不同肠道清洁度下急诊肠镜对急性下消化道大出血的诊断价值

发布时间：2018-03-18 02:32

本文选题：急性下消化道大出血　切入点：急诊肠镜　出处：《南方医科大学学报》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨急性下消化道大出血患者进行急诊肠镜的必要性及最佳肠道准备方式。方法收集近年南方医院188例急性下消化道大出血病例结肠镜检查相关资料,根据检查时机将患者分为急诊组与择期组,通过单因素分析不同肠镜检查时机对急性下消化道大出血诊断率的影响,在此基础上纳入肠道清洁度进行多因素分层分析,分析不同肠道清洁度对急诊肠镜诊断率的影响。结果急诊组118例,择期组70例,两组的诊断率无统计学差异(P=0.724),但急诊组确定性出血灶的诊断率显著高于择期组(P=0.041),口服泻药的比例则显著低于择期组(P0.001)。肠道清洁度"优"、"良"、"差"在口服泻药及清洁灌肠的患者中的比例依次为63.6%vs 13.5%、28.6%vs 24.3%、7.8%vs 62.2%(P0.001)。单因素Logistic分析结果示,清洁度"优"较"差"显著提高肠镜诊断率(P=0.012),多因素logistic模型中,分组与清洁度的交互效应分析结果显示清洁度"优"时急诊组诊断率显著高于择期组(P=0.030);亚组分析结果显示,急诊组清洁度"优"时诊断率显著高于清洁度"差"(P=0.015)。结论当肠道清洁度为"优"时,急诊肠镜对急性下消化道大出血的诊断率优于择期肠镜,但通过清洁灌肠准备肠道时肠道清洁度差,从而降低了其诊断优势,因此在患者血流动力学稳定的前提下,急诊肠镜肠道准备应尽量选用口服泻药。
[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.
【作者单位】：南方医科大学南方医院消化科;
【基金】：广州市科技计划项目(2012J4300091)
【分类号】：R57

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