急性非静脉曲张性上消化道出血的消化内镜诊治及再出血危险因素研究

Diagnosis and treatment of digestive endoscopy significance and risk factors of rebleeding in acute non-variceal upper gastrointestinal bleeding

目的:探讨急性非静脉曲张性上消化道出血(ANVUGIB)的消化内镜诊治及再出血危险因素。方法:选取我院2014-02-2016-04期间收治的196例ANVUGIB患者作为研究对象。采用内镜诊治ANVUGIB,根据首次内镜止血成功后是否再出血,把首次内镜止血成功的患者分为首次有效止血组和再出血组,统计ANVUGIB的首次内镜止血成功率、首次内镜止血成功再出血率、出血原因和再出血危险因素(例如输血治疗等),采用Pearson卡方检验、Yates卡方检验和多因素Logistic回归分析再出血危险因素。结果:首次内镜止血成功率为96.43%(189例),其中32例(16.33%)再次出血。54.08%(106例)的ANVUGIB病因是十二指肠溃疡。输血治疗、肿瘤出血、后续无质子泵抑制剂治疗、a级出血、出血病变直径≥2.0cm、Rockall评分>5分和Blatchford评分>6分是ANVUGIB内镜止血成功后再出血的独立危险因素(均P<0.05)。结论:内镜诊治ANVUGIB的效果明确。十二指肠溃疡是最常见的ANVUGIB病因。ANVUGIB内镜止血成功后再出血的危险因素众多。

Objective：This study was to investigate the significance of digestive endoscopy on diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding（ANVUGIB）,as well as the risk factors of rebleeding.Method：The 196 ANVUGIB patients,as the research object,were enrolled from People＇s Hospital of Lianjiang between February 2014 and April 2016.Diagnosis and treatment of ANVUGIB were used by digestive endoscopy.The first successful endoscopic treated patients were divided into the first effective hemostasis group and rebleeding group,depending on whether rebleeding or not.The first successful endoscopic treatment rate,the rebleeding after the first successful endoscopic treatment rate,causes of bleeding and risk factors of rebleeding（such as blood transfusion and so on）were statistically analyzed.The risk factors of rebleeding data were analyzed by Pearson chi square test,Yates chi square test,and multi factor Logistic regression analysis.Result：The first successful endoscopic treatment rate was 96.43%（189cases）.The rebleeding rate after the first successful endoscopic treatment was 16.33%（32cases）.54.08 %（106cases）cause of ANVUGIB was duodenal ulcers.Blood transfusion,tumor bleeding,no-subsequent using proton pump inhibitors,agrade bleeding,bleeding lesion diameter≥2.0cm,Rockall score5,and Blatchford6were independent risk factors of rebleeding after the first successful endoscopic treatment（P〈0.05）.Conclusion：The effect of using digestive endoscopy on diagnosis and treatment of ANVUGIB is definite.Duodenal ulcer is the most common etiology of ANVUGIB.There are many risk factors for rebleeding after the first successful digestive endoscopy treatment.