消化科

治疗胃静脉曲张(GV)出血

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使用方法1

(1)术前准备:

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(2)操作方法:

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WEIJINGMAIQUZHANGZHILIAOYUANZESHANGYISHOUSHUWEIZHU,JIXINGCHUXUEHUOGANGONGNENGCHAZHE,CHUYINGYONGYAOWUHES-BGUANWAI,JINGNEIJINGZHILIAOSHIZHUYAOSHOUDUAN。YIYONGJIAOZHURUWEIJINGMAIQUZHANGNEI,XUEYEXUNSUGUHUA,FENGDUXUEGUAN,ZUDUANXUELIU,DADAOZHIXUEDEMUDE。DANDUYINGYONGYIYONGJIAOHUOYUYINGHUAJILIANHEZHILIAOSHIGUANWEIDIJINGMAIQUZHANGCHUXUE,QIZHIXUELVWEI85%~100%,ZAICHUXUELVWEI3.7%~41% ,ZAICHUXUEZHEDUOSHUZAICIYONGYIYONGJIAOZHILIAORONGYIZHIXUE。

注意事项:

胃静脉曲张多位于胃底,注射医用胶时,镜轴要顺钟向转位,是注射的最佳位置。治疗前要吸净胃液,以免影响视野。胃底有大量血性液或凝血块时,很难在穿刺轴线的位置上观察到胃静脉曲张,因此应用S-B管洗净胃内血液后进行操作。胃静脉曲张有活动性出血者,尽量不要采取医用胶的方法,因视野不佳,成功率低。注射时将胃静脉曲张调整在穿刺针的轴线上,患者要减弱呼吸幅度,穿刺的力度要适当,避免呼吸幅度或穿刺力度过大,穿刺真外套管一并进入静脉内,退针后引起出血。助手配合操作要熟练,用三明治夹心法时,应快速将医用胶注射至胃静脉曲张内,防止血液逆流入针管内医用胶产生凝固反应,造成管腔堵塞,进入静脉内的计量不足,退针后出血。治疗上、下消化道出血,胃、十二指肠溃疡等。

使用方法2

  • 清洗胃镜后,镜头涂以薄层碘油或硅油,注胶导管必须清洁干燥注胶前,先向管内注入碘油。
  • 上、下消化道出血:胃镜直视下,找出出血部位,注入清水冲洗,后退胃镜,由活检孔插入备好的注胶管,接注射器推注康派特医用胶适量,即可形成一薄层白膜,覆盖止血,不易复发。操作完毕退镜时,应将注胶管和胃镜同时拔出。必须由下端抽出导管。下消化道出血用肠镜将康派特医用胶注在出血点即可止血。
  • 胃、十二指肠溃疡:在胃镜直视下,用细胞刷清洗溃疡后,注入双氧水5ml冲洗,通过吸引、注气使溃疡面无液渍,由活检孔插入塑料导管,接注射器推注康派特医用胶于溃疡面。使用量由医生根据溃疡面大小而定,将溃疡面覆盖严密即可。同上方法退镜。

注意事项:

  • 注胶导管和注射器一定要干燥。
  • 涂胶应均匀、用量不宜过大。
  • 镜头应涂碘油或硅油,操作完毕,退出镜头后,由下端抽出导管。


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