神经外科重症患者迟发型应激性消化道溃疡出血14例临床分析

The study of clinical analysis of 14 cases suffered from delayed stressful peptic ulcer bleeding in neurosurgery ICU

目的调查分析神经外科重症患者并发迟发型应激性消化道溃疡出血的危险因素、治疗及预后。方法选取2013年1月～2016年10月宣武医院神经外科重症监护室神经外科重症患者并发迟发型应激性消化道溃疡出血患者的临床资料,分析其发病的危险因素。结果共搜集应激性消化道溃疡出血病例28例,迟发型14例,非迟发型14例;与非迟发型应激性消化道溃疡出血相比,迟发型应激性消化道溃疡出血发病的可能性危险因素有PPI制剂的非常规预防使用(P=0.046)、非甾体类抗炎药的使用(P=0.004)、凝血功能的异常(P=0.000),高热(P=0.001),感染(P=0.012),住院时间的延长(P=0.008);治疗以胃肠减压、质子泵抑制剂标准剂量的使用、冰盐水加凝血酶灌洗、输血为主;2例迟发型应激性消化道溃疡出血患者发生失血性休克,无死亡病例。结论神经外科重症患者可发生迟发型应激性消化道溃疡,应该重视预防,可根据具体情况适当延长质子泵抑制剂的使用疗程,积极纠正异常的凝血功能,规范使用非甾体类抗炎药,积极控制体温并抗感染治疗。

Objective To investigate and analyze the risk factors,treatment and prognosis of patients with brain injury complicated by delayed stress peptic ulcer bleeding.Methods The clinical data of patients complicated by delayed stress peptic ulcer bleeding in Xuanwu Hospital NICU during the period from January 2013 to October 2016 were collected,risk factors were analyzed.Results 28 patients with stress peptic ulcer bleeding were collected,there are 14 delayed type cases and 14 cases of non delayed type;Compared to the non delayed type,Possible risk factors of delayed type cases were Lack of conventional prevention of PPI agents(P=0.046),the use of non steroidal anti-inflammatory drugs(P=0.004),abnormal blood coagulation function(P=0.000),high fever(P=0.001),infection(P=0.012),prolonged hospitalization time(P=0.008);the treatment of stress peptic ulcer bleeding mainly include gastrointestinal decompression,Standard dose using of proton pump inhibitors,lavage of Ice brine and thrombin,and blood transfusion;2 cases of delayed stress ulcer bleeding cause hemorrhagic shock,no patient died.Conclusion Delayed stress peptic ulcer bleeding could happen in severe patients in ICU of neurosurgery department,and more attention should be paid for prevention.Extend the use time of proton pump inhibitors,actively correct the abnormal coagulation function,canonical use of non steroidal anti-inflammatory drugs,and actively control the body temperature and carry out the anti-infection treatment according to the actual clinical situation.