上消化道出血住院患者临床特征分析

Analysis of Clinical Features of Hospitalized Patients with Upper Gastrointestinal Bleeding

目的分析我院上消化道出血患者病因情况,比较中青年和老年患者上消化道出血临床特征,总结上消化道出血患者的治疗和预后情况,为临床工作提供一定的指导。方法回顾性分析2013年5月~2014年4月我院收治的上消化道出血患者的临床资料。观察上消化道出血患者发病季节,发病原因,比较老年患者与中青年患者住院时间、入院时Blatchford评分、输血情况,回顾患者治疗和预后情况。结果上消化道出血一年四季均可发病,其中4、11、12月份为发病高峰期,占全年总出血人数的33.00%。胃溃疡患者多集中在老年患者,而十二指肠溃疡患者多集中在中青年患者。老年患者的住院天数比中青年患者住院天数长,差异有统计学意义(P<0.05)。老年患者中,中高危患者比率高于中青年患者(88.23%vs72.34%),差异有统计学意义(P<0.05)。入院时老年患者Blatchford评分9(8,11)约等于中青年患者9(5,11)。入院时老年患者输血比例高于中青年患者(9.80%vs7.45%),但差异无统计学意义(P>0.05)。60例消化性溃疡患者有2例需行介入止血治疗,1例患者因胃溃疡合并胆管癌去世,其余保守治疗后好转。结论老年患者上消化道出血主要病因为胃溃疡,中青年患者主要病因为食管胃底静脉曲张破裂出血。老年患者住院时间、输血人次和中高危患者比率均高于中青年患者。

Objective To analyze the etiology of upper gastrointestinal bleeding in our hospital,compare the clinical features of upper gastrointestinal bleeding in young and old patients,and summarize the treatment and prognosis of upper gastrointestinal bleeding patients,and provide some guidance for clinical work.Methods The clinical data of patients with upper gastrointestinal bleeding admitted to our hospital from May 2013 to April 2014 were retrospectively analyzed.To observe the onset season of the upper gastrointestinal bleeding patients,the cause of the disease,compare the hospitalization time of elderly patients with young and middle-aged patients,the Blatchford score at admission,blood transfusion,and review the treatment and prognosis of patients.Results Upper gastrointestinal bleeding can occur all year round,with 4,11 and 12 months as the peak incidence,accounting for 33.00%of the total number of bleeding in the year.Patients with gastric ulcer are mostly concentrated in elderly patients,while patients with duodenal ulcer are mostly concentrated in young and middle-aged patients.The hospitalization days of elderly patients were longer than those of young and middle-aged patients,the difference was statistically significant(P<0.05).Among the elderly patients,the ratio of patients with moderate to high risk was higher than that of young and middle-aged patients(88.23%vs 72.34%),the difference was statistically significant(P<0.05).At the time of admission,the elderly patient's Blatchford score of 9(8,11)was approximately equal to that of young and middle-aged patients 9(5,11).The proportion of blood transfusion in elderly patients was higher than that in young and middle-aged patients(9.80%vs 7.45%),but the difference was not statistically significant(P>0.05).Of the 60 patients with peptic ulcer,2 patients required interventional hemostasis,and 1 patient died of gastric ulcer and cholangiocarcinoma,and the other patients improved after conservative treatment.Conclusion The main cause of upper gastrointestinal bleeding in elderly patients is gastric ulcer.The main cause of middle-aged and young patients is bleeding due to esophageal and gastric varices.The rate of hospitalization,transfusion,and intermediate-risk patients in older patients was higher than that of young and middle-aged patients.