非甾体抗炎药相关性上消化道出血临床分析

Clinical characteristics analysis of non-steroidal anti-inflammatory drugs associated upper gastrointestinal bleeding

目的探讨非甾体抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)相关性上消化道出血的临床特点,为预防非甾体抗炎药相关性上消化道出血的发生提供依据和措施。方法收集新疆医科大学附属中医医院急诊科2007年1月—2009年12月因上消化道出血住院的167例患者的临床资料。以出血前1周是否服用过NSAIDs将患者分为NSAIDs组和非NSAIDs组。分析NSAIDs组的服药的种类、服药原因、用药时间等,比较两组患者临床特征[年龄、性别、既往有无心血管疾病病史、溃疡病史、幽门螺杆菌(Helicobacter pylori,HP)感染情况],临床症状(腹痛、消化不良)以及胃镜表现。结果 167例中有39例(23.35%)出血前1周服用过NSAIDs。NSAIDs组服药种类以阿司匹林占多数(19例,占48.71%);用药时间以1周以内最多见(15例,占38.46%);服药原因以预防心脑血管疾病为主(17例,占43.59%)。组间比较:NSAIDs组年龄≥60岁患者所占比例高于非NSAIDs组(P<0.05);NSAIDs组既往心脑血管病史较非NSAIDs组多见(P<0.05);NSAIDs组出血前消化道症状不明显(P<0.05);胃镜下NSAIDs组以胃溃疡、糜烂性出血多见,非NSAIDs组以十二指肠溃疡多见,差异有统计学意义(P<0.05)。NSAIDs组出血量>1 000mL者所占比例高于非NSAIDs组,差异有统计学意义(P<0.05)。结论高龄、既往心脑血管病史、既往消化性溃疡病史为NSAIDs相关性上消化道出血的危险因素。NSAIDs相关性上消化道出血临床表现的特点为起病隐匿、无明显腹痛,且出血量大。

Objective To evaluate the clinical characteristics of non-steroidal anti-inflammatory drugs（NSAIDs） associated upper gastrointestinal bleeding.Methods Clinical data with upper gastrointestinal bleeding（167 cases） from January 2007 — December 2009 were collected from Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University.All patients were divided into two groups（NSAIDs group and non-NSAIDs group） based on whether consumed NSAIDs 1 week previous bleeding.The type,usage duration and the reasons of NSAIDs were analyzed in NSAIDs group.The clinical feature [age,gender,history of peptic ulcer and cardio-cerebral-vascular disease and Helicobacter pylori（HP） infection],clinical symptoms（stomachache,dyspepsia）,level of hemoglobin,hospital day and gastroscope feature were compared with two groups.Results One hundred and sixty seven patients with upper gastrointestinal bleeding were collected,39（23.35%） patients consumed NSAIDs 1 week before bleeding.In NSAIDs group,the most frequently used NSAIDs drug was aspirin（19 cases,accounted 48.71%）.Patients taken NSAIDs for more than 1 year accounted 38.46%,which were the most.To prevent cardio-cerebral-vascular disease was the main reason.There were more elders（≥60 years） in NSAIDs group than non-NSAIDs group;NSAIDs group were more likely to have a history of cardio cerebral vascular disease（P0.05）.Gastrointestinal symptoms were not distinct in NSAIDs group（P0.05）.There were more gastric ulcer in NSAIDs group,and also more gastric multiple ulcer than control group（P0.05）.There was more hospital stay and cost in NSAIDs group（P0.05）.Conclusion The risk factors of NSAIDs associated upper gastrointestinal bleeding were advanced age,history of peptic ulcer,cardio cerebral vascular diseases,and long term use of drugs,etc.