摘要
目的:探讨急诊胃镜在上消化道出血诊治中的价值。方法:回顾性分析2009年1月至2011年12月因上消化道出血在中山大学附属第一医院急诊科就诊的502例患者的临床资料,根据检查的时间段分为急诊胃镜组和延迟胃镜组,其中溃疡性上消化道出血患者420例(急诊胃镜组299例,延迟胃镜组121例),静脉曲张性上消化道出血患者82例(急诊胃镜组49例,延迟胃镜组33例),比较分析两组患者的住院日、输血量、主要止血药物使用情况、是否进行外科止血和出院存活情况。结果:溃疡性上消化道出血和静脉曲张性上消化道出血的两组患者生长抑素使用率和输血量比较差异有统计学意义,P<0.05;急诊胃镜可降低溃疡性消化道出血患者外科手术治疗的风险(8/299:13/121,P=0.001)和缩短溃疡性消化道出血患者的住院天数[急诊胃镜组8(1,64)d,延迟胃镜组11(1,102)d,P=0.015];降低死亡率(溃疡性出血:2/299:9/121,P=0.001;静脉曲张性出血:1/49:4/33,P=0.023)。生存分析表明急诊胃镜提高上消化道出血患者30 d的生存率,x^2=17.840,P<0.001。结论:急诊胃镜治疗可显著减少上消化道出血患者长抑素类药物的使用,减少输血量,降低溃疡性出血患者外科手术治疗的风险和缩短住院天数,提高上消化道出血患者的总体生存率。
Objective：To explore the significance of emergence gastroscopy for the treatment of upper gastrointestinal hemorrhage. Methods： We retrospectively analyzed the clinical profiles of 502 patients with upper gastrointestinal hemorrhage who were admitted to the department of emergency, The First Affiliated Hospital of Sun Yat-sen University, between January 2009 and December 2011, and allocated these subjects into emergence gastroscopy and delayed gastroseopy group. A total of 420 patients with ulcerative upper gastrointestinal hemorrhage （299 received emergence gastroscopy and 121 were treated with delayed emergence gastroscopy） and 82 with varieeal upper gastrointestinal hemorrhage （49 received emergence gastroscopy and 33 were treated with delayed emergence gastroscopy） , respectively. The length of hospital stay, volume of blood transfusion, use of major hemostatic medication, implementation of surgical hemostasis and survival rate following discharge from the hospital were compared. Results： Patients with ulcerative upper gastrointestinal hemorrhage differed statistically from those with variceal upper gastrointestinal hemorrhage in terms of the use of somatostatin and volume of surgical blood transfusion （ P 〈 0.05 ）. Emergency gastroscopy resulted in reduced risk of surgical treatment in those with ulcerative upper gastrointestinal hemorrhage （8/299 vs. 13/121, P = 0. 001 ） and length of hospital stay （8 [1, 64] days vs. 11 [1, 102] days, P =0. 015） in patients with variceal upper gastrointestinal hemorrhage as well as lower mortality in both groups （ the former： 2/299 vs. 9/121, P =0.001 ; the latter： 1/49 vs. 4/33, P = 0. 023）. Survival analysis showed that emergence gastroscopy improved the 30-day survival rate of upper gastrointestinal hemorrhage （X^2= = 17. 840, P 〈 0. 001 ）. Conclusion： Emergence gastroseopy remarkably reduces the use of somatostatin and volume of blood transfusion in patients with upper gastrointestinal hemorrhage, and can reduce the risk of surgery, shorten the length of hospital stay and improve the overall survival rate in those with ulcerative upper gastrointestinal hemorrhage.
出处
《广州医学院学报》
2012年第5期28-31,共4页
Academic Journal of Guangzhou Medical College
关键词
急诊胃镜
上消化道出血
预后
emergence gastroscopy
upper gastrointestinal hemorrhage
prognosis
