摘要
目的探讨内镜治疗时机对早期药物治疗效果不佳的肝硬化食管胃静脉曲张破裂出血患者短期预后的影响。方法收集2018年8月至2021年3月南通市第三人民医院消化科及肝病科收治的166例肝硬化食管胃静脉曲张破裂出血经过早期积极内科治疗效果不佳后行内镜治疗患者的临床资料进行回顾性分析,根据内镜治疗时机不同分为三组,其中早期组患者在入院后4~<6 h行内镜治疗(52例),中期组患者在入院后6~<24 h行内镜治疗(55例),后期组患者在入院后≥24 h行内镜治疗(59例),比较三组患者的止血时间、早期再出血、住院死亡率、住院时间及在静脉曲张破裂出血后6周的生存率,并分析可能影响患者预后的相关因素。结果三组患者的止血时间、住院死亡率及住院时间比较差异有统计学意义(P<0.05),早期再出血患者比例比较差异无统计学意义(P>0.05)。中期组的止血时间明显长于早期组[(2.15±1.10)d比(1.38±0.65)d](P<0.05);后期组的止血时间、住院时间均长于早期组[(2.03±0.71)d比(1.38±0.65)d、17(14,21)d比15(10,20)d](P<0.05),早期再出血患者比例、住院死亡率均高于早期组[20.34%(12/59)比9.62%(5/52)、22.03%(13/59)比5.77%(3/52)](P<0.05);后期组的住院时间长于中期组[17(14,21)d比12(10,14)d](P<0.05)。6周随访终止,早期组7例死亡,中期组12例死亡,后期组19例死亡,三组的6周生存率比较差异有统计学意义(Log-Rank=5.107,P=0.024)。多因素分析结果显示,内镜治疗时机及Child-Pugh分级是影响早期药物治疗效果不佳的肝硬化食管胃静脉曲张破裂出血的独立危险因素(P<0.05)。结论对于早期药物治疗效果不佳的肝硬化食管胃静脉曲张破裂出血患者,入院后4~6 h行内镜治疗可以缩短住院时间、降低住院死亡率及提高患者6周生存率,而内镜治疗时机是影响肝硬化食管胃静脉曲张破裂出血患者短期预后的危险因素。
Objective To investigate the effect of endoscopic therapy timing on the short-term prognosis of patients with ruptured esophagogastric variceal bleeding in cirrhosis who had poor results of early pharmacological treatment.Methods The clinical data of 166 patients with ruptured esophagogastric variceal bleeding in cirrhosis admitted to the Department of Gastroenterology and Department of Hepatology of Nantong Third People′s Hospital from Aug.2018 to Mar.2021 who underwent endoscopic treatment after poor early active medical treatment were retrospectively analyzed.and the cases were divided into three groups according to the timing of endoscopic treatment:the patients in the early group underwent endoscopic treatment 4 to 6 h after admission(52 patients),the patients in the intermediate group underwent endoscopic treatment from 6 to 24 h after admission(55 patients),and the patients in the late group underwent endoscopic treatment≥24 h after admission(59 patients).The time to hemostasis,early rebleeding,in-hospital mortality,length of stay,and survival rate at 6 weeks after variceal rupture and bleeding in the three groups were compared,and the relevant factors that may affect patients′prognosis were analyzed.Results The differences in time to hemostasis,in-hospital mortality and length of stay were statistically significant between the three groups(P<0.05),and the differences in the proportion of patients with early rebleeding were not statistically significant(P>0.05).The time to hemostasis was significantly longer in the intermediate group than in the early group[(2.15±1.10)d vs(1.38±0.65)d](P<0.05);the time to hemostasis and length of hospital stay were longer in the late group than in the early group[(2.03±0.71)d vs(1.38±0.65)d,17(14,21)d vs 15(10,20)d](P<0.05),and the proportion of patients with early rebleeding and in-hospital mortality were higher than in the early group[20.34%(12/59)vs 9.62%(5/52),22.03%(13/59)vs 5.77%(3/52)](P<0.05);the length of hospital stay was longer in the late group than i
作者
卞兆连
程苕莼
刘一村
秦相清
朱陈
陈建
薛红
BIAN Zhaolian;CHENG Tiaochun;LIU Yicun;QIN Xiangqing;ZHU Chen;CHEN Jian;XUE Hong(Department of Gastroenterology,the Third Affiliated Hospital of Nantong University/Nantong Third People′s Hospital,Nantong 226006,China;Department of Hepatology,the Third Affiliated Hospital of Nantong University/Nantong Third People′s Hospital,Nantong 226006,China;Nantong University Medical School,Nantong 226001,China)
出处
《医学综述》
CAS
2023年第12期2470-2475,共6页
Medical Recapitulate
基金
江苏省“六大人才高峰”高层次人才选拔培养资助项目(YY-177)
江苏省青年医学重点人才培养项目(QNRC2016400)
南通市“十四五”科教强卫工程青年医学重点人才培养项目(通卫科教〔2021〕15号)
南通市市级科技计划(指导性)项目(JCZ20077)。
关键词
肝硬化
上消化道出血
内镜治疗时机
药物治疗
预后
Cirrhosis
Upper gastrointestinal hemorrhage
Timing of endoscopic treatment
Drug treatment
Prognosis
