老年与老年前期消化性溃疡临床对比分析

Studies on the clinical characteristics of peptic ulcer in the elderly and the presnium

目的研究老年人消化性溃疡的临床特点。方法回顾性分析我院１９９１年至１９９５年收治的２４６例老年人消化性溃疡，与同期住院的２８７例老年前期患者作对比。结果老年胃溃疡占同期胃溃疡住院人数的构成比已由１９９１年的２６．１％上升至１９９５年的３５．６％。老年组无规律性上腹痛，恶心呕吐，腹胀，体重减轻，黑便分别为４８．０％，５６．９％，４７．２％，３３．３％，４１．１％，高于对照组（分别为２５．８％，３３．５％，２５．１％，１７．１％，２８．９％）（Ｐ＜０．０１）。老年组并发大出血２１．６％，急性穿孔２１．３％，幽门梗阻９．８％；对照组分别为１０．１％，１３．９％，１７．４％。２组相比有显著性差异（Ｐ＜０．０１或Ｐ＜０．０５）。老年组溃疡大于２．５ｃｍ者占２３．２％，多于对照组（１２．５％）（Ｐ＜０．０１）。结论老年人胃溃疡发病率逐年上升，症状体征不典型，并发出血及穿孔多且严重。

Objective To study the clinical characteristics of peptic ulcer in the elderly. Methods From 1991 to 1995, clinical manifestations of 246 elderly peptic ulcer patients were analyzed and compared with those of 287 patients of the presenium. Results The occurrence of the gastric ulcer in the elderly group was gradually increased from 26 1% (1991) to 35 6% (1995) of the total number of cases we observed. The occurrence of irregular abdominal pain (48 1% in the edlerly vs 25 8% in the presenium), nausea/vomiting (56 9% vs 33 5%), abdominal distension (47 2% vs 25 1%), weight loss(33 3% vs 17 1%) and melena(41 1% vs 28 9%) were significantly more frequent ( P <0 01) in the elderly than in the presenium. In the elderly group, hemorrhea occurred in 21 6%, perforation in 21 3%, and pyloric obstruction in 9 8% of all the cases, while in the presenium group there were 10 1%, 13 9% and 17 4%, respectively, the difference between the corresponding figures being highly significant( P <0 05～0 01). Large ulcers with diameters more than 2 5cm accounted for 23 2% of all the peptic ulcers in the elderly, whereas it was only 12 5% in the presenium group( P <0 01). Conclusion In the elderly, the incidence of gastric ulcer was gradually increasing and its clinical manifestation was often atypical. Giant ulcers were more commonly seen in the elderly and the complications, such as hemorrhea and perforation, were more frequent and more serious in the elderly than in the presenium.