上消化道出血：关于内镜检查作用及结局的单中心回顾性研究
Upper Gastrointestinal Bleeding: A Retrospective, Single-Center Experience on the Role of Endoscopy and Outcomes.
作者信息
Someili Ali M, Mobarki Sarah Jaber, Moafa Razan Hamoud, Alsury Leena Nageeb, Shadad Roaa Hassan, Fathi Shroog Mohammed, Hamrani Amnah Hussain, Darisi Afnan Mohammed, Mohamed Amal H, Alqassmi Sameer, Mohrag Mostafa, Abdulrasak Mohammed
机构信息
Department of Internal Medicine, Faculty of Medicine, Jazan University, Saudi Arabia.
Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
出版信息
J Clin Med Res. 2025 Jan;17(1):22-34. doi: 10.14740/jocmr6134. Epub 2025 Jan 14.
BACKGROUND
Upper gastrointestinal bleeding (UGIB) is a common and potentially fatal medical emergency. This study aimed to investigate the frequency, causes, outcomes, and efficacy of endoscopy in the treatment of UGIB at King Fahad Central Hospital in Jazan, Saudi Arabia.
METHODS
Between January 2017 and December 2023, a retrospective study was performed including all hospitalized patients with UGIB. This research investigated sociodemographic characteristics, clinical history, endoscopic findings, treatment options, and results using statistical analysis, which included both descriptive and inferential approaches.
RESULTS
The study included 483 patients (of which 74.1% men), with a mean age of 53.9 ± 19.5 years. Hematemesis was observed in 67.5% of the patients, whereas melena occurred in 49.7% of the cases. Two-hundred sixty-two (54.2%) patients underwent endoscopy within the first 24 h from presentation. The most frequent endoscopic findings were esophageal varices (52.2%) and duodenal ulcers (21.7%). Bandings accounted for 48.0% of all endoscopic procedures, whereas 36.9% of the patients received epinephrine injections along with endoclips. Medical therapy mostly consisted of a mix of proton pump inhibitors (PPIs) and octreotide. A significant minority (43.5%) of the patients stayed in the hospital for 1 - 3 days, while 59.6% did not need blood transfusions. During the first 3 days, 7% of patients experienced rebleeding, with a 6% mortality rate. Using multivariate regression analysis, rebleeding was strongly associated with initial presentation with shock (P < 0.001), renal disease (P = 0.01), and increased transfusion requirement (P = 0.001). Mortality was strongly associated with steroid usage (P = 0.007), increasing transfusion requirements (P < 0.0001), and rebleeding (P = 0.002).
CONCLUSIONS
Timely endoscopy and proper treatment dramatically improved UGIB results. Identifying those who are at high risk and acting swiftly is a critical step in reducing the likelihood of recurrent bleeding and fatality.
背景
上消化道出血（UGIB）是一种常见且可能致命的医疗急症。本研究旨在调查沙特阿拉伯吉赞法赫德国王中央医院UGIB的发病频率、病因、治疗结果以及内镜治疗的疗效。
方法
2017年1月至2023年12月期间，开展了一项回顾性研究，纳入所有因UGIB住院的患者。本研究采用包括描述性和推断性方法在内的统计分析，调查了社会人口统计学特征、临床病史、内镜检查结果、治疗方案及治疗结果。
结果
该研究纳入483例患者（其中男性占74.1%），平均年龄为53.9±19.5岁。67.5%的患者出现呕血，而49.7%的患者出现黑便。262例（54.2%）患者在就诊后的最初24小时内接受了内镜检查。最常见的内镜检查结果为食管静脉曲张（52.2%）和十二指肠溃疡（21.7%）。套扎术占所有内镜手术的48.0%，而36.9%的患者在接受内镜夹治疗的同时接受了肾上腺素注射。药物治疗主要包括质子泵抑制剂（PPI）和奥曲肽的联合使用。少数患者（43.5%）住院1 - 3天，而59.6%的患者无需输血。在最初3天内，7%的患者再次出血，死亡率为6%。采用多因素回归分析，再次出血与初次就诊时出现休克（P<0.001）、肾病（P = 0.01）及输血需求增加（P = 0.001）密切相关。死亡率与使用类固醇（P = 0.007）、输血需求增加（P<0.0001）及再次出血（P = 0.002）密切相关。
结论
及时进行内镜检查和恰当治疗可显著改善UGIB的治疗结果。识别高危患者并迅速采取行动是降低再次出血和死亡可能性的关键步骤。
Zotero 插件