目的 比较内镜下注射去氨加压素与肾上腺素治疗老年急性消化性溃疡出血的临床疗效。方法 选取2014年10月—2018年11月杨凌示范区医院收治的老年急性消化性溃疡出血患者70例作为研究对象。采用随机数字表法将患者分为对照组和观察组，每组各35例。对照组内镜下注入0.1%盐酸肾上腺素注射液，0.5~1 mL/次，总量控制在2.0~6.0 mL。观察组注入醋酸去氨加压素注射液，0.3 μg/kg。观察两组患者的临床疗效、止血情况、诺丁汉健康调查问卷（NHP）和不良反应发生情况。结果 两组治疗总有效率比较差异无统计学意义。治疗后，观察组止血时间、即时止血率、再出血率、输血量和转外科手术率改善程度均优于对照组，但相比差异无统计学意义。治疗后，观察组患者精力、情感、睡眠、社会生活和躯体活动评分均显著低于对照组（P<0.05），疼痛评分比较无显著差异。治疗期间，观察组心血管不良反应发生率显著低于对照组（P<0.05）。结论 内镜下注射去氨加压素治疗老年急性消化性溃疡出血效果与注射肾上腺素相当，但内镜下注射去氨加压素的心血管不良发应发生率低，患者生活质量高，尤其是对于合并心血管疾病的老年患者，值得进一步临床推广应用。

Objective To compare the clinical efficacy of endoscopic injection of desmopressin and epinephrine in treatment of elderly patients with acute peptic ulcer bleeding. Methods A total of 70 cases elderly patients with acute peptic ulcer bleeding admitted to Yangling Demonstrtion Zone Hospital from October 2014 to November 2018 were selected as the research objects. The patients were divided into control group and observation group by random number table method, 35 patients in each group. Patients in the control group was injected with 0.1% Epinephrine Hydrochloride Injection under endoscopy, 0.5-1 mL/time, and the total amount was controlled within 2.0-6.0 mL. Patients in the observation group was injected with Desmopressin Acetate Injection, 0.3 μg/kg. After treatment, clinical efficacy, hemostasis, NHP score, and adverse reactions were observed in two groups. Results There was no significant difference in the total effective rate between two groups. After treatment, hemostasis time, immediate hemostasis rate, rebleeding rate, blood transfusion volume, and conversion rate of surgery in the observation group was better than those in control group, but the difference was not statistically significant. After treatment, the scores of energy, emotion, sleep, social life, and physical activity in the observation group were significantly lower than those in the control group (P<0.05), and there was no significant difference in pain scores. During the treatment, the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusion The therapeutic effect on endoscopic injection of desmopressin in treatment of elderly patients with acute peptic ulcer bleeding is comparable to and epinephrine. However, the incidence of adverse cardiovascular events caused by endoscopic injection of desmopressin is low and the quality of life of the patients is high, especially for the elderly patients with cardiovascular diseases, which is worthy of further clinical promotion and application.

R975