老年消化道出血414例临床分析及死亡风险评估  

A retrospective analysis of clinical characteristics and mortality of gastrointestinal bleeding in 414 elderly patients

作　　者：石卉[1] 吴本俨[1] 宫媛[1] 

机构地区：[1]解放军总医院南楼消化内科,北京100853

出　　处：《中华内科杂志》2011年第8期642-645,共4页Chinese Journal of Internal Medicine

基　　金：中央保健专项资金科研课题（B2009A105）

摘　　要：目的 分析老年消化道出血（GIB）患者的临床特点,评估其死亡风险因素.方法 回顾分析解放军总医院16年内（1994至2009年）414例老年GIB患者的临床资料,分析其临床特征及导致死亡的相关凶素.结果 入组患者年龄65～96岁,平均83.5岁.老年患者发生GIB的主要原因是消化性溃疡（33.1%,137/414）、胃十二指肠黏膜糜烂（28.5%,118/414）和肿瘤（21.0%,87/414）;主要临床症状为黑便（71.0%,294/414）;导致老年患者GIB的药物主要为非甾体消炎药（NSAIDs）,包括阿司匹林（11.1%,46/414）、对乙酰氨基酚（8.9%,37/414）和吲哚美辛（1.9%,8/414）.药物导致GIB的比例以及胃十二指肠黏膜糜烂导致GIB的比例在2004-2009年份段明显增加（P〈0.05）.有58例患者因GIB在30 d内死亡,30 d病死率为14%.本组老年GIB患者中,死亡患者的年龄、发生GIB时舒张压、心率、出血量及Hb与未死亡者相比差异明显（P〈0.001）.肝硬化、门静脉高压导致GIB的老年患者,以及合并心力衰竭、肾衰竭是影响30 d病死率的相关因素.结论 老年GIB患者30 d病死率与高龄、合并症及全身状况密切相关.Objective To analyze clinical characteristics of patients with gastrointestinal bleeding （GIB）and the death-related risk factors.Methods A retrospective analysis Was conducted in 414 patients hospitalized for GIB during a 16-year period of 1994 to 2009.Logistic regression analysis identified predictors of mortality.Results The mean age of the 414 patients is 83.5 years old,ranging from 65 to 96years old.The main causes of GIB were peptic ulcer（33.1%,137/414）,gastroduodenal mucosal erosion （28.5%,118/414）and tumor（21.0%,87/414）.The main symptom was melena（71.0%,294/414）.Drugs that induced GIB were mainly non-steroidal anti-inflammatory drugs,including aspirin（11.1%,46/414）,acetaminophen（8.9%,37/414）and indomethacin（1.9%,8/414）.14%of patients（58/414） died of GIB in 30 days.The proportion of drug-induced GIB and gastroduodenal mucosal erosion caused GIB had increased significantly during the period of 2004 to 2009（P〈0.05）.Analysis of 30-day mortality risk showed advanced age,low diastolic blood pressure,high heart rate,low hemoglobin levels at presentation and hemorrhage volume in dead GIB elderly patients were significantly different compared with GIB elderly patients alive.Presence of severe comorbidity（heart failure and renal failure）and caused by cirrhosis and portal hypertension in GIB elderly patients were the only independent predictors of 30-day mortality （P〈0.001）.Conclusion Death of GIB patients occurred predominantly in elderly patients with severe comorbidities and systemic conditions at presentation.

关 键 词：胃肠出血 老年人 病死率 回顾性研究 

分 类 号：R57[医药卫生—消化系统]