严重急性呼吸综合征合并消化道出血的临床特点与影响因素

Clinical characteristics of gastrointestinal hemorrhage in SARS and factors affecting its occurrence

目的 探讨严重急性呼吸综合征(SARS)合并消化道出血的临床特点与影响因素。方法 回顾性分析与比较我院收治的SARS患者中合并消化道出血者的临床资料。结果 220例SARS患者中并发消化道出血20例,占9％,出血发生在病程的5-35d。5例有呕血或黑便,15例粪潜血阳性。经法莫替丁、奥美拉唑、立止血、凝血酶和输血治疗,16例7-10 d内出血停止,4例因SARS合并呼吸衰竭死亡。在预防性服用H2受体阻滞剂组消化道出血率低于未预防性服药者(P<0.01)。伴明显精神症状、低氧血症、以及T淋巴细胞亚群CD3+计数低下者消化道出血率较高(P<0.05)。而应用糖皮质激素剂量的大小以及性别、年龄、多肺叶受损、肝功异常、血小板减少,T淋巴细胞亚群CD4+CD8+计数减低等因素与对照组比较差异无显著性。结论 低氧血症、精神恐惧、免疫功能低减在SARS患者病程中为诱发消化道出血的重要因素;H2受体阻滞剂法莫替丁对预防SARS患者消化道出血有一定作用,对明显缺氧的危重患者,为预防出血应使用更强抑酸剂。

Objective To study the clinical characteristics of gastrointestinal (GI) hemorrhage in SARS and factors affecting its occurrence. Methods Retrospective study on clinical data of SARS cases complicated with gastrointestinal hemorrhage admitted to our hospital. Results Of 220 SARS cases gastrointestinal hemorrhage occurred in 20 patients (9% ) , with 13 males, 7 females, age ranged 19 -83 years (50 ±20) , onset at the 5th to 35th day of illness (22±9) , hematemesis/melena in 5 cases, positive occult blood test in 15. After treated with famotidine, omeprazole, reptilase and thrombin bleeding stopped in 16 cases within 7 to 10 days. Four cases died of respiratory failure. Rate of hemorrhage was lower in patients receiving prophylactic therapy with H2 receptor blocker famotidine than those without prophylactic therapy (P <0. 01). Anoxia, prominent mental symptoms, and low CD3+ T lymphocytes indicated a higher incidence of hemorrhage with respect to the controls, while dosage of glucocorticosteroid used, sex, age, number of pulmonary lobes affected, liver function abnormality, thrombocytopenia, and low CD4+ /CD8+ T lymphocyte level were the factors do not having the influence on the development of gastrointestinal bleeding. Conclusion Anoxia, mental distress, low immune function constitute factors precipitating GI hemorrhage in SARS; H2 receptor blocker famotidine is useful in its prevention. In critical patients with marked anoxia the use of intense agents omeprazole in suppressing acid secretion is recommended.