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[目的]探究急性非静脉性上消化道出血内镜下治疗失败的危险因素及预防对策。方法选取我院自2013年6月~2015年6月收治的100例急性非静脉性上消化道出血并接受内镜治疗的患者,其中首次内镜治疗成功的为对照组,首次内镜治疗失败的为观察组,每组各50例患者。分别对两组患者的一般情况、临床情况、实验室检查、内镜下表现等进行单因素分析,寻找有差异的变量。将单因素分析中差异有统计学意义的指标作为自变量,以内镜成功与否为因变量,进行多因素Logistic回归分析,寻找内镜治疗失败的危险因素。[结果]经过单因素分析显示,两组在年龄、既往消化道出血史、输血情况、尿素氮、白蛋白、凝血酶原时间、出血直径大小、出血至止血时间这八项指标上差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄(OR=1.075,95%CI:1.008-1.146)、既往消化道出血史(OR=1.263,95%CI:1.373-1.884)、凝血酶原时间(OR=1.384,95%CI:1.382-2.013)、出血直径大小(OR=1.435,95%CI:1.011-1.157)、出血至止血时间(OR=1.326,95%CI:1.287-1.764)差异有统计学意义,是初次内镜下止血失败,需要介入、外科手术或死亡的危险因素。[结论]年龄,凝血酶原时间,既往消化道出血,出血直径大小,出血至止血时间为急性非静脉性上消化道出血内镜下治疗失败的危险因素,即在首次内镜治疗后,可能会有再出血,进一步治疗需要或死亡的危险。对于血尿素氮异常、白蛋白显著下降、有输血史的患者,需警惕再次出血的可能。
[Objective] To explore the risk factors of failure of endoscopic treatment of acute non-venous upper gastrointestinal bleeding and its preventive measures. Methods A total of 100 patients with acute non-venous upper gastrointestinal bleeding undergoing endoscopic treatment in our hospital from June 2013 to June 2015 were enrolled in this study. The first endoscopic treatment was successful in the control group, and the first endoscopic treatment failed For the observation group, each group of 50 patients. Respectively, the two groups of patients in general, clinical conditions, laboratory tests, endoscopic findings were univariate analysis to find different variables. Univariate analysis of the differences were statistically significant indicators as independent variables to endoscopic success or failure as a dependent variable, multivariate Logistic regression analysis to find the risk factors for failure of endoscopic treatment. [Results] After univariate analysis, there were statistically significant differences between the two groups in the eight indicators of age, previous history of gastrointestinal bleeding, blood transfusion, urea nitrogen, albumin, prothrombin time, bleeding diameter, bleeding to stop bleeding time Significance (P <0.05). Multivariate logistic regression analysis showed that age (OR = 1.075, 95% CI: 1.008-1.146), previous history of gastrointestinal bleeding (OR = 1.263, 95% CI: 1.373-1.884), prothrombin time (OR = 1.384, 95% CI: 1.382-2.013), the size of the hemorrhage (OR = 1.435, 95% CI: 1.011-1.157), the time from hemorrhage to hemostasis (OR = 1.326, 95% CI: 1.287-1.764) was statistically significant Initial endoscopic failure to stop bleeding requires intervention, surgery or death risk factors. [Conclusion] Age, prothrombin time, previous gastrointestinal bleeding, bleeding diameter, bleeding to stop bleeding time are the risk factors of failure of endoscopic treatment of acute non-venous upper gastrointestinal bleeding, that is, after the first endoscopic treatment, There will be rebleeding, further treatment of the risk of need or death. Abnormal blood urea nitrogen, albumin decreased significantly, history of blood transfusion in patients with the need to guard against the possibility of bleeding again.