早期内镜诊治应用于老年急性非静脉曲张性上消化道大出血患者的价值分析

Early endoscopic intervention of acute nonvariceal upper gastrointestinal bleeding of senile patients

目的探讨早期内镜在老年急性非静脉曲张性上消化道大出血(ANVUGIB)患者的诊断和治疗中的价值。方法回顾分析该院2015年1月-2015年9月150例老年ANVUGIB的患者早期内镜和择期内镜的诊疗结果,分析上消化道大出血的原因,比较两组患者在内镜病因检出率、首次出血止血成功率、再出血率、外科手术率、平均止血时间、输血量、平均住院时间和平均住院费用的差别。采用诺丁汉健康调查问卷(NHP)比较两组患者出院3个月后生活质量的差别。结果老年ANVUGIB出血患者中,消化性溃疡、胃癌和急性糜烂出血性胃炎是最常见的出血原因。与择期内镜组相比,早期内镜组病因检出率、首次出血止血成功率明显增高(P<0.05),再出血率、外科手术率明显降低,患者输血量减少,平均住院时间缩短,平均住院费用降低(P<0.05),两组差异有统计学意义,早期内镜组患者出院3个月后生活质量明显高于择期内镜组患者(P<0.05)。结论老年ANVUGIB患者进行早期内镜检查及治疗安全,效果确切,能尽快明确出血原因,减少患者住院费用,值得推广。

Objective To investigate the clinical value of early endoscopic intervention in diagnosis and treatment of acute nonvarieeal upper gastrointestinal bleeding （ANVUGIB）. Methods A retrospective analysis was performed of 150 senile patients with ANVUGIB who were intervened by early endoscopy or selective endoscopy from Janurary 2015 to September 2015. The causes of ANVUGIB were analyzed. The diagnosis rates, success rates of hemostasis, rates of rebleeding, surgery, hemostatie time, blood transfusion volume, hospitalization time, hospitalization cost were compared in early endoscopy group and selective endoscopy group. The quality of life was compared between the two groups by NHP after the patients left hospital for three months. Results Peptic ulcer, gastric cancer, acute hemor- rhagic gastritis were the three major causes of ANVUGIB. The diagnosis rate and successful hemostasis rates of early endoscopy group were significantly higher than that in selective endoscopy group （P 〈 0.05）. The rates of rebleeding and surgery were significantly lower, the blood transfusion volume was reduced, hospitalization time were shorten, and hospitalization cost were lower in early endoscopy group （P 〈 0.05）. The quality of life of early endoscopy group was statistically higher than that in selective endoscopy group （P 〈 0.05）. Conclusion Early endoscopic intervention is safe, effective and identify hemorrhage cause fast in diagnosis and treatment in senile patients with ANVUGIB. It is worthy of widespread promoting.