上消化道出血182例患者的临床分析

Clinical Analysis of Upper Gastrointestinal Bleeding in 182 Patients

目的探讨上消化道出血的常见病因,观察肿瘤标志物在胃癌出血患者中的异常率,分析患者未能行胃镜检查明确出血病因的原因。方法对我院出院诊断考虑为"上消化道出血"的182例患者临床资料进行回顾性分析。结果 182例上消化道出血患者中,消化道溃疡出血61例(占33%),胃癌出血12例(占7%),食管、胃底静脉曲张破裂出血8例占4%;其中男性分别占85%(52/61)、67%(8/12)、8/8。胃癌患者癌胚抗原异常率为33%(4/12)。89例上消化道出血患者病因未明的原因:患者或家属拒绝胃镜检查48例(占54%),因心肌梗死、不稳定型心绞痛、心功能不全不宜行胃镜检查7例占8%。结论 (1)上消化道出血最常见原因为消化性溃疡合并出血,其次为胃癌出血及食管、胃底静脉曲张破裂出血;(2)此3类出血患者均男多于女;(3)肿瘤标志物用于协助诊断胃癌的意义有限;(4)患者或家属拒绝行胃镜检查或必要时胃镜复查是不能明确上消化道出血病因的最常见原因。

Objective To explore the common causes of upper gastrointestinal bleeding,observe the incidence of abnormal tumor markers in gastric cancer patients with bleeding,and to analyze why patients unable to get the specific reasons for bleeding by gastroscopy.Methods Clinical data of 182 cases with discharge diagnosis of upper gastrointestinal bleeding were Retrospectively analyzed.Results Of the 182 cases with upper gastrointestinal bleeding,61 cases（33%）had peptic ulcer bleeding,12 cases had gastric cancer bleeding（7%）,8 cases had esophageal and gastric variceal bleeding（4%）,among which males accounted for 85%（52/61）,67%（8/12） and 8/8 respectively.Incidence of abnormal carcinoembryonic antigen was 33%（4/12）in patients with gastric cancer.Etiology of 89 cases with upper gastrointestinal bleeding were unknown：48 cases（54%）or their families refused endoscopy,7 cases（8%）should not undergo gastroscopy due to myocardial infarction,unstable angina and heart failure.Conclusion（1）The most common cause of upper gastrointestinal bleeding is peptic ulcer bleeding,followed by gastric cancer bleeding and esophageal and gastric variceal bleeding.（2）The three types of bleeding happened more to men than to women.（3）Diagnostic tumor markers is of limited assistance for the diagnosis of gastric cancer（4）The most common cause for unspecific reason of upper gastrointestinal bleeding is patients or their families refused gastroscopy or repeated gastroscopy when necessary.