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急性上消化道出血的内镜检查时机
Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding


James Y.W. Lau ... 其他 • 2020.04.02
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急性上消化道出血,是否应紧急内镜检查

 

李嘉†,张文辉‡,祁小龙§*

天津市第二人民医院肝病科;‡解放军总医院第五医学中心肝硬化诊疗一中心;§兰州大学第一医院门静脉高压研究所(中心)*

*通讯作者

 

急性上消化道出血是消化科常见的危急重症,具有潜在的致死风险,其中以消化性溃疡最为常见1。内镜检查不仅能够明确出血的原因和部位,还可以进行相应的止血治疗,从而减少再出血及降低死亡率2。国际上消化道出血共识小组建议:在出血就诊后24小时内应尽快行内镜检查3。针对急性静脉曲张出血,中华医学会肝病学分会、中华医学会消化病学分会、中华学会消化内镜学分会联合发表指南建议:应在食管胃静脉曲张出血12~24小时内行胃镜检查4

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摘要


背景

目前建议急性上消化道出血患者在消化科会诊后24小时内接受内镜检查。但在24小时之前的更短时间范围内进行内镜检查的作用尚未明确。

 

方法

为了评价紧急内镜检查可否改善进一步出血或死亡风险高的患者的结局,我们将有急性上消化道出血的明显表现并且Glasgow-Blatchford评分≥12分(评分范围为0~23分,评分较高表示进一步出血或死亡的风险较高)的患者随机分组,分别在消化科会诊后6小时内(紧急内镜检查组)或6~24小时(早期内镜检查组)接受内镜检查。主要终点是随机分组后30日内的全因死亡。

 

结果

共计516例患者被纳入试验。紧急内镜检查组和早期内镜检查组的30日死亡率分别为8.9%(23/258例患者)和6.6%(17/258)(差异,2.3个百分点;95%置信区间[CI],-2.3~6.9)。紧急内镜检查组28例患者(10.9%)和早期内镜检查组20例患者(7.8%)在30日内发生了进一步出血(差异,3.1个百分点;95% CI,-1.9~8.1)。在紧急内镜检查组158例患者中的105例(66.4%)和早期内镜检查组159例患者中的76例(47.8%)中,初次内镜检查发现了有活动性出血或可见血管的溃疡。我们在初次内镜检查时对紧急内镜检查组155例患者(60.1%)和早期内镜检查组125例患者(48.4%)进行了内镜下止血治疗。

 

结论

在进一步出血或死亡风险高的急性上消化道出血患者中,消化科会诊后6小时内进行内镜检查的30日死亡率并未低于消化科会诊后6~24小时进行内镜检查(由中国香港特别行政区食物及卫生局的医疗卫生研究基金[Health and Medical Fund]资助,在ClinicalTrials.gov注册号为NCT01675856)。





作者信息

James Y.W. Lau, M.D., Yuanyuan Yu, Ph.D., Raymond S.Y. Tang, M.D., Heyson C.H. Chan, M.B., Ch.B., Hon-Chi Yip, M.B., Ch.B., Shannon M. Chan, M.B., Ch.B., Sally W.Y. Luk, M.B., Ch.B., Sunny H. Wong, Ph.D., Louis H.S. Lau, M.B., Ch.B., Rashid N. Lui, M.B., Ch.B., Ting T. Chan, M.B., Ch.B., Joyce W.Y. Mak, M.B., Ch.B., Francis K.L. Chan, M.D., and Joseph J.Y. Sung, M.D.
From the Institute of Digestive Disease, the Chinese University of Hong Kong, Shatin, Hong Kong. Address reprint requests to Dr. Lau at the Department of Surgery, Rm. 64026, Lui Chee Woo Clinical Science Bldg., Prince of Wales Hospital, 32 Ngan Shing St., Shatin, Hong Kong, or at laujyw@surgery.cuhk.edu.hk.

 

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