急诊室早期内镜检查对消化性溃疡出血患者有益吗？一项“意外对照”研究。

Is early endoscopy in the emergency room beneficial in patients with bleeding peptic ulcer? A "fortuitously controlled" study.

作者信息

Schacher G M, Lesbros-Pantoflickova D, Ortner M A, Wasserfallen J B, Blum A L, Dorta G

机构信息

Service de Gastroentérologie, Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland.

出版信息

Endoscopy. 2005 Apr;37(4):324-8. doi: 10.1055/s-2004-826237.

DOI:10.1055/s-2004-826237

PMID:15824941

Abstract

BACKGROUND AND STUDY AIMS

In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer, though most of these studies defined "early" as endoscopy performed within 24 hours after admission. Using the length of hospital stay as the primary criterion for the clinical outcome, we compared the results of endoscopy done immediately after admission (early endoscopy in the emergency room, EEE) with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours ("delayed" endoscopy in the endoscopy unit, DEU).

PATIENTS AND METHODS

We conducted a retrospective analysis of data from 81 consecutive patients with bleeding peptic ulcer admitted in 1997 and 1998 (age range 16 - 90 years). Of these 81 patients, 38 underwent DEU (the standard therapy at the hospital) and 43 underwent EEE. Patients in the two groups were comparable with regard to admission criteria, were equally distributed with respect to their risk of adverse outcome (assessed using the Baylor bleeding score and the Rockall score), and differed only in the treatment they received. Endoscopic hemostasis was performed whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding.

RESULTS

We found similar rates in the two groups for recurrent bleeding (16 % in DEU patients vs. 14 % in EEE patients), persistent bleeding (8 % in DEU patients vs. none in EEE patients), medical complications (21 % in DEU patients vs. 26 % in EEE patients), the need for surgery (8 % in DEU patients vs. 9 % in EEE patients), and the length of hospital stay (5.1 days for DEU patients vs. 5.9 days for EEE patients). None of the differences between the two groups in these parameters were statistically significant. None of the patients died.

CONCLUSIONS

Early endoscopy in an emergency room did not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.

摘要

背景与研究目的

在既往的随机试验中，早期内镜检查改善了消化性溃疡出血患者的预后，不过这些研究大多将“早期”定义为入院后24小时内进行的内镜检查。以住院时间作为临床结局的主要标准，我们比较了入院后立即进行的内镜检查（急诊室早期内镜检查，EEE）与推迟至住院后首个24小时内但仍在正常工作时间进行的内镜检查（内镜室“延迟”内镜检查，DEU）的结果。

患者与方法

我们对1997年和1998年收治的81例连续性消化性溃疡出血患者（年龄范围16 - 90岁）的数据进行了回顾性分析。这81例患者中，38例行DEU（医院的标准治疗），43例行EEE。两组患者在入院标准方面具有可比性，在不良结局风险（使用贝勒出血评分和罗卡尔评分评估）方面分布均衡，仅在接受的治疗上有所不同。所有Forrest Ⅰ型、Ⅱa型和Ⅱb型溃疡出血患者均尽可能进行内镜止血。

结果

我们发现两组在再出血率（DEU组患者为16%，EEE组患者为14%）、持续性出血率（DEU组患者为8%，EEE组患者无）、医疗并发症发生率（DEU组患者为21%，EEE组患者为26%）、手术需求率（DEU组患者为8%，EEE组患者为9%）以及住院时间（DEU组患者为5.1天，EEE组患者为5.9天）方面相似。两组在这些参数上的差异均无统计学意义。无患者死亡。