消化內鏡治療非靜脈曲張性上消化道出血后再出血危險因素分析 ??

彭敦煌

【摘要】 目的：分析消化內鏡治療非靜脈曲張性上消化道出血后再出血的危險因素。方法：以2017年9月-2018年9月在筆者所在醫院采用消化內鏡治療后發生再出血的37例非靜脈曲張性上消化道出血患者作為觀察組，以治療后未見再出血的37例患者作為對照組，兩組均采用消化內鏡治療，調取臨床資料，從患者實驗室指標、病因、入院時病情等多方面出發，對比兩組差異，分析再出血的危險因素。結果：觀察組血紅蛋白、血小板計數均低于對照組，凝血酶原時間、血尿素氮均高于對照組，差異均有統計學意義（P<0.05），兩組纖維蛋白原比較差異無統計學意義（P>0.05）。觀察組入院時休克患者占比高于對照組，入院時出血時間長于對照組，差異均有統計學意義（P<0.05），兩組消化性潰瘍、惡性腫瘤、胃十二指腸糜爛、血管畸形患者占比差異無統計學意義（P>0.05）。結論：消化內鏡治療非靜脈曲張性上消化道出血期間，入院時出血時間過長、休克、血紅蛋白等實驗室指標異常為誘發術后再出血的主要原因。需從上述角度出發，對再出血進行預防。

【關鍵詞】 消化內鏡 非靜脈曲張性上消化道出血 再出血 危險因素

[Abstract] Objective： To analyse risk factors of recurrent bleeding after non-varicose upper gastrointestinal bleeding treated by digestive endoscopy. Method： From September 2017 to September 2018， 37 patients with non-varicose upper gastrointestinal bleeding after digestive endoscopy were used as the observation group and the patients without rebleeding as the control group. Both groups were treated with digestive endoscopy. The clinical data of the two groups were obtained. The similarities and differences between the two groups were compared from the laboratory indexes， etiology， condition at admission and other aspects， and the risk factors of rebleeding were analyzed. Result： The hemoglobin and platelet count in the observation group were lower than those in the control group， prothrombin time and blood urea nitrogen were significantly higher than those in the control group， the differences were statistically significant （P<0.05）， but there was no significant difference in Fibrinogen between the two groups （P>0.05）. The proportion of the patients with shock in the observation group was higher than that of the control group， and the bleeding time was longer than that of the control group， the differences were statistically significant （P<0.05）. There was no significant difference in the proportion of peptic ulcer， malignant tumor， gastroduodenal erosion and vascular malformation between the two groups （P>0.05）. Conclusion： During the treatment of non-varicose upper gastrointestinal bleeding by digestive endoscopy， the bleeding time at admission was too long， and the laboratory indexes such as shock and hemoglobin were abnormal， which were the main causes of postoperative rebleeding. From the above point of view， it is necessary to prevent rebleeding.

非靜脈曲張性上消化道出血為臨床的急危重癥，多由消化性潰瘍、胃十二指腸糜爛、惡性腫瘤等因素所導致，患者死亡率介于3.5%～10%[1]。流行病學研究結果顯示，與女性相比，男性發生該疾病的風險更高[2]。發病后，將消化內鏡應用到疾病的治療過程中，可有效止血。但臨床研究發現，采用消化內鏡治療后，部分患者可見再出血[3]。為改善患者的預后，從筆者所在醫院2017年9月-2018年9月收治的非靜脈曲張性上消化道出血患者中，隨機選取37例再出血患者作為樣本，分析了再出血的危險因素，現報告如下。