非静脉曲张性上消化道出血急诊内镜越早越好?  

Is emergency endoscopy in patients with nonvariceal upper gastrointestinal bleeding as early as possible?

作　　者：徐平萍 徐洪雨[1] XU Pingping;XU Hongyu(Department of Gastroenterology,the First Hospital Affiliated to Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院消化内科,黑龙江哈尔滨150001

出　　处：《胃肠病学和肝病学杂志》2020年第12期1408-1410,1415,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：虽然提倡为上消化道出血(upper gastrointestinal bleeding,UGIB)的患者行急诊内镜检查,但急诊内镜的最佳时机仍不确定。本文就已有的关于非静脉曲张性上消化出血(nonvariceal upper gastrointestinal bleeding,NVUGIB)急诊内镜的随机对照试验和回顾性队列研究的可比较的结局进行评估,其中包括死亡率、再出血率、对手术干预的需求、输血量、住院时长等。将其归类为患者行急诊内镜时间为入院后的3 h、6 h、12 h、24 h以内。得出结论:急诊内镜有助于对NVUGIB患者进行危险分层并减少住院治疗的需求,同时它也可能发现更多的活动性出血从而增加治疗性内镜的使用。但无证据表明极早期内镜有助于减少再出血的风险或提高生存率,因此对于大多数无绝对禁忌证的NVUGIB患者,应在24 h内接受内镜检查。Although emergency endoscopy is recommended for patients with upper gastrointestinal bleeding(UGIB),the optimal timing of emergency endoscopy remains uncertain.This article evaluated the comparatived outcomes of existing randomized controlled trials and retrospective cohort studies of nonvariceal upper gastrointestinal bleeding(NVUGIB)emergency endoscopy,including mortality,rebleeding rates,the need for surgical intervention,the amount of blood transfusion,and the length of hospital stay.The patients were classified as emergency endoscopy within 3 hours,6 hours,12 hours,or 24 hours after admission.It is concluded that emergency endoscopy is helpful for risk stratification of NVUGIB patients and reduces the need for hospitalization.It may also find more active bleeding and increase the use of therapeutic endoscopes.However,there is no evidence that very early endoscopy can help reduce the risk of rebleeding or improve survival rate.Therefore,for most patients with NVUGIB without absolute contraindications,endoscopy should be performed within 24 hours.

关 键 词：非静脉曲张性上消化道出血 急诊内镜 死亡率 再出血 

分 类 号：R57[医药卫生—消化系统]