急性消化性溃疡出血的内镜治疗

Endoscopic management of acute peptic ulcer bleeding.

作者信息

Lu Yidan, Chen Yen-I, Barkun Alan

机构信息

Division of Gastroenterology, McGill University Health Center, McGill University, 1650 Cedar Avenue, Montréal H3G 1A4, Canada.

Division of Gastroenterology, McGill University Health Center, McGill University, 1650 Cedar Avenue, Montréal H3G 1A4, Canada; Division of Clinical Epidemiology, McGill University Health Center, McGill University, 687 Pine Avenue West, Montréal H3A 1A1, Canada.

出版信息

Gastroenterol Clin North Am. 2014 Dec;43(4):677-705. doi: 10.1016/j.gtc.2014.08.003. Epub 2014 Sep 16.

DOI:10.1016/j.gtc.2014.08.003

PMID:25440919

Abstract

This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.

摘要

本综述讨论了消化性溃疡所致上消化道出血的内镜治疗的适应证、技术方面及相对疗效。对内镜检查前的注意事项，如促动力药的使用和内镜检查时机进行了综述。此外，本文还探讨了内镜检查后的护理方面，如内镜检查后质子泵抑制剂的疗效、剂量和疗程、幽门螺杆菌检测以及预防再出血方面的治疗益处；以及急性消化性溃疡出血后非甾体抗炎药、抗血小板药物和口服抗凝剂（包括直接凝血酶抑制剂和Xa因子抑制剂）的使用。