摘要
目的探讨急性下消化道出血的临床特征及急诊肠镜诊断策略.方法选择2014-01/2017-12绍兴市中心医院接诊的210例急性下消化道出血患者为研究对象,分析急性下消化道出血的临床特征;将210例患者按肠道准备方式分为清洁灌肠组169例、口服泻药组41例,分析不同肠道清洁度对急诊肠镜诊断的影响.结果210例患者中男女比例为1.50:1;老年、中年、青年患者分别占45.71%(96/210)、29.05%(61/210)、25.24%(53/210).隐性失血10.48%,显性失血89.52%;出血方式以黑便、鲜红色血便、暗红色血便最为常见,出血病因以肠道炎症或感染发病最为常见,占35.71%,其次为结直肠息肉,占20.95%.老年组中发病以结直肠癌、肠道炎症或感染、结直肠息肉为主.中年组以肠道炎症或感染、结直肠息肉、结直肠癌为主.青年组以肠道炎症或感染、结直肠息肉、血管病变为主,清洁灌肠组中肠道清洁度优良率低于口服泻药组,差异具有统计学意义(P<0.05),清洁度优、良、差的肠镜诊断准确率为91.04%(61/67)、80.85%(38/47)、52.42%(65/124),清洁度优、良时肠道诊断符合率均高于清洁度差,差异具有统计学意义(P<0.05),清洁度优时肠道诊断符合率与清洁度良比较,差异无统计学意义(P>0.05).结论急性下消化道出血在男性中常见,老年人为多发人群,病因多为肠道炎症、结直肠息肉,不同年龄段出血病因存在一定的差异;出血多以黑便、鲜红色血便、暗红色血便为主;肠道清洁度优能提高急诊肠镜的诊断率,而口服泻药肠道清洁度优于清洁灌肠,临床在患者血流动力学稳定的基础上,应尽可能以口服泻药实施肠道准备,以提高诊断符合率.
AIM To investigate the clinical features of acute lower gastrointestinal bleeding and its diagnostic strategy with emergency enteroscopy. METHODS Two hundred and ten patients with acute lower gastrointestinal bleeding at our hospital from January 2014 to December 2017 were selected, and the clinical features of acute lower gastrointestinal bleeding were analyzed. The patients were then divided into two groups based on the bowel preparation method used： a cleansing enema group（169 cases） and an oral cathartic group（41 cases）. The influence of intestinal tract cleanliness on emergency enteroscopy diagnosis was then analyzed.RESULTS The ratio of males to females in 210 patients was 1.50：1. The elderly, middle-aged, and young patients accounted for 45.71%（96/210）, 29.05%（61/210）, and 25.24%（53/210）, respectively. There were 10.48% of hidden blood loss and 89.52% of overt blood loss. The hemorrhage was mostly common with melena, bright red bloody stools, and dark red bloody stools. The bleeding was mostly caused by intestinal inflammation or infection（35.71%） and polyps of the rectum and colon（20.95%）. Colorectal cancer, intestinal inflammation or infection, and polyps of the rectum and colon were main causes in the elderly group. Intestinal inflammation or infection, polyps of the rectum and colon, and colorectal cancer were main causes in the middle-aged group. Intestinal inflammation or infection, polyps of the rectum and colon, and vascular disease were main causes in the young group. The excellent rate of intestinal tract cleanliness in the cleansing enema group was lower than that of the oral cathartic group（P 0.05）. The diagnostic accuracy of enteroscopy with excellent, good, and poor cleanliness was 91.04%（61/67）, 80.85%（38/47）, and 52.42%（65/124）, respectively. The diagnostic accordance rate of enteroscopy with excellent or good cleanliness was higher than that of enteroscopy with poor cleanliness（P 0.05）. There was no statistical difference in the diagnostic accordance rate between enteroscopy with excellent and good cleanliness（P 0.05）. CONCLUSION Acute lower gastrointestinal hemorrhage is common in males and the elderly population. Main causes are intestinal inflammation and polyps of the rectum and colon, and there is certain difference in the causes of bleeding in patients of different ages. Hemorrhage is mostly common with melena, bright red bloody stools, and dark red bloody stools. Good intestinal tract cleanliness can increase the diagnostic rate of emergency enteroscopy, and the intestinal tract cleanliness associated with oral cathartic is better than that of cleansing enema. Therefore, based on patient＇s hemodynamic stability, using bowel preparation with oral cathartic can improve the diagnostic accordance rate.
作者
何银云
陆烨
刘奇
Yin-Yun He;Ye Lu;Qi Liu(Department of Emergency,Shaoxing Central Hospital,Shaoxing 312000,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2018年第26期1556-1561,共6页
World Chinese Journal of Digestology
关键词
急性下消化道出血
临床特征
急诊肠镜
肠道清洁度
Acute lower gastrointestinal bleeding
Clinicalfeatures
Emergency enteroscopy
Intestinal tract cleanliness
