老年急性上消化道出血患者临床分析

Clinical Analysis of Elderly Patients with Acute Upper Gastrointestinal Bleeding

背景：近年老年急性上消化道出血（AUGIB）的发生率迅速升高。目的：探讨老年AUGIB的病因、临床结局和主要死亡危险因素。方法：纳入2007年1月～2010年1月老年AUGIB患者378例，按年龄分为低龄组（60～80岁，n=231）和高龄组（〉80岁，n=147），回顾性分析患者的基本临床特征、急诊诊疗和临床结局，并筛选高龄组患者的死亡危险因素。结果：高龄组患者较易发生合并症（P〈0．05）。两组的主要出血原因均为消化性溃疡，高龄组静脉曲张破裂出血者比例明显低于低龄组（P〈0．05）．食管炎患者比例明显高于低龄组（P〈0．05）。两组均少见再出血和需行急诊手术止血者。高龄组并发症发生率（P=0．05）和死亡率高于低龄组（P〈0．05）。高风险特征型、人院血尿素氮升高、再出血、严重合并症与高龄组患者死亡相关（P〈0．05）。多因素分析示严重合并症是高龄组患者的独立死亡危险因素（P〈0．05）。结论：老年AUGIB患者再出血和急诊手术率均相对较低，高龄患者预后较差，严重合并症是造成高龄患者死亡的主要因素。

Background： The prevalence of acute upper gastrointestinal bleeding （AUGIB） in elderly patients has been increasing rapidly in recent years. Aims： To evaluate the etiology, clinical outcome and main risk factors of death in elderly patients with AUGIB. Methods： Three hundred and seventy-eight elderly patients with AUGIB admitted from Jan. 2007 to Jan. 2010 were enrolled. Patients were divided into younger group （60-80 years old, n=231） and aged group （〉80 years old, n= 147）. Basic clinical characteristics, emergency diagnosis and treatment and clinical outcome were analyzed retrospectively, and risk factors of death in aged patients were screened. Results： Co-morbidity was more common in aged group （P〈0.05）. The main cause of bleeding was peptic ulcer in both groups. There were less patients with variceal bleeding and more patients with oesophagitis in aged group （P〈0.05）. Rebleeding and emergency surgery were uncommon in both groups. Complications （P=0.05） and mortality （P〈0.05） were more common in aged group. The presence of high risk stigmata, higher blood urea nitrogen level on admission, rebleeding and severe co-morbidity were related to mortality （P〈0.05）, and multivariate analysis showed severe co-morbidity was an independent risk factor of death in aged patients （P〈0.05）. Conclusions： Rebleeding and emergency surgery are relatively less occurred in elderly AUGIB patients. Aged patients may have a poor prognosis, and severe co-morbidity may be the main cause of death in those patients.