西藏地区再发性上消化道出血临床特征与防治探讨

Clinical characterestics、 prevention and treatment of recurrent upper digestive tract hemorrhage in Tibetan district

本组上消化道出血患者再出血率较高(汉族43.1%、藏族22.2%).两次出血时诱因、病因大多各异(分别为93.9%、89.4%),第二次出血量较第一次增大(P<O.01)、合并休克者增多(P<O.05).与本组整体上消化道出血资料相比,再发性出血病因中十二指肠球都溃疡所占比例增大,其发病机理中损害性因素增强较保护性因素薄弱更为重要,提出主要预防措施是使用H_2—受体阻滞剂长期维特治疗,强调了低氧分压下抗休克治疗给氧及纠正酸中毒的重要性.

In the group of upper digestive tract hemorrhage patients, the recurrent rate was relatively high (the Hans 43. 1%, Tibetans 22. 2%, P>0. 05). The clinical characteristics of recurrent hemorrhage patients were: (1) The patients were young (mean age 26 yers), 2/3 of them had medical history of chronic duodenal disease. (2) The first hemorrhage majority occured after one year of arrival in Tibet (87. 9%). (3) Majority of the first hemorrhage had predisposing cause (71. 2%) and about half of the secondary hemorrhage had no clear predisposing cause (45. 5%). (4) In the cause of recurrent hemorrhage, the percentage of duodenal bulbar ulcer was higher (89. 4%). (5) The blood volume of secondary hemorrhage was increased than the first (P<0. 01) and the complication of shock was increased (P<0. 05) . The writer recommends a long-term using of H2 - receptor blocking agent for prevention of recurrent hemorrhage and emphasis that under altitude hypoxia enviroment and secondary polycythemia condition, oxigen inhalation and correction of acidosis for anti- shock treatment is of great importance.