食管胃静脉曲张胃镜治疗围术期管理现状京津冀地区问卷调查

Status of perioperative management of esophageal and gastric varices in the treatment of gastroscopy:A questionnaire survey in the Beijing-Tianjin-Hebei region

目的了解食管胃静脉曲张胃镜治疗围术期管理现状、可能存在的问题及不同地区、不同医院之间存在的差异。方法金数据App设计网络调查问卷在京津冀地区开展食管胃静脉曲张胃镜治疗的医院进行调查。软件中“数据报表及高级报表”功能进行数据初步分析,SPSS软件Pearson卡方检验。结果有效问卷97份(97家医院)。麻醉胃镜治疗占20.0%(15.0%:35.0%)。95.9%的医院开展急诊胃镜,出血12h内实施的医院59家(63.4%)。门脉系统栓塞、肝内动门脉分流在近50%的医院视作胃镜治疗禁忌证。择期胃镜治疗前61家医院(62.9%)预防性使用降门脉压药物,37家医院(38.1%)预防性使用抗菌药物。套扎治疗住院观察至14d者明显多于其他治疗方法(x^(2)=16.335,P=0.000)。66家医院(68.0%)<50%的二级预防患者接受内镜联合非选择性卩受体阻滞剂治疗。胃镜治疗间隔时间1-4周不等,疗程结束首次复查胃镜时间1-12月不等。遵嘱完成胃镜疗程并规律随访的患者比例在46家医院(47.4%)<50%。结论目前食管胃静脉曲张围术期管理不同地区、不同医院之间存在较大差异,需进一步研究并加以规范。

Objective To investigate the status of perioperative management of endoscopic treatment for esophagogastric varices,revealing potential problems and the differences between different regions and hospitals.Methods "Golden Data"app was used to design a network questionnaire and then the survey was issued through mobile phones.Data report function in the app and SPSS Pearson chi-square test were conducted for data analysis.Results Ninety-seven valid questionnaires were taken back from 97 hospitals.Treatment under anesthesia was adopted in the hospitals by about 20.0%(15.0%;35.0%).95.9%of the hospitals carried out emergency gastroscopy and 59(63.4%)implemented it within 12 hours of bleeding.Portal vein system embolism and intrahepatic arterio-portal shunt were regarded as the contraindications of gastroscopy in nearly 50%of the surveyed hospitals.As in selective gastroscopy,61 hospitals(62.9%)used vasoactive drugs,and 37 hospitals(38.1%)used antibiotics prophy-lactically.Patients who accepted EVL were more prone to 14 days of hospitalization than those used other treatment methods(x^(2)=16.335,P=0.000).No more than half of the patients undergone secondary prevention in 66 hospitals(68.0%)were treated with endoscopy combined with non-selective beta blockers.The treatment interval ranged from 1 to 4 weeks,and the first gastroscopy review time ranged from 1 to 12 months after the therapy course.The proportion of patients who could complete the gastroscope course and be followed up regularly was less than 50%in 46 hospitals(47.4%).Conclusion The perioperative management of endoscopic treatment for esophagogastric varices is not ideal and lacks guidance to follow,calling for further study and standardization.