胃部肿瘤出血性休克发病的相关因素分析与对症干预

The related factors and symptomatic intervention analysis for the stomach cancer with hemorrhagic shock

目的分析胃部肿瘤出血性休克的发病相关因素，探讨限制性液体复苏的预后效果。方法选择2010年9月至2013年11月问收治的胃部肿瘤患者120例，对所有患者的流行病学状况与休克发病情况进行调查，并且对休克患者进行了限制性液体复苏干预。结果120例患者中出现出血性休克18例，发病率为15．0％。单因素分析显示，出血性休克发生的相关危险因素为年龄、酗酒、抗生素应用情况、血乳酸水平、病程、合并高血压、体重指数等（P〈0．05）。非条件Logistic回归分析结果显示，年龄、抗生素应用情况、血乳酸水平为出血性休克的独立危险因素（P〈0．05）。胃部肿瘤出血性休克患者在液体复苏后平均中心动脉压控制在55～60mmHg之间，心率控制在120-130次／min之间，不同时间点比较，差异无统计学意义（P〉0．05）。复苏后患者的血清IL-2和IFN-α含量明显下降，与复苏前差异有统计学意义（P〈0．05）。结论胃部肿瘤出血性休克的发病与年龄、抗生素应用情况、血乳酸水平明显相关，限制性液体复苏的应用能保持生命体征的稳定，其作用的发挥与降低炎症因子的表达有关。

Objective To investigate the related factors of incidence of stomach cancer with hemor- rhagic shock, and discuss the prognosis effect of the fluid resuscitation. Methods 120 patients with gastric cancer from hospitalized from September 2010 to November 2013 were selected, the epidemiological situation and the incident of shock in all patients were investigated and the shock patients were given the fluid resus- citation intervention. Results 18 cases occurred hemorrhagic shock in 120 patients, the incidence rate was 15.0%. Risk factors of univariate analysis associated with hemorrhagic shock were age, alcoholism, use of antibiotics, blood lactate levels, duration of hypertension and body mass index （ P 〈 0. 05 ）. Logistic regres- sion analysis showed that age, use of antibiotics, blood lactate levels were the major independent risk factors for cause hemorrhagic shock （ P 〈 0. 05 ）. After limited fluid resuscitation, the mean arterial pressure were controlled between 55 -60mmHg and heart rate were controlled between 120 - 130 beats / min, and the difference at different time points were not statistically significant （ P 〉 0. 05 ）. After resuscitation, the serum IL-2 and IFN-ct levels were significantly decreased in patients compared with pre-recovery and the difference were statistically significant （P 〈 0. 05）. Conclusion Gastric cancer of hemorrhagic shock were signifi- cantly related to age, use of antibiotics, blood lactate levels, The application of fluid resuscitation can main- tain stable vital signs ,which were related to decreased expression of inflammatory factors.