摘要
目的:评估不同出血严重程度的非静脉曲张性上消化道出血(ANVUGIB)患者行紧急内镜检查与非紧急内镜检查的临床结局。方法:回顾性分析2017年1月—2022年4月在宿迁市第一人民医院经内镜检查确诊为ANVUGIB的382例患者的病例资料。从患者的病历和内镜检查记录中采集患者的人口社会学、临床和实验室检查数据。格拉斯哥-布拉奇福德出血评分(GBS)<12分的患者视为低风险(n=240),GBS≥12分为高风险(n=121)。紧急内镜检查定义为自入院到内镜检查的时间<12 h,非紧急内镜检查为自入院到内镜检查时间≥12 h。综合结局包括发生以下1项或以上的事件:住院期间全因死亡、住院期间再出血、输血、以止血为目的的手术、介入放射学干预或内镜再干预。采用多因素logistic回归分析考察不同的内镜检查时间对综合结局的影响。结果:97例(25.4%)患者接受了紧急内镜检查,285例(74.6%)接受了非紧急内镜检查。紧急内镜检查组患者发生再出血、以止血为目的的手术、介入放射学干预、内镜再干预、需要输血的比例高于非紧急内镜检查组。在多因素分析中,紧急内镜检查患者发生综合结局的风险是非紧急内镜检查患者的5倍以上(OR=5.60,95%CI:2.80~11.40,P<0.001)。分层分析结果发现,在低风险患者中,紧急内镜检查患者发生综合结局的风险是非紧急内镜检查患者的7倍以上(OR=7.20,95%CI:3.40~13.40,P<0.001)。而在高风险患者中,紧急内镜检查不是患者发生综合结局的危险因素(OR=2.88,95%CI:0.78~11.33,P=0.138)。结论:入院12 h内实施镜检可使高风险ANVUGIB患者获益,低风险ANVUGIB患者不宜在入院12 h内实施镜检。
Objective: To evaluate the clinical outcomes of acute nonvaricose upper gastrointestinal bleeding(ANVUGIB) patients with different bleeding severity undergoing urgent endoscopy and non-urgent endoscopy. Methods: The medical records of 382 patients diagnosed with ANVUGIB by endoscopy in our hospital from January 2017 to April 2022 were retrospectively analyzed. Demographic, sociological, clinical and laboratory data were collected from the patient’s medical and endoscopic records. Patients with GBS <12 were considered as low risk(n=240), and patients with GBS ≥12 were considered high risk(n=121). Urgent endoscopy was defined as the time from admission to endoscopy <12 h, and non-urgent endoscopy was defined as the time from admission to endoscopy ≥12 h. The composite outcome included the occurrence of one or more of the following events: in-hospital death from any cause, in-hospital rebleeding, blood transfusion, surgery for hemostasis, interventional radiological intervention, or endoscopic reintervention. Multivariate logistic regression analysis was used to investigate the effect of different endoscopy time on the comprehensive outcome. Results: Ninety-seven patients(25.4%) underwent urgent endoscopy and 285 patients(74.6%) underwent non-urgent endoscopy. The proportion of rebleeding, surgery for hemostasis, interventional radiology intervention or endoscopic reintervention, and blood transfusion in the urgent endoscopy group were higher than those in the non-urgent endoscopy group. In multivariate analysis, patients with urgent endoscopy had a more than 5-fold higher risk of composite outcome than patients with non-urgent endoscopy(OR=5.60, 95%CI: 2.80-11.40, P<0.001). Stratified analysis showed that among low-risk patients, the risk of composite outcome was more than 7 times higher in patients with urgent endoscopy than in patients with non-urgent endoscopy(OR=7.20, 95%CI: 3.40-13.40, P<0.001). In high-risk patients, urgent endoscopy was not a risk factor for overall outcome(OR=2.88, 95%CI: 0.78-11.33,
作者
杨修玲
蔡奉娟
王巧珍
侍艳
孙彦荣
YANG Xiuling;CAI Fengjuan;WANG Qiaozhen;SHI Yan;SUN Yanrong(Department of Gastroenterology,Suqian First People's Hospital,Suqian,Jiangsu,223812,China;Endoscopic Center,Suqian First People's Hospital)
出处
《临床急诊杂志》
CAS
2023年第3期149-154,159,共7页
Journal of Clinical Emergency
