老年人上消化道出血154例临床分析

Clinical analysis of upper gastrointestinal bleeding in elderly patients： Report of 154 cases

目的探讨老年人上消化道出血的临床特点。方法回顾性分析我院2003年1月～2007年12月间收治的154例以上消化道出血为主要表现的老年病人的临床特点，并与同期中青年病例比较。结果与中青年人相比，老年人上消化道出血存在明显诱因者较少见（39．6％），出血方式表现为呕血者较少见（21．6％），其伴随疾病（49．4％）和并发症（21.4％）较多，再出血率（16．9％）和死亡率（11．7％）较高。出血病因中，老年人以胃溃疡最多见（27．9％），其次为十二指肠溃疡（18．8％）及胃癌（18．2％）；而中青人以十二指肠溃疡（34．3％）最多见，其次为胃溃疡（16．3％）及胃癌（10．6％）。老年人胃溃疡及胃癌出血的发生率均高于中青年人，而十二指肠溃疡出血的发生率则低于中青年人（P〈O．05）。结论老年人上消化道出血以消化性溃疡多见，胃溃疡及胃癌出血的发生率较高，伴随疾病和并发症多，再出血率和死亡率高。

Objective To investigate the clinical features of upper gastrointestinal bleeding in elderly patients. Methods We retrospectively analyzed the clinical features of 154 aged patients with upper gastrointestinal bleeding treated in our hospital from January 2003 to December 2007, and compared them with those of 227 younger patients during the same period. Results Compared with the younger patients, aged patients had fewer known contributing causes for upper gastrointestinal bleeding （39.6%） and fewer aged patients exhibited upper gastrointestinal bleeding in the form of hematemesis （21.6%）, but they had more underlying diseases （49.4%） and complications （21.4%）, more bleeding recurrences （16.9%） and higher mortality （11.7%）. The main cause of upper gastrointestinal bleeding in elderly patients was gastric ulcer （27.9%）, duodenal ulcer （18.8%） and gastric cancer （18.2%）, while the main cause in younger patients was duodenal ulcer （34.3 %）, gastric ulcer （16.3 %） and gastric cancer （10.6 %）. The bleeding rate of gastric ulcer or gastric cancer in elderly patients was higher than that in younger patients, but the bleeding rate of duodenal ulcer in elderly patients was lower than that in younger patients （P 〈 0.05）. Conclusions In aged patients, peptic ulcer is the main cause of upper gastrointestinal bleeding, and the bleeding rate of gastric ulcer or gastric cancer is higher. They have more underlying diseases and complications, more bleeding recurrences and higher mortality.