肝硬化合并上消化道出血行急诊胃镜检查的最佳时机探讨

The best time for emergency gastroscopy in patients with liver cirrhosis complicated with upper gastrointestinal bleeding

目的:探讨肝硬化合并上消化道出血行胃镜检查的最佳时机,为优化临床诊疗提供依据。方法:共收集本院急诊内科2017年2月~2018年10月期间救治的120例肝硬化合并上消化道出血患者,入院后根据急诊胃镜检查的不同时机(出血后8 h内、出血后8 h^24 h、出血后24 h^48 h),分别记为观察A组(n=38)、观察组B组(n=45)和观察C组(n=37),术后随访6个月。观察上述3组急诊胃镜检查的出血部位检出率、止血效果、再出血率、并发症率和死亡率,比较输血量、住院天数和医疗费用等。结果:观察A组出血部位检出率78.95%明显高于观察B组57.78%、C组48.65%,差异有统计学意义,观察B、C组出血部位检出率比较,差异不显著。观察A组止血成功率97.37%高于观察C组,再出血率2.63%低于观察组C组,差异均有统计学意义,3组并发症率、死亡率比较差异均无统计学意义。3组住院时间、住院期间输血量和相关医疗费用比较,差异均有统计学意义,组间两两比较,差异均有统计学意义。结论:急诊胃镜检查时机是影响肝硬化合并上消化道出血患者诊疗效果的重要因素,建议出血后8 h内尽早行胃镜检查。

Objective To explore the best time for gastroscopy in patients with cirrhosis and upper gastrointestinal bleeding,and to provide basis for optimizing clinical diagnosis and treatment.Methods 120 patients with liver cirrhosis complicated with upper gastrointestinal hemorrhage were collected from February 2017 to October 2018.After admission,the patients were divided into observation group A(n=38),observation group B(n=45)and observation group B(n=45)according to the different time of emergency gastroscopy(within 8 hours after hemorrhage,8 hours to 24 hours after hemorrhage and 24 hours to 48 hours after hemorrhage).Group C(n=37)was observed and followed up for 6 months.The detection rate of bleeding sites,hemostasis effect,rebleeding rate,complication rate and mortality rate of the three groups were observed,and the blood transfusion volume,hospitalization days and medical expenses were compared.Results The detection rate of bleeding sites in group A was 78.95%,which was significantly higher than that in group B(57.78%)and group C(48.65%).The difference was statistically significant.There was no significant difference in the detection rate of bleeding sites between group B and C.The success rate of hemostasis in group A was 97.37%higher than that in group C,and the rebleeding rate was 2.63%lower than that in group C.The difference was statistically significant.There was no significant difference in complication rate and mortality among the three groups.There were significant differences in hospitalization time,blood transfusion volume during hospitalization and related medical expenses among the three groups.There were significant differences between the two groups.Conclusion The timing of emergency gastroscopy is an important factor affecting the diagnosis and treatment of patients with liver cirrhosis complicated with upper gastrointestinal bleeding.It is suggested that gastroscopy be performed as soon as possible within 8 hours after bleeding.