非甾体类抗炎药致急性上消化道出血的临床观察

Clinical analysis of non steroidal anti-inflammatory drugs in the treatment of acute upper gastrointestinal bleeding

目的观察非甾体类抗炎药(NSAIDs)致急性上消化道出血(AGUB)的临床特征。方法选择NSAIDs致AGUB患者40例作为观察组,另选择同期非NSAIDs胃黏膜糜烂出血的AGUB患者40例作为对照组,比较2组患者性别、年龄、临床症状、相关实验室检查、胃镜检查、住院时间及病死率。结果 2组年龄、无消化系统症状发生率比较差异均有统计学意义(P<0.05);2组性别、血红蛋白水平、住院时间、病死率比较差异均无统计学意义(P>0.05)。观察组病变性质为多发性、糜烂性病变、Hp感染阳性、病灶位于胃部发生率均高于对照组,差异均有统计学意义(P<0.05);2组Forrest分级Ⅰ~Ⅱ级比较差异无统计学意义(P>0.05)。结论 NSAIDs致AGUB临床比较常见,具有其特殊的临床及内镜表现,根据特点及早实施针对性措施:严格掌握NSAIDs应用指征、尽可能使用非NSAIDs类镇痛剂、必要时使用抑酸药物或胃黏膜保护药物、使用COX-2特异性抑制剂等,可预防及减少AGUB的发生。

Objective To observe the clinical features of acute upper digestive tract hemorrhage(AGUB） caused by non-steroidal anti-inflammatory drugs(NSAIDs）. Methods 40 patients with NSAIDs related AGUB were selected as observation group,In the same period,40 patients with non NSAIDs gastric mucosal erosions and bleeding were treated with AGUB as control group,the gender,age,clinical symptoms,related laboratory tests,gastroscopy,length of stay,and mortality were compared between the 2 groups. Results There was significant difference in the incidence of age and non-digestive system symptoms between the two groups(P〈0. 05）; There was no significant difference in gender,hemoglobin level,length of stay,and mortality between the two groups(P〈0. 05）. The incidence of multiple lesions,erosive lesions,positive Hp infection,and lesions in the stomach of the observation group was higher than that of control group,and the differences were statistically significant(P〈0. 05）; There was no significant difference in the two groups of Forrest grade Ⅰ-Ⅱ grade(P〉0. 05）.Conclusion The clinical manifestations of AGUB caused by NSAIDs are relatively common,with its special clinical and endoscopic features,according to the characteristics of early implementation of targeted measures： strict control of NSAIDs indications,the use of non-NSAIDs type analgesics,if necessary,use of acid suppression drugs or stomach Mucosal protection drugs,the use of COX-2 specific inhibitors,can prevent and reduce the occurrence of AGUB.