抗栓治疗合并急性下消化道出血患者的临床特征分析  

Clinical characteristics of antithrombotic therapy in patients with acute lower gastrointestinal bleeding

作　　者：孙亚梅 张杰[1] Sun Yamei;Zhang Jie(Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院消化内科,北京100029

出　　处：《中国医刊》2023年第12期1304-1306,共3页Chinese Journal of Medicine

摘　　要：目的探讨抗栓治疗合并急性下消化道出血患者的临床特征。方法回顾性分析2018年1月1日至2023年5月31日于首都医科大学附属北京安贞医院接受抗栓治疗合并急性下消化道出血住院患者的临床资料,收集患者的一般资料、合并症、临床用药、实验室指标、内镜下表现及预后情况并进行总结分析。结果共纳入28例抗栓治疗合并急性下消化道出血的住院患者,其中男16例,女12例,平均年龄(69.14±8.29)岁。28例患者中,血便21例(75%),黑便7例(25%)。71.4%(20/28)的患者通过灌肠进行肠道准备,28.6%(8/28)的患者通过口服聚乙二醇电解质散进行肠道准备。20例(71.4%)患者在出血24h内进行结肠镜检查,其余8例(28.6%)患者在出血24h以后进行结肠镜检查。15例患者(53.6%)采用静脉麻醉。结肠镜检查发现结直肠溃疡合并出血14例(50.0%),结直肠肿瘤合并出血6例(21.4%),血管破裂出血4例(14.3%),缺血性肠炎合并出血2例(7.1%),憩室并出血1例(3.6%),肠道紫癜出血1例(3.6%)。经治疗,24例(85.7%)好转出院,4例(14.3%)死亡。结论抗栓治疗合并急性下消化道出血患者的出血原因主要为结直肠溃疡,其次是结直肠肿瘤和血管破裂,在灌肠后及时行结肠镜检查可明确出血原因并指导诊疗。Objective To investigate the clinical characteristics of antithrombotic therapy in patients with acute lower gastrointestinal bleeding.Method Clinical data of patients treated with antithrombotic therapy with acute lower gastrointestinal bleeding at Beijing Anzhen Hospital,Capital Medical University from January 1,2018 to May 31,2023 were retrospectively analyzed.General data,complications,clinical medication,laboratory indicators,endoscopic manifestations and prognosis of patients were collected.Result 28 hospitalized patients treated with antithrombotic therapy with acute lower gastrointestinal bleeding were included in this study.The average age of the patients was 69.14±8.29 years old,including 16 males and 12 females.There were 21 patients(75%)with blood stool and 7 patients(25%)with black stool.71.4%(20/28)of the patients were prepared by enema,28.6%(8/28)of the patients were prepared by oral bowel purging drug polyethylene glycol electrolyte powder.Twenty patients(71.4%)underwent colonoscopy within 24 hours of bleeding,and 8 patients(28.6%)underwent colonoscopy after 24 hours of bleeding.Of these,15 patients(53.6%)underwent intravenous anesthesia.There were 14 patients(50.0%)with colorectal ulcer complicated with bleeding,6 patients(21.4%)with colorectal tumor complicated with bleeding,4 patients(14.3%)with vascular rupture and bleeding,2 patients(7.1%)with ischemic enteritis complicated with bleeding,1 patient(3.6%)with diverticular bleeding,and 1 patient(3.6%)with intestinal purpura bleeding.Twenty-four patients(85.7%)were discharged from hospital with improvement,and 4 patients(14.3%)died.Conclusion To the patients treated with antithrombotic therapy with acute lower gastrointestinal bleeding,colorectal ulcer is the main cause of bleeding,followed by colorectal tumor and vascular rupture.Timely colonoscopy after enema can identify the cause of bleeding and guide diagnosis and treatment.

关 键 词：抗栓治疗 急性下消化道出血 临床特征 结肠镜 

分 类 号：R574[医药卫生—消化系统]