维持性血液透析患者并发消化道出血28例临床分析

Clinical analysis of 28 patients with gastrointestinal bleeding in maintenance hemodialysis

目的：探讨维持性血液透析患者并发消化道出血的病因及临床特点。方法回顾性分析28例血液透析并发消化道出血患者的临床资料，对出血的病因及临床特点进行分析总结。结果血液透析患者消化道出血发生率为20．9％，上消化道出血23例（82．1％），下消化道出血5例（17．9％）。上消化道出血原因中胃食管十二指肠黏膜糜烂渗血15例（65．2％），消化性溃疡8例（34．8％），幽门螺杆菌（Hp）感染率为66.7％（12／18）。消化道出血发生在血液透析进行3个月内10例（35．7％）。应用深静脉置管进行透析13例（46．4％），动静脉内瘘15例（53．6％）。出血患者预后，23例（82．1％）继续进行血液透析治疗，2例（7．2％）转为腹膜透析，3例（10．7％）死亡。结论血液透析患者消化道出血以上消化道出血居多，以胃食管十二指肠黏膜糜烂渗血为主，Hp 感染率较高，1／3以上的消化道出血发生在血液透析3个月内，内科综合治疗联合无肝素透析多数患者预后良好。

Objective To explore the reasons and clinical characteristics of gastrointestinal bleeding in maintenance hemodialysis patients.Methods Clinical data of 28 hemodialysis patients combined with gastrointestinal bleeding were retrospectively analyzed.The reasons and clinical characteristics of gastrointestinal bleeding were analyzed.Results The incidence rate of gastrointestinal bleeding in hemodialysis patients was 20.9%,hemorrhage of upper digestive tract in 23 cases （82.1%）and hemorrhage of lower digestive tract in 5 cases （17.9%）.The reasons of hemorrhage of upper digestive tract were mucosal erosion bleeding of gastric esophagus duodenum in 15 cases （65.2%）and peptic ulcer in 8 cases （34.8%）.The positive rate of helicobacter pylori infection was 66.7%（12 /18）.In 10 cases （35.7%）,gastrointestinal bleeding happened within three months after hemodialysis.Vascular access for hemodialysis were used by central venous catheterization in 13 cases （46.4%）and arteriovenous fistula in 15 cases （53.6%）.The prognosis of gastrointestinal bleeding in hemodialysis patients were continuing hemodialysis in 23 cases （82.1%）,turned to peritoneal dialysis in 2 cases （7.2%）and death in 3 cases （10.7%）.Conclusion The major reason of gastrointestinal bleeding in hemodialysis patients is hemorrhage of upper digestive tract.Mucosal erosion bleeding of gastric esophagus duodenum is major in hemorrhage of upper digestive tract.The positive rate of helicobacter pylori infection is higher.More than 1 /3 gastrointestinal bleeding happens within three months after hemodialysis.The prognosis of the majority of patients is good by internal medicine combined therapies and no heparin hemodialysis.