老年患者消化性溃疡穿孔及出血后短期病死率的研究  

Research for short-term case fatality rate in gerontai patient after peptic ulcer perforation and bleeding

作　　者：梁艳斌[1] 符宏宇[2] 陈辉[2] 蒋晓渠[1] 

机构地区：[1]上海市第一人民医院分院急诊科,200081 [2]上海第二军医大学附属长海医院消化内镜中心

出　　处：《临床内科杂志》2012年第3期181-184,共4页Journal of Clinical Internal Medicine

摘　　要：目的研究消化性溃疡穿孔和出血后短期病死率与年龄的关系，并确定合并症对此关系的影响。方法收集2004年4月～2010年12月住院治疗并首次被诊断为消化性溃疡穿孔的患者295例和消化性溃疡合并出血患者1032例。根据住院病史及出院记录确定其诊断结果及是否死亡，溃疡的合并症及相关药物的使用信息通过住院病史获得。将两组患者分别分为65岁以下组、65—79岁组、80岁及以上组。计算年龄、性别和合并症与标准30天病死率的关系，用COX回归的方法评价老年患者与年轻患者30天死亡比值比（MRR）。结果295例消化性溃疡穿孔患者中年龄在65～79岁者107例（36．3％），80岁以上者73例（24．7％）；〈65岁的患者中标准30天病死率为3．5％，年龄在80岁以上的患者达到21．9％，校正MRR值达5．2（95％CI：4．3～6．8）。在1032消化性溃疡出血患者中，年龄在80岁以上者338例（32．8％），〈65岁患者的标准30天病死率为1．7％，年龄〉80岁的患者达8．3％，调整后的MRR为3．6％（95％CI：2．8—4．9）。分层分析显示，老年患者的高MRR与合并症的严重程度无关。结论衰老是一个独立于合并症、与消化性溃疡穿孔或出血预后不良存在强关联的预测因素。Objective To study the correlation of age with short-term case fatality rate in peptic ulcer perforation and bleeding, and to evaluate the effect of complications on this correlation. Methods Those hospitalized patients with a first-time discharge diagnosis of perforated peptic ulcer （295 cases） or bleeding peptic ulcer（ 1032 cases） from April lst,2004 to December 31st,2010 were recruited. Information about diagnosis, death, complications and medicine was obtained through the patient＇ s medical records. We devided peptic ulcer perforation and bleeding peptic ulcer patients in 2 groups and each group was divided into 3 groups according to the age： under 65,65 to 79 and above 80 years. We analyzed the correlation between age, gender and complications and standardized 30-day case fatality rates, and esti- mated adjusted 30-day mortality rate ratios（MRR） comparing elderly with younger patients by Cox＇ s re- gression analysis. Results Of the 295 cases with peptic ulcer, 107 cases was from 65 to 79 years group （36.3%） ,73 cases was from over 80 years group（24.7% ）. Standard 30-day mortality was 3.5% in patients less＇than 65 years old,patients over the age of 80 was up to 21.9% ,and the adjusted MRR was up to 5.2（95% CI：4.3-6.8）. Of 1032 patients with peptic ulcer bleeding,338 cases were ever 80 years of age（32.8% ）. Adjusted MRR was 3.6% （95% CI：2. 8-4. 9）. Stratified analysis showed that high MRR was not correlated with the severity of the complications. Conclusions Aging is a strong predictor of poor prognosis associated with the peptic ulcer perforation or bleeding and is independent out of the complications.

关 键 词：衰老 老年患者 消化性溃疡 穿孔 出血 合并症 短期病死率 

分 类 号：R573.1[医药卫生—消化系统]