消化内镜治疗非静脉曲张性上消化道出血后再出血危险因素分析 ??

彭敦煌

【摘要】 目的：分析消化内镜治疗非静脉曲张性上消化道出血后再出血的危险因素。方法：以2017年9月-2018年9月在笔者所在医院采用消化内镜治疗后发生再出血的37例非静脉曲张性上消化道出血患者作为观察组，以治疗后未见再出血的37例患者作为对照组，两组均采用消化内镜治疗，调取临床资料，从患者实验室指标、病因、入院时病情等多方面出发，对比两组差异，分析再出血的危险因素。结果：观察组血红蛋白、血小板计数均低于对照组，凝血酶原时间、血尿素氮均高于对照组，差异均有统计学意义（P<0.05），两组纤维蛋白原比较差异无统计学意义（P>0.05）。观察组入院时休克患者占比高于对照组，入院时出血时间长于对照组，差异均有统计学意义（P<0.05），两组消化性溃疡、恶性肿瘤、胃十二指肠糜烂、血管畸形患者占比差异无统计学意义（P>0.05）。结论：消化内镜治疗非静脉曲张性上消化道出血期间，入院时出血时间过长、休克、血红蛋白等实验室指标异常为诱发术后再出血的主要原因。需从上述角度出发，对再出血进行预防。

【关键词】 消化内镜 非静脉曲张性上消化道出血 再出血 危险因素

[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.

非靜脉曲张性上消化道出血为临床的急危重症，多由消化性溃疡、胃十二指肠糜烂、恶性肿瘤等因素所导致，患者死亡率介于3.5%～10%[1]。流行病学研究结果显示，与女性相比，男性发生该疾病的风险更高[2]。发病后，将消化内镜应用到疾病的治疗过程中，可有效止血。但临床研究发现，采用消化内镜治疗后，部分患者可见再出血[3]。为改善患者的预后，从笔者所在医院2017年9月-2018年9月收治的非静脉曲张性上消化道出血患者中，随机选取37例再出血患者作为样本，分析了再出血的危险因素，现报告如下。