Chalasani Naga, Kahi Charles, Francois Fritz, Pinto Amar, Marathe Atul, Bini Edmund J, Pandya Prashant, Sitaraman Shanti, Shen Jianzhao
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2003 Mar;98(3):653-9. doi: 10.1111/j.1572-0241.2003.07294.x.
Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding.
All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000.
A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding.
The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.
现有文献表明，每次静脉曲张出血发作的死亡率为30%-50%。在过去20年里，静脉曲张出血的管理有了显著进展。这些进展对静脉曲张出血自然病程的影响尚不清楚。因此，开展了一项回顾性多中心研究，以确定静脉曲张出血的结局，并描述当前静脉曲张出血管理的实践模式。
纳入1997年1月1日至2000年6月30日在四家大型县级医院住院的所有有记录的静脉曲张出血患者。研究结局包括住院死亡率、6周死亡率和总死亡率、再出血率、输血需求及住院时间。出院后，对患者进行随访直至死亡或2000年6月30日研究结束日期。
共纳入231名受试者，其住院死亡率、6周死亡率和总死亡率分别为14.2%、17.5%和33.5%。随访期间再出血频率为29%。总住院时间中位数为8天（0-34天）。输注浓缩红细胞单位数中位数为4单位（0-60单位）。95%的患者在24小时内接受了上消化道内镜检查，除8名患者外所有患者均接受了内镜治疗（结扎术64%，硬化疗法33%）。74%的患者使用了奥曲肽。7.5%的患者为控制急性静脉曲张出血进行了门体分流术。
本研究中静脉曲张出血后的死亡率显著低于先前报道。这表明静脉曲张出血管理方面的进展改善了静脉曲张出血后的结局。
