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目的:探讨急诊胃镜在上消化道出血诊治中的价值。方法:回顾性分析2009年1月至2011年12月因上消化道出血在中山大学附属第一医院急诊科就诊的502例患者的临床资料,根据检查的时间段分为急诊胃镜组和延迟胃镜组,其中溃疡性上消化道出血患者420例(急诊胃镜组299例,延迟胃镜组121例),静脉曲张性上消化道出血患者82例(急诊胃镜组49例,延迟胃镜组33例),比较分析两组患者的住院日、输血量、主要止血药物使用情况、是否进行外科止血和出院存活情况。结果:溃疡性上消化道出血和静脉曲张性上消化道出血的两组患者生长抑素使用率和输血量比较差异有统计学意义,P<0.05;急诊胃镜可降低溃疡性消化道出血患者外科手术治疗的风险(8/299:13/121,P=0.001)和缩短溃疡性消化道出血患者的住院天数[急诊胃镜组8(1,64)d,延迟胃镜组11(1,102)d,P=0.015];降低死亡率(溃疡性出血:2/299:9/121,P=0.001;静脉曲张性出血:1/49:4/33,P=0.023)。生存分析表明急诊胃镜提高上消化道出血患者30 d的生存率,x~2=17.840,P<0.001。结论:急诊胃镜治疗可显著减少上消化道出血患者长抑素类药物的使用,减少输血量,降低溃疡性出血患者外科手术治疗的风险和缩短住院天数,提高上消化道出血患者的总体生存率。
Objective: To explore the value of emergency endoscopy in the diagnosis and treatment of upper gastrointestinal bleeding. Methods: The clinical data of 502 patients who were treated in the emergency department of the First Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2011 were analyzed retrospectively. They were divided into emergency gastroscope group and delayed gastroscope Group (420 patients with ulcerative upper gastrointestinal bleeding (299 patients in emergency gastroscopy group and 121 patients in delayed gastroscope group, 82 patients in varicose upper gastrointestinal bleeding group (49 patients in emergency gastroscopy group and 33 patients in delayed gastroscopy group, The days of hospitalization, blood transfusion, the use of the main hemostatic drugs and the surgical bleeding and discharge were compared between the two groups. Results: There was a significant difference in the somatostatin use rate and blood transfusion between the two groups of patients with ulcerative upper gastrointestinal bleeding and varicose upper gastrointestinal bleeding, P <0.05; emergency endoscopy can reduce the incidence of ulcer gastrointestinal bleeding in patients with surgery Surgical treatment risk (8/299: 13/121, P = 0.001), and shorter hospital stay for patients with ulcerative gastrointestinal bleeding (emergency gastroscopy group 8 (1,64) d, delayed gastroscope group 11 (1,102) d, P = 0.015]; mortality reduction (ulcer bleeding: 2/299: 9/121, P = 0.001; variceal bleeding: 1/49: 4/33, P = 0.023). Survival analysis showed that emergency endoscopy increased the 30-day survival rate of patients with upper gastrointestinal bleeding, x ~ 2 = 17.840, P <0.001. Conclusions: Emergency endoscopy can significantly reduce the use of somatostatin in patients with upper gastrointestinal bleeding, reduce blood transfusion, reduce the risk of surgical treatment in patients with ulcer bleeding and shorten the length of stay, and improve the overall survival rate of patients with upper gastrointestinal bleeding .