Rockall评分高危患者行急诊内镜的诊疗价值  

Diagnostic and therapeutic value of emergency endoscopy in acute nonvariceal upper gastrointestinal bleeding patients with high-risk Rockall score

作　　者：马丽娜[1] 张乃丽[2] 王加斌[3] 雷宇峰[4] 刘变英[4] 

机构地区：[1]滨州医学院临床医学院,山东省烟台市264003 [2]滨州医学院基础医学院,山东省烟台市264003 [3]江苏省沭阳县人民医院消化科,江苏省沭阳县223600 [4]山西煤炭中心医院消化内科,山西省太原市030006

出　　处：《世界华人消化杂志》2015年第33期5366-5371,共6页World Chinese Journal of Digestology

基　　金：滨州医学院科技计划基金资助项目;No.BY2014KJ08~~

摘　　要：目的:探讨急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)Rockall评分高危患者行急诊内镜的诊疗价值.方法:对2011-08/2013-12山西煤炭中心医院消化内科55例ANVUGIB Rockall评分高危患者的临床资料、治疗方法及治疗结果作回顾性分析研究,其中出血后24-48 h内行急诊内镜检查患者30例,出血后3-5 d行内镜检查患者25例,比较行急诊内镜组与非急诊内镜组的病因检出率、住院花费、住院时间、输血量、死亡率等指标.结果:急诊内镜组与非急诊内镜组的出血病因构成差异无统计学意义(P>0.05);急诊内镜组病因确诊率高于非急诊内镜组(93.33%vs 56.00%)(P=0.001<0.01);急诊内镜组住院时间和住院费用及输血量显著低于非急诊内镜组(10.0 d±6.7 d vs 16.4 d±7.3 d,13034.4元±9967.2元vs 14110.2元±9780.8元,1180.7 m L±634.7 m L vs 1420 m L±725.9 m L)(P<0.05);急诊内镜组死亡率低于非急诊内镜组(6.67%vs 12.00%)(P>0.05).结论:对于ANVUGIB Rockall评分高危患者,行急诊内镜检查虽不能明显降低其死亡率,但可以显著改善其医疗过程,有利于临床,其优势尚待大样本的临床研究.AIM：To investigate the diagnostic and therapeutic effect of emergency endoscopy in nonvariceal upper gastrointestinal bleeding（NVUGIB） patients with a high-risk Rockall METHODS：The clinical data for 55 high-risk patients with NVUGIB treated at Department of Gastroenterology of Shanxi Coal Center Hospital from August 2011 to December 2013 were analyzed retrospectively.Of these patients,30 who underwent endoscopy in 24-48 h were allocated to the emergency endoscopy group,and 25 who underwent endoscopy after 48 h were allocated to the control group.Data including age,sex,bleeding history,chronic disorder history,time from bleeding to endoscopic examination,blood transfusion,shock index,hemoglobin,length of hospital stay,expenses,Rockall score,etiology diagnosis rate,length of hospital stay,and mortality were compared between the two groups to find the variables with a significant difference.RESULTS：The two groups had no significant differences in etiology（P〈0.05）.There were statistical differences between the two groups in etiology diagnosis rate（93.33%vs 56.00%,P = 0.001 0.01）,hospitalization time（10.0 d± 6.7 d vs 16.4 d ± 7.3 d,P〈0.05）,and cost of hospitalization（13034.4 yuan ± 9967.2 yuan vs14110.2 yuan ± 9780.8 yuan,P〈0.05）.The two groups had no significant differences in mortality rate（6.67 vs 12.00%,P〈0.05）.CONCLUSION：Emergency endoscopy is a reliable and safe modality for NVUGIB patients with a high-risk Rockall score.

关 键 词：Rockall评分 非静脉曲张性上消化道出血 急诊内镜 

分 类 号：R573.2[医药卫生—消化系统]