老年人急性非静脉曲张性上消化道出血在不同时机内镜诊治的临床价值

Clinical Value of Endoscopic Diagnosis and Treatment of Acute Nonvariceal Upper Gastrointestinal Bleeding in the Elderly at Different Times

目的探讨老年人急性非静脉曲张性上消化道出血(ANVUGIB)在不同时机内镜诊治的临床价值。方法选取2017年3月-2021年3月在我院救治的112例ANVUGIB老年患者作为研究对象,随机分为观察组和对照组,每组56例。观察组的患者于入院12h内行急诊内镜检查,对照组于入院12~24h行急诊内镜检查。观察两组,ANVUGIB的病因检出情况;再次出血情况、入住ICU、30天内再次住院、院内死亡;内镜检查时间和住院时间。结果ANVUGIB最常见的病因是胃溃疡,共62例。对照组病因的检出率为85.71%,观察组病因的检出率为96.42%,差异具有统计学意义(P<0.05);对照组再次出血率、入住ICU率、30d内再次住院率和院内死亡率(14.28%、7.14%、17.86%、8.92%)都高于观察组(3.57%、1.78%、7.14%、3.57%),其中两组再次出血率和30d内再次住院率的差异具有统计学意义(P<0.05);两组患者内镜检查时间的差异无统计学意义(P>0.05),对照组住院时间长于观察组,且差异具有统计学意义(P<0.05)。结论入院12h内行急诊内镜检查可以提高ANVUGIB的病因检出率,但是没有改善再次出血、入住ICU、30d内再次住院和院内死亡等临床预后。

Objective To investigate the clinical value of endoscopic diagnosis and treatment of acute nonvariceal upper gastrointestinal hemorrhage(ANVUGIB)in the elderly at different times.Methods 112 elderly patients with ANVUGIB treated in our hospital from March 2017 to March 2021 were randomly divided into observation group and control group,56 cases in each group.The patients in the observation group received emergency endoscopy within 12 hours after admission,while the patients in the control group received emergency endoscopy within 12~24 hours after admission.The etiology of ANVUGIB was observed in the two groups;Rebleeding,ICU stay,rehospitalization within 30 days,hospital death;Endoscopy time and hospital stay.Results The most common cause of ANVUGIB was gastric ulcer(62 cases).The detection rate of etiology was 85.71%in the control group and 96.42%in the observation group,with significant difference(P<0.05);The rebleeding rate,ICU admission rate,rehospitalization rate within 30 days and in-hospital mortality rate in the control group(14.28%,7.14%,17.86%,8.92%)were higher than those in the observation group(3.57%,1.78%,7.14%,3.57%),and the difference between the two groups was statistically significant(P<0.05);There was no significant difference in endoscopy time between the two groups(P>0.05),while the hospitalization time of the control group was longer than that of the observation group,and the difference was statistically significant(P<0.05).Conclusion Emergency endoscopy within 12 hours after admission can improve the etiological detection rate of ANVUGIB,but it does not improve the clinical prognosis of rebleeding,ICU admission,readmission within 30 days and in-hospital death.