经导管动脉栓塞术治疗急性非静脉曲张性上消化道出血的疗效分析
[Efficacy Analysis of Transcatheter Arterial Embolization in Acute Non-Variceal Upper Gastrointestinal Bleeding].
作者信息
Liu Bang-Xi, Wang Xiao-Ze, Yan Yu-Ling, Xiao Xue, Yang Li, Luo Xue-Feng
机构信息
Department of Gastroenterology and Sichuan University-University of Oxford Huaxi Joint Center for Gastrointsetinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 May;53(3):398-403. doi: 10.12182/20220560203.
OBJECTIVE
To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB), and to guide clinical practice and continue to optimize diagnosis and treatment strategies.
METHODS
This retrospective study included 266 patients who underwent angiography due to ANVUGIB between March 2016 and March 2021. Data on the positive rate of angiography, the technical success rate and clinical success rate of TAE, and the rebleeding rate and the all-cause mortality within 30 days after TAE treatment were collected, and the influencing factors relevant to the above events were analyzed accordingly.
RESULTS
All 266 patients completed angiography--the positive rate of angiography was 54.1% (144/266), the total technical success rate was 97.3% (217/223), the clinical success rate was 73.1% (155/212), and the rebleeding rate and all-cause mortality within 30 days were 26.9% (57/212) and 16.1% (35/217), respectively. This study found that shock index>1 ( =5.950; 95% : 1.481-23.895; =0.012), computed tomography angiography (CTA) positive result ( =6.813; 95% : 1.643-28.252; =0.008) and interval<24 h ( =10.530; 95% : 2.845-38.976; <0.001) were independent predictors of positive angiography. Shock index>1 ( =2.544; 95% : 1.301-4.972; =0.006) and INR>1.5 ( =3.207; 95% : 1.381-7.451; =0.007) were independent risk factors for rebleeding. Patients with postoperative bleeding ( =3.174; 95% : 1.164-8.654; =0.024) and patients with rebleeding after embolization ( =34.665; 95% : 11.471-104.758; <0.001) had a higher risk of death within 30 days.
CONCLUSION
TAE is safe and effective in the treatment of ANVUGIB. Patients with shock index>1 and positive CTA are more likely to be angiographic positive, and should undergo angiography as early as possible after bleeding. In addition, rebleeding after embolization deserves high attention.
目的
评估经导管动脉栓塞术（TAE）治疗急性非静脉曲张性上消化道出血（ANVUGIB）的安全性和有效性，以指导临床实践并持续优化诊疗策略。
方法
本回顾性研究纳入了2016年3月至2021年3月因ANVUGIB接受血管造影的266例患者。收集血管造影阳性率、TAE技术成功率和临床成功率，以及TAE治疗后30天内再出血率和全因死亡率的数据，并相应分析与上述事件相关的影响因素。
结果
266例患者均完成血管造影——血管造影阳性率为54.1%（144/266），总技术成功率为97.3%（217/223），临床成功率为73.1%（155/212），30天内再出血率和全因死亡率分别为26.9%（57/212）和16.1%（35/217）。本研究发现，休克指数>1（P = 5.950；95%置信区间：1.481 - 23.895；P = 0.012）、计算机断层血管造影（CTA）阳性结果（P = 6.813；95%置信区间：1.643 - 28.252；P = 0.008）和出血间隔<24小时（P = 10.530；95%置信区间：2.845 - 38.976；P < 0.001）是血管造影阳性的独立预测因素。休克指数>1（P = 2.544；95%置信区间：1.301 - 4.972；P = 0.006）和国际标准化比值（INR）>1.5（P = 3.207；95%置信区间：1.381 - 7.451；P = 0.007）是再出血的独立危险因素。术后出血患者（P = 3.174；95%置信区间：1.164 - 8.654；P = 0.024）和栓塞后再出血患者（P = 34.665；95%置信区间：11.471 - 104.758；P < 0.001）30天内死亡风险更高。
结论
TAE治疗ANVUGIB安全有效。休克指数>1且CTA阳性的患者血管造影阳性可能性更大，出血后应尽早行血管造影。此外，栓塞后再出血值得高度关注。
Zotero 插件