急性非静脉曲张性上消化道出血:单中心5年811例回顾性分析

Acute nonvariceal upper gastrointestinal bleeding: retrospective analysis of single-center, 811 cases, 5 years

目的探讨急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)的单中心病因构成和临床特点及急诊食管胃十二指肠内镜(esophagogastroduodenoscopy,EGD)的诊治价值。方法收集武汉大学人民医院近5年(2013年7月至2018年6月)ANVUGIB患者的临床资料、内镜发现及诊治结果进行回顾性分析。急诊EGD定义为患者首次消化道出血后24 h内行内镜诊治。结果 811例患者(男女比例为4.3∶1)接受急诊EGD诊治共计898次,病灶检出率98.5%(799/811)。消化性溃疡(72.5%,588/811)中Ⅰb级最多(34.2%,244/714),内镜下治疗93.7%(551/588),治疗成功率95.5%(526/551),使用最多的止血方法是金属夹(46.9%,335/714)。院内死亡率为9.0%(73/811),其中止血失败致死亡占8.2%(6/73)。结论消化性溃疡是ANVUGIB最常见的病因。急诊EGD在其诊治中具有重要意义。

Objective To investigate the etiology and clinical characteristics of acute nonvariceal upper gastrointestinal bleeding(ANVUGIB) in single-center, and to investigate the value of diagnosis and treatment of emergency esophago gastroduo denoscopy(EGD).Methods The clinical data, endoscope findings and outcomes of diagnosis and treatment of the patients with ANVUGIB who underwent emergency EGD in nearly 5 years(from Jul. 2013 to Jun. 2018) in Renmin Hospital of Wuhan University were analyzed. Emergency EGD was defined that examination and(or) treatment by EGD within 24 hours after first gastrointestinal bleeding.Results 811 patients(F/M was 4.3∶1) received 898 times of examination and(or) therapy of emergency EGD. The detection rate of lesions was 98.5%(799/811). In peptic ulcers(72.5%, 588/811), Ⅰb grade was the most common(34.2%, 244/714), the rate of endoscopic treatment was 93.7%(551/588) and treatment success was 95.5%(526/551), metal clip was the most popular hemostasis method(46.9%, 335/714). The hospital mortality rate was 9.0%(73/811), and 8.2%(6/73) of them died of hemostasis failure. Conclusion Peptic ulcer is the most common cause of ANVUGIB. There is the great importance of emergency EGD in the diagnosis and treatment of ANVUGIB.