床旁气管插管麻醉后行急诊内镜下止血治疗老年急性非静脉曲张性上消化道出血的临床效果和安全性

Clinical efficacy and safety of emergency endoscopic hemostasis treatment following anesthesia with bedside endotracheal intubation for acute non-variceal upper gastrointestinal bleeding in the elderly

目的探讨床旁气管插管麻醉后行急诊内镜下止血治疗老年急性非静脉曲张性上消化道出血(ANVUGIB)患者的疗效及安全性。方法回顾性分析83例发病24 h内行急诊内镜止血治疗的老年ANVUGIB患者的临床资料,其中行床旁气管插管麻醉后内镜下止血治疗62例(床旁气管插管麻醉组),行床旁非气管插管内镜下止血治疗21例(床旁非插管组)。比较两组患者的止血效果、内镜止血所需时间、输血量、住院时间,以及吸入性肺炎发生率和治疗后4周死亡率。结果床旁气管插管麻醉组有效止血率、有效止血后再出血率、内镜止血所需时间、输血量、住院时间等指标均优于床旁非插管组,吸入性肺炎发生率和4周内病死率均低于床旁非插管组(均P<0.05)。结论床旁气管插管麻醉后行内镜下止血治疗老年ANVUGIB患者,成功率高、并发症少、死亡率低。

Objective To investigate the efficacy and safety of emergency endoscopic hemostasis treatment following anesthesia with bedside endotracheal intubation for elderly patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods The clinical data of 83 elderly patients with ANVUGIB,who underwent emergency endoscopic hemostasis treatment within 24 hours of the attack,were analyzed retrospectively,including 62 cases undergoing endoscopic hemostasis treatment following anesthesia with bedside endotracheal intubation(bedside endotracheal intubation anesthesia group)and 21 cases undergoing endoscopic hemostasis treatment with bedside non-intubation(bedside non-intubation group).Hemostasis effect,duration of endoscopic hemostasis,blood transfusion volume,hospital stay,as well as incidence rate of aspiration pneumonitis and mortality within 4 weeks after treatment were compared between the two groups.Results The bedside endotracheal intubation anesthesia group had superior effective hemostasis rate,rebleeding rate following effective hemostasis,duration of endoscopic hemostasis,blood transfusion volume and hospital stay,along with lower incidence rate of aspiration pneumonitis and lower mortality within 4 weeks after treatment,as compared with the bedside non-intubation group(all P<0.05).Conclusion Endoscopic hemostasis following bedside endotracheal intubation anesthesia has a high success rate of hemostasis,few complications and low mortality in elderly ANVUGIB patients.