介入栓塞术治疗抗血小板药物致老年消化道溃疡大出血的单中心研究及患者预后影响因素Logistic回归方程分析  

Single-center study of interventional embolization for treatment of massive hemorrhage from peptic ulcer caused by antiplatelet drugs in elderly patients:Therapeutic effects and prognostic factors

作　　者：伍燕侠 李朋 Yan-Xia Wu;Peng Li(Department of Emergency Medicine,Zhejiang Litongde Hospital,Hangzhou 310053,Zhejiang Province,China)

机构地区：[1]浙江省立同德医院急诊内科,浙江省杭州市310053

出　　处：《世界华人消化杂志》2021年第18期1077-1083,共7页World Chinese Journal of Digestology

摘　　要：背景介入栓塞术式是当前治疗本病重要手段,可有效止血,提高救治成功率,目前,介入栓塞术治疗抗血小板药物致老年消化道溃疡大出血效果已得到诸多研究者肯定,但术后再出血发生率较高,加以再出血影响因素众多,仍有10%-30%患者会发生再出血,严重威胁其生命安全,且各研究报道结果不一,故尝试通过单、多因素方式分析本地区抗血小板药物致消化道溃疡出血患者介入栓塞术后再出血影响因素,为今后临床治疗提供参考依据.目的探讨介入栓塞术在抗血小板药物致老年消化道溃疡大出血中应用效果,并分析预后影响因素.方法前瞻性选取2016-05/020-05我院255例抗血小板药物致老年消化道溃疡大出血患者,均接受介入栓塞术治疗,统计止血效果、并发症及预后,Logistic回归方程分析预后影响因素.结果255例抗血小板药物致老年消化道溃疡大出血患者止血有效率为94.90%,并发症发生率为2.75%(7/255);术后随访30 d发现,抗血小板药物致老年消化道溃疡大出血患者再出血率为12.81%,根据30 d预后情况分为再出血组(n=31)和未再出血组(n=211);两组年龄、抗血小板药物使用时间、溃疡史、消化道恶性肿瘤史、Hp阳性、呕血、休克、输血量、血红蛋白(haemoglobin,Hb)、白蛋白(albumin,ALB)、中性粒细胞绝对值(absolute neutrophil count,ANC)、尿素氮(blood urea nitrogen,BUN)、血小板计数(PLT)、溃疡位置、溃疡大小比较,差异有统计学意义(P<0.05);Logistic回归方程分析,发现年龄、抗血小板药物使用时间、溃疡史、Hp阳性、休克、输血量、ANC、BUN、Forrest分级Ⅰa是抗血小板药物致老年消化道溃疡大出血预后危险因素,Hb、ALB、PLT是预后保护因素(P<0.05).结论介入栓塞术可提高抗血小板药物致老年消化道溃疡大出血患者止血效果,但再出血发生情况不容乐观,与输血量、BUN、Hb等因素密切相关,建议临床做好上述指�BACKGROUND Interventional embolization is an important method for the treatment of peptic ulcer bleeding,which can effectively stop bleeding and improve the success rate of treatment.At present,the effect of interventional embolization in the treatment of massive bleeding from gastrointestinal ulcer caused by antiplatelet drugs in elderly patients has been confirmed in many studies,but the incidence of postoperative rebleeding is high,and there are many influencing factors for rebleeding.There are still 10%-30%of patients with rebleeding,which is a serious threat to their life safety,and the results are different across studies and reports.Therefore,this study aimed to analyze the influencing factors for rebleeding in patients with gastrointestinal ulcer bleeding caused by antiplatelet drugs after interventional embolization through single and multi-factor methods,so as to provide a reference for future clinical treatment.AIM To investigate the effect of interventional embolization in the treatment of massive hemorrhage from peptic ulcer caused by antiplatelet drugs in elderly patients,and to analyze the prognostic factors.METHODS From May 2016 to May 2020,255 patients with massive gastrointestinal ulcer hemorrhage caused by antiplatelet drugs at our hospital were prospectively selected.All patients received interventional embolization.The hemostatic effect,complications,and prognosis were recorded.Logistic regression equation was used to analyze the prognostic factors.RESULTS The effective rate of hemostasis was 94.90%in 255 elderly patients with gastrointestinal ulcer bleeding caused by antiplatelet drugs,and the complication rate was 2.75%(7/255).After 30 d of follow-up,it was found that antiplatelet drugs caused serious bleeding in elderly patients with gastrointestinal ulcer.The bleeding rate was 12.81%.According to the 30-day prognosis,the patients were divided into either a rebleeding group(n=31)or a non-rebleeding group(n=211);the two groups differed significantly in age,duration of antiplatelet drug use,

关 键 词：消化道溃疡大出血 老年 抗血小板药物 急诊绿色通道内镜 介入栓塞术 

分 类 号：R573.1[医药卫生—消化系统]