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经导管动脉栓塞治疗胃肠道出血:临床转归和预测死亡率的预后因素。

Transcatheter arterial embolization for gastrointestinal bleeding: Clinical outcomes and prognostic factors predicting mortality.

机构信息

Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

出版信息

Medicine (Baltimore). 2022 Aug 5;101(31):e29342. doi: 10.1097/MD.0000000000029342.

Abstract

We evaluated clinical outcome and prognostic factors predicting mortality of transcatheter arterial embolization (TAE) for acute gastrointestinal (GI) bleeding. Fifty-nine patients (42 men, 17 women; mean age 66.1 ± 17.0) who underwent 59 TAE procedures for GI bleeding during 2013-2018 were retrospectively evaluated. Clinical outcomes included technical success, adverse events, and rebleeding and mortality rate within 30 days. The technical success rate was 100%. Angiography showed contrast extravasation in 41 (69.5%) patients and indirect signs of bleeding in 16 (27.1%) patients. Two (3.4%) patients underwent prophylactic embolization. TAE-related adverse events occurred in 7 (11.9%) patients; adverse events were more common for mid GI or lower GI bleeding than for upper GI bleeding (22.6% vs 0%, P = 0.007). Rebleeding within 30 days was observed in 22 (37.3%) patients after TAE. Coagulopathy was a prognostic factor for rebleeding (odds ratio [OR] = 3.53, 95% confidence interval 1.07-11.67, P = .038). Mortality within 30 days occurred in 11 (18.6%) patients. Coagulopathy (OR = 24, 95% confidence interval 2.56-225.32, P = .005) was an independent prognostic factor for mortality within 30 days. TAE is an effective, safe, and potentially lifesaving procedure for GI bleeding. If possible, coagulopathy should be corrected before TAE as it may reduce rebleeding and mortality.

摘要

我们评估了经导管动脉栓塞术(TAE)治疗急性胃肠道(GI)出血的临床结果和预测死亡率的预后因素。回顾性分析了 2013 年至 2018 年间 59 例(42 例男性,17 例女性;平均年龄 66.1±17.0)接受 59 次 TAE 治疗 GI 出血的患者。临床结果包括技术成功率、不良事件、30 天内再出血和死亡率。技术成功率为 100%。血管造影显示 41 例(69.5%)患者有造影剂外渗,16 例(27.1%)患者有间接出血征象。2 例(3.4%)患者行预防性栓塞。7 例(11.9%)患者发生 TAE 相关不良事件;中胃肠道或下胃肠道出血的不良事件发生率高于上胃肠道出血(22.6%比 0%,P = 0.007)。TAE 后 30 天内再出血 22 例(37.3%)。凝血功能障碍是再出血的预后因素(比值比[OR] = 3.53,95%置信区间 1.07-11.67,P = 0.038)。30 天内死亡率为 11 例(18.6%)。凝血功能障碍(OR = 24,95%置信区间 2.56-225.32,P = 0.005)是 30 天内死亡的独立预后因素。TAE 是治疗胃肠道出血的一种有效、安全且可能挽救生命的方法。如果可能,TAE 前应纠正凝血功能障碍,以降低再出血和死亡率。

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