急性非静脉曲张上消化道出血临床特征分析

Clinical characteristics of acute non-variceal upper gastrointestinal hemorrhage

目的分析急性非静脉曲张上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANNUGIB)病因构成、内镜下表现,探讨影响患者预后的危险因素。方法收集我院2005年1月-2010年12月已确诊因急性非静脉曲张上消化道出血(AN-VUGIB)首次入院且资料完整的患者临床资料,共计858例。出院后随访30 d,并将死亡或出院后30 d为临床研究终点,回顾性分析ANVUGIB临床特征。结果 (1)老年组发病率明显高于青、中年组,急性胃黏膜病变占老年组发病病因首位,而青、中年组中十二指肠球部溃疡占首位。(2)出血后行急诊胃镜(≤48 h)检查内镜下有出血征象明显多于>48 h的胃镜检查。(3)女性在十二指肠球部溃疡比率明显高于男性,复合性溃疡比率较男性高,男性在胃溃疡、胃癌、急性胃黏膜病变以及食管癌和Mallory-Wiess综合征比率高于女性。(4)老年组病死率明显高于青、中年组(6.8%、0、1.9%),老年组再出血发生率高于青、中年组(9.3%、4.4%、4.9%)。结论 ANVUGIB以高龄男性多见,青、中年组发病病因中十二指肠球部溃疡占首位,老年组发病病因以急性胃黏膜病变为首位。ANVUGIB老年患者死亡率和再出血率均高于青、中年组,急诊胃镜有助于ANVUGIB的诊断。

Objective To investigate the etiology,endoscopic characteristics of acute nonvariceal upper gastrointestinal bleeding,and analyze the risk factors for prognosis.Methods The clinical data of 858 patients of acute non-variceal upper gastrointestinal bleeding（ANVUGIB） from Jan.2005 to Dec.2010 were collected.A 30 days’ follow-up was discharged,and the clinical features of AUVUGIB were analyzed retrospectively at the destination or death.Results（1） The incidence of ANVUGIB in aged group was significantly higher than that in the younger group,and the main cause of ANVUGIB in aged group was acute gastric mucosal lesions,while the main cause of ANVUGIB was duodend vlcer in the younger group.（2） Emergency endoscopy within 48 hours after bleeding had more positive signs of bleeding.（3） The rate of duodenal ulcer and complex ulcer in women was significantly higher than that in men,while the rate of gastric ulcer,gastric cancer,esophageal cancer,acute gastric mucosal lesions and Mallory-Wiess syndrome in men was higher than that in women.（4） The mortality in aged group was significantly higher than that in the young,middle-aged group（6.8%,0 and 1.9%）,and the incidence of re-bleeding was higher than that in the younger group（9.3%,4.4%,4.9%）.Conclusion ANVUGIB is common in elderly men,the incidence of duodenal ulcer causes account for the most in the young middle aged group,while the acute gastric mucosal lesions is the main cause in the aged group.The rate of mortality and re-bleeding for ANVUGIB in elderly patients are greater than those in the younger group.The emergency endoscopy is recommended to diagnose ANVUGIB.