自发性脑出血并发消化道出血的影响因素分析  

Stress ulcer prophylaxis for gastrointestinal bleeding in spontaneous intracerebral hemorrhage

作　　者：杨铁城[1] 于东明[1] 李建国[1] 任添华[1] 李丽霞[1] 董小燕[1] 

机构地区：[1]首都医科大学附属北京天坛医院急诊科,北京100050

出　　处：《中国急救复苏与灾害医学杂志》2013年第12期1077-1080,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的回顾性分析北京天坛医院急诊科808例自发性脑出血（ICH）的病历资料，研究消化道出血的发生率，危险因素及应激性溃疡预防措施（sup）。方法回顾性分析808例ICH的病历资料，比较消化道出血组与未发生消化道出血组的临床资料的差异。Logistic回归分析消化道出血发生的危险因素。结果808例ICH患者中，消化道出血发生率为26．7％，其中3例发生严重消化道出血。多因素logistic回归显示，年龄、血肿体积、格拉斯哥评分（GCS）及脓毒症是消化道出血的独立预测因子。高达63．4％的患者接受了SUP，SUP组的消化道出血发生率显著高于非suP组（30．9％VS19．6，P〈0．01）。结论ICH后消化道出血发生率较高，但严重消化道出血少见。年龄、血肿体积、GCS及脓毒症是消化道出血的独立预测因子。Objective To analyze 808 cases of spontaneous intracerebral hemorrhage （ICH） and the correlation with gastrointestinal （GI） bleeding. Methods A retrospective review was conducted of the medical records of 808 ICH patients. Specifically, clinical parameters of ICH patients with subsequent GI bleeding were compared to those of patients without GI bleeding. These parameters included Glasgow Coma Scale （GCS） scores, head computed tomography findings （i.e., sites of ICH, ICH volume, and intraventricular extension of hemorrhage） at admission, treatments, application of stress ulcer prophylaxis （SUP）, sepsis, length of hospital stay, in-hospital mortality, and modified Rankin Scale （mRS） scores at discharge. Risk factors for GI bleeding were identified using logistic regression analysis. Results The incidence of GI bleeding was 26.7%, including three cases of severe GI bleeding （0.35%）. Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, GCS score, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients who received SUP had significantly higher incidences of GI bleeding than those who did not receive SUP. Conclusion GI bleeding occurred frequently following ICH, but severe events were rare. Age, GCS score, sepsis, and ICH volume were independent predictors of GI bleeding occurring after ICH.

关 键 词：脑出血 消化道出血 危险因素 应激性溃疡预防 

分 类 号：R743[医药卫生—神经病学与精神病学]