自发性脑出血并发消化道出血216例临床分析

Clinical analysis of 216 cases with gastrointestinal bleeding after spontaneous intracerebral hemorrhage

目的分析自发性脑出血消化道出血（ICH）患者的危险因素及应激性溃疡预防措施（SUP）的应用情况。方法回顾性分析2008年6月-2009年12月北京天坛医院急诊科及神经内科收治的808例ICH患者病历资料，其中消化道出血组216例及无消化道出血组592例。比较两组年龄、性别、既往病史、格拉斯哥昏迷评分（GCS）评分、头颅CT结果（出血部位、血肿体积、破入脑室与否）、治疗情况、SUP应用情况、脓毒症、住院时间、住院病死率等资料的差异。Logistic回归分析消化道出血发生的危险因素。结果①808例ICH患者中，消化道出血发生率为26．7％（216／808），其中3例（0．35％）为严重消化道出血。②消化道出血组患者住院时间及住院病死率均显著高于未并发消化道出血组，差异有统计学意义（P〈0．05或P〈0．01）。两组患者年龄、既往消化道性溃疡或出血、肾功能不全、GCS评分、出血部位、血肿体积、破入脑室与否及脓毒症等比较，差异均有统计学意义（P〈0．05或P〈0．01）。两组共有512例（63．4％）患者接受了SUP，接受SUP患者的消化道出血发生率显著高于未接受SUP患者，差异有高度统计学意义（P〈0．01）。③多因素Lo-gistic回归显示，年龄、血肿体积、GCS评分及脓毒症是消化道出血的独立预测因子。结论ICH后消化道出血发生率较高，但严重消化道出血少见。年龄、血肿体积、GCS评分及脓毒症是消化道出血的独立预测因子。SUP对于消化道出血的预防价值仍需进一步研究确立。

Objective To analyze the risk factors of gastrointestinal bleeding after spontaneous intracerebral hemorrhage （ICH） and the situation application of stress ulcer prevention （SUP）. Methods A retrospective review was conducted of the medical records of 808 ICH patients in Beijing Tiantan Hospital, Capital Medical University from June 2008 to December 2009 including 216 cases in gastrointestinal bleeding group and 592 cases in non-gastrointestinal bleeding group. The age, gender, anamnesis, GCS scores, head CT （bleeding position, hematoma volume, breaking into the ventricles or not）, treatment condition, application of SUP, pyohemia, hospital stays, hospital mortality rates between the two groups were compared. Risk factor for gastrointestinal bleeding were identified using Logistic regression analysis. Results ①The incidence of gastrointestinal bleeding was 26.7% （216/808）, including 3 cases of severe gastrointestinal bleeding （0.35%） in 808 cases of ICH. ② Hospital stays, hospital mortality rates in gastrointestinal bleeding group were higher than those in non-gastrointestinal bleeding group, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. The differences of age, digestive tract ulcer or bleeding, renal insufficiency, GCS scores, bleeding position, hematoma volume, breaking into the ventricles or not, pyohemia in the two groups were statistically significant （P 〈 0.05 or P 〈 0.01）. 512 cases were treated with SUP （63.4%）. The incidence of gastrointestinal bleeding in patients with SUP was higher than that in patients without SUP, the difference was statistically significant （P 〈 0.01）. ③Age, hematoma volume, GCS scores, pyohemia were the independent predictors of gastrointestinal bleeding according to the Logistic regression analysis. Conclusion Gastrointestinal bleeding occurs frequently following ICH, but severe event is rare. Age, GCS score, pyohemia and hematoma volume are independent predictors of gastrointestinal bleeding occurring after ICH.