2026 年第 7 期 第 21 卷

急性心肌梗死合并上消化道出血患者内镜治疗后短期预后及临床特征

Short-term prognosis and clinical characteristics of patients with acute myocardial infarction complicated with upper gastrointestinal bleeding after endoscopic therapy

作者：李姝溦孙亚梅张杰

英文作者：Li Shuwei Sun Yamei Zhang Jie

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性心肌梗死；上消化道出血；消化内镜；内镜止血术

英文关键词：Acutemyocardialinfarction;Uppergastrointestinalbleeding;Gastrointestinalendoscopy;Endoscopichemostasis

• 摘要：

• 目的 探讨急性心肌梗死（AMI）合并上消化道出血患者内镜治疗后的短期预后及临床特征，揭示安全实施内镜治疗的条件及影响预后的关键因素。方法 回顾性纳入2012年1月至2025年8月首都医科大学附属北京安贞医院收治的AMI合并上消化道出血且成功接受内镜下止血治疗患者64例，采集患者的一般情况、病史、实验室检查、心脏及出血特征和转归等信息，并以内镜成功止血后30 d全因死亡为主要终点事件，将患者分为存活组（44例）与死亡组（20例），进行分析比较。结果 64例患者年龄（63±13）岁，男性占79.7%（51/64），急性非ST段抬高型心肌梗死占60.9%（39例），急性ST段抬高型心肌梗死占39.1%（25例）。入院时53.1%（34例）的患者存在心功能不全。所有患者均成功完成内镜下止血，内镜治疗过程中无并发症发生。30 d随访期内44例（68.8%）患者存活，20例（31.2%）死亡，成功止血后，95.0%(19/20)患者的死亡原因为心源性。死亡组中因存在较为严重的心脏基础病变，使用机械通气、主动脉内球囊反搏、体外膜氧合和连续性肾脏替代治疗的比例明显高于存活组［80.0%（16/20）比25.0%（11/44）、35.0%（7/20）比9.1%（4/44）、45.0%（9/20）比4.5%（2/44）、40.0%（8/20）比0（0/44）］（均P＜0.05）。结论 AMI合并上消化道出血并接受内镜止血治疗的患者多伴有心功能不全。高级生命支持的应用可能有助于实现血流动力学稳定，为成功实施内镜止血治疗提供支持，但其更可能反映患者的病情危重程度。患者预后还取决于心脏基础病变的严重程度。

• Objective To explore the short-term prognosis and clinical characteristics of patients with acute myocardial infarction (AMI) complicated with upper gastrointestinal bleeding after endoscopic therapy, and to identify the safe conditions for endoscopic treatment and key prognostic factors. Methods A total of 64 patients admitted to Beijing Anzhen Hospital, Capital Medical University from January 2012 to August 2025 with AMI combined with upper gastrointestinal bleeding who received successful endoscopic hemostasis were retrospectively enrolled. Clinical data including general information, medical history, laboratory examinations, cardiac and bleeding characteristics, and clinical outcomes were collected. The primary endpoint was all-cause mortality within 30 d after successful endoscopic hemostasis. Patients were divided into survival group (44 cases) and death group (20 cases) for comparative analysis. Results The age of the 64 patients was (63±13) years old, among whom 79.7%(51/64) were male. Non-ST-segment elevation myocardial infarction accounted for 60.9%(39 cases), and ST-segment elevation myocardial infarction accounted for 39.1%(25 cases). Cardiac insufficiency was present in 53.1%(34 cases) on admission. All patients achieved successful endoscopic hemostasis without intraoperative complications. During the 30 d follow-up period, 44 patients (68.8%) survived and 20 patients (31.2%) died, among whom 95.0%(19/20) died of cardiac causes after successful hemostasis. Due to severe underlying cardiac diseases in the death group, the proportions of patients receiving mechanical ventilation, intra-aortic balloon pump, extracorporeal membrane oxygenation and continuous renal replacement therapy were significantly higher than those in the survival group［80.0%(16/20) vs 25.0%(11/44), 35.0%(7/20) vs 9.1%(4/44), 45.0%(9/20) vs 4.5%(2/44), 40.0%(8/20) vs 0(0/44)］(all P＜0.05). Conclusions Most patients with AMI combined with upper gastrointestinal bleeding undergoing endoscopic hemostasis are complicated with cardiac insufficiency. The application of advanced life support contributes to hemodynamic stability and guarantees the safe implementation of endoscopic hemostasis, while it also reflects critical illness severity. The prognosis of patients is determined by the severity of underlying cardiac lesions.