内镜下金属止血夹联合埃索美拉唑治疗Forrest Ⅱb级急性非静脉曲张性消化道出血的效果及经济效益分析

Clinical study and economic benefit analysis of endoscopic metal hemostatic clip combined with esomeprazole in treatment of Forrest Ⅱb acute non-variceal upper gastrointestinal bleeding

目的 评估内镜下金属止血夹联合埃索美拉唑治疗ForrestⅡb级急性非静脉曲张性上消化道出血(NVOGIB)的疗效,并分析该联合疗法的经济效益。方法 回顾性分析48例经内镜下金属止血夹联合埃索美拉唑治疗的ForrestⅡb级NVOGIB患者临床资料(联合组),并将经性别、年龄等基线资料1∶1匹配的48例埃索美拉唑治疗的ForrestⅡb级NVOGIB患者作为对照组。记录两组临床疗效、病情转归情况(输血率、住院时间、7 d再出血率)及不良反应发生情况,比较两组治疗1个月后黏膜愈合情况(再生黏膜成熟度及组织学再生黏膜成熟度),并对两种治疗方案行成本-效果分析。结果 联合组临床疗效显著高于对照组(P <0.05),住院时间则显著低于对照组(P <0.05)。两组输血率、7 d再出血率及不良反应发生情况比较,差异无统计学意义(P> 0.05)。治疗1个月后,联合组再生黏膜成熟度、组织学再生黏膜成熟度均优于对照组(P <0.05)。联合组成本高于对照组(P <0.05),但联合组成本-效果比为91.45,低于对照组的97.07;与联合组相比,对照组每增加1个单位治疗总有效率,需要增加费用52.15元。结论 内镜下金属止血夹联合埃索美拉唑治疗ForrestⅡb级NVOGIB效果显著,安全可靠,且更经济。

Objective To evaluate the efficacy of endoscopic metal hemostatic clip combined with esomeprazole in the treatment of Forrest Ⅱb acute non-variceal upper gastrointestinal bleeding(NVOGIB),and analyze the economic benefit of the combined therapy.Methods The clinical data of 48 patients with Forrest Ⅱb NVOGIB who were treated with endoscopic metal hemostatic clip combined with esomeprazole were retrospectively analyzed(combined group),and 48 patients with Forrest Ⅱb NVOGIB by a 1:1 match of baseline data such as gender and age treated with someprazole were selected as control group.Clinical efficacy,disease outcomes(blood transfusion rate,hospital stay,7-day re-bleeding rate)and occurrence of adverse reactions were recorded in the two groups.The mucosal healing status(reproductive mucosal maturity and histological reproductive mucosal maturity)were compared between the two groups after 1 month of treatment.The cost-effectiveness analysis of the two treatment regimens was performed.Results The clinical efficacy of the combined group was significantly higher than that of the control group(P<0.05),and the hospital stay was significantly shorter than that of control group(P<0.05).There were no statistical differences in blood transfusion rate,7-day re-bleeding rate and occurrence of adverse reactions between the two groups(P<0.05).After 1 month of treatment,the reproductive mucosal maturity and histological regenerative mucosal maturity of combined group were better than those of the control group(P<0.05).There was higher cost in the combined group(P<0.05),but the cost-effectiveness ratio of 91.45 in combined group was lower than that of 97.07 in the control group.The total effective rate of treatment for every additional unit in the control group needed increased cost of 52.15 yuan compared to combined group.Conclusion Endoscopic metal hemostatic clip combined with esomeprazole has a significant effect in the treatment of Forrest Ⅱb NVOGIB,and it is safe and more economical.