肠溶阿司匹林相关的上消化道出血150例临床分析

Clinical analysis of 150 cases of enteric-coated aspirin induced upper gastrointestinal bleeding

目的分析小剂量肠溶阿司匹林相关上消化道出血的临床特点、危险因素以及预后。方法回顾性分析2011年1月至2012年10月首都医科大学附属北京安贞医院收治的150例非静脉曲张性上消化道出血住院患者的临床资料，按出血是否与肠溶阿司匹林相关分为肠溶阿司匹林组（71例）和非肠溶阿司匹林组（79例），对2组患者的临床特点、危险因素及预后等进行分析并加以比较。结果肠溶阿司匹林组的上消化道出血患者年龄高于非肠溶阿司匹林组[（66±12）岁比（56±16）岁]，差异有统计学意义（P〈0．05）。肠溶阿司匹林组的急性胃黏膜病变的发生比例及幽门螺杆菌的感染比例均高于非肠溶阿司匹林组[18．3％（13／71）比3．8％（3／79），26．8％（19／71）比12．7％（10／79）]，差异均有统计学意义（均P〈0．05）。2组血红蛋白水平比较差异无统计学意义[（83±22）g／L比（90±25）g／L，P〉0．05]。止血时间及住院时间肠溶阿司匹林组明显长于非肠溶阿司匹林组[分别为（2．4±0．9）d比（1．7±1．3）d，（13±4）d比（10±4）d]，差异均有统计学意义（P〈0．05）。肠溶阿司匹林组中服用肠溶阿司匹林不足1个月的患者较服用时间〉1个月的患者血红蛋白水平低，止血时间较长，住院时间延长，差异均有统计学意义[（55±20）g／L比（86±20）g／L，（3．8±1．7）d比（2．2±0．6）d，（17．3±1．8）d比（12．3±3．6）d，均P〈0．01]。结论口服小剂量肠溶阿司匹林可增加上消化道出血的风险，且胃黏膜损伤较常见，患者出血量较大，预后较差。口服肠溶阿司匹林的高危患者服药前应评估其风险，清除幽门螺杆菌治疗、加用抗溃疡药物可降低其出血风险。

Objective To analyze the clinical features, risk factors, and prognosis of gastrointestinal bleeding associated with small doses .of aspirin. Methods The clinical data of 150 patients with non-variceal upper gastrointestinal bleeding hospitalized in Beijing anzhen hospital from January 2011 to October 2012 were retrospectively analyzed. All 150 patients were divided into aspirin group including 71 patients and non-aspirin group including 79 patients. The clinical features, risk factors, and prognosis of two group were analyzed and compared. Results The age of upper gastrointestinal bleeding in aspirin group [ （66 ± 12） old years ] was higher than that in non-aspirin group [ （56 ± 16） old years ], and there was significant difference （P 〈 0.05 ）. The proportion of the occurrence of acute gastric mucosal lesions and helicobacter pylori infection in aspirin group were higher than the proportion of that in non-aspirin group [ 18.3 % （ 13/71 ） vs 3.8 % （ 3/79 ）, 26.8 % （ 19/71 ） vs 12.7 % （10/79） ], and there were significant differences （ all P 〈 0.05）. The hemoglobin in two groups were not significantly different [ （83 ± 22） g/L vs （90 ± 25） g/L, P 〉 0.05 ]. The time of bleeding and hospitalization in aspirin group was significantly longer than those in non-aspirin group [ （ 2.4± 0.9 ） d vs （ 1.7 ± 1.3 ） d, （ 13± 4） d vs （ 10 ± 4） d ], which was significant difference （P 〈 0.05 ）. The patients took aspirin less than one months had less hemoglobin, took longer time of bleeding, stayed longer in hospital than the patients took aspirin more than one months in aspirin group [ （55 ± 20）g/L vs （86 ±20）g/L, （3.8 ±l.7）d vs （2.2 ±0.6）d, （17.3 ± 1.8）d vs （12.3 ±3.6）d], and there were significant differences （ all P 〈 0.01 ）. Conclusions Low-dose aspirin can increase the risk of gastrointestinal bleeding and gastric mucosal injury is common. The prognosis is poor because of large amount of bleeding. The patients at high risk of gastrointestinal bleeding should assess the risk of bleeding frequently. The treatment the helicobacter pylori and using anti-ulcer drugs before taking oral aspirin medication can reduce the risk of bleeding.