高危食管胃静脉曲张破裂出血急诊胃镜检查时机的选择

Study on the timing of emergency gastroscopy for patients with high-risk acute esophagogastric variceal bleeding

目的探讨高危肝硬化伴急性食管胃静脉曲张破裂出血患者不同时机急诊胃镜的临床价值,寻求最佳时机。方法选取2019年1月~2021年2月我院收治的高危肝硬化伴急性食管胃静脉曲张破裂出血的患者77例进行回顾性分析和随访,根据胃镜诊疗时机的不同分为A组(n=28)、B组(n=23)及C组(n=26)。A组患者在入院后0~6 h内行胃镜检查,B组患者在入院后6~12 h内行胃镜检查,C组患者在入院后12~24 h内行胃镜检查,比较3组患者平均住院日、住院期间红细胞输血量、住院费用、急性期止血情况、再出血情况、6周病死率及肝性脑病发生率情况。结果3组患者出血部位检出率和急性期止血成功率方面相比,差异有统计学意义(P<0.05),入院后6 h和6~12 h内行胃镜检查能提高出血部位检出率,6~12 h内行胃镜检查出血部位检出率和急性期止血率更高。但3组住院时间、输血量、住院费用、肝性脑病发生率、早期再出血率、6周病死率比较,差异无统计学意义(P>0.05)。结论急诊内镜介入时机可影响高危食管胃静脉曲张破裂出血患者出血部位检出率和急性期止血率。为尽可能发现出血病灶,提高急性期止血成功率,建议高危患者于入院后6~12 h内行胃镜检查,但更早(6 h内)行胃镜检查尚需更多的临床循证证据。

Objective To explore the clinical value of emergency gastroscopy at different times in high-risk liver cirrhosis patients combine with acute esophageal and gastric variceal bleeding,and seek the best time.Methods 77 cases of high-risk liver cirrhosis combine with acute esophageal and gastric variceal bleeding in our hospital were divided into group A(n=28),group B(n=23)and group C(n=26)according to the timing of gastroscopy.Patients undergo gastroscopy within 6 hours after admission in group A,6~12 hours after admission in group B and 12~24 hours after admission in group C.The average length of stay,amount of average red blood cell transfusion,hospitalization expenses,hemostasis in acute phase,rebleeding,6-week mortality and the incidence of hepatic encephalopathy were compared among the three groups.Results There was significant difference in the control of acute bleeding and detect the bleeding site among the three groups(P<0.05).Gastroscopy performed within 6h and 6~12h after admission can improve the detection rate of bleeding site,and gastroscopy performed within 6~12h has higher detection rate of bleeding site and acute hemostasis rate.However,there was no significant difference in hospitalization time,blood transfusion volume,hospitalization expenses,incidence of hepatic encephalopathy,early rebleeding rate and 6-week mortality(P>0.05).Conclusion In order to find bleeding lesions as much as possible and improve the success rate of acute hemostasis,it is recommended that high risk patients should have gastroscopy within 6~12 hours after admission,but more clinical evidence is needed for gastroscopy earlier(within 6 hours).