金立强 陈丽玲 陈梅香

【摘要】 目的：探讨不同时间内镜治疗老年急性上消化道出血对患者临床结局的影响。方法：选取晋江市医院2021年5月—2023年5月收治的100例急性上消化道出血患者为对象，根据不同治疗方式进行分组，其中在发病12 h内采取内镜治疗为观察组，在发病12～24 h采取内镜治疗为参照组，各50例。对比两组围手术期相关指标、生化指标及临床治疗结局。结果：观察组输血量少于参照组，手术时间、呕血或黑便停止时间、术后进食时间及住院时间均短于参照组（P<0.05）。治疗后，观察组血小板、血红蛋白及血清白蛋白指标均高于参照组（P<0.05）。两组再出血、转入重症监护病房、术后30 d复发及死亡发生率比较，差异均无统计学意义（P>0.05）。结论：与发病12～24 h采取内镜治疗相比，对老年急性上消化道出血在发病12 h内进行内镜治疗可取得更为理想的干预及止血效果，积极缩短相关治疗时间。

【关键词】 急性上消化道出血 不同时机 内镜治疗 临床结局

The Impact of Endoscopic Treatment at Different Times on the Clinical Outcomes of Elderly Patients with Acute Upper Gastrointestinal Hemorrhage/JIN Liqiang， CHEN Liling， CHEN Meixiang. //Medical Innovation of China， 2024， 21（15）： 0-101

[Abstract] Objective： To explore the impact of endoscopic treatment at different times on the clinical outcomes of elderly patients with acute upper gastrointestinal hemorrhage. Method： A total of 100 patients with acute upper gastrointestinal hemorrhage admitted to Jinjiang Hospital from May 2021 to May 2023 were selected as the subjects， and they were divided into groups according to different treatment methods， endoscopic treatment within 12 h of onset was used as the observation group， and endoscopic treatment within 12 to 24 h of onset was used as the reference group， with 50 cases in each group. The perioperative related indexes， biochemical indexes and clinical outcomes were compared between the two groups. Result： The blood transfusion volume in the observation group was less than that in the control group， and the surgical time， time to stop vomiting blood or black stool， postoperative eating time and hospital stay were shorter than those in the control group （P<0.05）. After treatment， the platelet， hemoglobin and serum albumin indicators of the observation group were higher than those of the control group （P<0.05）. There were no significant differences in the incidences of rebleeding， transfer to intensive care unit， recurrence and death 30 days after surgery between two groups （P>0.05）. Conclusion： Compared with endoscopic treatment within 12 to 24 hours of onset， endoscopic treatment for acute upper gastrointestinal hemorrhage in the elderly within 12 hours of onset can achieve more ideal intervention and hemostasis effects， actively shorten the relevant treatment time.

[Key words] Acute upper gastrointestinal hemorrhage Different time Endoscopic therapy Clinical outcomes

First-author's address： Digestive Department， Jinjiang Hospital， Jinjiang 362200， China

doi：10.3969/j.issn.1674-4985.2024.15.023

急性上消化道出血是临床常见的一种急危重症，主要因屈氏韧带以上胃部、食管、十二指肠、胰管等病变引起的急性出血，具有病情严重、发病急、进展快等特点，若干预、救治不及时，可因失血过多而迅速死亡，严重危及患者生命健康安全[1]。同时，在临床诊治过程中、治疗方式、治疗时机选择的不当，不仅会给患者带来巨大损失，严重情况还可影响临床救治效率，导致患者出现死亡情况[2-3]。因而，及早找出出血原因、部位，再有针对性地采取相应的止血措施，对于临床救治患者具有十分重要的意义。目前，临床对于该病治疗多实施药物或是内镜治疗，其中实施药物治疗，虽能在一定程度上缓解患者出血等症状，但难以做到完全或是彻底止血等，治疗后极其容易再次出血；……