非静脉曲张性上消化道出血内镜治疗术后再出血危险因素分析

Risk Factors Analysis of Postoperative Rehemorrhage of Non-variceal Upper Gastrointestinal Bleeding Following Endoscopic Therapy

目的探讨非静脉曲张性上消化道出血内镜治疗术后再出血的危险因素。方法选择2010年1月—2015年1月在河北工程大学附属医院住院行内镜下治疗的非静脉曲张性上消化道出血520例,按照术后有无再出血分为再出血组(100例)和未再出血组(420例)两组,详细记录比较两组一般资料和实验室检查结果,寻找内镜治疗后再出血的独立危险因素。结果两组年龄、性别、饮酒史、抽烟史、消化道出血史、Ⅰb级出血、Ⅱa级出血、镜下治疗方法、应用药物情况及血小板≤100×109/L、白蛋白≤38 g/L、活化部分凝血活酶时间≥37 s及纤维蛋白原≤2 g/L情况比较差异无统计学意义(P>0.05),而Ⅰa级出血、出血病变直径>2 cm、输血量>800 ml、合并慢性肾功能不全、合并肝硬化、血红蛋白≤90 g/L及凝血酶原时间(PT)≥17 s情况比较差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示Ⅰa级出血、出血病变直径>2 cm、输血量>800 ml、合并慢性肾功能不全、合并肝硬化、血红蛋白≤90 g/L及PT≥17 s为非静脉曲张性上消化道出血内镜治疗术后再出血的独立危险因素。结论非静脉曲张性上消化道出血内镜治疗术后再出血危险因素包括Ⅰa级出血、出血病变直径>2 cm、输血量>800 ml、合并慢性肾功能不全、合并肝硬化、血红蛋白≤90 g/L和PT≥17 s。对于具有此类危险因素的非静脉曲张性上消化道出血患者要及时镜下止血,在积极输血和纠正低血红蛋白同时,密切监测凝血功能及肝、肾功能,以防止再出血。

Objective To investigate risk factors of rehemorrhage in nonvariceal upper gastrointestinal bleeding（ NVUGIB） patients undergoing endoscopic therapy. Methods In a retrospective study,520 patients undergoing endoscopic therapy for NVUGIB admitted to the Affiliated Hospital of Hebei Engineering University during January 2010 and January 2015 were investigated for rehemorrhage. The patients were divided into the rebleeding group after endoscopic therapy and the nonrebleeding group according to whether there was rebleeding after surgery or not. Data on clinical presentation,laboratory test outcomes were collected and compared. Risk factors for rebleeding were identified. Results There were no significant differences in age,gender,drinking history,smoking history,history of gastrointestinal bleeding,class Ib hemorrhage,class IIa hemorrhage,endoscopic therapy methods,drug use,platelet≤100 × 109/ L,albumin ≤38 g / L,activated partial thromboplastin time≥37 s and fibrinogen≤2 g / L between the two groups（ P 0. 05）. The patients in the two groups had significant difference in class Ia hemorrhage,diameter of the ulcer 2 cm,transfused blood 800 ml,comorbidity with chronic renal disease,comorbidity with liver cirrhosis,initial bleeding level ≤90 g / L and prothrombin time≥17 s（ P 0. 05）. In the multivariate Logistic analysis,class Ia hemorrhage,diameter of the ulcer 2 cm,transfused blood 800 ml,comorbidity with chronic renal disease,comorbidity with liver cirrhosis,initial bleeding level ≤90 g / L and prothrombin time≥17 s were risk factors for rebleeding following endoscopic therapy of NVUGIB. Conclusion Class Ia hemorrhage,diameter of the ulcer 2 cm,transfused blood 800 ml,comorbidity with chronic renal disease,comorbidity with liver cirrhosis,initial bleeding level ≤90 g / L and prothrombin time ≥ 17 s are identified as risk factors for rebleeding following endoscopic therapy of NVUGIB. In clinical practice,patients of NVUGIB with these risk factors need close attention,endoscopic hemostasis treatment as early as possible,positive blood transfusion and correction of low hemoglobin,the coagulation function and liver and kidney function should be closely monitored at the same time in order to prevent rehemorrhage.