肝硬化食管胃底静脉曲张破裂出血床旁急诊内镜治疗的效果及危险因素

Efficacy and risk factors analysis of bedside emergency endoscopic treatment of esophagogastric variceal bleeding in cirrhotic patients

目的探讨ICU肝硬化门脉高压症食管胃底静脉曲张破裂出血床旁急诊内镜治疗的效果及相关危险因素分析。方法回顾性分析2016年6月至2021年6月入住我院ICU行床旁急诊内镜治疗的117例肝硬化食管胃底静脉曲张破裂出血患者的临床资料。根据急诊内镜治疗术后72 h内有无活动性出血,分为急诊内镜止血成功组(n=85)、失败组(n=32)。将急诊内镜止血成功组患者分为早期再出血组(n=18)和非再出血组(n=67)。通过单因素分析及多因素回归Logistic分析,分析影响急诊内镜止血失败及早期再出血的独立危险因素。根据6周死亡情况,分析影响6周生存预后的相关因素。结果117例食管胃底静脉曲张破裂出血患者中,急诊内镜止血失败率为27.35%(32/117)。多因素分析提示,术前气管插管、合并休克、肝性脑病Ⅲ~Ⅳ期、WBC升高是急诊内镜治疗失败的独立危险因素。早期再出血率为21.18%(18/85);多因素分析显示,Child-Pugh评分是ICU急诊内镜治疗成功后早期再出血的独立危险因素。6周的累计死亡率为42.74%(50/117),Child-Pugh高评分、术前气管插管、合并肝衰竭是6周内死亡的危险因素。结论床旁急诊内镜是ICU食管胃底静脉曲张破裂出血患者的有效止血措施,气管插管、休克、肝性脑病、WBC升高是急诊内镜止血失败的独立危险因素。Child-Pugh评分是预判急诊内镜治疗后早期再出血的重要指标。气管插管、休克、Child-Pugh高评分提示6周预后不良。

Objective To investigate the efficacy and risk factors of bedside emergency endoscopic treatment of esophagogastric variceal bleeding(EGVB)for cirrhotic patients in ICU.Methods Retrospectively analyze the clinical data of 117 liver cirrhosis patients with EGVB that accepted emergency bedside endoscopic treatment in ICU of our hospital from Jun.2016 to Jun.2021.According to the presence or absence of active bleeding within 72 hours after emergency endoscopic treatment,the patients were divided into the successful hemostasis group(n=85),the failed hemostasis group(n=32).And the successful hemostasis group were further subgrouped into the early rebleeding group(n=18)and non-rebleeding group(n=67).A univariate analysis was performed to find the differential factors between the two groups.Then the independent risk factors of the failed emergency endoscopic hemostasis group and early rebleeding group were compared by multivariate analysis of Logistic regression.And the factors of 6-week mortality were analyzed.Results The failure rate of emergency endoscopic hemostasis was 27.35%(32/117)in 117 patients with EGVB.Multivariate analysis showed that endotracheal intubation,shock,hepatic encephalopathyⅢ~Ⅳstage and elevated WBC were independent risk factors of emergency endoscopic treatment failure.In the successful hemostasis group,the early rebleeding rate was 21.18%(18/85),multivariate analysis showed that Child-Pugh score was an independent risk factor of early rebleeding after emergency endoscopic treatment in ICU.The cumulative 6-week mortality was 42.74%(50/117),the high Child-Pugh score,endotracheal intubation and liver function failure were the risk factors for death within 6 weeks.Conclusion Bedside emergency endoscopy is an effective hemostatic measure for patients with EGVB in ICU.Endotracheal intubation,shock,hepatic encephalopathy,and elevated WBC are independent risk factors for hemostatic failure of emergency endoscopy.The Child-Pugh score is an important predictor of early rebleeding after endoscopic treatment.Endotracheal intubation,shock,and high Child-Pugh score suggest a poor 6-weeks prognosis.