内镜诊疗时机对急诊肝硬化食管胃底静脉曲张破裂出血患者救治效果及预后的影响  

Impact of the Timing of Endoscopic Diagnosis and Treatment on Treatment Effect and the Prognosis of Emergency Patients with Esophageal and Gastric Variceal Bleeding in Liver Cirrhosis

作　　者：陈正彦 刘君颖[1] 张然[1] 蒋举峰 贺照霞[1] 刘玮[1] 余海洋[1] 张红娟 CHEN Zhengyan;LIU Junying;ZHANG Ran;JIANG Jufeng;HE Zhaoxia;LIU Wei;YU Haiyang;ZHANG Hongjuan(Digestive Endoscopy Center,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院消化内镜中心,河南郑州450000

出　　处：《河南医学研究》2024年第13期2339-2343,共5页Henan Medical Research

摘　　要：目的探讨内镜诊疗时机对急诊肝硬化食管胃底静脉曲张破裂出血(EGVB)患者救治效果及预后的影响。方法选取2018年10月至2023年2月河南中医药大学第一附属医院收治的高危急诊肝硬化EGVB患者96例进行回顾性分析和随访,根据内镜诊疗时机不同分为A组(35例,入院后0~6 h内行内镜诊疗)、B组(29例,入院后6~12 h内行内镜诊疗)和C组(32例,入院后12~24 h内行内镜诊疗),比较3组治疗情况(出血部位检出率、止血成功率、再出血率、死亡率)、输血量、住院时间、住院费用。并根据患者生存情况分为存活组(86例)和死亡组(10例),比较两组临床资料,采用多因素logistic回归分析影响高危急诊肝硬化EGVB患者预后的因素。结果A组和B组出血部位检出率高于C组(P<0.05);A组和B组比较,差异无统计学意义(P>0.05);B组止血成功率高于A组和C组(P<0.05);A组和C组比较,差异无统计学意义(P>0.05);3组再出血率和死亡率比较,差异无统计学意义(P>0.05)。3组输血量、住院时间、住院费用比较,差异无统计学意义(P>0.05)。存活组和死亡组腹水征、血钠、ALT、AST比较,差异有统计学意义(P<0.05);多因素logistic回归分析显示,腹水征、血钠降低是影响高危急诊肝硬化EGVB预后的危险因素(P<0.05)。结论高危急诊肝硬化EGVB患者于入院后6~12 h内行内镜诊疗可提高患者救治效果,但入院后0~6 h内行内镜诊疗需更多临床循证证据,且腹水征、血钠降低是影响患者预后的因素。Objective To investigate the impact of the timing of endoscopic diagnosis and treatment on treatment effect and the prognosis of emergency patients with esophageal-gastric varices bleeding(EGVB)in liver cirrhosis.Methods A total of 96 high-risk emergency patients with liver cirrhosis and EGVB who were admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from October 2018 to February 2023 were reviewed.They were divided into group A(35 cases),group B(29 cases)and group C(32 cases)according to the timing of endoscopic diagnosis and treatment.Patients in group A underwent endoscopic diagnosis and treatment within 0-6 hours after admission.Patients in group B underwent endoscopic diagnosis and treatment within 6-12 hours after admission,and those in group C underwent endoscopic diagnosis and treatment within 12-24 hours after admission.Treatment outcomes(the detection rate of bleeding site,success rate of hemostasis,rebleeding rate and mortality rate),blood transfusion volume,length of hospital stay,and hospitalization expenses were compared among the groups.According to survival status,the patients were divided into survival group(86 cases)and death group(10 cases).Clinical data of the two groups were compared,and multivariate logistic regression analysis was performed to identify the prognostic factors of high-risk emergency EGVB in liver cirrhosis.Results The detection rate of bleeding site in group A and B was higher than that in group C(P<0.05),but there was no difference between group A and group B(P>0.05).The success rate of hemostasis in group B was higher than that in group A and C(P<0.05),there was no difference between group A and group C(P>0.05).There was no difference in blood transfusion volume,hospital stay and hospital cost among the three groups(P>0.05).Univariate analysis found that there were statistically significant differences in ascites syndrome,blood sodium,ALT and AST between the survival group and the death group(P<0.05).Multivariate logistic regression analysis

关 键 词：急诊 高危 肝硬化 食管胃底静脉曲张破裂出血 内镜诊疗 时机 救治效果 预后 

分 类 号：R573.2[医药卫生—消化系统]