急性非静脉曲张性上消化道出血内镜止血成功后再出血的危险因素分析

Risk factors associated with rebleeding after the first successful endoscopic treatment in acute nonvariceal upper gastrointestinal bleeding

目的探讨急性非静脉曲张性上消化道出血(ANVUGIB)首次内镜止血成功后再出血的危险因素。方法回顾ANVUGIB首次内镜止血成功患者316例,按3d内是否再出血分为再出血组(n=80)和无再出血组(n=236),对比两组患者临床及辅助检查资料、内镜下表现、内镜治疗及后续治疗等变量的差异。单因素χ2检验选出差异有统计学意义的因素,并以之为自变量,是否再出血为因变量,行多因素Logistic回归分析,寻找再出血的危险因素。结果两组患者恶性肿瘤出血、抑酸药使用、血红蛋白、入院时休克、病灶喷射样出血、支持治疗情况、内镜治疗方法等差异有统计学意义(P<0.05)。经向后删除法Logistic回归分析,保留在模型中的变量有单一方法内镜治疗(OR=5.383)、恶性肿瘤出血(OR=4.812)、无后续PPIs(OR=4.351)、HGB<90g/L(OR=4.342)、病灶喷射样出血(OR=4.320)、支持治疗不足(OR=3.271),其95%CI下限均大于1。结论单一方法内镜治疗、恶性肿瘤出血、无后续PPIs、血色素低、病灶喷射样出血、支持治疗不足是ANVUGIB首次内镜止血成功后再出血的危险因素。

Objective To investigate the risk factors associated with rebleeding after the first successful endoscopic treatment in acute nonvariceal upper gastrointestinal bleeding （ANVUGIB）. Methods This was a retrospective review of 316 patients with the first successful endoscopic treatment due to acute nonvariceal upper gastrointestinal bleeding.The patients were divided into the rebleeding group within 3 days （n = 80） and the non-rebleeding group （n = 236）. Data on clinical presentation, laboratory test, endoscopic findings and treatment were collected. Risk factors for rebleeding were identified by multivariable Logistic regression. Re- sults The patients in two groups had significant difference with malignant tumor bleeding, subsequent acid in- hibitory drug use, hemoglobin, shock at the time of admission, jet bleeding, nutrition support, the method of en- doscopic treatment （P 〈 0.05）. Logistic regression analysis by backward elimination method revealed that the single method of endoscopic treatment（OR = 5.383）, patients with malignant tumor bleeding （OR = 4.812）, no subsequent PPIs （OR = 4.351）, HGB 〈 90 g/L （OR= 4.342）, bleeding in the lesions as jet （OR = 4.320）, inadequate nutritional support （OR = 3.271） were retained in the model, their lower limits of 95% CI were more than 1. Conclusions The single method of endoscopic treatment, patients with malignant tumor bleeding, no subse quent PPIs, low hemoglobin, jet bleeding, inadequate nutritional support were high risks for rebleeding after the first successful endoscopic treatment in ANVUGIB.