重症监护病房内上消化道出血的临床分析

Clinical study of upper gastrointestinal hemorrhage in intensive care unit

目的探讨重症监护患者上消化道出血的主要因素，以及并发上消化道出血与病死率的关系。方法回顾分析重症监护病房（ICU）并发上消化道出血（急性非静脉曲张性上消化道出血）急危重病患者252例，按发病后上消化道出血发生时间与病死率的关系进行比较分析，并根据治疗超过3d后继发感染和上消化道出血与病死率的关系进行比较分析。结果发生上消化道出血的主要疾病为脑血管意外和重度颅脑损伤；上消化道出血出现时间愈早（分别为〈1d、1～3d、〉3d）死亡率愈高（P〈0．05）；治疗超过3d后出现继发感染者上消化道出血发生率增加（P〈0．05），其中呼吸机相关性肺炎35例，占83．33％，且继发感染伴上消化道出血患者病死率增加（P〈0．05）。结论ICU患者出现上消化道出血提示预后不良；及时发现上消化道出血，防治感染尤其是呼吸机相关性肺炎等对ICU患者预后有重要意义。

Objective To investigate the main factors of upper gastrointestinal hemorrhage in intensive care unit and relationship of upper gastrointestinal hemorrhage with mortality. Methods We retrospectively analyzed the 252 acute critical diseases patients with upper gastrointestinal hemorrhage （acute non-variceal upper gastrointestinal bleeding） in our ICU last two years. We compared and analyzed the relationship between occurrence of upper gastroin- testinal hemorrhage and morality, and the relationship between motality and secondary infection or upper gastrointesti- nal hemorrha after curing more than three days. Results Main diseases with upper gastrointestinal hemorrhage are cerebrovascular accidents and severe craniocerebral injuries. Motality is higher（ P 〈 0.05 ） when appearance time of upper gastrointestinal hemorrhage is earlier（ respectively is less 1 day, 1 to 3 days, more than 3days）. Occurrence rate of upper gastrointestinal hemorrhage increases in secondary infection patients after curing more than 3 days （ P 〈 0.05）. There are 35 patients with ventilator-associated pneumonia in secondary infection patients, the percentage is 83.33%. Motality increases in secondary infection patients with upper gastrointestinal hemorrhage（P 〈 0.05）. Concinsiou Occurrence of upper gastrointestinal hemorrhage in patients in intensive care unit suggests poor prognosis. Finding upper gastrointestinal hemorrhage timely and preventing secondary infection, especialy ventilator-associated pneumonia is important to prognosis of patients in intensive care unit.