急性非静脉曲张性上消化道出血内镜下治疗失败的危险因素

Risk factors associated with failure of endoscopic therapy for acute non-variceal upper gastrointestinal bleeding

目的:急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointcstinal bleeding,ANVUGIB)内镜下止血治疗回顾性分析,寻找内镜治疗失败的相关危险因素,早期识别再出血及死亡的高危患者,探讨其临床应用的价值.方法:收集2010-01/2013-10因ANVUGIB并行内镜下止血在贵阳医学院附属医学院住院的患者为研究对象,共52例,其中男41例,女11例.按首次内镜下止血治疗后成功与否,分为成功组和失败组.分别通过对一般情况、临床情况、出血至内镜下止血时间、实验室检查、内镜下表现、Rockall评分、Blatchford评分进行统计学分析,寻找有差异的变量.以差异有统计学意义的因素为自变量,以内镜成功与否为应变量,进行多因素Logistic回归分析,寻找内镜治疗失败的危险因素,P<0.05为差异有统计学意义.均采用SPSS18.0统计软件包进行统计分析.结果:年龄、输血情况、尿素氮、胆碱酯酶、白蛋白、凝血酶原时间在内镜下止血成功组与失败组结果比较差异均有统计学意义(P<0.05);性别、出血史、慢性病史、非甾体药物史、出血至内镜下止血时间、休克指数、血红蛋白、血小板计数、红细胞压积、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、间接胆红素、肌酐、活化部分凝血活酶时间、纤维蛋白原、术前用药、出血部位、出血程度分级、病变大小、Rockall评分、Blatchford评分在内镜下止血成功组与失败组结果差异无统计学意义(P>0.05);用向后删除法进行Logistic回归分析,年龄(OR=1.076,95%CI:1.009-1.147)、凝血酶原时间有统计学意义(OR=1.684,95%CI:1.053-2.693),是初次内镜下止血失败,需要介入、外科治疗或死亡的危险因素.结论:对年龄较大、凝血酶原时间延长的非静脉曲张性上消化道出血患者,进行首次内镜下止血失败的危险性较高,可能需要进一步介入治疗、外科手术治疗,或死亡的危险性增高.对于胆碱酯酶<5000 U/L、血尿素氮异常、白蛋白显著下降、有输血史的患者,需警惕再次出血的可能.

AIM： To determine risk factors associated with failure of endoscopic therapy for acute non-variceal upper gastrointcstinal bleeding （ANVUGIB）.METHODS： This was a retrospective cohort study of 52 patients with acute ANVUGIB who were admitted to the Affiliated Hospital of Guiyang Medical College from January 2010 to October 2013. Based on the therapeutic effect after first endoscopic therapy, the patients were divided into either a success or a failure group. Data including age, sex, bleeding history, chronic disorder history, non-steroidal anti-inflammatory drug history, time from bleeding to endoscope examination, blood transfusion, shock index, hemoglobin, blood routine examination, liver and renal function examination, parameter of anticoagulative system, causes and type of bleeding, lesion size, Rockall and Blatchford grade were compared between the two groups to find the variables with a significant difference. Risk factors for treatment failure were identified using multivariable logistic regression. RESULTS： Therapeutic failure rate was 23.7% （12/52）. The two groups had significant differences in age, blood transfusion, BUN, CHE, ALB, and PT. Logistic regression analysis revealed that age （OR = 1.076, 95%CI： 1.009-1.147） and PT （OR = 1.684, 95%CI： 1.053-2.693） were independent risk factors. CONCLUSION： ANVUGIB patients with old age or long PT have a higher risk of failure of endoscopic therapy and should be given interventional therapy or surgery when necessary.