1187例上消化道出血急会诊的病因分析

Analysis of the cause of emergency consultation in 1187 cases of upper gastrointestinal bleeding

目的评估上消化道出血急会诊病例的出血病因构成。方法回顾性研究2018年6月—2019年6月解放军总医院第一医学中心消化内科急会诊中,上消化道出血病例,采集患者相关临床资料,分析不同性别、不同年龄患者的病因构成。结果本研究共纳入1187例急会诊中上消化道出血病例,其中男性组752例,女性组435例;中青年组(<60岁)628例,老年组(≥60岁)559例。常见病因依次是肝硬化失代偿门脉高压480例,非甾体类抗炎药(NSAID)相关急性胃黏膜病变310例,消化性溃疡177例,恶性肿瘤117例,血管畸形34例,贲门黏膜撕裂综合征19例,胃间质瘤16例,另有不明原因34例。男性组消化性溃疡占比高于女性组,差异有统计学意义(P<0.05)。中青年组肝硬化失代偿期门脉高压、消化性溃疡、贲门黏膜撕裂综合征的构成比均高于老年组,NSAID相关急性胃黏膜病变、恶性肿瘤的构成比低于老年组,差异有高度统计学意义(P<0.01)。结论年龄和性别因素可以影响急性上消化道出血的病因构成。

Objective To evaluate the cause of bleeding in emergency consultations with upper gastrointestinal bleeding.Methods A retrospective study of cases of upper gastrointestinal bleeding in the emergency consultation of Department of Gastrointestinal,the First Medical Center,Chinese People′s Liberation of China General Hospital from June 2018 to June 2019,relevant clinical data of patients were collected,and the etiological composition of patients of different genders and ages were analyzed.Results A total of 1187 cases of upper gastrointestinal bleeding in emergency consultation were included in this study,including 752 cases in the male group and 435 cases in the female group;628 cases in the young and middle-aged group(<60 years old),and 559 cases in the elderly group(≥60 years old).The common causes were 480 cases of decompensated portal hypertension in liver cirrhosis,310 cases of non-steroidal anti-inflammatory drug(NSAID)related acute gastric mucosal disease,177 cases of peptic ulcer,117 cases of malignant tumor,and 34 cases of vascular malformations,19 cases of cardiac mucosal tear syndrome,16 cases of gastric stromal tumor,and 34 cases of unknown cause.The proportion of peptic ulcers in the male group was higher than that in the female group,and the difference was statistically significant(P<0.05).The proportions of portal hypertension,peptic ulcer,and cardiac mucosal tear syndrome during decompensated liver cirrhosis in the young and middle-aged group were higher than those of the elderly group,while the proportions of NSAID-related acute gastric mucosal lesions and malignant tumors were lower than those of the elderly group,and the differences were highly statistically significant(P<0.01).Conclusion Age and gender factors can affect the cause of acute upper gastrointestinal bleeding.