急性非静脉曲张性上消化道出血的急诊胃镜检查时机

Timing of Emergency Gastroscopy for Acute Nonvariceal Upper Gastrointestinal Bleeding

背景:急性非静脉曲张性上消化道出血是一种常见的消化科急症,既往指南推荐在24 h内行急诊胃镜检查。目的:探讨紧急胃镜检查(胃镜检查时机<12 h)是否为急性非静脉曲张性上消化道出血更佳的检查时机。方法:纳入2012年12月—2021年4月上海交通大学医学院附属仁济医院收治的急性非静脉曲张性上消化道出血患者750例。按胃镜检查时机分为紧急组(胃镜检查时机<12 h)和非紧急组(胃镜检查时机≥12 h)。低危(GBS评分<12分)和高危(GBS评分≥12分)患者又进一步分为紧急亚组和非紧急亚组。比较两组间性别、年龄、GBS评分、住院时间、住院费用、内镜下止血率、再出血率、输血率、输血量、急诊DSA率、急诊手术率、死亡率。结果:紧急组的年龄、GBS评分、住院时间明显低于非紧急组(P<0.05),内镜下止血率明显升高(P<0.05),而两组的性别、住院费用、再出血率、输血率、输血量、急诊DSA率、急诊手术率、死亡率相比差异无统计学意义(P>0.05)。在低危患者中,紧急亚组与非紧急亚组之间基线资料相比差异均无统计学意义(P>0.05)。在高危患者中,紧急亚组的年龄明显低于非紧急亚组(P<0.05),而两组其余指标相比差异均无统计学意义(P>0.05)。结论:紧急胃镜检查(检查时机<12 h)并没有使患者获益,并不是急性非静脉曲张性上消化道出血患者更佳的急诊胃镜检查时机。

Background:Acute nonvariceal upper gastrointestinal bleeding is a frequent emergency of Department of Gastroenterology.Guidelines recommend that gastroscopy should be performed within 24 hours.Aims:To assess whether urgent gastroscopy(<12 hours)is optimal timing for acute nonvariceal upper gastrointestinal bleeding.Methods:A total of 750 patients with acute nonvariceal upper gastrointestinal bleeding from December 2012 to April 2021 at Renji Hospital,School of Medicine,Shanghai Jiao Tong University were enrolled.Patients were divided into urgent group(<12 hours)and non⁃urgent group(≥12 hours)according to the timing of gastroscopy.Low⁃risk(GBS<12)and high⁃risk(GBS≥12)patients were further divided into urgent subgroup and non⁃urgent subgroup.Gender,age,GBS,hospital stay,hospitalization expense,endoscopic hemostatic rate,rebleeding rate,blood transfusion rate,blood transfusion volume,emergency DSA rate,emergency surgery rate,death were compared between the two groups.Results:Compared with non⁃urgent group,age,GBS,hospital stay were significantly decreased in urgent group(P<0.05),while endoscopic hemostatic rate were significantly increased(P<0.05).No significant differences in gender,hospitalization expense,rebleeding rate,blood transfusion rate,blood transfusion volume,emergency DSA rate,emergency surgery rate,death were found between the two groups(P>0.05).For low⁃risk patients,no significant differences in above⁃mentioned basic data were found between urgent subgroup and non⁃urgent subgroup(P>0.05).For high⁃risk patients,age in urgent subgroup was significantly lower than that in non⁃urgent subgroup(P<0.05),and no significant differences in the other above⁃mentioned basic data were found between the two subgroups(P>0.05).Conclusions:Urgent gastroscopy(<12 hours)does not improve clinical outcomes,which is not the optimal timing for acute nonvariceal upper gastrointestinal bleeding.