感染及贫血对食管胃底静脉曲张破裂出血患者内镜治疗成功率的影响

Effect of infection and anemia on the success rate of patients with esophageal variceal bleeding treated by endoscopy

目的探讨合并感染及不同程度贫血对食管胃底静脉曲张破裂出血患者内镜治疗成功率的影响。方法回顾性分析我院首次经胃镜检查诊断为食管胃底静脉曲张破裂出血患者281例,分析合并感染及不同程度贫血对内镜治疗成功率的影响。结果 281例患者中,40例患者在内镜治疗后5d内再次出血,再出血率为14.2%;17例患者因消化道大出血抢救无效死亡,死亡率为6.0%。合并感染患者70例,感染率为24.9%,合并感染患者在内镜治疗后5d内的再出血率为32.9%,死亡率为17.1%,明显高于无感染的患者(8.1%),差异有统计学意义(P<0.05);合并重度贫血者(血红蛋白≤60g/L)65例,在内镜治疗后5d内的再出血发生率为41.5%,死亡率为23.1%,均明显高于轻中度贫血患者,差异有统计学意义(P<0.05)。结论当食管胃底静脉曲张破裂出血患者合并感染及重度贫血时,内镜治疗成功率明显降低,内镜治疗前积极控制感染及纠正贫血可能提高内镜治疗成功率,降低死亡率。

Objective To investigate the effect of infection and anemia on the success rate of patients with esophageal variceal bleeding treated by endoscopy. Methods Retrospectively collected 281 patients who were first diagnosed with esophageal variceal bleeding by endoscopy in our hospital. Analyzed the success rate of the pateints suffered infection and anemia or not. Results 40 patients occured rebleeding within 5 days after treatment, the rebleeding rate was 14.2%. 17 patients died due to gastrointestinal hemorrhage, the mortality rate was 6.0%. 70 patients suffered with infection, the infection rate was 24.9%, the rebleeding rate within 5 days after treatment was 32.9% and mortality was 17.1%, which was significantly higher than that in the non-infected patients（8.1%）, the difference was statistically significant（P〈0.05）. 65 patients suffered with severe anemia（hemoglobin ≤60 g/L）, the rebleeding rate within 5 days after treatment was 41.5% and mortality was 23.1%, which was significantly higher than that of mild and moderate anemia patients, the difference was statistically significant（P〈0.05）. Conclusion Success rate of endoscopic treatment in esophageal variceal bleeding significantly reduces when the patients are complicated by infection and severe anemia, and active infection control and correction of anemia may improve the success rate and reduce mortality rate.