上消化道出血急诊内镜检查和治疗

Emergency diagnostic and therapeutic endoscopy for upper gastrointestinal bleeding

目的比较上消化道出血急诊内镜检查及止血的即刻止血率、再出血发生率及住院死亡率．方法上消化道出血４８６例，分为两组，Ａ组为１９９１年底以前出血者（ｎ＝２０９），Ｂ组为１９９２年以后出血者（ｎ＝２７７）．两组大出血发生率无显著差别．Ｂ组出血后２４ｈ内行急诊检查者明显多于Ａ组（Ｐ＜００１）．结果Ｂ组急性胃粘膜损伤出血（９７％）多于Ａ组（５３％），原因不明出血者（４３％）少于Ａ组（９６％）．经过治疗，Ｂ组出血控制率（９４４％）高于Ａ组（６０３％），再出血率（９４％）低于Ａ组（１５８％），住院死亡率（２８％）低于Ａ组（１０１％）．结论急诊内镜检查可提高出血病因诊断率，配合有效的止血措施。

AIM To compare the initial hamostasis, rebleeding and hospital mortality with emergency diagnostic and therapeutic endoscopy for upper gastrointestinal bleeding. METHODS 486 cases with upper gastrointestinal bleeding was divided into two groups. Group A includes 209 patients with bleeding from 1986 to 1991 and group B 277 cases from 1992 to 1995. There was no significant difference in the incidence of massive bleeding between the two groups. There were more patients who underwent emergency endoscopy within 24 hours in group B than in group A (P<0 01). RESULTS There were more patients (9 7%) with acute gastric mucosal injury and fever patients (4 3%) with bleeding of unknown causes in group B than in group A (5 3%, 9 6%), the success rate of controlling in active bleeding by the therapeutic endoscopy, in group B (94 4%) was higher than in group A (60 3%), the rebleeding and hospital mortality in group B (9 4%, 2 8%) was lower than group A (15 8%, 10 1%). CONCLUSION The emergency endoscopy can increase the diagnostic rate of upper gastrointestinal bleeding, and when supplemented with other effective homastasis it will raise the controlling rate for active bleeding and lower the hospital mortality as well.