老年急性非静脉曲张性上消化道出血患者的最佳内镜检查时机
Optimal endoscopy timing in elderly patients presenting with acute non-variceal upper gastrointestinal bleeding.
作者信息
Cagir Yavuz, Durak Muhammed Bahaddin, Yuksel Ilhami
机构信息
Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, 06800, Turkey.
Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, 06230, Turkey.
出版信息
BMC Gastroenterol. 2024 Dec 2;24(1):444. doi: 10.1186/s12876-024-03541-z.
BACKGROUND
To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes.
METHODS
Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12-24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints.
RESULTS
The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12-24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24-48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24-48 h (late) (OR: 3.133, 95%Cl: 1.127-8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay.
CONCLUSIONS
Early endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding.
背景
基于临床结局评估老年非静脉曲张性上消化道出血（NVUGIB）患者的最佳内镜检查时间。
方法
将65岁以上出现NVUGIB的患者根据内镜检查时间分为三组：极早期内镜检查（<12小时）、早期内镜检查（12 - 24小时）和晚期内镜检查（>24小时）。对于血流动力学不稳定、持续出血或输血后血细胞比容仍低的患者，在最初12小时内进行内镜干预。研究的临床结局包括：主要终点为30天死亡率，将内镜干预需求、再出血和住院时间视为次要终点。
结果
研究人群共468例，其中260例年龄≥65岁。根据内镜检查时间，65岁以上患者中180例（69.2%）进行了极早期内镜检查（12小时内），150例（72.1%）年轻患者进行了极早期内镜检查（p>0.05）。65岁以上患者和年轻患者中分别有53例（20.4%）和41例（19.7%）进行了早期内镜检查（12 - 24小时），而分别有27例（10.4%）和17例（8.2%）患者进行了晚期内镜检查（24 - 48小时）（所有参数p>0.05）。≥65岁人群中基于内镜检查时间的亚组临床结果及组间比较。组间比较发现，极早期内镜检查组手术/放射学干预需求的可能性明显低于晚期内镜检查组[3（1,7）对（3,7），p = 0.016]，极早期组、早期内镜检查组和晚期内镜检查组的30天死亡率在内镜检查时间方面差异有统计学意义（极早期组15.6%、早期内镜检查组7.5%和晚期内镜检查组29.6%）（所有组p<0.05）。24 - 48小时（晚期）内的内镜检查时间（OR：3.133，95%Cl：1.127 - 8.713，p：0.029）是住院期间再出血的独立预测因素。
结论
早期内镜检查可能有利于急性上消化道出血的管理，尤其是在合并症高且出血严重的老年人群中。
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