소화성궤양 출혈의 조기재출혈에 관한 위험 인자분석

Abstract

Background/Aims : Rebleeding are after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20~30%. The risk of death after admission to hospital for acute peptic ulcer bleeding depends on age, the presence of shock, co-mobid condition, or presence of major stigma of recent hemorrhage. Endoscopic findings provide the best estimation of the risk of rebleeding. Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. Methods: There was reviewed 78pateints who presented with bleeding peptic ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, argon plasma coagulation and clipping. There was compared the clinical variables (age, co-mobid illness, pulse rate, initial SBP, hemoglobin), endoscopic characteristics of ulcer(size, number, and location of ulcer, Modified Forrest criteria) between the patients who bled early(n=10) and who did not bleed (n=68) within 3days. Results: The statistically significant correlates with early rebleeding after hemostasis were volume of transfusion(p<0.001), Modified Forrest criteria(p=0.017). In Multivariate analysis volume of transfusion was significant risk factor. Conclusion: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variable and endoscopic finding. Early identification of risk factors can predict the prognosis of peptic ulcer bleeding