336例海勤人员上消化道出血临床分析

Clinical analysis of 336 cases of upper digestive tract homorrhage in the shipboard personnel

目的 探讨海勤人员发生上消化道出血的临床特点、诱因和病因,为其针对性防治提供依据.方法 回顾性分析336例海勤人员上消化道出血的临床资料,并与同时期同年龄段的971例非海勤人员上消化道出血的病例进行对比分析.结果 海勤人员上消化道出血的年龄主要在30岁以下,而非海勤人员主要在30岁以上.引起海勤人员上消化道出血的主要诱因为晕船（58.6％）,其次为过度疲劳（占10.2％）、精神紧张（占8.6％）和饮酒（占7.7％）,与服用非甾体类药物（NSAIDs）关系不明显,差异无统计学意义（P＞0.05）.而非海勤人员上消化道出血的主要诱因为饮酒和服用NSAIDs,也与过度疲劳、精神紧张和暴食关系密切,差异有统计学意义（P＜0.05）.海勤人员上消化道出血的主要病因是消化性溃疡,次要病因为胃黏膜糜烂和贲门撕裂;非海勤人员上消化道出血的主要病因也是消化性溃疡.此外,胃底-食管静脉曲张、胃黏膜糜烂和胃癌也是消化道出血的常见原因（共占41.8％）.结论 海勤人员上消化道出血的主要诱因为晕船,主要病因则为消化性溃疡,为防治提供了依据.

Objective To investigate clinical features,induction factors and causes of upper digestive tract homorrhage in the shipboard personnel,so as to provide evidence for its prevention and treatment.Methods Clinical data of 336 cases with upper digestive tract homorrhage among the shipboard personnel were analyzed retrospectively.At the same time,971 cases of upper digestive tract homorrhage that occurred in the non-shipboad personnel with the same age catogery were selected as control.Results The shipboard personnel with upper digestive tract homorrhage were mostly under the age of 30,while the non-shipboard personnel who had the same problem were older than 30.Main induction factors of upper digestive tract hemonrhage among the shipboard personnel were：motion sickness （accounting for 58.6％）,next excessive fatigue （accounting for 10.2％）;then mental stress （accounting for 8.6％）,and finally alcoholism （accounting for 7.7％）.Research findings revealed that the disorder was not directy related to the application of nonsteroidal antiinflammtory drugs （NSAIDs）.On the other hand,main induction factors of upper digestive tract hemorrhage in the non-shipboard personnel were：alcoholism and the application of NSAIDs,and the disorder was also closely related with excessive fatigue,mental stress and excessive eating.The main causes of upper digestive tract hemorrhage among the shipboard personnel were peptic ulcer,gastric mucosal erosion and cardia laceration,while the main reason for upper digestive tract homorrhage among the non-shipboard personnel was also peptic ulcer.In addition,gastro-esophageal varices,gastric mucosal erosion and gastric cancer were also common causes for the disorder （accouting for 41.8％）.Conclusions The main induction factor of upper digestive tract homorrhage among the shipboard personnel was motion sickness and the main cause of the disease was peptic ulcer.For this reason,measures should be taken to guard against motion sickness,e.g.strengthening anti-seasickness exercise,and administering medication and acupuncture when motion sickness occurred.The prevention and treatment of motion sickness would help to reduce the occurrence of peptic ulcer.For the patients with known peptic ulcer,the administration of mucosal protective agent and a proton pump inhibitor could achieve satisfactory results.