高危消化性溃疡出血患者再出血的危险因素分析

Risk factors of rebleeding in patients with high-risk peptic ulcer bleeding

目的探讨高危消化性溃疡出血(PUB)患者再出血的危险因素。方法回顾性分析2010年3月至2020年4月宁夏医科大学总医院及心脑血管病医院收治的262例高危PUB患者的临床资料,分析其再出血的危险因素。结果再出血组出现休克、输血量≥1000 mL的比例明显高于未再出血组,血红蛋白(HGB)、红细胞压积(HCT)、血清白蛋白(ALB)均低于未再出血组,差异均有统计学意义(P<0.05)。两组AIMS65、罗卡尔(Rockall)评分、格拉斯哥-布拉奇福德(Glasgow Blatchford)评分,溃疡位于胃角、十二指肠和吻合口的比例比较差异有统计学意义(P<0.05)。多因素分析显示,休克(OR=5.338,95%CI:2.456~11.600,P<0.001)、输血量≥1000 mL(OR=3.387,95%CI:1.424~8.054,P=0.006)、低蛋白血症(OR=0.897,95%CI:0.836~0.963,P=0.003)、十二指肠溃疡(OR=0.239,95%CI:0.080~0.719,P=0.011)及未使用钛夹止血(OR=0.333,95%CI:0.129~0.858,P=0.023)是再出血的独立危险因素。结论休克、输血量≥1000 mL、低蛋白血症、十二指肠溃疡是影响高危PUB患者早期再出血的独立危险因素,早期钛夹止血可有效降低再出血风险。

Objective To investigate the risk factors of rebleeding in the patients with peptic ulcer bleeding(PUB).Methods The clinical data of 262 patients with high-risk PUB admitted and treated in the General Hospital of Ningxia Medical University and Cardiocerebrovascular Diseases Hospital from March 2010 to April 2020 were retrospectively analyzed, and the risk factors of rebleeding were analyzed.Results The proportions of shock appearance, blood transfusion volume ≥1 000 mL in the rebleeding group were significantly higher than those in the non-bleeding group, hemoglobin(HGB),hemotocrit(HCT) and serum albumin levels were lower than those in the non-rebleeding group, and the differences were statistically significant(P<0.05).The AIMS65 scores, Rockall score, Glasgow Blatchford score and proportions of rebleeding of ulcers located in gastric angle, duodenum and anastomotic orifice had statistical differences(P<0.05).The multivariate analysis showed that shock(OR=5.338,95%CI:2.456-11.600,P<0.001),blood transfusion volume ≥1 000 mL(OR=3.387,95%CI:1.424-8.054,P=0.006),hypoproteinemia(OR=0.897,95%CI:0.836-0.963,P=0.003),duodenal ulcer(OR=0.239,95%CI:0.808-0.719,P=0.011) and hemostasis without using titanium clips(OR=0.333,95%CI:0.129-0.858,P=0.023) were the independent risk factors for rebleeding.Conclusion Shock, blood transfusion volume ≥1 000 mL,hypoproteinemia and duodenal ulcer are the independent risk factors affecting early rebleeding in high-risk patients with peptic ulcer bleeding.Early titanium clip hemostasis could effectively reduce the risk of rebleeding.