超早期胃镜应用于急性非静脉曲张性上消化道出血的价值

Clinical value of rapid endoscopy in acute nonvariceal upper gastrointestinal bleeding

目的探讨急性非曲张性上消化道出血患者早期胃镜检查的时间与临床疗效之间的关系。方法回顾性分析93例48 h内接受胃镜检查的非静脉曲张性上消化道出血的临床资料,根据接受胃镜的时间分为超早期胃镜组(≤8 h)、早期胃镜组(8～24h)及常规胃镜组(24～48 h),分析其内镜检查阳性率、活动性出血发现率、输血率、内镜下止血后再出血率等。结果各组均未发现明显操作相关并发症,超早期胃镜组19例患者,首次胃镜发现17例阳性出血病灶(17/19,89.47%),其中10例为活动性出血(10/19,52.63%),1例输血患者(1/19,5.26%),1例内镜止血后再出血(1/10,10%);早期胃镜组28例患者,首次胃镜发现26例阳性病灶(26/28,92.86%),其中13例有活动性出血(13/28,46.43%),4例输血患者(4/28,14.29%),未发现内镜止血后再出血患者;常规胃镜组46例患者首次胃镜发现39例阳性病灶(39/46,84.78%),其中9例有活动性出血(9/46,19.57%),10例输血患者(10/46,21.74%)及1例内镜止血后再出血(1/9,11.11%)。结论超早期胃镜组及早期胃镜组在发现活动性出血病灶方面优于常规胃镜组,而在病灶发现阳性率等方面并无明显优势,同样可获得较好的内镜止血率,并不能明显减少输血率。

Objective To examine the relationship between time to endoscopy and clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding （NVUGIB）. Methods Clinical data of 93 NVUGIB patients who received endoscopy within 48 h after hemorrhage were analyzed retrospectively. The patients were divided into RE group（8 h） , EE group （8 -24 h ） and NE group （24 -48 h） according to the the time between hemorrhage and endoscopy. The positive lesions, active hemorrhage, number of blood transfusion and rebleeding were analyzed. Results In 93 pa- tients, positive lesions were found in 17 patients in RE group （17/19,89.47%）,26 patients in RE group （26/28, 92.86% ） , 39 patients in RE group （39/46, 84.78% ） ; active hemorrhage were found in 10 patients in RE group （10/19,52.63%）, 13 patients in RE group （13/28, 46.43% ）, 9 patients in RE group （9/46, 19.57% ）, 1 patient in the RE group（ 1/19,5.26% ）, 4 patients in the RE group （4/28,14.29）,10 patients in the NE group （10/46, 21.74% ） received blood transfusion, after endoscopic hemostasis, 1 patient in the RE group （1/10,10%） and 1 pa- tient in the NE group （ 1/9, 11.11% ） were rebleeding. Conclusion RE group and EE group can find more active hemorrhage than NE group, but there was no difference in discovering positive lesions. These results may help inform the debate about emergency endoscopy service provision.