探究急性非静脉性上消化道出血内镜下治疗失败的危险因素及预防对策  

To explore the risk factors and preventive countermeasures of the failure of tract endoscopic in the acute non venous upper gastrointestinal hemorrhage treatment

作　　者：黄理[1] 姚朝光[1] 江秋维 黄霜湘 韦巍巍[1] 满桂月[1] 覃馨颉 李小敏[1] 

机构地区：[1]河池市人民医院消化内科,广西河池547000

出　　处：《中国中西医结合消化杂志》2016年第3期194-197,共4页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的]探究急性非静脉性上消化道出血内镜下治疗失败的危险因素及预防对策。方法选取我院自2013年6月-2015年6月收治的100例急性非静脉性上消化道出血并接受内镜治疗的患者,其中首次内镜治疗成功的为对照组,首次内镜治疗失败的为观察组,每组各50例患者。分别对两组患者的一般情况、临床情况、实验室检查、内镜下表现等进行单因素分析,寻找有差异的变量。将单因素分析中差异有统计学意义的指标作为自变量,以内镜成功与否为因变量,进行多因素Logistic回归分析,寻找内镜治疗失败的危险因素。[结果]经过单因素分析显示,两组在年龄、既往消化道出血史、输血情况、尿素氮、白蛋白、凝血酶原时间、出血直径大小、出血至止血时间这八项指标上差异有统计学意义（P〈0.05）。多因素Logistic回归分析显示,年龄（OR=1.075,95%CI：1.008-1.146）、既往消化道出血史（OR=1.263,95%CI：1.373-1.884）、凝血酶原时间（OR=1.384,95%CI：1.382-2.013）、出血直径大小（OR=1.435,95%CI：1.011-1.157）、出血至止血时间（OR=1.326,95%CI：1.287-1.764）差异有统计学意义,是初次内镜下止血失败,需要介入、外科手术或死亡的危险因素。[结论]年龄,凝血酶原时间,既往消化道出血,出血直径大小,出血至止血时间为急性非静脉性上消化道出血内镜下治疗失败的危险因素,即在首次内镜治疗后,可能会有再出血,进一步治疗需要或死亡的危险。对于血尿素氮异常、白蛋白显著下降、有输血史的患者,需警惕再次出血的可能。[Objective]To explore the failure risk factors and preventive countermeasures of tract endoscopic in the treatment of acute non venous upper gastrointestinal hemorrhage.[Methods]100patients who suffered from acute non venous upper gastrointestinal bleeding and then got timely endoscopic therapy in our hospital were selected from June 2013 to June 2015.They were divided into two groups：group of 50 patients who were cured by the first endoscopic treatment;group of 50 patients who got faling endoscopic treatment for the first time.The general situations,clinical situations,laboratory examinations,endoscopic performance of each groups were univariate analyzed respectively,and then we looked for differences between the variables.The variables that appeared statistical significant difference were chosen as independent variables,and the success or failure of endoscopic treatment were seen as the dependent variable,the multi-factor were analyzed by Logistic regression method,and then we found the dangerous factors ofendoscopic treatment failure.[Results]Through single factor analysis,statistical significant differences were founded in age,history of gastrointestinal bleeding,blood transfusion,urea nitrogen,albumin,prothrombin time,the range of bleeding,and bleeding time in the two groups（P〈0.05）.And Multiariable Logistic regression analysis showed that there were significant differences in age（OR= 1.075,95% CI：1.008 1.146）,the history of the digestive tract hemorrhage（OR=1.263,95% CI：1.373 1.884）,prothrombin time（OR=1.384,95% CI：1.382 2.013）,the range of bleeding（OR=1.435,95%CI：1.011-1.157）,and bleeding time（OR=1.326,95%CI：1.287-1.764）,so the factors are the hazards of the failure of first time endoscopic hemostatic,the need to perform an interventional operation or surgery and death.[Conclusion]Age,prothrombin time,the range of bleeding,bleeding time and the history of gastrointestinal bleeding were risk factors for the failure of tract endoscopic in the acute non venous upper gastr

关 键 词：上消化道出血 内镜下止血 危险因素 预防对策 

分 类 号：R57[医药卫生—消化系统]