急诊胃镜检查可降低急性上消化道出血患者的死亡风险

Emergency gastroscopy reduces the risk of death in patients with acute upper gastrointestinal bleeding

目的探究影响急性上消化道出血患者院内死亡的危险因素,分析急诊内镜检查的作用,为基层医院开展相关工作提供参考。方法纳入2022年1月至12月因急性上消化道出血于兴化市人民医院住院的370例患者,其中278例进行了急诊胃镜检查。分析急性上消化道出血的常见原因和部位,采用logistic回归分析急性上消化道出血死亡的影响因素。结果370例急性上消化道出血的患者中,男性为主[67.3%(249/370)],中位年龄70(57~78)岁,入院时中位血红蛋白水平72(57~96)g/L,其中278例进行了胃镜检查,130例接受了输血治疗,输血2(1.5~3.5)U红细胞,中位住院时间5(4~7)d。内镜检查组的年龄小于未内镜检查组(P<0.001),血红蛋白水平高于未内镜检查组(P<0.001),止血药物使用及输血比例低于未内镜检查组(P=0.027,P<0.001)。接受胃镜检查的患者,上消化道出血原因包括:144例(51.8%)为溃疡相关的出血,61例(22.0%)为急性黏膜病变导致的出血,27例(9.7%)为肿瘤导致的出血,12例(4.3%)为贲门撕裂,5例(1.8%)为血管畸形所致的出血,29例(10.4%)为静脉曲张出血。出血部位包括:170例(61.1%)出血部位为胃,53例(19.1%)位于食管,54例(19.4%)为十二指肠,1例(0.4%)为胃十二指肠复合溃疡出血。全部患者中,19例院内死亡,92例未行急诊胃镜检查的患者中死亡16例,病死率17.4%;278例行急诊胃镜检查的患者中死亡3例,病死率1.08%。Logistic单因素回归分析发现高龄(>70岁)、血红蛋白低(<70 g/L)、输血和急诊胃镜检查均是急性上消化道出血患者院内死亡的影响因素,多因素回归分析提示急诊胃镜检查(OR=0.043,95%CI:0.010~0.198,P<0.001)可以减少急性上消化道出血患者院内死亡的发生。结论急性上消化道出血常见于老年患者,在血流动力学稳定的基础上及早行内镜检查,明确病因,联合传统药物进行内镜下止血治疗,能够改善患者的预后,降低急性上消化道出血的病死率。

Objective To explore the risk factors of hospital death in patients with acute Upper gastrointestinal bleeding,analyze the role of emergency endoscopy,and provide reference for grass-roots hospitals to carry out related work.Methods A total of 370 patients with acute Upper gastrointestinal bleeding hospitalized in the Xinghua People′s Hospital from January to December 2022 were included,278 of whom underwent emergency gastroscopy.The common causes and locations of acute Upper gastrointestinal bleeding were analyzed,and the influencing factors of death from acute upper gastrointestinal bleeding were analyzed by logistic regression.Results Among 370 patients with acute Upper gastrointestinal bleeding,the majority were male[67.3%(249/370)],the median age was 70(57-78)years old,and the median hemoglobin level at admission was 72(57-96)g/L.Among them,278 patients underwent gastroscopy,and 130 patients received blood transfusion treatment of 2(1.5-3.5)units of red blood cells transfusion.The median length of stay was 5(4-7)days.The age of the endoscopic group was younger than that of the non endoscopic group(P<0.001),and the hemoglobin level was higher than that of the non endoscopic group(P<0.001).The proportion of hemostatic drug use and blood transfusion was lower than that of the non endoscopic group(P=0.027,P<0.001).In patients undergoing gastroscopy,the causes of upper gastrointestinal bleeding included 144 cases(51.8%)of ulcer related bleeding,61 cases(22.0%)of bleeding caused by acute mucosal lesions,27 cases(9.7%)of bleeding caused by tumors,12 cases(4.3%)of bleeding caused by cardiac tears,5 cases(1.8%)of bleeding caused by vascular malformations,and 29 cases(10.4%)of bleeding caused by varices.The bleeding sites included:170 cases(61.1%)had bleeding from the stomach,53 cases(19.1%)from the esophagus,54 cases(19.4%)from the duodenum,and 1 case(0.4%)from gastroduodenal compound ulcer bleeding.Among all patients,19 died in the hospital,and among 92 patients who did not undergo emergency gastroscopy,16 died,with a mortality rate of 17.4%;Among 278 patients who underwent emergency gastroscopy,3 died,with a mortality rate of 1.08%.Logistic single factor regression analysis found that the elderly(>70 years old),low hemoglobin(<70 g/L),blood transfusion and emergency gastroscopy were the influencing factors of hospital death in patients with acute upper gastrointestinal bleeding.Multivariate regression analysis showed that emergency gastroscopy(OR=0.043,95%CI:0.010-0.198,P<0.001)could reduce the hospital death of patients with acute upper gastrointestinal bleeding.Conclusions Acute upper gastrointestinal bleeding is common in elderly patients.On the basis of stable hemodynamics and early endoscopic examination,identifying the cause and combining traditional drugs for endoscopic hemostasis can improve the prognosis of patients and reduce the mortality of acute upper gastrointestinal bleeding.