Factors Associated with Mortality of Patients Undergoing Angiography for Massive Gastrointestinal Bleeding

接受緊急血管攝影檢查之急性胃腸出血病人死亡因子的探討

杜振豐(Cheng-Hong Toh) ； 饒啟明(Kee-Min Yeow) ； 蔡培葵(Pei-Kwei Tsay) ； 張潤忠(Yun-Chung Cheung) ； 曾振輝(Jeng-Hwei Tseng) ； 洪建褔(Cheng-Fu Hung) ； 吳樹鏗(Shu-Hang Ng) ； 萬永亮(Yung-Liang Wan)

《中華放射線醫學雜誌》 28卷6期 (2003/12) Pp. 353-360

摘要

急性胃腸出血病人常因為內視鏡找不到出血點而接受緊急血管攝影檢查。本研究之目的為評估和這類病人有關的住院死亡率因子。此回溯性研究乃針對從1998年12月至2002年5月，97位接受緊急血管攝影檢查之急性胃腸出血的病患。經由統計方法，分析和死亡率有關的因子。針對血管攝影前的不同程度的顯著臨床因子，進一步分析治療方法對存活的影響。結果：40位病人在住院中死亡，死亡率是41.2%。多變量統計分析結發現與高死亡率有關的因子包括嚴重共病，凝血異常及保守性治療。非保守性治療可增進具有嚴重共病或沒有凝血異常的病人的存活率。結論：在因急性胃腸出血而接受血管攝影檢查之病人，其死亡率與嚴重共病，凝血異常及保守性治療有相關。

關鍵字

凝血異常 ； 胃腸出血 ； 住院死亡率

並列摘要

Acute massive gastrointestinal (GI) bleeding patients with negative endoscopic findings are frequently referred for emergent visceral angiography. The purpose of this study is to evaluate the factors associated with in-hospital mortality of these patients.
The records of 97 consecutive patients who underwent emergent visceral angiography for acute massive GI bleeding between December 1998 and May 2002 were retrospectively reviewed. Statistical analysis of relevant factors was performed to determine contributions of these factors to in-hospital mortality. The impact of treatment on survival was analyzed in relation to the pre-angiography levels of significant clinical factors.
In-hospital mortality occurred in 41.2% (40 of 97) of patients. Multivariate analysis identified association of comorbidity (p= 0.006), coagulopathy (p ＜0.001), and conservative treatment (p=0.005) associated with higher mortality. Non-conservative treatment significantly improved survival of patient with comorbidity (p = 0.001) or without coagulopathy (p=0.011).
In patients undergoing angiography for massive gastrointestinal bleeding, presence of comorbidity and coagulopathy, and conservative treatment are associated with higher mortality.

並列關鍵字

Coagulopathy ； Gastrointestinal hemorrhage ； Hospital mortality