2056例上消化道出血病因构成及相关因素分析  

Analysis of etiological and related factors responsible for upper gastrointestinal bleeding in 2056 patients

作　　者：蔡玲[1] 张玫[1] 赵丹丹[1] 赵曲川[1] 牛小羽[1] 

机构地区：[1]首都医科大学宣武医院消化内科,北京100053

出　　处：《首都医科大学学报》2015年第6期978-981,共4页Journal of Capital Medical University

摘　　要：目的回顾性分析近10年来上消化道出血(upper gastrointestinal bleeding,UGIB)的病因构成及与相关因素的关系。方法收集2005年1月至2014年12月因UGIB行急诊胃镜检查的2 056例患者资料,包括年龄、性别、出血病因、伴随疾病及服药史。结果 1)UGIB患者中男性多于女性,男女性别比例为2.87∶1.00,前后5年性别构成比无明显变化。2)中青年组患者比例降低,老年组比例明显增加(P<0.01)。3)前后5年UGIB病因构成比发生了变化,无论中青年组还是老年组,消化性溃疡始终居第1位,食管-胃底静脉曲张比例均下降(P<0.004)。反流性食管炎和老年组急性胃黏膜病变比例上升(P<0.004)。4)中青年以十二指肠溃疡为主,胃溃疡和胃癌所致UGIB多见于老年人,反流性食管炎出血老年人更多些。5)中青年组患者服用非甾体消炎药(nonsteroidal anti-inflamatory drugs,NSAIDs)及抗凝类药比率为2.67%,而老年组为24.55%,2组患者服用NSAIDs及抗凝类药比率差异有统计学意义(P<0.01)。6)前后5年UGIB住院病死率下降,其中肝硬化、全身性疾病病死率明显下降,急性胃黏膜病变病死率明显上升,差异均有统计学意义(P<0.01)。结论 10年来UGIB首要病因仍是消化性溃疡,但比例已呈下降趋势,反流性食管炎已成为UGIB的另一个重要病因,随着老年人数的增加,NSAIDs及抗凝类药相关性急性胃黏膜病变出血增加,必须引起重视。Objective To investigate the etiology and related factors of upper gastrointestinal bleeding（ UGIB） in the past 10 years.Methods The data of 2 056 patients receiving emergency treatment for UGIB in a single medical center between January 2005 and December 2014 were collected. Etiological analysis was done based on age,gender and time period. Results 1） UGIB occurred more often in men than in women with a ratio of 2. 87 ∶ 1. 00. Gender composition was no significant difference between the first and later 5years. 2） Proportion of young and middle-aged patients decreased,as compared with that of the elderly group（ P〈0. 01）. 3） Etiological analysis of UGIB was different between the first and later 5 years. No matter the young and middle-aged or the elderly group,peptic ulcer ranked first,esophageal gastric varices fell（ P〈0. 004）. Reflux esophagitis and acute gastric mucosal lesions in the elderly group rate rose（ P〈0. 004）. 4） Duodenal ulcer was the main cause of UGIB in the young and middle-aged patients,whereas gastric ulcer and gastric carcinoma accounted for more at elderly people. 5） Percentage of patients taking nonsteroidal anti-inflamatory drugs（ NSAIDs） and anticoagulation drugs was 2. 67% in the young and middle-aged group and 24. 55% in the elderly group（ P〈0. 01）. 6） Within five years UGIB hospital mortality from 4. 51% to 1. 24%（ P〈0. 01）,which cirrhosis,systemic disease mortality decreased significantly,acute gastric mucosal lesions significantly increased（ P〈0. 01）. Conclusion In the past 10 years,primary etiological analysis of UGIB was peptic ulcer,but the proportion had been declining. Reflux esophagitis is another important etiology of UGIB. With the increasing number of the elderly patients,acute gastric mucosal lesions bleeding due to NSAIDs and anticoagulation drugs increased.

关 键 词：上消化道出血 病因 因素分析 

分 类 号：R573.2[医药卫生—消化系统]