摘要
为探讨分析急性上消化道出血(upper gastrointestinal hemorrhage,UGIB)患者消化内镜检查的最佳时机。回顾性分析2020年6月至2022年6月,就诊于北京友谊医院急诊科并接受消化内镜检查的736例急性UGIB患者。根据就诊后内镜检查时间分为急诊内镜组(12 h内)和择期内镜组(12 h后)。比较两组患者一般临床资料、内镜相关资料、介入栓塞率、外科手术率、输血量、30 d内的再出血率、死亡率和平均住院时间。本研究共纳入428名患者,其中326名患者进行了急诊内镜检查(76.2%)。与择期内镜组相比,急诊内镜组心率明显增加(Ρ=0.043)而收缩压降低(Ρ=0.061)。14例(3.3%)患者内镜治疗失败后请血管介入科行经动脉栓塞,6例(1.4%)患者转入普通外科行手术治疗,两组患者没有明显差异(Ρ=0.115,Ρ=0.561)。两组患者平均输血量和住院时间没有明显差异(Ρ=0.138,Ρ=0.799)。30 d内再出血率为10.0%(43/428),急诊内镜组为11.7%(38/326),择期内镜组为4.9%(5/102)(Ρ=0.048)。30 d总死亡率为6.8%(29/428),急诊内镜组和择期内镜组没有差异(7.7%和3.9%,Ρ=0.189)。UGIB患者择期内镜与急诊内镜相比,30 d再出血概率低,介入栓塞率、外科手术率、输血量、30 d死亡率和平均住院时间没有明显差别。UGIB患者在血液动力学稳定后,宜采用择期内镜。
In order to explore the optimal time of endoscopy in patients with acute upper gastrointestinal hemorrhage(UGIB).736 patients with acute UGIB who received digestive endoscopy examination in the Emergency Department of Beijing Friendship Hospital from June 2020 to June 2022 were retrospective analysised.According to the endoscopic examination time after visit the Department of Emergency,the patients were divided into emergency endoscopy group(within 12 hours after visit the Department of Emergency)and selective endoscopy group(after 12 hours).The general clinical data,endoscopic related data,interventional embolization rate,surgical procedure rate,blood transfusion volume,30 day rebleeding rate,mortality rate,and average hospital stay of the two groups were compared.A total of 428 patients were enrolled in this study,326 of whom underwent emergency endoscopic examination(76.2%).Compared with the elective endoscopy group,the emergency endoscopy group showed a significant increase in heart rate(Ρ=0.043)and a decrease in systolic blood pressure(Ρ=0.061).14 patients(3.3%)were referred to the vascular intervention department for transarterial embolization after endoscopic treatment failed,while 6 patients(1.4%)were transferred to general surgery for surgical treatment.The two groups of patients(Ρ=0.115,Ρ=0.561)showed no significant difference.There was no significant difference in average blood transfusion volume and hospital stay between the two groups of patients(Ρ=0.138,Ρ=0.799).The rate of rebleeding within 30 days was 10.0%(43/428),11.7%(38/326)in the emergency endoscopy group,and 4.9%(5/102)in the elective endoscopy group(Ρ=0.048).The total 30-day mortality rate was 6.8%(29/428),and there was no difference between the emergency endoscopy group and the elective endoscopy group(7.7%and 3.9%,Ρ=0.189).Compared with emergency endoscopy,elective endoscopy for UGIB patients has a lower probability of rebleeding after 30 days,and there is no significant difference in intervention embolization rate,surgical surgery rate,blood transfusion volume,30-day mortality rate,and average hospital stay.After hemodynamic stability,UGIB patients should use selective endoscopy.
作者
赵云华
葛旭
李丹
邓彦俊
张文江
ZHAO Yun-hua;GE Xu;LI Dan;DENG Yan-jun;ZHANG Wen-jiang(Department of Emergency,Beijing Friendship Hospital,Beijing 100050,China;Internal Medicine Department,Tsinghua University Hospital,Beijing 100084,China)
出处
《科学技术与工程》
北大核心
2024年第14期5753-5759,共7页
Science Technology and Engineering
关键词
消化道出血
消化内镜
治疗时机
gastrointestinal hemorrhage
endoscopy
time-to-treatment
