上消化道出血827例结局分析

Retrospective outcome analysis of 827 patients with upper gastrointestinal hemorrhage

目的 了解上消化道出血的原因、治疗药物及其预后等方面的逐年演变过程，为今后诊治本病提供参考．方法 回顾性总结我院１７ ａ 来收治的８２７ 例次上消化道出血，进行逐年纵横对比分析．结果 十二指肠球部溃疡是历年上消化道出血的首要原因，胃溃疡、肝硬变、Ｍａｌｌｏｒｙ Ｗｅｉｓｓ 综合征、急性胃粘膜病变则交替成为第２ 位出血原因；内镜诊断率和急诊内镜率逐年提高，１９９８年达到８０ ％ ，内镜下见出血者占内镜检查的２４－３ ％ ，而见到活动性出血者仅占内镜检查者的１４－９ ％ ；内镜下止血１０８ 例次，成功率１００ ％ ；１９９４ 年前治疗药物主要为云南白药和甲氰咪胍，之后，随着立止血、质子泵抑制剂（ＰＰＩ） 、法莫替丁、雷尼替丁等药物使用的逐渐增多，前二者的使用逐渐减少，善得定多用于肝硬变出血；住院天数和止血天数呈逐年下降的趋势，但幅度微小；雷尼替丁、法莫替丁、ＰＰＩ、立止血、善得定的使用以及及时的内镜检查和内镜下治疗在提高止血效果、缩短住院天数、降低死亡率方面可能起到了一定作用．结论 大多数上消化道出血者在入院时已自行止血，患者的预后在某种意义上主要取决于疾病本身和病情的轻重，药物的干预有一定作用，但比较有限。

AIM To reveal the evolution of the causes, medication and prognosis of upper gastrointestinal hemorrhage. METHODS Medical records of 827 consecutive hospitalized patients with upper gastrointestinal hemorrhage were reviewed by correlation analysis year after year. RESULTS Duodenal ulcer was the first cause of upper gastrointestinal hemorrhage. Gastric ulcer, cirrhosis, Mallory Weiss syndrome or acute gastric mucous lesion was the second cause of the illness alternatively. The rate of endoscopy and emergent endoscopy has been going up year after year and got up to 80% in 1998. Bleeding and active hemorrhage, respectively were found in 24 3% and 14 9% of the patients underwent endoscopy before medication. Endoscopic hemostasis was performed in 108 patients by spraying hemostatics and a good response was achieved subsequently. Hemostatics were mainly cimetidine and yunnan baiyao before 1994. Reptilase, PPI, famotidine and ranitidine were used increasingly while cimetidine and yunnan baiyao were used decreasingly. Octreotide was used in patients with cirrhosis commonly. The length of hospital stay and the period from admission to bleeding cease tended to be shorter year by year, but the reduction rate was small. The uses of ranitidine, famotidine, PPI, reptilase, octreotide, early endoscopy and endoscopic therapy may play a role in improving the therapeutic effect of hemostasis, reducing the hospitalization and the mortality. CONCLUSION The bleedings have stopped in the majority of the patients with upper gastrointestinal hemorrhage upon admission. The prognosis of the patients depends on the diseases themselves and their severities, and medication plays a limited role in improving the prognosis. Therefore, what medicine should be used clinically depends upon the specific diseases and causes. There is no need to seek to use new and expensive medicine.