| 摘要: |
| 目的：探讨急性食管胃静脉曲张破裂出血在床旁与运送至手术室进行急诊内镜止血的应用价值。方法：选择本地区近2年肝硬化合并食管胃静脉曲张破裂出血行急诊内镜止血治疗患者作为研究对象，术前均进行充分综合评估生命体征，进行液体复苏，腹部增强CT检查，必要时输红细胞纠正贫血治疗。在床旁进行内镜治疗纳入A组，运送至手术室进行内镜治疗纳入B组。A组患者由急诊科医师在气管插管麻醉后内镜操作，B组患者由麻醉科医师在气管插管再进行内镜操作。比较2组患者术前风险、麻醉时间、操作时间、止血成功率、术后拔管时间、吸入性肺炎、住院时间、住院费用、死亡率、再出血率等指标。结果：A、B组两组患者在术中止血时间统计学差异（P<0.01），术后早期再出血、迟发性再出血未见统计学差异（P>0.05），术后6周死亡率未见统计学差异（P>0.05）；两组术后住院时间、费用存在统计学差异（P<0.01），吸入性肺炎存在统计学差异（P<0.05）,术后4周检查肝功能、肾功能、D-二聚体、凝血酶原活动度未见统计学差异（P>0.05），术后；术后均未出现严重异位栓塞病例。结论：对于急性食管胃静脉曲张破裂出血，进行气管插管在床旁与运送至手术室进行急诊内镜止血均可以达到非常好的效果。对于出血量大、休克患者在床旁治疗可以减少吸入性肺炎、窒息事件的发生，明显缩短住院时间、降低住院费用。 |
| 关键词: 管胃静脉曲张破裂出血 急诊内镜 不同场地 急诊止血 |
| DOI： |
| 分类号: |
| 基金项目:2021年度公益类金华市科学技术研究计划项目（2021-4-022）腹部影像学在门脉高压性出血患者急诊胃镜处理临床应用的研究 |
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| Efficacy of emergency endoscopic hemostasis in different venues for acute esophagogastric variceal bleeding |
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weiwei1, HONG YUPING2, TAO MAOGEN3,4,5, CHEN CHONG6, Cai Jianting6
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1.The Second Affiliated Hospital of Zhejiang University school of medicine;2.Jinhua Hospital Affiliated to Zhejiang University School of Medicine;3.Lanxi City People'4.'5.s Hospital;6.the Second Affiliated Hospital Zhejiang University School of Medicine
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| Abstract: |
| Objective: To investigate the application value of emergency endoscopic hemostasis in patients with esophagogastric variceal bleeding at bedside or transported to the operating room. Methods: Patients with cirrhosis complicated with esophagogastric variceal bleeding in recent 2 years who were treated by emergency endoscopic hemostasis were selected as the study subjects. Before surgery, comprehensive assessment of vital signs, fluid resuscitation, abdominal enhanced CT examination, and red blood cell transfusion to correct anemia were performed. Endoscopic treatment at the bedside was included in group A, and transport to the operating room for endoscopic treatment was included in group B. Patients in group A were endoscopically intubated and anesthesia performed by emergency department physicians, and patients in group B were endoscopically intubated and anesthesia performed by anesthesiologists after intravenous anesthesia. Preoperative risk, anesthesia time, operation time, hemostatic success rate, postoperative extubation time, aspiration pneumonia, hospital stay, hospital cost, mortality, rebleeding rate and other indicators were compared between the two groups. Results: The time of intraoperative hemostasis between group A and group B was statistically different (P<0.01). There was no significant difference in early postoperative rebleeding and delayed rebleeding (P>0.05). There was no significant difference in mortality at 6 weeks after surgery (P>0.05). There were statistical differences in hospital stay and cost between the two groups (P<0.01), and there were statistical differences in aspiration pneumonia (P<0.05). There were no statistical differences in liver function, kidney function, D-dimer and prothrombin time activity 4 weeks after surgery (P>0.05). No severe ectopic embolism occurred after operation. Conclusion: Patients with esophagogastric variceal bleeding, emergency endoscopic hemostasis after endotracheal intubation at the bedside or transport to the operating room can achieve very good results. Patients with heavy bleeding and shock, bedside treatment can reduce the incidence of aspiration pneumonia and asphyxia, significantly shorten the length of hospitalization and reduce hospitalization costs. |
| Key words: esophagogastric variceal bleeding emergency endoscopy different venues emergency hemostasis |