同轴微导管PVA栓塞介入治疗动脉性下消化道出血的研究

来源期刊：广州医药 | 869-874 发布时间：2024-09-24 收稿时间：2025/11/17 15:48:18 阅读量：22

作者：: 孙泽西,

王洋,

赵菲,

关键词：: 动脉性下消化道出血同轴微导管聚乙烯醇颗粒介入栓塞止血效果; arterial lower gastrointestinal bleeding coaxial microcatheter polyvinyl alcohol particles interventional embolization hemostatic effect

DOI：: 10.3969/j.issn.1000-8535.2024.08.007

收稿时间：: 2023-10-30
修订日期：
接收日期：
引用总数：: 0

目的研究同轴微导管聚乙烯醇颗粒（PVA）栓塞治疗动脉性下消化道出血患者的应用效果。方法本研究为前瞻性研究,选择河南科技大学第一附属医院2022年1月—2023年6月收治的118例动脉性下消化道出血患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各59例。两组均行数字减影血管造影检查明确出血情况,常规组予以内镜下注射止血治疗,试验组经同轴微导管PVA栓塞进行止血治疗,比较两组患者的治疗效果及预后情况。结果在不同治疗方案下,试验组的技术成功率、临床成功率分别为89.83%（53/59）、84.75%（50/59）,均高于常规组[71.19%（42/59）、64.41%（38/59）]（χ²=11.071、10.911,P<0.05）;试验组的止血时间、凝血酶原时间（PT）、凝血酶时间（TT）分别为（50.25±10.37）min、（10.25±2.31）s、（16.33±4.47）s,均低于常规组[（55.36±10.72）min、（12.44±3.61）s、（19.35±4.23）s]（t=2.632、3.925、3.769,P<0.05）;试验组治疗后的动脉搏动指数（PI）、阻力指数（RI）分别为（1.12±0.33）（0.51±0.21）,均低于常规组[（1.65±0.41）（0.73±0.22）]（t=7.735、5.556,P<0.05）;试验组治疗7、14、30 d后的再出血率分别为5.08%（3/59）、8.47%（5/59）、10.17%（6/59）,均低于常规组[20.34%（12/59）、25.42%（15/59）、28.81%（17/59）]（χ²=10.495、10.207、11.071,P<0.05）;试验组的并发症发生率8.47%（5/59）低于常规组22.03%（13/59）,差异均具有统计学意义（χ²=7.113,P<0.05）。结论与常规内镜下止血相比,同轴微导管PVA栓塞可显著提升动脉性下消化道出血患者的止血成功率,对缩短患者止血时间、促进凝血系统恢复、降低再出血风险及相关并发症发生风险均有积极意义。

Objective To study the effect of coaxial microcatheter PVA embolization in the treatment of patients with arterial lower gastrointestinal bleeding．Methods This study is a prospective study,118 patients with arterial lower gastrointestinal bleeding admitted between January 2022 and June 2023 were selected as the study subjects．They were randomly divided into a conventional group（59 cases）and an experimental group（59 cases）using computer randomization．Both groups underwent digital subtraction angiography examination to determine the bleeding situation．The conventional group received conventional endoscopic hemostasis treatment,while the experimental group received coaxial microcatheter PVA embolization for hemostasis treatment．The treatment efficacy and prognosis were compared between two groups．Results Under different treatment plans,the technical success rate and clinical success rate of the experimental group were 89.83%（53/59）and 84.75%（50/59）,respectively,which were higher than those of the conventional group [71.19%（42/59）and 64.41%（38/59）]（χ²=11.071、10.911,P<0.05）．The hemostatic time,PT,and TT of the experimental group were（50.25±10.37）min,（10.25±2.31）seconds,and（16.33±4.47）seconds,respectively,which were shorter than those of the conventional group [（55.36±10.72）min,（12.44±3.61）seconds,and（19.35±4.23）seconds]（t=2.632、3.925、3.769,P<0.05）．The arterial PI and RI of the experimental group after treatment were（1.12±0.33） and（0.51±0.21）,lower than those of the conventional group [（1.65±0.41）and（0.73±0.22）]（t=7.735、5.556,P<0.05）．The rebleeding rates of the experimental group after 7 days,14 days and 30 days of treatment were 5.08%（3/59）,8.47%（5/59） and 10.17%（6/59）,respectively,which were lower than those of the conventional group [20.34%（12/59）,25.42%（15/59） and 28.81%（17/59）]（χ²=10.495,10.207,11.071,P<0.05）．The incidence of complications in the experimental group was 8.47%（5/59）,which was lower than that in the conventional group 22.03%（13/59）（χ²=7.113,P<0.05）．Conclusions Compared with conventional endoscopic hemostasis,coaxial microcatheter PVA embolization can significantly improve the success rate of hemostasis in patients with arterial lower gastrointestinal bleeding,shorten the hemostasis time,promote coagulation system recovery,reduce the risk of rebleeding and related complications,with a positive significance．

1、贾波,李健.同轴微导管技术聚乙烯醇颗粒栓塞治疗大咯血疗效分析[J].中国基层医药,2020,27(7):876-878.

2、岳天华,袁鹏,吴式,等.PVA颗粒联合同轴微导管栓塞治疗支气管扩张所致大咯血的临床效果[J].中华介入放射学电子杂志,2017,5(1):9-12.

3、吴追文,高松学,吴玉,等.聚乙烯醇颗粒支气管动脉栓塞治疗急性咯血的疗效评估[J].河北医科大学学报,2020,41(6):734-737.

4、 JIN L,CHUN H J,OH J S,et al.Selective arterial embolization of renal angiomyolipoma:Comparing ethanol-lipiodol emulsion and polyvinyl alcohol particles as embolic agents[J].Diagn Interv Radiol.2023,29(1):170-174.

5、周铮. 聚乙烯醇颗粒栓塞剂在晚期肝癌伴上消化道出血患者经导管肝动脉化疗栓塞术中的应用效果[J].临床合理用药杂志,2022,15(18):90-93.

6、沈榆棋,常晗晓,张广见,等.经桡动脉入路Simmons 2导管同轴技术在颅内未破裂动脉瘤栓塞术中的应用[J].中华神经外科杂志,2022,38(12):1204-1208.

7、 BRUCE G,ERSKINE B.Analysis of time delay between computed tomography and digital subtraction angiography on the technical success of interventional embolisation for treatment of lower gastrointestinal bleeding[J].J Med Radiat Sci.2020,67(1):64-71.

8、冯宝强. 数字减影血管造影诊断及介入治疗不明原因下消化道出血[J].影像研究与医学应用,2020,4(6):237-238.

9、余海洋,梅峻豪,秦立昊,等.下消化道出血介入栓塞治疗的研究进展[J].中华普通外科杂志,2022,37(9):715-717.

10、 WERNER D J,BAAR T,KIESSLICH R,et al.Endoscopic hemostasis makes the difference:Angiographic treatment in patients with lower gastrointestinal bleeding[J].World J Gastrointest Endosc.2021,13(7):221-232.

11、张吉桂,周翔禹.消化内镜下不同止血夹治疗上消化道出血的疗效及对白蛋白、血红蛋白和血小板水平的影响[J].中国内镜杂志,2021,27(2):76-82.

12、余涛,梁建群.血凝酶内镜下喷洒配合钛夹治疗不明原因下消化道出血的临床效果[J].临床医学研究与实践,2021,6(4):62-64.

13、陈浩源,金世柱,张思佳.内镜技术治疗下消化道出血的研究进展[J].现代消化及介入诊疗,2021,26(6):786-788.

14、薛彩霞,张雁霞.714例上消化道出血的临床特点、病因及危险因素分析[J].山西大同大学学报(自然科学版),2022,38(3):73-75,85.

15、李球森,李生,徐红燕,等.130例下消化道出血的病因、临床特征及危险因素[J].临床与病理杂志,2023,43(4):682-688.

16、 TRIANTAFYLLOU K,GKOLFAKIS P,GRALNEK I M,et al.Diagnosis and management of acute lower gastrointestinal bleeding:European Society of Gastrointestinal Endoscopy(ESGE)Guideline[J].Endoscopy.2021,53(8):850-868.

17、赵年,李春华,李德秀,等.动脉性消化道出血的DSA介入治疗分析[J].现代消化及介入诊疗,2016,21(2):344-345.

18、中华医学会消化内镜学分会结直肠学组,中国医师协会消化医师分会结直肠学组,国家消化系统疾病临床医学研究中心.下消化道出血诊治指南(2020)[J].中华消化内镜杂志,2020,37(10):685-695.

19、牛占红. 明胶海绵颗粒/聚乙烯醇颗粒介入栓塞治疗大咯血疗效观察[J].实用医学影像杂志,2019,20(5):518-519.

20、张翔宇,柯娥,曹长健.动脉性下消化道出血介入治疗研究进展[J].介入放射学杂志,2021,30(6):632-635.

21、 LI M F,LIANG H L,CHIANG C L,et al.Management of acute lower gastrointestinal bleeding by pharmaco-induced vasospasm embolization therapy[J].J Chin Med Assoc,2022,85(2):233-239.

22、陈熙. 不明原因的消化道出血临床诊断中胶囊内镜的应用及准确性分析[J].国际医药卫生导报,2021,27(7):1047-1049.

23、吴豪智,孙相钊.奥曲肽联合泮托拉唑对上消化道出血患者胃液pH值和血红蛋白水平的影响[J].华夏医学,2021,34(5):86-89.

24、 KATE V,SURESHKUMAR S,GURUSHANKARI B,et al.Acute upper non-variceal and lower gastrointestinal bleeding[J].J Gastrointest Surg,2022,26(4):932-949.

25、周俊平. 急性消化道出血与急性脑出血24小时诊疗数据与临床路径标准的对比[J].广州医药,2023,54(8):100-105.