目的急性出血性直肠溃疡(AHRU)是以突发性、无痛,直肠溃疡大量出血.迄今为止,很少有研究分析AHRU再出血的危险因素.在这项研究中,我们通过多中心研究阐明了AHRU初次止血后再出血的危险因素.方法选取2015年1月至2020年5月在3个医疗中心确诊的AHRU患者149例。我们回顾性调查了以下因素:年龄,性别,体重指数(BMI),性能状态(PS),Charlson合并症指数(CCI),合并症,药物,实验室检查,内镜检查结果,内窥镜检查整个直肠的视图,止血方法,输血史,震惊,初始止血后改变姿势的说明,和临床课程。结果149例患者中有35例(23%)出现再出血。多变量分析表明,再出血的重要因素是PS4[比值比(OR),5.23;95%置信区间(CI)],1.97-13.9;p=0.001],输血史(或,3.66;95%CI,1.41-9.51;p=0.008),低估计肾小球滤过率(eGFR)水平(OR,0.98;95%CI,0.97-0.99;p=0.001),内窥镜检查对整个直肠的视野不佳(或,0.33;95%CI,0.12-0.90;p=0.030),和使用单极止血钳(OR,4.89;95%CI,1.37-17.4;p=0.014)。结论与AHRU再出血相关的因素是PS(PS4)不良,输血,低eGFR,内窥镜检查整个直肠的视野不佳,和使用单极止血钳。
Objective Acute hemorrhagic rectal ulcer (AHRU) is characterized by sudden, painless, and massive bleeding from rectal ulcers. To date, few studies have analyzed the risk factors for AHRU rebleeding. In this study, we clarified the risk factors of rebleeding after initial hemostasis of AHRU through a multicenter study. Methods A total of 149 patients diagnosed with AHRU between January 2015 and May 2020 at 3 medical centers were enrolled. We retrospectively investigated the following factors: age, sex, body mass index (BMI), performance status (PS), Charlson comorbidity index (CCI), comorbidities, medications, laboratory examinations, endoscopic findings, view of the entire rectum on endoscopy, hemostasis method, blood transfusion history, shock, instructions for posture change after initial hemostasis, and clinical course. Results Rebleeding was observed in 35 (23%) of 149 patients. A multivariate analysis showed that significant factors for rebleeding were PS 4 [odds ratio (OR), 5.23; 95% confidence interval (CI)], 1.97-13.9; p=0.001], a blood transfusion history (OR, 3.66; 95% CI, 1.41-9.51; p=0.008), low an estimated glomerular filtration rate (eGFR) levels (OR, 0.98; 95% CI, 0.97-0.99; p=0.001), poor view of the whole rectum on endoscopy (OR, 0.33; 95% CI, 0.12-0.90; p=0.030), and use of monopolar hemostatic forceps (OR, 4.89; 95% CI, 1.37-17.4; p=0.014). Conclusion Factors associated with rebleeding of AHRU were a poor PS (PS4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps.