急诊青年上消化道出血患者预后不良的预测因素  

Predictive factors for poor prognosis of young patients with upper gastrointestinal bleeding in emergency department

作　　者：韩凤 牛欢[1] 梁立秋 刘元税[1] 欧阳艳红[1] Han Feng;Niu Huan;Liang Liqiu;Liu Yuanshui;Ouyang Yanhong(Hainan Hospital Emergency Center,Hainan Medical College,Hainan Provincial People's Hospital,Haikou 57031l,China)

机构地区：[1]海南省人民医院海南医学院附属海南医院急救中心,海口570311

出　　处：《中华急诊医学杂志》2022年第9期1255-1261,共7页Chinese Journal of Emergency Medicine

摘　　要：目的探析急诊科(emergeney department,ED)收治青年上消化道出血(upper gastrointestinal bleeding,UGIB)患者的预后危险因素,以提高患者的急诊处置和分流效率。方法回顾性分析2019年1月1日至2020年12月31日就诊于海南省人民医院ED青年UGIB患者的临床资料。院内病死率为主要研究终点,重症监护病房(intensive care unit,ICU)入住率、住院时间是次要研究终点。纳入标准:(1)符合急性上消化道出血诊断标准;(2)年龄18~40岁;(3)临床资料完整。排除标准:(1)出血及咯血来自口、鼻腔、咽喉部位;(2)院内发生的消化道出血;(3)下消化道出血;(4)临床资料缺失。结果383例患者中,有268例(70.0%)接受上消化道内镜检查,最常见的内镜诊断是十二指肠溃疡(64.6%)和食管-胃底静脉曲张破裂出血(16.8%)。71例(18.5%)患者需要内镜治疗,5例(1.3%)需要外科手术治疗,7例(1.8%)需要介入治疗。病死率是2.1%,ICU入住率为2.3%,住院时间为5(3,6)d。伴随肝病、出现晕厥/昏迷症状患者的ICU入住率和病死率较高(均P<0.05)。血小板减少(<120×10^(9)/L)患者较血小板正常患者的住院时间明显延长[8(5,11)d vs.4(3,6)d,P<0.001]。与存活的患者相比,死亡患者的白细胞计数、尿素氮、肌酐、谷草转氨酶、丙氨酸转氨酶、活化部分凝血酶时间水平明显升高(均P<0.05),血红蛋白、白蛋白水平以及SpO_(2)、格拉斯哥昏迷评分(Glasgow coma score,GCS)显著降低(均P<0.05)。低GCS是入住ICU(OR=33.973,95%CI:1.582~729.417,P=0.024)和病死(OR=20.583,95%CI:1.368~309.758,P=0.029)的独立危险因素。结论急诊室青年UGIB患者的预后不良因素包括伴随肝病、晕厥/昏迷、合并感染、高氮质血症、肾功能受损、肝功能障碍、凝血障碍,入院时的贫血、低SpO_(2)、低GCS以及低蛋白血症。Objective To investigate the prognostic risk factors of young patients with upper gastrointestinal bleeding(UGIB)in emergency department(ED),so as to improve the efficiency of emergency treatment and diversion of these patients.MethodsA retrospective analysis was performed on the clinical data of young patients with UGIB in the ED of Hainan Provincial People's Hospital from January 1,2019 to December 30,2020.In-hospital mortality was the primary endpoint of the study,and admission to the Intensive Care Unit(ICU)and length of hospital stay were the secondary endpoints.Inclusion criteria:(1)patients met the diagnostic criteria of acute UGIB;(2)age ranged from 18 to 40 years old;and(3)complete clinical data.Exclusion criteria:(1)bleeding and hemoptysis from the mouth,nose and throat;(2)gastrointestinal beding occurred in hospital;(3)lower gastrointestinal bleeding;(4)incomplete clinical data.Results Among the 383 patients,268(70.0%)underwent upper gastrointestinal endoscopy,and the most frequent endoscopic diagnoses were duodenal ulcer(64.6%)and esophagealgastric varices bleding(16.8%).Seventy-one(18.5%)patients required endoscopic treatment,5(1.3%)patients required surgical treatment,and 7(1.8%)patients required intervention treatment.The mortality rate was 2.1%,the ICU admission rate was 2.3%,and the length of hospital stay was 5(3,6)d.The ICU admission rate and mortality rate were significantly higher in patients with liver disease and in patients with syncope/coma(all P<0.05).Patients with thrombocyte levels(<120×10^(9)/L)had a significantly longer length of hospital stay than that of patients with normal platelets[8(5,11)d vs.4(3,6)d,P<0.001].The dead patients had significantly higher white blood cell count,urea nitrogen,creatinine,aspartate aminotransferase,alanine aminotransferase and activated partial thrombin time levels(all P<0.05),and significantly lower hemoglobin,albumin,SpO,and Glasgow coma score(GCS)levels(all P<0.05).Low GCS was an independent risk factor of ICU admission(OR=33.973,95%CI:1.582~729.4

关 键 词：上消化道出血 预后不良 死亡 急诊科 青年患者 

分 类 号：R573.2[医药卫生—消化系统]