摘要
背景:食管静脉曲张破裂出血(EVB)是肝硬化失代偿期最严重的并发症之一,早期内镜诊疗对患者预后有重要意义。然而目前急诊内镜时机尚未完全统一。目的:探讨EVB患者内镜诊疗时机以及急诊内镜时间> 24 h的影响因素,为优化诊疗流程提供理论依据。方法:纳入2010年1月—2016年6月新疆维吾尔自治区人民医院收治的124例EVB患者,依据急诊内镜时间分为急诊内镜组(12～24 h)和择期内镜组(> 24 h),回顾性分析两组的临床资料,应用二元Logistic回归分析影响急诊内镜时间> 24 h的因素。结果:急诊内镜组与择期内镜组的学历、对EVB的了解、家庭成员、非工作日就诊、住院天数、住院费用、死亡率、外院二次转运时间、获取知情同意时间相比差异均有统计学意义(P <0. 05)。二元Logistic回归分析结果显示,急诊内镜时间> 24 h的危险因素为对EVB不甚了解(OR=4. 644,95%CI:1. 206～17. 888,P=0. 026)、家庭成员众多(OR=5. 895,95%CI:1. 115～31. 171,P=0. 037)、非工作日就诊(OR=3. 653,95%CI:1. 297～19. 487,P=0. 014)、获取知情同意时间(OR=1. 391,95%CI:1. 115～1. 687,P=0. 005)。结论:血流动力学稳定的EVB患者最好在出血后24 h内接受内镜诊疗。对EVB了解较少、家庭成员众多、非工作日就诊、获取知情同意时间增加延长了EVB患者急诊内镜的时间,因此应进一步加强相关知识的宣传,优化非工作日EVB的诊疗流程,使患者利益最大化。
Background:Esophageal variceal bleeding(EVB)is one of the most serious complications of decompensated cirrhosis,and early endoscopic diagnosis and treatment is of great significance for the prognosis of patients.However,the timing of emergency endoscopy has not yet been completely unified.Aims:To explore the timing of endoscopic diagnosis and treatment and the influencing factors of emergency endoscopic timing>24hours in patients with EVB for providing a theoretical basis to optimize the diagnosis and treatment process.Methods:A total of124patients with EVB from Jan.2010to June2016at the People’s Hospital of Xinjiang Uyghur Autonomous Region were recruited in this study.The patients were divided into emergency endoscopy group(within12-24hours)and elective endoscopy group(>24hours)according to timing of emergency endoscopy;clinical data between the two groups were retrospectively analyzed.The influencing factors for emergency endoscopic timing>24hours were analyzed by using binary Logistic regression analysis.Results:Educational level,poorly understanding of EVB,more family members,visit hospital during leisure hours,hospital stay,cost of hospitalization,mortality rate,referred from other hospitals,time for obtaining informed consent were significantly different between emergency endoscopy group and elective endoscopy group(P<0.05).Binary Logistic regression showed that poorly understanding of EVB(OR=4.644,95%CI:1.206-17.888,P=0.026),more family members(OR=5.895,95%CI:1.115-31.171,P=0.037),visit hospital during leisure hours(OR=3.653,95%CI:1.297-19.487,P=0.014),and time for obtaining informed consent(OR=1.391,95%CI:1.115-1.687,P=0.005)were the risk factors for emergency endoscopic timing>24hours.Conclusions:EVB patients with stable hemodynamics should be treated with endoscopy within24hours after bleeding.Poorly understanding of EVB,more family members,visiting hospital during leisure hours and long time for obtaining informed consent prolong the timing of emergency endoscopy for EVB patients,therefore,the publi
作者
王志远
高峰
WANG Zhiyuan;GAO Feng(Department of Gastroenterology, the People’s Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830001)
出处
《胃肠病学》
2018年第11期673-678,共6页
Chinese Journal of Gastroenterology
关键词
食管静脉曲张破裂出血
急诊
内镜
影响因素
诊断
治疗
Esophageal Variceal Bleeding
Emergency
Endoscopy
Influencing Factors
Diagnosis
Therapy
