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

摘要

目的：探讨消化内镜治疗上消化道出血后再出血危险因素。方法：选取本院收治的300例经消化内镜治疗止血成功的上消化道出血患者作为研究对象，根据患者的再出血情况，分为A组（再出血，n=76）和B组（未出血，n=224），对两组患者临床资料进行对比分析。结果：两组在上消化道出血史、性别、年龄、血小板、血红蛋白、血尿素氮方面比较差异均无统计学意义（P>0.05）；A组在单一内镜治疗、入院时休克、HGB<90 g/L、Ⅰa级出血、支持治疗缺乏、后续PPIs缺乏、恶性肿瘤出血方面，与B组比较差异均有统计学意义（P<0.05）；单一内镜治疗、HGB<90 g/L、Ⅰa级出血、支持治疗缺乏、后续PPIs缺乏、恶性肿瘤出血均是上消化道出血止血后再出血的危险因素（P<0.05）。结论：消化内镜治疗上消化道出血后再出血的危险因素包括支持治疗不足、喷射样出血、血色素水平低、缺少后续PPIs、恶性肿瘤出血，临床上应当密切观察、加强防护，早期实施手术治疗，以免病情加重。%Objective:To investigate the risk factors of digestive endoscopy in the treatment of rebleeding of upper gastrointestinal tract hemorrhage.Method:300 patients with upper gastrointestinal hemorrhage who were stopped bleeding successfully by digestive endoscopy treatment in our hospital were selected as research objects,according to the rebleeding of patients,they were randomly divided into the group A(rebleeding group)for 76 cases and the group B(non bleeding group) for 224 cases,the clinical data of the two groups were compared and analyzed.Result: There were no significant differences in the history of upper gastrointestinal bleeding,gender,age,platelet,hemoglobin,blood urea nitrogen between the two groups(P>0.05).Single endoscopic therapy,shock on admission,HGB<90 g/L,class Ia hemorrhage, the lack of support treatment,follow-up PPIs deficiency,malignant tumor hemorrhage in the group A were significantly better than those in the group B,the differences were statistically significant(P<0.05). Single endoscopic therapy, shock on admission,HGB<90 g/L,class Ia hemorrhage,the lack of support treatment,follow-up PPIs deficiency, malignant tumor hemorrhage were the risk factors of hemorrhage of upper gastrointestinal tract bleeding after bleeding (P<0.05).Conclusion:The risk factors of digestive endoscopy in the treatment of rebleeding of upper gastrointestinal tract hemorrhage include inadequate support treatment,jet-like bleeding,low level of hemoglobin,the lack of follow-up PPIs,malignant tumor hemorrhage.In clinical practice we should be closely observed,strengthen protection,implement operation treatment in the early,in order to avoid aggravation condition.