45例突发无痛性大量便血的卧床患者的临床资料分析

Sudden-onset,painless,and massive hematochezia in bedridden patients:a case series of 45 patients

目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进行回顾性分析并按照出血原因的不同进行归类整理。结果粪性溃疡26例,包括19例多发溃疡、7例单发溃疡,患者平均年龄为(68.3±14.6)岁,中位卧床时间为12.0(9.0,19.3)d,使用抗凝、抗血小板药物的有12例。急性出血性直肠溃疡综合征(AHRUS)15例,包括6例多发溃疡、9例单发溃疡,患者平均年龄为(65.7±11.5)岁,中位卧床时间为10(8,17)d,使用抗凝、抗血小板药物的有7例。粪性溃疡、AHRUS患者采用电子结肠镜下钛夹夹闭止血、经肛门缝合结扎止血或(电子结肠镜下电凝后)凡士林纱布填塞压迫止血等方式处理后,出血完全控制。异物损伤2例,考虑原因分别为开塞露操作不当、灌肠操作,经肛门缝合结扎止血后出血得以控制。直肠憩室1例,予以蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后出血得以控制。直肠癌1例,予蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后症状好转,后由于直肠癌基础疾病,患者家属放弃进一步治疗,患者死亡。结论临床中应对突发无痛性大量便血予以足够重视,早期发现并积极处理对患者的临床转归具有重要的意义。对于老年卧床患者、合并严重基础疾病的卧床患者,要注意考虑粪性溃疡、AHRUS的可能。

Objectives To summarize the clinical data of 45 bedridden patients with sudden-onset,painless,and massive hematochezia and inform clinical treatment.Methods The analyses included 45 patients with hematochezia treated at our hospital between January 2010 and December 2020.All patients fulfilled the criteria of blood loss>400 m L and being bedridden≥7 days.Patients’clinical data were collected,analyzed,and categorized by the causes of hematochezia.Results Twenty-six patients were diagnosed with stercoral ulcer,including 19 patients with multiple ulcer and 7 with solitary ulcer;the mean(SD)age of these patients was 68.3(14.6)years with a median interval of being bedridden for 12.0(9.0,19.3)days;12 patients received anticoagulant and/or antiplatelet therapies.Fifteen patients had acute hemorrhagic rectal ulcer syndrome(AHRUS),including 6 with multiple ulcer and 9 with solitary ulcer;the mean(SD)age of these patients was 65.7(11.5)years,and the median interval of being bedridden for 10(8,17)days;7 patients received anticoagulant and/or antiplatelet therapies.The patients with stercoral ulcer or AHRUS were treated with titanium clamp under colonoscopy,transanal suture ligation,or Vaseline gauze compression(electrocoagulation under colonoscopy could be performed first);the bleeding was subsequently controlled.Two patients had foreign object damage,for which plausible causes included improper use of glycerine and enema;the bleeding was controlled after suture.One patient had rectal diverticulum;the bleeding was controlled after coloclysis with hemocoagulase and Vaseline gauze compression.One patient had rectal cancer,and bleeding was alleviated after coloclysis with hemocoagulase and Vaseline gauze compression;however,this patient died because the family refused further treatments.Conclusion Attention should be paid to patients with sudden-onset,painless,and massive hematochezia.Early identification and active treatment could significantly influence patients’prognoses.Stercoral ulcer and AHRUS should be considered for bedridden patients of older age or coexisting severe comorbidities.