内镜治疗非静脉曲张性上消化道出血失败的影响因素

目的探讨内镜治疗急性非静脉曲张性上消化道出血失败的影响因素。方法将通江县人民医院以及西南医院收治的719例上消化道出血患者按照手术最终成败情况分为成功组和失败组,统计各组相关危险因素资料,并对相关危险因素进行分析。结果组间比较表明两组患者在年龄、既往消化道出血史、内镜下喷射样出血、胃十二指肠溃疡、出血直径、休克、乙酰水杨酸、血细胞比容、血红蛋白水平、血小板计数方面的差异有统计学意义(P<0.05)。多因素回归分析表明出血部位、既往出血史、伴随疾病严重程度、血小板数量>10×109/L、休克以及喷射性出血是引起内镜止血失败的独立危险因素。结论出血部位在胃小弯侧壁及十二指肠球部后壁、既往出血史、伴随严重疾病、血小板数量≤10×109/L、休克、喷射性出血的急性非静脉曲张性上消化道出血患者内镜治疗失败的风险较大。

Analysis on the Risk Factors of Treatment for Nonvariceal Upper Gastrointestinal Bleeding under Endoscope

Objective To investigate the risk factors of the treatment for acute non-variceal upper gastrointestinal bleeding under endoscope.Methods 719 patients with upper gastrointestinal hemorrhage from Tongjiang County People′s Hospital and Southwest were collected and then divided into success group and failure group according to the final surgery result.The relevant risk factors were summarized and analyzed.Results The comparison analysis showed that between the two groups there were significant differences in age,gender,previous history of gastrointestinal bleeding,treatment time,jet bleeding under endoscope,gastro duodenal ulcer,diameter of bleeding site,shock,acetylsalicylic acid,hematocrit,hemoglobin level,platelet count(P<0.05).Multivariate logistic regression analysis showed that the bleeding site,history of bleeding,accompanied disease severity,platelet count>10×109/L,shock and jet bleeding were independent risk factors leading to endoscopic homeostasis failure.Conclusion Acute non-variceal upper gastrointestinal hemorrhage patients with bleeding site in the sidewall of lesser curvature of the stomach or the posterior wall of duodenal,previous history of bleeding,accompanied by serious illness,platelet count≤10×109/L,shock,jet bleeding have a higher risk of failure.