急诊胃镜下止血导致吸入性肺炎的相关危险因素分析

Risk factors and prognosis of aspiration pneumonia after emergency endoscopic hemostasis

目的 虽然所有的内窥镜手术都有吸入性肺炎的风险,但医生对内镜操作后发生吸入性肺炎的因素知之甚少。本研究旨在确定急诊内窥镜止血后吸入性肺炎的危险因素。方法 对2018年1月至2020年1月本院急诊上消化道出血经内窥镜治疗的患者214人进行回顾性分析,病人的资料及临床特点,包括上消化道出血的原因,内镜止血时间,生命体征以及术后是否发生吸入性肺炎等。采用单因素和多因素logistic回归分析对患者合并吸入性肺炎的相关危险因素进行筛查,并进一步分析患者预后情况。结果 在214例急诊经内镜止血的患者中30例(14%)发生了吸入性肺炎。多因素分析显示年龄大于75岁(优势比(OR)5.99;95%置信区间(CI)1.7-13.8;P=0.017),内镜操作持续时间大于30分钟(OR为3.73;95%CI 1.4-18.1;P=0.027),既往有脑血管病史(OR为4.8;95%CI 1.6-14.7;P=0.02)是独立的危险因素导致吸入性肺炎。结论 急诊经内镜下止血后患吸入性肺炎的发生与患者高龄,既往有脑中风、帕金森等脑血管病史,内镜操作时间长密切相关,在治疗这些患者时,应制定相应的预防措施以降低吸入性肺炎发生率和改善预后。

Objective Although all endoscopic procedures carry the risk of aspiration pneumonia,little is known about the factors that lead to aspiration pneumonia after emergency endoscopic procedures.The aim of this study was to determine the risk factors for aspiration pneumonia after emergency endoscopic hemostasis.Methods From January 2018 to January 2020,214 patients with upper gastrointestinal bleeding treated by emergency endoscopy in our hospital were retrospectively analyzed.The data and clinical characteristics of the patients were analyzed,including the cause of upper gastrointestinal bleeding,endoscopic hemostasis time,vital signs and postoperative aspiration pneumonia.Univariate and multivariate logistic regression analysis were used to screen the related risk factors of aspiration pneumonia,and the prognosis of patients was further analyzed.Results 30(14%)developed aspiration pneumonia in 214 patients who underwent endoscopic hemostasis,Multivariate analysis showed that age over 75 years(odds ratio(OR)5.99;95%confidence interval(CI)1.7 to13.8;P=0.017),the duration of endoscopic procedure was more than 30 minutes(OR 3.73;95%CI,1.4 to 1812;P=0.027),previous history of cerebrovascular disease(or 4.8;95%CI,1.6 to 14.7;P=0.02)were independent risk factors for aspiration pneumonia.Conclusion The occurrence of aspiration pneumonia after emergency endoscopic hemostasis is closely related to the patient s advanced age,previous cerebrovascular history such as cerebral stroke and Parkinson s disease,and long endoscopic operation time.In the treatment of these patients,corresponding preventive measures should be formulated to reduce the incidence of aspiration pneumonia and improve the prognosis.