老年人上消化道出血245例临床分析

Clinical Analysis of 245 Cases of Senile Upper Gastrointestinal Bleeding

目的探讨老年人上消化道出血的临床特点。方法回顾性总结分析黄山市人民医院2008年1月-2010年12月间收治的245例经胃镜、X线钡餐确诊上消化道出血老年患者临床资料,并与同期非老年患者295例比较。结果老年人上消化道出血病因中主要为胃溃疡,其次为胃癌和食管静脉曲张破裂,而非老年患者以十二指肠溃疡最多见,其次为胃溃疡和食管静脉曲张破裂。老年人上消化道出血伴随疾病和发生低血压或休克较多(P<0.05);使用阿司匹林或非甾体类抗炎药物,老年组25例,非老年组12例(P<0.05);老年组死亡13例,病死率为5.33%,非老年组死亡3例,病死率为1.01%(P<0.05)。结论老年人上消化道出血伴随疾病和并发症多,病因仍以消化性溃疡为多见,同时警惕胃癌的存在。详细询问病史,全面体格检查,常规进行大便隐血试验,尽早胃镜检查明确诊断。慎用NSAIDs,及早诊治合并症,降低病死率。

Objective To analyze the clinical features of the upper gastrointestinal bleeding in elderly patients. Methods The clinical features of 245 aged patients with upper gastrointestinal bleeding confirmed by gastroscope or X-ray barium meal from January 2008 to December 2010 were analyzed retrospectively, and was compared to the results of 295 non-geriatric patients. Results The main cause of upper gastrointestinal bleeding in elderly patients was gastric ulcer, followed by gastric cancer and esophagus varicosity breakage. While the main cause in non-geriatric patients was duodenal ulcer, gastric ulcer and esophagus varicosity breakage. The aged patients with upper gastrointestinal bleeding had more underlying diseases and complications（ hypotension or shock） ,P 〈0.05. The cases taking aspirin or non-steroidal anti-inflammatory drugs was 25 in the elderly group and 12 in the non-elderly group,P 〈0.05.3 cases died in the elderly group with a mortality rate of 5.33% ,while 3 cases died in the nonelderly group with a mortality was of 1.01% （ P 〈 0.05 ）. Conclusion The aged patients with upper gastrointestinal bleeding have more underlying diseases and complications. The main cause was peptic ulcer and gastric cancer. To collect patient history in detail, conduct physical examination fully and take route stool occult blood test and timely gastroscope examination, early diagnosis and treatment of complications can reduces the mortality rate. The use of NSAIDs should be cautioned.