急性上消化道出血诱发心肌损伤患者最佳胃镜治疗时机的研究

Study on Best Time of Gastroscopy in Patients with Myocardial Injury Induced by Acute Upper Gastrointestinal Hemorrhage

目的:探讨急性上消化道出血诱发心肌损伤患者最佳胃镜治疗时机。方法:选取2018年1月-2020年8月于本院治疗的116例急性上消化道出血诱发心肌损伤患者,将其分为两组,A组为0.068 4 ng/mL<hs-cTnI≤0.684 ng/mL者,B组为hs-cTnI>0.684 ng/mL者。A组行急诊胃镜(出血后24~48 h)者25例,择期胃镜(出血后48 h~7 d)37例,B组行急诊胃镜者24例,择期胃镜30例。分别比较A、B组急诊胃镜和择期胃镜的治疗情况,比较A组和B组急诊胃镜组治疗情况。结果:A组患者中急诊胃镜组和择期胃镜组病因检出率、术后复发出血率、输血量、住院时间比较,差异均有统计学意义(P<0.05)。B组患者中急诊胃镜组和择期胃镜组病因检出率、术后复发出血率、输血量、住院时间比较,差异均有统计学意义(P<0.05)。A组和B组中急诊胃镜组心电图情况比较,差异有统计学意义(P<0.05)。结论:急性上消化道出血诱发心肌损伤患者中,无论0.068 4 ng/mL<hs-cTnI≤0.684 ng/mL还是hs-cTnI>0.684 ng/mL者,与行择期胃镜相比,行急诊胃镜可减少输血量、缩短住院时间。

Objective:To investigate the best time of gastroscopy in patients with myocardial injury induced by acute upper gastrointestinal hemorrhage.Method:A total of 116 patients with myocardial injury induced by acute upper gastrointestinal hemorrhage treated in our hospital from January 2018 to August 2020 were selected.They were divided into two groups,group A (0.068 4 ng/mL<hs-cTnI≤0.684 ng/mL) and group B (hs-cTnI > 0.684 ng/mL).Group A received emergency gastroscopy (24 to 48 h after bleeding) in 25 cases,and selective gastroscopy (48 h to 7 d after bleeding) in 37 cases.In group B,24 patients received emergency gastroscopy,and 30 patients received elective gastroscopy.The treatment of emergency gastroscopy and elective gastroscopy in group A and B were compared,respectively.The treatment of emergency gastroscopy group was compared between group A and group B.Result:In group A,the etiology detection rate,postoperative recurrent bleeding rate,blood transfusion volume and length of stay of emergency gastroscopy group and selective gastroscopy group were compared,the differences were statistically significant (P<0.05).In group B,the etiology detection rate,postoperative recurrent bleeding rate,blood transfusion volume and length of stay of emergency gastroscopy group and selective gastroscopy group were compared,the differences were statistically significant (P<0.05).Comparison of ECG in emergency gastroscopy group between group A and group B,the difference was statistically significant (P<0.05).Conclusion:Among myocardial injury induced by acute upper gastrointestinal hemorrhage patients,whether 0.068 4 ng/mL<hs-cTnI≤0.684 ng/mL or hs-cTnI>0.684 ng/mL,emergency gastroscopy can reduce the amount of blood transfusion and shorten the length of hospital stay compared with elective gastroscopy.