急诊上消化道出血186例临床分析

Clinical Analysis of 186 Patients with Emergency Upper Gastrointestinal Hemorrhage

目的:探讨急诊科上消化道出血的病因构成及特点。方法:回顾性分析我科2010年1月至2012年1月诊治的186例上消化道出血患者的临床资料。结果:(1)上消化道出血主要病因为消化性溃疡46.9%、急性胃黏膜病变12.7%、肝硬化9.0%、胃癌7.2%,贲门撕裂症6.0%。(2)急诊内镜诊断明确的阳性率(95.6%)显著高于非急诊内镜(81.3%),P<0.01。(3)服用非甾体消炎药(NSAIDs)患者急性胃黏膜病变发生率(39.5%)明显高于未服用者(4.1%),P<0.01;服用NSAIDs患者消化性溃疡发生率(52.6%)虽高于未服用者(39.2%),但差异无统计学意义,P>0.05。结论:服用NSAIDs是上消化道出血的重要原因,急性胃黏膜病变发生率较前有所增加,急诊内镜检查有助于上消化道出血的诊断。

Objective： To investigate the causes and clinical feature of patients with upper gastrointestinal bleeding in emergency department. Methods：The clinical data of 186 patients with upper gastrointestinal bleeding were analyzed from Jan 2010 to Jan 2012. Results： （1） The main causes of upper gastrointestinal bleeding were peptic ulcer 46.9% ,acute gastric mucosal lesion 12.7% ,cirrhosis of liver 9.0% ,gastric carcinoma 7.2% ,Mallory- Weiss syndrome 6.0%. （2） The patients who took emergency endoscopy could be diagnosed than those patients who did not （ 95.6% vs 81.3%, P 〈 0.01）. （3） The incidence of acute gastric mucosal lesion in patients taking NSAIDs was significantly higher than that in patients not taking （39.5% vs 4.1%,P 〈 0.01）.The incidence of peptic ulcer in patients taking NSAIDs was higher than that in patients not taking （52.6% vs 39.2% ,P 〉 0.05）. Conclusions： NSAIDS is one of the most important causes of upper gastrointestinal hemorrhage. The incidence of acute gastric mucosal lesion significantly increased. Emergency endoscopy is helpful to the diagnosis of upper gastrointestinal bleeding.