老年急性上消化道出血78例病因分析

Etiology of acute upper gastrointestinal bleeding in 78 elderly geriatric patients

目的探讨老年急性上消化道出血的临床病因特点。方法回顾性分析我院2004年10月至2007年9月收治的78例老年急性上消化道出血患者（老年组）的临床资料；并与同期50例中青年急性上消化道出血患者（中青年组）的临床病因进行比较。结果老年组急性上消化道出血的病因依次为消化性溃疡、恶性肿瘤、急性胃黏膜病变、食道及胃底静脉曲张，其中胃溃疡及恶性肿瘤的患病率[分别为39．7％（29／78）和15．4％（12／78）]，明显高于中青年组的22．0％（11／50）和4．0％（2／50），差异有统计学意义（P〈0．05）；老年组的呕血黑便、伴随疾病的发生率[分别为94．9％（74／78）、65．4％（51／78）]明显高于中青年组[分别为76．0％（38／50）和24．0％（12／50）]，差异有统计学意义（P〈0．01）；老年组上腹部疼痛的发生率39．7％（31／78）明显低于中青年组的58．0％（29／50），差异有统计学意义（P〈0．05）。结论老年急性上消化道出血的病因中胃溃疡和恶性肿瘤占有重要地位，以呕血黑便、失血性休克及伴随疾病为主要临床表现。

Objective To study the clinical etiology of acute upper gastrointestinal bleeding in geriatric patients. Methods The clinical data of the geriatric patients with acute upper gastrointestinal bleeding in recent 3 years were analyzed retrospectively and compared with 50 cases of in young and middle-age patients of acute upper gastrointestinal bleeding during the same period. Results Causes of acute upper gastrointestinal bleeding in old age group peptic ulcer, cancer, acute gastric mucosal lesion, esophageal and gastric varices. The prevalence rate of malignant and gastric ulcer were significantly higher than those in young and middle-aged group （P 〈 0.05 ）. The incidence of hematemesis melena, hemorrhagic shock and associated diseases in old age group were significantly higher than that in young and middle-aged group（P 〈 0.05, P 〈0.01 ）. The incidence of upper abdominal pain were significantly lower than that of young and middle-aged group （P 〈 0.05 ）. Conclusion Gastric ulcer and malignant are important causes of geriatric patients with acute upper gastrointestinal bleeding. Meanwhile hematemesis melena, hemorrhagic shock and associated diseases are the main clinical manifestations.