不同时机急诊内镜干预急性食管胃底静脉曲张出血的临床研究  

Emergent endoscopic intervention of acute esophageal and gastric fundal varices bleeding at different times

作　　者：韦炜 吕敏芳[1] 洪依萍 陶茂根 马骥 俞有荣 蔡建庭[1] Wei Wei;Lyu Minfang;Hong Yiping;Tao Maogen;Ma Ji;Yu Yourong;Cai Jianting(Department of Gastroenterology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Gastroenterology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China;Department of Gastroenterology,Lanxi People's Hospital,Jinhua 321100,China;Department of Gastroenterology,Yongkang First People's Hospital,Jinhua 321300,China;Department of Gastroenterology,Pujiang People's Hospital,Jinhua 321200,China)

机构地区：[1]浙江大学医学院附属第二医院消化科,杭州310009 [2]浙江大学医学院附属金华医院消化科,金华321000 [3]兰溪市人民医院消化科,金华321100 [4]永康市第一人民医院消化科,金华321300 [5]浦江县人民医院消化科,金华321200

出　　处：《中华消化内镜杂志》2024年第9期697-701,共5页Chinese Journal of Digestive Endoscopy

基　　金：金华市科学技术研究计划项目(2021-4-022)。

摘　　要：目的探讨不同时机急诊内镜干预对急性食管胃底静脉曲张出血的临床应用价值。方法选择2020年7月至2022年12月浙江大学医学院附属第二医院74例、浙江大学医学院附属金华医院41例、兰溪市人民医院36例、永康市第一人民医院31例及浦江县人民医院25例总共207例通过胃镜确诊为肝硬化合并食管胃底静脉曲张出血的患者,对其临床资料进行回顾性分析,按照病例是否进行内镜干预以及内镜治疗的不同时机分为3组。在出血6 h内行内镜治疗的病例纳入A组(n=68);出血超过6 h,在24 h内行内镜治疗的病例纳入B组(n=72);选择药物保守治疗、未进行内镜治疗的病例纳入C组(n=67)。比较3组的预后转归(止血成功率、早期再出血率、病死率)以及治疗效益(开放饮食时间、输血量、住院时间、住院费用)。结果A组、B组、C组止血成功率分别为100.00%(68/68)、97.22%(70/72)和86.57%(58/67),差异有统计学意义(χ^(2)=13.51,P<0.001)。A组无患者死亡,B组和C组的死亡率分别为2.78%(2/72)和13.43%(9/67),3组死亡率比较差异有统计学意义(χ^(2)=15.61,P<0.001)。A组无早期再出血,B组和C组的早期再出血率分别为2.86%(2/70)和13.43%(5/58),3组比较差异无统计学意义(χ^(2)=3.41,P=0.182)。3组患者开放饮食时间[A组(28.32±2.52)h、B组(37.25±2.45)h、C组(66.62±2.65)h,F=58.69,P<0.001]、输血量[A组(3.62±0.30)U、B组(5.46±0.37)U、C组(6.25±0.39)U,F=11.35,P<0.001]、住院时间[A组(6.58±0.23)d、B组(7.83±0.34)d、C组(8.24±0.45)d,F=5.75,P=0.004]及费用[A组(10152±821)元、B组(13568±1017)元、C组(15306±1186)元,F=4.96,P=0.008]比较,差异有统计学意义。止血成功与未成功患者的肝功能Child-Pugh分级差异有统计学意义(χ^(2)=15.63,P<0.001)。结论急性食管胃底静脉曲张出血在早期24 h内行内镜下诊疗可改善预后转归,减轻患者经济负担,临床应用价值高。Objective To investigate the clinical value of emergent endoscopic intervention at different times of acute esophageal and gastric fundal varices bleeding.Methods From July 2020 to December 2022,data of 207 cases of liver cirrhosis with esophageal and gastric fundal variceal bleeding diagnosed by gastroscopy were retrospectively analyzed,including 74 cases from the Second Affiliated Hospital,Zhejiang University School of Medicine,41 cases from Affiliated Jinhua Hospital,Zhejiang University School of Medicine,36 cases from Lanxi People's Hospital,31 cases from Yongkang First People's Hospital and 25 cases from Pujiang People's Hospital.Patients were divided into 3 groups according to the time of endoscopic intervention and treatment.Patients who received endoscopic treatment within 6 h of hemorrhage were included in group A(n=68);patients within 6-24 hours were in group B(n=72).A total of 67 patients selected for conservative drug treatment were included in group C,who did not undergo endoscopic therapy.The prognosis(success rate of hemostasis,early rebleeding rate,mortality rate)and treatment benefit(open diet time,blood transfusion volume,hospital stay,hospital cost)of the 3 groups were compared.Results The success rates of hemostasis were 100.00%(68/68),97.22%(70/72),86.57%(58/67)in group A,B and C respectively with significant difference(χ^(2)=13.51,P<0.001).The mortalities of the three groups were 0.00%(0/68)in group A,2.78%(2/72)in group B and 13.43%(9/67)in in group C respectively with significant difference(χ^(2)=15.61,P<0.001).The early rebleeding rates of the three groups were 0.00%(0/68)in group A,2.86%(2/70)in group B,and 13.43%(5/58)in group C respectively with significant difference(χ^(2)=3.41,P=0.182).There were significant differences in open diet time(group A:28.32±2.52 h,group B:37.25±2.45 h,group C:66.62±2.65 h,F=58.69,P<0.001),blood transfusion volume(group A:3.62±0.30 U,group B:5.46±0.37 U,group C:6.25±0.39 U,F=11.35,P<0.001),hospital stay(group A:6.58±0.23 d,group B:7.83±0.34 d,gro

关 键 词：食管和胃静脉曲张 出血 时机 急诊内镜 

分 类 号：R57[医药卫生—消化系统]