【摘要】 目的 了解上消化道出血的病因及急诊胃镜检查在上消化道出血的临床应用价值。方法 414例上消化道出血患者来诊后或入院后立即进行胃镜检查，生命体征不稳定及高龄患者建立静脉通道、补液、制酸、止血、输血、多功能心电监护，血压恢复后即行胃镜检查，用Forrest分类法作为判断出血依据。结果 414例患者中消化性溃疡269例(65%)，急性胃黏膜病变65例(15.7%)，胃癌48例(11.6%)，食管胃底静脉曲张破裂出血17例(4.1%)，Dieulafoy病7例(1.7%)，无1例病情加重或死亡。结论 上消化道出血常见病因为消化性溃疡、急性胃黏膜病变、胃癌、食管胃底静脉曲张破裂出血，Dieulafoy病增多，急诊胃镜检查可提高诊断阳性率，且安全。

     【关键词】 上消化道出血；急诊胃镜

    Analysis of emergency endoscope examination to 414 cases with hemorrhage of upper digestive tract

    LI Si,Dai Yue-li.Department of Internal Medicine,The People’s Hospital in Yun County,Yunnan Province.675800,China

    【Abstract】 Objective To probe the causes of hemorrhage of upper digestive tract and make an evaluation of clinical applicating value to emergency endoscope examination.Methods To judge hemorrhage with Forrest classification standard,414 cases with hemorrhage of upper digestive tract endured emergency endoscope examination as soon as admitted hospital except elderly of patients with unstable physical signs whose conventional intravenous infusion be established,with treatment of transfusion、hemostasis、reduced gastric acid from hypersecretion and monitor by multi-parameter,provided gastroscope examination as soon as possible when blood pressure be normal.Results In whole group,peptic ulcer for 269 cases(65%),65 cases(15.7%)with acute hemorrhagic lesion of gastric mucosa,48 patients(11.6%)suffered carcinoma of stomach,hemorrhage from esophageal varices for 17 cases(4.1%),7 cases(1.7%)with Dieulafoy disease (erosion).None of patients exacerbation or death during examination.Conclusion The causes for hemorrhage of upper digestive tract mainly were peptic ulcer,acute hemorrhagic lesion of gastric mucosa,carcinoma of stomach or hemorrhage from esophageal varices,with rising trend in incidence of Dieulafoy disease (erosion).Emergency endoscope examination can increase diagnostic accordance rate with safety. ......