Vogt W
Medizinische Klinik, Fachbereich Gastroenterologie, Städtische Kliniken Esslingen.
Praxis (Bern 1994). 2002 Mar 20;91(12):493-7. doi: 10.1024/0369-8394.91.12.493.
In patients with hematemesis an emergency endoscopy has to be done as soon as possible. In ulcer disease emergency endoscopic treatment is indicated in ulcers with active bleeding or with visible vessels in the base of the ulcer. There is no significant difference in the efficacy between the various endoscopic methods of hemostasis. Gold standard in the treatment of acute variceal bleeding is the hemostasis by endoscopic ligation or sclerotherapy. Because of the very low complication rate variceal ligation is the therapy of choice in the prevention of variceal rebleeding. Especially in patients with preexisting portal hypertensive gastropathy an additional therapy with beta-blocker is recommended. In the prevention of first variceal bleeding a combination therapy with beta-blocker and nitrate is indicated in patients with big varices with red colour signs and in patients with decompensated liver cirrhosis (Child B).
对于呕血患者，必须尽快进行急诊内镜检查。在溃疡病中，对于有活动性出血或溃疡底部可见血管的溃疡，急诊内镜治疗是必要的。各种内镜止血方法的疗效没有显著差异。急性静脉曲张出血治疗的金标准是内镜下套扎或硬化治疗止血。由于并发症发生率极低，套扎术是预防静脉曲张再出血的首选治疗方法。特别是对于已有门静脉高压性胃病的患者，建议加用β受体阻滞剂治疗。在预防首次静脉曲张出血方面，对于有红色征的大静脉曲张患者和失代偿期肝硬化（Child B级）患者，建议使用β受体阻滞剂和硝酸盐联合治疗。
