本文選題：急性下消化道大出血　切入點(diǎn)：急診腸鏡　出處：《南方醫(yī)科大學(xué)學(xué)報(bào)》2017年04期 　論文類型：期刊論文

【摘要】：目的探討急性下消化道大出血患者進(jìn)行急診腸鏡的必要性及最佳腸道準(zhǔn)備方式。方法收集近年南方醫(yī)院188例急性下消化道大出血病例結(jié)腸鏡檢查相關(guān)資料,根據(jù)檢查時(shí)機(jī)將患者分為急診組與擇期組,通過(guò)單因素分析不同腸鏡檢查時(shí)機(jī)對(duì)急性下消化道大出血診斷率的影響,在此基礎(chǔ)上納入腸道清潔度進(jìn)行多因素分層分析,分析不同腸道清潔度對(duì)急診腸鏡診斷率的影響。結(jié)果急診組118例,擇期組70例,兩組的診斷率無(wú)統(tǒng)計(jì)學(xué)差異(P=0.724),但急診組確定性出血灶的診斷率顯著高于擇期組(P=0.041),口服瀉藥的比例則顯著低于擇期組(P0.001)。腸道清潔度"優(yōu)"、"良"、"差"在口服瀉藥及清潔灌腸的患者中的比例依次為63.6%vs 13.5%、28.6%vs 24.3%、7.8%vs 62.2%(P0.001)。單因素Logistic分析結(jié)果示,清潔度"優(yōu)"較"差"顯著提高腸鏡診斷率(P=0.012),多因素logistic模型中,分組與清潔度的交互效應(yīng)分析結(jié)果顯示清潔度"優(yōu)"時(shí)急診組診斷率顯著高于擇期組(P=0.030);亞組分析結(jié)果顯示,急診組清潔度"優(yōu)"時(shí)診斷率顯著高于清潔度"差"(P=0.015)。結(jié)論當(dāng)腸道清潔度為"優(yōu)"時(shí),急診腸鏡對(duì)急性下消化道大出血的診斷率優(yōu)于擇期腸鏡,但通過(guò)清潔灌腸準(zhǔn)備腸道時(shí)腸道清潔度差,從而降低了其診斷優(yōu)勢(shì),因此在患者血流動(dòng)力學(xué)穩(wěn)定的前提下,急診腸鏡腸道準(zhǔn)備應(yīng)盡量選用口服瀉藥。
[Abstract]:Objective to investigate the necessity of emergency colonoscopy in patients with acute lower gastrointestinal hemorrhage and the best way to prepare their intestines. Methods 188 cases of acute lower gastrointestinal hemorrhage in Southern Hospital were collected with colonoscopy in recent years. The patients were divided into emergency group and selective group according to the time of examination. The influence of different time of colonoscopy on the diagnosis rate of acute lower gastrointestinal hemorrhage was analyzed by univariate analysis. On this basis, the intestinal cleanliness was analyzed by multivariate stratification analysis. The effect of different intestinal cleanliness on the diagnosis rate of emergency colonoscopy was analyzed. Results 118 cases in emergency group, 70 cases in selective group, There was no statistical difference in the diagnosis rate between the two groups. However, the diagnostic rate of deterministic bleeding foci in the emergency group was significantly higher than that in the selective group, and the proportion of oral laxatives was significantly lower than that in the selective group (P 0.001). The intestinal cleanliness of the two groups was excellent, good and poor in oral laxative and clearance. The proportion of patients with enema was 63.6 vs 13.528. 6, and 7.8vs 62.2 P0.001. the results of univariate Logistic analysis showed that, In multivariate logistic model, the interaction effect analysis of group and cleanliness showed that the diagnostic rate of emergency group was significantly higher than that of selective group, and the subgroup analysis showed that the diagnostic rate of emergency group was significantly higher than that of selective group, and the subgroup analysis showed that the diagnostic rate of emergency group was significantly higher than that of selective group. The diagnostic rate of acute lower gastrointestinal hemorrhage in emergency group was significantly higher than that in emergency group (P 0.015). Conclusion when the intestinal cleanliness is excellent, the diagnostic rate of emergency colonoscopy is better than that of selective colonoscopy. However, the intestinal cleanliness is poor when preparing the intestine by cleaning enema, which reduces the diagnostic advantage. Therefore, under the premise of stable hemodynamics, the emergency enteroscopy should choose oral laxatives as far as possible.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院消化科;
【基金】：廣州市科技計(jì)劃項(xiàng)目(2012J4300091)
【分類號(hào)】：R57

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