颅脑损伤患者术后应激性溃疡出血发生情况及相关因素调查  

Investigation of the occurrence of postoperative stress ulcer bleeding in patients with craniocerebral injury and related factors

作　　者：曹娅妮 伍玉玲 关沛 CAO Yani;WU Yuling;GUAN Pei(The Second Affiliated Hospital of the Military Medical University of the PLA Air Force(Tangdu Hospital of the Air Force Medical University),Xi′an Shaanxi 710000,China)

机构地区：[1]中国人民解放军空军军医大学第二附属医院(空军军医大学唐都医院),陕西西安710038

出　　处：《中国急救复苏与灾害医学杂志》2023年第9期1176-1179,1236,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：陕西省医学科学研究重点课题计划(编号:2019JM1232)。

摘　　要：目的探讨颅脑损伤患者术后应激性溃疡出血发生情况及相关因素,为临床预防术后应激性溃疡出血提供参考。方法选取2019年2月—2022年8月中国人民解放军空军军医大学第二附属医院400例颅脑损伤患者作为研究对象,根据术后是否发生应激性溃疡出血分为发生组(n=50)与未发生组(n=350)。采用单因素、多因素分析颅脑损伤患者术后应激性溃疡出血的影响因素。结果400例颅脑损伤患者术后50例发生应激性溃疡出血,发生率为12.50%(50/400);单因素分析显示,发生组与未发生组在高血糖、消化道溃疡或出血史、低血压、使用抗凝剂或抗血小板聚集药物、机械通气时间>48 h比例及格拉斯哥昏迷评分(GCS)方面对比,差异有统计学意义(P<0.05);Logistic多因素回归分析显示,GCS评分>11.83分是颅脑损伤患者术后应激性溃疡出血的独立保护因素,高血糖、低血压、消化道溃疡或出血史、机械通气时间>48 h及使用抗凝剂或抗血小板聚集药物是颅脑损伤患者术后应激性溃疡出血的独立危险因素(P<0.05)。结论颅脑损伤患者术后应激性溃疡出血受高血糖、GCS评分、低血压、机械通气时间等因素影响,临床需密切监测及管理以上风险因素,以尽可能减少术后应激性溃疡出血的发生。Objective To investigate the occurrence and related factors of stress ulcer bleeding in patients with craniocerebral injury after surgery,and to provide reference for clinical prevention of stress ulcer bleeding after surgery.Methods 400 patients with craniocerebral injury in our hospital from February 2019 to August 2022 were selected as research objects,and divided into occurrence group(n=50)and non-occurrence group(n=350)according to whether stress ulcer bleeding occurred after surgery.The influence factors of stress ulcer bleeding after craniocerebral injury were analyzed by single factor and multi factor.Results Stress ulcer bleeding occurred in 50 of 400 patients with craniocerebral injury,the incidence was 12.50%(50/400).Univariate analysis showed that there were statistically significant differences in hyperglycemia,history of digestive tract ulcers or bleeding,hypotension,use of anticoagulants or antiplatelet aggregation drugs,proportion of mechanical ventilation time>48 hours and GCS score between the occurrence group and the non-occurrence group(P<0.05).Logistic multivariate regression analysis showed that GCS score>11.83 was an independent protective factor for postoperative stress ulcer bleeding in patients with craniocerebral injury.Hyperglycemia,hypotension,history of gastrointestinal ulcer or bleeding,mechanical ventilation time>48 hours,and use of anticoagulants or antiplatelet aggregator were independent risk factors associated with postoperative stress ulcer bleeding in patients with cranial injury(P<0.05).Conclusion Stress ulcer bleeding in patients with craniocerebral injury after surgery is affected by hyperglycemia,GCS score,hypotension,mechanical ventilation time and other factors.It is necessary to closely monitor and manage the above risk factors in clinic,so as to reduce the occurrence of stress ulcer bleeding after surgery as much as possible.

关 键 词：颅脑损伤 格拉斯哥昏迷评分 应激性溃疡出血 影响因素 

分 类 号：R651.1[医药卫生—外科学]