急性非静脉曲张性上消化道出血内镜下诊治分析及Glasgow—Blatchford评分系统在急诊内镜检查前的预判作用  

Endoscopic diagnosis and treatment analysis of patients with acute nonvariceal upper gastrointestinal bleeding and value of Glasgow - Biatchford score systems before Urgent Endoscopy

作　　者：庞艳华[1] 杜丽川[1] 郝建宇[1] 刘振[1] 李宁[1] 吴东方[1] Pang Yah-hua;Du Li-chuan;Hao Jian-yu;Liu Zhen;Li Ning;Wu dong-fang(Department of Gastroenterology,Beijing Chaoyang Hospital,Capital Medical University,Beifing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院消化内科,北京100020

出　　处：《中国急救医学》2018年第9期810-813,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 回顾分析急性非静脉曲张性上消化道出血（acute nonvariceal upper gastrointestinal bleeding, ANVUGIB）患者的内镜下诊治情况及Glasgow-Blatchford评分（GBS）结果，总结GBS与急诊内镜检查时间对患者的影响。 方法 回顾性收集2014-01~2018-01在北京朝阳医院内镜中心诊治的ANVUGIB患者295例。按内镜检查时间分为两组，急诊内镜组162例（24h以内进行内镜检查者）和非急诊内镜组133例（24h以后进行内镜检查者）。计算GBS，GBS≥6分为中高危组210例，＜6分为低危组85例。统计内镜下诊治情况及转归,分析各组资料对患者的影响。 结果 ANVUGIB患者病因中消化性溃疡为204例（69.1%），Forrest分级Ⅰa~Ⅱb者176例（59.7%），镜下止血治疗153例（86.9%）。在外科手术及介入治疗方面，急诊内镜组低于非急诊内镜组（1.9% vs.5.3%，P=0.032；1.2% vs.3.8%，P=0.021），两组比较差异有统计学意义（P＜0.05）。急诊内镜时间（≤24 h）对中高危组的临床结局有预测作用（OR0.91,95%CI0.75~1.22;P=0.003）。低危组和中高危组中，收缩压都是疾病结局的预测因素（P＜0.05）。 结论 消化性溃疡出血占ANVUGIB病因中的第一位，60%为高危溃疡；内镜下治疗以药物注射＋钛夹止血联合治疗为主。GBS＜6分的低危患者24 h以内进行内镜检查与24 h后行内镜检查，不影响疾病转归；GBS≥6分的中高危者24 h以内进行内镜检查优于24 h后内镜检查。GBS对ANVUGIB患者内镜检查前的评估有重要作用。Objective A retrospective cohort study was conducted of patients with acute nonvariceal upper gastrointestinal bleeding （ ANVUGIB ） to assess the effects of Glasgow - Blatchford score（GBS） score and emergency endoscopic examination time on patients. Methods Collected 295 cases of ANVUGIB patients who were admitted in 2014 - 01 ~ 2018 - 01 in the center of the Beijiug Chaoyang Hospital . By endoscopic examination time, the patients were divided into two groups, the urgent group, which include 162 cases （ endoscopic inspect within 24 h） and nonurgent group 133 cases （ after 24 h）. GBS score were calculated, GBS score 6 or higher were medium - high risk group of 210 cases, and 〈 6 were low - risk group of 85 cases. Statistics of endoscopic diagnosis and treatment and outcome were analyzed. Results The number of peptic ulcer patients was 204 cases （69. 1% ）, and Forrest grading Ⅰa to Ⅱb 176 cases （59.7%） , of which 153 cases （86.9%） were underwent treatment of endoscopy. Of the number of surgical and interventional treatment patients, the urgent group is lower than the nonurgent group（1.9% vs. 5.3%, P = 0. 032 ; 1.2% vs. 3.8%, P = 0. 021 ）, and the two groups were statistically significant （P 〈 0.05 ）. Emergency endoscopic time （24 h） on the medium - high risk groups can be used to predict the clinical outcome （OR O. 91, 95% CI 0.75 ~ 1.22; P = 0. 003）, in the medium- high risk group of patients with endoscopic examination time and disease outcome were statistically significant （P 〈 0.05）. However, low- risk patients were not significantly different between endoscopic examination time and disease outcome. Conclusion Haemorrhage from the peptic ulcer accounts for 60% ANVUGIB causes, and endoscopic treatment is given priority to with drug injection ＋ titanium clamp hemostatic combination therapy. GBS 〈 6 points in low - risk patients, endoscopic examination within 2d h and after 24 h does not influence the outcome of disease, and GBS of six points or high pa

关 键 词：急性非静脉曲张性上消化道出血(ANVUGIB) GLASGOW Blatchford评分(GBS) 急诊内镜检查 

分 类 号：R573.2[医药卫生—消化系统]