急诊CT结合早期结肠镜检查对急性下消化道出血诊断作用的研究

doi:10.3969/j.issn.1002-1949.2018.08.016

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (8): 719-723 DOI: 10.3969/j.issn.1002-1949.2018.08.016

Emergency CT combined with early colonoscopy in the diagnosis of acute lower gastrointestinal bleeding

Xu Hong-tuan, Zhang Jian, Wang Xin-ling

Department of Gastrointestinal Surgery, People′s Hospital of Ganyu District, Lianyungang 221000, China

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Abstract Objective o evaluate the accuracy and safety of emergency CT combined with early colonoscopy in the diagnosis of acute lower gastrointestinal bleeding (LGIB). Methods A retrospective study was conducted to analyze the clinical data of 316 patients with acute LGIB who underwent early colonoscopy at the emergency department of gastroenterology in our hospital. According to the different examination methods, the patients were divided into two groups: the emergency CT combined with early colonoscopy group (emergency CT group, n=178) and early colonoscopy alone group (colonoscopy group, n=138). The two methods to diagnose patients with LGIB vascular lesions and non-vascular lesions detection rate were compared. The diagnostic accuracy of emergency CT and the predictors of vascular bleeding were analyzed. The effect of emergency CT on clinical prognosis and serum creatinine was evaluated. Results The detection rate of vascular lesions ［36.0% (64/178) vs. 20.3% (28/138), χ2=9.243, P=0.002］ and the proportion of endoscopically treated patients ［34.8% (62/178) vs. 13.0% (18/138), χ2=19.517, P<0.001］ in the emergency CT group was significantly higher than that in the colonoscopy group. The sensitivity and specificity of emergency CT combined with early colonoscopy in the diagnosis of vascular lesions and non-vascular lesions in LGIB patients were 37.5% (26.0%~50.0%), 88.6% (80.9%~93.5%) and 81.81% (59.0%~94.0%), 80.8% (73.5%~86.5%), respectively. No patients in the emergency CT group had contrast nephropathy. Conclusion The combination of emergency CT and early colonoscopy in the diagnosis of LGIB can significantly increase the detection rate of vascular lesions, with high safety. The method of diagnosis can promote patients as soon as possible endoscopic treatment, and worthy of clinical application.

Key words： Lower gastrointestinal bleeding (LGIB) Emergency computed tomography Early colonoscopy

About author:: Xu Hong-tuan, E-mail: xvhtlyg@sina.com

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Xu Hong-tuan,Zhang Jian,Wang Xin-ling. Emergency CT combined with early colonoscopy in the diagnosis of acute lower gastrointestinal bleeding[J]. Chinese Journal of Critical Care Medicine, 2018, 38(8): 719-723.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.08.016 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I8/719

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