摘要
目的研究分析不同内镜检查时机对急性上消化道出血(AUGIB)患者的临床治疗效果和成本效益的影响。方法回顾性分析2022年1月至2023年12月就诊中山大学孙逸仙纪念医院急诊科并在48 h内接受急诊内镜检查AUGIB患者,根据患者入急诊科后接受内镜检查的时间分为紧急内镜组(≤12 h)、早期内镜组(>12~24 h)、常规内镜组(>24~48 h),收集患者临床资料,采用倾向性评分逆概率加权法(IPTW)平衡三组患者的基线特征,比较三组患者的治疗效果,进行内镜检查的成本效益分析。结果共纳入AUGIB患者282例,其中紧急内镜组102例,早期内镜组136例,常规内镜组44例,经IPTW调整后,三组的年龄、性别、既往消化系统疾病病史、初始病情严重程度等基线资料实现平衡(P均>0.05)。IPTW调整前后的样本进行单因素分析发现,紧急内镜组、早期内镜组和常规内镜组在接受止血干预率、重症监护病房(ICU)住院率和住院期间的全因死亡率方面差异无统计学意义(P均>0.05),紧急内镜组接受输血比例、输血量、急诊留观时间及医疗费用均低于早期内镜组及常规内镜组,组间差异有统计学意义(P均<0.05)。结论AUGIB患者就诊后12 h内接受紧急内镜检查可以缩短急诊留观时间、降低医疗费用、减少输血需求,在提高医疗服务效率和降低患者就医成本方面展现出显著的优势。
Objective To analyze the clinical effectiveness and cost-effectiveness of different endoscopy timing in patients with acute upper gastrointestinal bleeding(AUGIB).Methods The patients with AUCIB presented in the emergency department of Sun Yat-Sen Memorial Hospital from January 2022 to December 2023 who received endoscopy within 48 hours were studied retrospectively and were classified based on endoscopic timing postadmission:urgent(t<12h),early(12 h<t≤24 h)and routine(24 h<t≤48 h).According to the patient's clinical data,the inverse probability of treatment weighting(IPTW)was used to balance the baseline characteristics of the three groups,the treatment effect of the three groups were compared,and the cost-effectiveness of endoscopy was analyzed.Results A total of 282 AUCIB patients were included,including 102 in the urgent endoscopy group,136 in the early endoscopy group and 44 in the routine endoscopy group.After IPTW adjustment,the baseline data of age,sex,past medical history of digestive system disease,and severity of initial disease in the three groups were balanced(All P>0.05).By univariate analysis,there was no statistical difference in the rate of hemostasis,ICU admission and all-cause mortality during hospitalization in three groups(All P>0.05),the proportion of blood transfusion,volume of blood transfused,emergency observation time,and medical costs in the urgent endoscopy group were all significantly lower than those in the early endoscopy group and the routine endoscopy group(All P<0.05).Conclusion Compared with early and routine endoscopy,urgent endoscopy can shorten emergency observation time and reduce medical cost and blood transfusion volume,which shows significant advantages in improving the efficiency of medical service and reducing the cost of medical treatment for patients.
作者
吴娜
胡骏
文才
陈慧
吴浩
李莉
余涛
WU Na;HU Jun;WEN Cai;CHEN Hui;WU Hao;LI Li;YU Tao(Emergency Department,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2024年第9期770-775,共6页
Chinese Journal of Practical Internal Medicine
关键词
急性上消化道出血
内镜检查时机
成本效益分析
acute upper gastrointestinal bleeding
timing of endoscopy
economic benefits
