不同时机行急诊胃镜对肝硬化相关食管胃底静脉曲张破裂出血的干预效果

Intervention effects of emergency gastroscopy at different timing on cirrhosis-associated esophageal and gastric variceal bleeding

目的比较不同时机行急诊胃镜对肝硬化相关食管胃底静脉曲张破裂出血(EGVB)的干预效果。方法将90例肝硬化相关EGVB患者分为A组、B组及C组各30例。A组、B组、C组分别在发病后6~<12 h、发病后12~24 h、发病后24 h进行急诊胃镜诊治。比较3组患者出血部位检出率、止血成功率、再出血率、治疗后6个月内病死率、住院时间和住院费用、输血量、术后并发症的发生率。结果A组、B组、C组出血部位检出率依次降低,A组止血成功率优于其他两组,且再出血率低于C组(均P<0.05)。A组、B组、C组输血量、住院时间、住院费用依次增加(均P<0.05),但3组患者术后并发症发生率差异无统计学意义(P>0.05)。结论对于肝硬化相关EGVB的患者,与发病后12 h比较,早期(发病后6~<12 h)进行急诊胃镜诊治效果更好、再出血风险更低,术后恢复更快。

Objective To compare the intervention effects of emergency gastroscopy at different timing on cirrhosis-associated esophageal and gastric variceal bleeding(EGVB).Methods Ninety patients with cirrhosis-associated EGVB were divided into group A,group B and group C,with 30 cases in each group.Groups A,B and C were treated by emergency gastroscopy 6 to<12 hours after episode,12 to 24 hours after episode and 24 hours after episode,respectively.The three groups were compared in terms of detection rate of bleeding site,success hemostasis rate,re-bleeding rate,case fatality within 6 hours after treatment,hospital stay,hospitalization costs,blood transfusion volume,and incidence rate of postoperative complications.Results The detection rates of bleeding site in group A,group B and group C decreased successively,group A had superior success hemostasis rate than other two groups,along with lower re-bleeding rate than group C(all P<0.05).Blood transfusion volume,hospital stay,and hospitalization costs in group A,group B and group C increased successively(all P<0.05),but there was no statistically significant difference in incidence rate of postoperative complications among the three groups(P>0.05).Conclusion For patients with cirrhosis-associated EGVB,early(6 to<12 hours after episode)emergency gastroscopy achieves better therapeutic effect,lower risk of re-bleeding and rapider postoperative recovery than the procedure performed 12 hours after episode.