Zhang Jia-ying, Wang Ye, Zhang Jing, Ding Shi-gang, Zhou Li-ya, Lin San-ren
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2010 Dec 18;42(6):703-7.
To determine risk factors associated with failure of endoscopic therapy in acute non-variceal upper gastrointestinal bleeding (ANVUGIB ).
This was a retrospective cohort study of 223 patients admitted to Peking University Third Hospital between 1 January 2005 and 31 December 2009, with acute non-variceal upper gastrointestinal bleeding. Data on clinical presentation, laboratory test, endoscopic findings, and treatment outcomes were collected. Risk factors for treatment failure were identified using multivariable Logistic regression with backward selection.
Therapeutic failure rate was 19.3%(43/223). In univariate analysis, the two groups had significant difference in age, history of gastrointestinal bleeding, ASA, shock, haemoglobin level, Hct, PLT, time of endoscopic treatment, gastric ulcer, duodenal ulcer, lesion size and active spurting of blood. Multivariate Logistic regression analysis revealed that shock [odds ratio (OR) 3.058, 95% confidence interval (CI) 1.295-7.221], history of gastrointestinal bleeding (OR 2.809, 95% CI 1.207-6.539), PLT>100×10⁹/L (OR 0.067, 95% CI 0.009-0.497), active spurting of blood (OR 10.390, 95% CI 2.835-38.080) and lesion size≥2.0 cm (OR 7.111, 95% CI 1.628-31.069) were risk factors associated with failure of endoscopic therapy. The number of comorbidities>1 (OR 9.580,95%CI 1.383-66.390) and active spurting of blood (OR 9.971, 95% CI 1.820-54.621) were factors related with need for surgical intervention or death.
Patients with shock, history of gastrointestinal bleeding, PLT<100×10⁹/L, active spurting of blood and large lesion size, have high risks for continued bleeding or rebleeding after endoscopic treatment. These patients may be more likely to benefit from aggressive post-hemostasis care.
确定急性非静脉曲张性上消化道出血（ANVUGIB）内镜治疗失败的相关危险因素。
这是一项对2005年1月1日至2009年12月31日期间北京大学第三医院收治的223例急性非静脉曲张性上消化道出血患者进行的回顾性队列研究。收集了临床表现、实验室检查、内镜检查结果及治疗结果的数据。采用多变量Logistic回归及向后选择法确定治疗失败的危险因素。
治疗失败率为19.3%（43/223）。单因素分析显示，两组在年龄、消化道出血史、美国麻醉医师协会（ASA）分级、休克、血红蛋白水平、血细胞比容、血小板计数、内镜治疗时间、胃溃疡、十二指肠溃疡、病变大小及活动性出血等方面存在显著差异。多变量Logistic回归分析显示，休克[比值比（OR）3.058，95%置信区间（CI）1.295 - 7.221]、消化道出血史（OR 2.809，95% CI 1.207 - 6.539）、血小板计数>100×10⁹/L（OR 0.067，95% CI 0.009 - 0.497）、活动性出血（OR 10.390，95% CI 2.835 - 38.080）及病变大小≥2.0 cm（OR 7.111，95% CI 1.628 - 31.069）是内镜治疗失败的相关危险因素。合并症数量>1（OR 9.580，95% CI 1.38
