急诊内镜在急性非静脉曲张性上消化道出血中的诊疗价值

Value of Emergent Endoscopy in Diagnosis and Treatment of Acute Nonvariceal Upper Gastrointestinal Bleeding

急性非静脉曲张性上消化道出血（ANVUGIB）是临床常见急症之一，随着内镜技术的普及，急诊内镜已成为ANVUGIB的首选诊治方法。目的：探讨急诊内镜在ANVUGIB中的诊疗价值。方法：连续纳入2008年1月～2010年7月上海仁济医院确诊的ANVUGIB患者215例．回顾性分析患者的临床资料，比较急诊内镜组（出血48h内行胃镜检查）和择期内镜组（〉48h行胃镜检查）的ANVUGIB病因检出率以及急诊内镜治疗组和内科保守治疗组的止血有效率、再出血率和手术率。结果：消化性溃疡、消化道肿瘤和糜烂出血性胃炎是本组ANVUGIB患者的三大病因，以消化性溃疡最为常见。急诊内镜组的病因检出率显著高于择期内镜组（P〈0．05）；急诊内镜治疗组的止血有效率显著高于内科保守治疗组．再出血率和手术率显著低于内科保守治疗组（P〈0．05）。结论：对ANVUGIB患者，急诊内镜是迅速安全、疗效确切的诊疗方法，值得在临床推广应用。

Acute nonvariceal upper gastrointestinal bleeding （ANVUGIB） is one of the common medical emergency. With the popularization of endoscopy, emergent endoscopy has become the preferred method in the diagnosis and treatment of ANVUGIB. Aims： To investigate the value of emergent endoscopy in the diagnosis and treatment of ANVUGIB. Methods： Retrospective analysis of 215 concecutive patients with ANVUGIB admitted in Shanghai Renji Hospital from January 2008 to July 2010 was performed. The diagnosis rates of emergent endoscopy （endoscopy performed within 48 hours） and selective endoscopy （endoscopy performed after 48 hours）, as well as the success rates of hemostasis, and rates of rebleeding and surgery in endoscopic treatment group and conventional medical treatment group were analyzed. Results： Peptic ulcer, gastrointestinal carcinoma and hemorrhagic gastritis were the three major causes of ANVUGIB, of which peptic ulcer was the most common cause. The diagnosis rate of emergent endoscopy was significantly higher than that of selective endoscopy （P〈0.05）. The success rate of hemostasis was much higher and the rates of rebleeding and surgery were much lower in endoscopic treatment group as compared with conventional medical treatment group （P〈0.05）. Conclusions： Emergent endoscopy is fast, safe and effective for the diagnosis and treatment of ANVUGIB, and is worthy of widespread application in clinical practice.