366例上消化道出血患者临床特征分析

Analysis of clinical characteristics of 366 patients with upper gastrointestinal bleeding

目的:了解上消化道出血患者的临床特征,为今后防治上消化道出血提供依据。方法:分析2018年1月至2020年8月收治的366例上消化道出血患者的病案资料,描述患者总体临床特征,比较不同年龄、性别患者的临床特征。结果:(1)366例上消化道出血男性282例(77.05%),女性84例(22.95%);(2)患者年龄14~90岁,平均年龄(56.7±15.6)岁;(3)出血方式:呕血46例(12.57%),黑便173例(47.27%),呕血加黑便130例(35.52%),便血17例(4.64%);(4)病因:十二指肠溃疡122例(33.33%)、胃溃疡83例(22.68%)、食管胃底静脉曲张90例(24.59%)、复合性溃疡36例(9.84%)、胃癌14例(3.83%)、胃黏膜损伤10例(2.73%)、其他病因11例(3.01%);(5)治疗方面:内镜下止血124例(33.88%),转入ICU治疗15例(4.10%),外科或介入11例(3.01%),死亡7例(1.91%),Hp(+)101例(27.60%);(6)青年组、中年组男性上消化道出血率高于女性(P<0.05),老年组死亡率高于青年组、中年组(P<0.05);(7)病因构成:青年组、老年组以十二指肠溃疡构成比最高,中年组以食管胃底静脉曲张构成比最高(P<0.05),女性复合性溃疡比例高于男性(P<0.05)。结论:上消化道出血患者以中老年患者为主,常见病因为消化道溃疡、食管胃底静脉曲张,男性发病率高于女性,与其不良生活方式密切相关,对老年上消化道出血患者要控制出血同时兼顾基础疾病的治疗,减少并发症,降低病死率。

Objective:To understand the clinical characteristics of patients with upper gastrointestinal bleeding,and to provide evidence for the prevention and treatment of upper gastrointestinal bleeding in the future.Methods:The medical record data of 366 cases of upper gastrointestinal bleeding admitted from January 2018 to August 2020 were analyzed,with the overall clinical characteristics of the patients described,and the clinical characteristics of patients of different ages and genders compared.Results:Among the 366 cases of upper gastrointestinal bleeding,282 cases were males(77.05%)and 84 cases were females(22.95%);their ages were 14-90 years old and the average age was(56.73±15.61)years old;their bleeding patterns are as follows:46 cases of hematemesis(12.57%),173 cases of melena(47.27%),130 cases of vomiting+melena(35.52%),17 cases of hematochezia(4.64%);In terms of etiology,there were 122 cases of duodenal ulcer(33.33%),83 cases of gastric ulcer(22.68%),90 cases(24.59%)of esophageal and gastric varices,36 cases of compound ulcers(9.84%),14 cases of gastric cancer(3.83%),10 cases of gastric mucosal injury(2.73%),and 11 cases of other causes(3.01%);in terms of treatment,24 cases(33.88%)were treated with hemostasis under endoscopy,15 cases were transferred to ICU(4.10%),11 cases were treated with surgery or intervention(3.01)%),7 cases died(1.91%),and 101 cases were Hp(+)(27.60%);the upper gastrointestinal bleeding rate of the young and the middle-aged was significantly higher than that of women(P<0.05),and the mortality rate of the old group was significantly higher than that of the youth group and the middle-aged group(P<0.05);the composition of the duodenal ulcer was the highest in the middle-aged and elderly group,and the composition of esophageal and gastric varices was the highest in the middle-aged group(P<0.05);the proportion of females with compound ulcers in the composition was significantly higher than that of males(P<0.05).Conclusion:Patients with upper digestive bleeding are mainly middle-aged and elderly patients.The common causes are peptic ulcers,esophagal and gastric varices.The incidence rate of men is significantly higher than that of women,which is closely related to their poor lifestyle.For elderly patients with upper gastrointestinal bleeding,it is necessary to control bleeding,treat underlying diseases,reduce complications and reduce the mortality rate.