Improved patient survival after acute variceal bleeding: A multicenter, cohort study
Improved patient survival after acute variceal bleeding: A multicenter, cohort study
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DOI：
10.1016/s0002-9270(02)06016-1
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发表时间：
2003-03-01
影响因子：
9.8
通讯作者：
Shen, JZ
中科院分区：
文献类型：
--
作者：
Chalasani, N;Kahi, C;Shen, JZ
目的：现有文献表明，每次静脉曲张出血的死亡率为30-50%。在过去的二十年里，静脉曲张出血的治疗取得了重大进展。这些发展对静脉曲张出血的自然史的影响尚不清楚。因此，我们进行了一项回顾性的多中心研究，以确定静脉曲张出血的结局，并描述当前静脉曲张出血治疗的实践模式。方法：选取1997年1月1日至2000年6月30日在四家大型县级医院住院的所有有静脉曲张出血记录的患者。研究结果包括住院、6周、总死亡率、再出血率、输血需求；以及停留时间。出院后，对患者进行随访，直到2000年6月30日患者死亡或研究结束。结果：共纳入231例患者，住院死亡率、6周死亡率和总死亡率分别为14.2%、17.5%和33.5%。随访期间再出血发生率为29%。总住院时间中位数为8天（0-34天）。输血填充红细胞单位中位数为4u （0- 60u）。95%的患者在24小时内进行了上镜检查，除8例患者外，其余患者均进行了内镜治疗（结扎64%，硬化治疗33%）。74%的患者使用奥曲肽。为控制急性静脉曲张出血，7.5%的患者行门静脉分流术。结论：本研究中静脉曲张出血后的死亡率明显低于先前报道。这表明在处理静脉曲张出血方面取得的进展改善了静脉曲张出血后的预后。
OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of,variceal bleeding.METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement; and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000.RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding.CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.