin88patientsinthefirstsurgery.Severeesopha-gogastricvaricealbleedingwasalleviatedin87patientsbyEISadministration(97.7%),ofwhich,17wererelievedwithrepeatedEIS,andcom-plicationsoccurredin7cases(7.86%)and1casediedinthestudy(1.1%).CONCLUSION:Combinedtreatmentofmodi-fiedSengstaken-BlakemoretubeinsertedbyguidewireandEISshowsrelativelysafeandeffectiveperformanceforpatientswithsevereesophagogastricvaricealbleeding.KeyWords:Esophagogastricvaricealbleeding;Endoscopicinjectionsclerotherapy;ModifiedSeng-staken-Blakemoretube;GuidewireinsertionChenBF,ShenYZ,WangLZ,WangY,SunKW,ZhouYC,QinY.CombinedtreatmentofmodifiedSengstaken-BlakemoretubeinsertedbyguidewireandEISfor89patientswithsevereesophagogastricvaricealbleeding.ShijieHuarenXiaohuaZazhi2009;17(13):1363-1365摘要目的:研究改良三腔管导丝插入牵引急诊硬化对食管静脉曲张大出血患者的治疗效果.方法:致死性食管静脉曲张破裂大出血患者89例,应用改良三腔管导丝插入法,并在改良三腔管牵引5min后牵引下行急诊内镜硬化治疗(EIS),于曲张静脉内注射5%鱼肝油酸钠6-10mL,平均用量约35mL.术后禁食24h,观察患者血压、呼吸、心率和再出血,常规静脉给予H2A或PPI和抗生素.结果:致死性食管静脉曲张破裂活动性大出血时改良三腔管插入成功率100%;首次牵引下EIS明确出血部位88例,首次急诊EIS止血成功87例(97.7%).其中17例为多次EIS后止血,www.wjgnet.com®■背景资料食管静脉曲张破裂出血是肝硬化最严重的并发症之一,其死亡率较高.传统应用三腔二囊管...