消化性溃疡出血患者早期再出血的危险因素分析  

Risk factor analysis for early rebleeding in patients with peptic ulcer bleeding

作　　者：张丽娜[1] 马治国 杨少奇[1] 黄李雅[1] 杨力[1] Zhang Lina;Ma Zhiguo;Yang Shaoqi;Huang Liya;Yang Li(Department of Gastroenterology,The General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院消化内科,银川 [2]银川市中医医院内科

出　　处：《中华消化杂志》2018年第8期543-547,共5页Chinese Journal of Digestion

摘　　要：目的探讨影响消化性溃疡出血（PUB）患者发生早期再出血的危险因素。方法纳入2006年6月至2017年5月在宁夏医科大学总医院住院的1210例PUB患者，将治疗后出血停止的1040例患者作为对照组，早期再出血的170例患者为再出血组。分析两组患者的病历资料，统计学方法采用卡方检验、t检验和多因素logistic回归分析。结果再出血组与对照组患者的性别、年龄、居住地、呕血、休克、输血量、服用抗凝药物、合并疾病、血红蛋白、血清白蛋白、血尿素氮、中性粒细胞占比、血小板计数、溃疡位置、溃疡最大径、Forrest分级和胃镜下治疗差异均有统计学意义（P均〈0．05）。其中再出血组患者胃镜下止血治疗率为92．56％（112／121），低于对照组的98．70％（228／231），差异有统计学意义（X^2=13．609，P=0．001）。将以上变量进行多因素分析，结果显示Forrest分级（OR=7．735，P〈0．01）、血红蛋白（OR=7．332，P=0．040）、休克（OR=5．245，P〈0．01）、溃疡大小（OR=2．360，P=0．029）是PUB患者发生再出血的独立危险因素，对评估再出血风险的作用为Forrest分级〉血红蛋白〉休克〉溃疡大小。结论Forrest分级、血红蛋白、休克、溃疡大小是影响PUB患者发生早期再出血的危险因素，胃镜下止血治疗可降低再出血风险。Objective To explore the risk factors for early rebleeding in patients with peptic ulcer bleeding （PUB）. Methods From June 2006 to May 2017, a total of 1 210 hospitalized patients with PUB from The General Hospital of Ningxia Medical University were enrolled. Totally 1 040 patients with bleeding stopped after the treatment were taken as the control group. And 170 patients with early rebleeding were as the rebleeding group. The clinical data of the patients in two groups were analyzed. Chi-square test, t-test and multivariate factors analysis were performed for statistical analysis. Results Between control group and rebleeding group, there were statistical significances in gender, age, place of residence, hematemesis, shock, volume of blood transfusion, anticoagulant use, combined diseases, hemoglobin level, albumin level, urea nitrogen, neutrophil ratio, platelet count, ulcer location, maximum ulcer diameter, Forrest classification and endoscopic treatment （all P〈0. 05）. The rate of endoscopic hemostasis of rebleeding group （92. 56%, 112/121） was lower than that of control group （98.70%, 228/231）, and the difference was statistically significant （X2 ： 13. 609, P〈0. 001）. The result of multivariate logistic regression analysis showed that Forrest classification （odds ratio （OR） = 7. 735, P〈0. 01 ）, hemoglobin （OR=7. 332, P=0. 040）, shock （OR：5. 245, P〈0. 01） and ulcer size （OR=2. 360, P=0. 029） were independent risk factors for rebleeding in patients with PUB. The effect of Forrest classification better than hemoglobin, hemoglobin better than shock and shock better than ulcer size in assessing the risk of rebleeding. Conclusions Forrest classification, hemoglobin, shock, ulcer size are the risk factors for rebleeding in patients with PUB. Endoscopic hemostasis can reduce the risk of rebleeding.

关 键 词：消化性溃疡出血 再出血 影响因素 

分 类 号：R573.2[医药卫生—消化系统]