不同时机急诊胃镜对肝硬化出血治疗价值

Value of emergency endoscopy in different time for the treatment of cirrhosis bleeding

目的观察不同时机急诊胃镜对肝硬化合并出血治疗价值。方法将118例患肝硬化出血患者随机为急诊胃镜组（A、B、C组）及非急诊胃镜组（D组）,A组患者在入院后6 h和内行胃镜检查,B组患者在入院后6-12 h内行胃镜检查,C组患者入院后12-48 h内行胃镜检查,D组患者在入院后48 h后行胃镜检查,四组均酌情进行胃镜下治疗;评价四组患者的再出血率、病死率、并发症发生率、平均住院日、住院期间输血量及总住院费。结果急诊胃镜组与非急诊胃镜组在再出血率、病死率及并发症发生率方面相比,差异有统计学意义（P〈0.05）;急诊胃镜组间A组与C组在再出血率、病死率及并发症发生率方面相比,差异有统计学意义（P〈0.05）;4组在住院期间输血量、住院天数及花费等方面相比,差异有统计学意义（P〈0.05）,A组在输血量、住院天数及总住院费用方面均明显低于C组和D组。结论肝硬化出血尽早给予急诊胃镜检查,胃镜检查时间是影响患者止血效果及预后的重要因素。

Objective To investigate the application value of emergency endoscopy in the different time in the diag-nosis and treatment of cirrhosis bleeding .Methods One hundred and eighteen patients with cirrhosis bleeding were randomly divided into emergency endoscopy group （A, B, C groups）, and non-emergency endoscopy group （D group）, patients in A group were carried endoscopy at 6 hours after hospitalization , patients in group B were carried endoscopy at 6-12 hours after hospitalization , patients in C group were carried endoscopy at 12-48 hours after hospitalization;pa-tients in D group were carried endoscopy after 48 hours after hospitalization .They were treated depending on the condi-tions by endoscopy .Rebleeding rate , mortality and complication rates , the average , amount of blood transfusion during hospitalization and total hospitalization expenses of such confinement of 4 groups were evaluated .Results There were significant differences in the hemorrhage rate , mortality and complication rates between emergency endoscopy group and the non-emergency gastroscopy group , there were significant differences in the hemorrhage rate , mortality and complica-tion rates in the groups of emergency gastroscopy between A group and C group （P〈0.05）.In four groups, there were significant differences in the hospital transfusion amount , hospitalization days and cost （ P〈0 .05 ） , the blood transfu-sion volume , hospitalization days and total hospitalization costs in A group were significantly lower than those in C group and D group .Conclusion Cirrhosis bleeding should be given emergency gastroscopy as soon as possible , time is the important factor influencing the hemostatic effect and prognosis of patients.