经导管动脉栓塞治疗急性非曲张静脉上消化道出血的疗效分析

  目的  评估经导管动脉栓塞（transcatheter arterial embolization, TAE）治疗急性非曲张静脉上消化道出血（acute non-variceal upper gastrointestinal bleeding, ANVUGIB）的安全性和有效性。  方法  回顾性纳入266例2016年3月–2021年3月期间因ANVUGIB行血管造影的患者，统计血管造影阳性率、TAE技术成功率和临床成功率，TAE治疗后30 d内再出血率及全因死亡率，分析与上述事件相关的影响因素。  结果  266例患者均完成血管造影，血管造影阳性率为54.1%（144/266），TAE技术成功率为97.3%（217/223），TAE临床成功率为73.1%（155/212），TAE治疗后30 d内再出血率及全因死亡率分别为26.9%（57/212）、16.1%（35/217）。本研究发现休克指数>1〔比值比（OR）=5.950，95%置信区间（CI）:1.481～23.895，P=0.012〕、CT血管造影（CTA）阳性（OR=6.813，95%CI:1.643～28.252，P=0.008）及间隔时间<24 h （OR=10.530，95%CI:2.845～38.976，P<0.001）是血管造影阳性的独立预测因子；休克指数>1（OR=2.544，95%CI:1.301～4.972，P=0.006）及国际标准化比值>1.5（OR=3.207，95%CI:1.381～7.451，P=0.007）是TAE治疗后30 d内再出血的独立危险因素；术后出血（OR=3.174，95%CI:1.164-8.654，P=0.024）及栓塞后再出血（OR=34.665，95%CI:11.471～104.758，P<0.001）患者TAE治疗后30 d内的死亡风险更高。  结论  TAE治疗ANVUGIB安全有效。休克指数>1和CTA阳性的患者更有可能血管造影阳性，且应该在出血后早期完成血管造影。栓塞后再出血仍需要高度重视。

Efficacy Analysis of Transcatheter Arterial Embolization in Acute Non-Variceal Upper Gastrointestinal Bleeding

  Objective  To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB), and to guide clinical practice and continue to optimize diagnosis and treatment strategies.  Methods  This retrospective study included 266 patients who underwent angiography due to ANVUGIB between March 2016 and March 2021. Data on the positive rate of angiography, the technical success rate and clinical success rate of TAE, and the rebleeding rate and the all-cause mortality within 30 days after TAE treatment were collected, and the influencing factors relevant to the above events were analyzed accordingly.  Results  All 266 patients completed angiography--the positive rate of angiography was 54.1% (144/266), the total technical success rate was 97.3% (217/223), the clinical success rate was 73.1% (155/212), and the rebleeding rate and all-cause mortality within 30 days were 26.9% (57/212) and 16.1% (35/217), respectively. This study found that shock index>1 (OR=5.950; 95% CI: 1.481-23.895; P=0.012), computed tomography angiography (CTA) positive result (OR=6.813; 95% CI: 1.643-28.252; P=0.008) and interval<24 h (OR=10.530; 95% CI: 2.845-38.976; P<0.001) were independent predictors of positive angiography. Shock index>1 (OR=2.544; 95% CI: 1.301-4.972; P=0.006) and INR>1.5 (OR=3.207; 95% CI: 1.381-7.451; P=0.007) were independent risk factors for rebleeding. Patients with postoperative bleeding (OR=3.174; 95% CI: 1.164-8.654; P=0.024) and patients with rebleeding after embolization (OR=34.665; 95% CI: 11.471-104.758; P<0.001) had a higher risk of death within 30 days.  Conclusion  TAE is safe and effective in the treatment of ANVUGIB. Patients with shock index>1 and positive CTA are more likely to be angiographic positive, and should undergo angiography as early as possible after bleeding. In addition, rebleeding after embolization deserves high attention.