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目的探讨对严重急性下消化道出血患者在急诊肠镜检查过程中使用蠕动冲洗泵的效果及安全性。方法选取严重急性下消化道出血患者12例,患者需行急诊肠镜检查但不耐受口服肠道准备,能耐受聚乙二醇电解质液灌肠。实施未行常规肠道准备的急诊肠镜检查,检查过程中联合使用蠕动冲洗泵。回顾性分析患者的临床资料。结果12例中,肠镜顺利到达回盲部11例。水泵冲洗前波士顿肠道准备量表(BBPS)评分为(3.42±0.52)分,水泵冲洗后BBPS评分为(8.25±0.62)分。明确出血来源9例,其中结肠息肉治疗后出血3例,内痔出血2例,结肠多发溃疡伴出血2例,结肠血管畸形、缺血性肠病各1例。采用热活检钳+钛夹止血4例,氩气刀治疗术+钛夹止血4例,单纯钛夹止血1例;最终手术治疗1例;血管造影检查介入治疗2例。无重复肠镜检查及再出血。结论对严重急性下消化道出血不宜行常规肠道准备的患者,肠镜检查过程中使用蠕动冲洗泵辅助,安全性高,效果好。
Objective To investigate the effect and safety of using peristaltic irrigation pump in patients with severe acute gastrointestinal bleeding during emergency colonoscopy. Methods Twelve patients with severe acute gastrointestinal bleeding were enrolled in this study. The patients underwent emergency colonoscopy but were not tolerated by oral gut preparation and were able to tolerate polyethylene glycol electrolyte solution enema. The implementation of emergency gut examination is not routine gut preparation, check the process of joint use of peristaltic irrigation pump. Retrospective analysis of the clinical data of patients. Results 12 cases, colonoscopy successfully reached the ileocecal 11 cases. The Boston Transit Score (BBPS) score was (3.42 ± 0.52) before pump flushing and BBPS score (8.25 ± 0.62) after pump flushing. 9 cases of bleeding were identified. Among them, 3 cases of bleeding after colonic polyps treatment, 2 cases of internal hemorrhoids, 2 cases of multiple ulcer with hemorrhage, 1 case of colon vascular malformation and 1 case of ischemic bowel disease. 4 cases were treated with hot biopsy forceps and titanium clips, 4 cases were treated with argon knife, 4 cases were treated with titanium clips, 1 case was treated with titanium clip alone, 1 case was treated by final surgery, and 2 cases were treated by angiography. No repeat colonoscopy and rebleeding. Conclusion Patients with severe acute gastrointestinal bleeding should not be routine gut preparations, the use of peristaltic pump assisted colonoscopy, high safety, good effect.