脑源性与非脑源性疾病所致应激性溃疡相关胃肠道出血的影响因素及临床预后差异:一项回顾性队列研究  

Difference of influencing factors and clinical outcomes of gastrointestinal bleeding associated with stress ulcers between brain-derived and non-brain-derived disease:a retrospective cohort study

作　　者：黄镪 孙金梅[1] 韩燕飞[1] 张拥波[1] Qiang Huang;Jinmei Sun;Yanfei Han;Yongbo Zhang(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《中华脑血管病杂志（电子版）》2024年第4期309-316,共8页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：北京友谊医院科研启动基金资助项目(yyqdktgl2021-10)。

摘　　要：目的探讨神经重症监护病房(NCU)脑源性疾病与普通重症监护病房(GICU)非脑源性疾病患者的应激性溃疡(SU)及临床有意义的应激性溃疡伴胃肠道出血(CIB)事件的危险因素及临床预后的差异。方法纳入2016年1月1日至2020年1月1日在首都医科大学附属北京友谊医院NCU及GICU连续性收治的SU患者,以CIB和30 d全因死亡事件为主要终点指标。采用Pearsonχ^(2)检验或Mann-Whitney U检验比较组间相应变量的差异,采用逻辑回归分析主要终点指标的影响因素。结果共纳入261例符合入组标准的SU患者(NCU组149例,GICU组112例),其中女性88例(33.7%),年龄为65(53,76)岁。SU患者中有136例(52.1%)发生CIB,NCU组和GICU组各有68例。相比GICU组,NCU组的SU患者年龄更大,高血压和既往有卒中病史的比例更高,但有冠心病史、有慢性胃病史、长期应用糖皮质激素或同等药物、有肝功能不全、有肾功能不全、有呼吸衰竭和有凝血功能障碍患者的比例更低,差异均具有统计学意义(P均<0.05)。类似地,与GICU组相比,NCU组CIB患者有卒中病史的比例更高,但有冠心病史、长期应用糖皮质激素或同等药物、有肾功能不全和有凝血功能障碍的患者比例更低,差异均具有统计学意义(P均<0.05)。NCU组SU患者30 d全因死亡率明显低于GICU组(16.2%vs 29.7%,χ^(2)=6.748,P=0.009),但对应的2组CIB患者30 d全因死亡率差异无统计学意义(30.9%vs 41.8%,P>0.05)。逻辑回归分析结果提示30 d全因死亡的独立影响因素包括:长期应用糖皮质激素或同等药物[比值比(OR)=2.439,95%可信区间(CI):1.131~5.259]、有输血治疗(OR=3.329,95%CI:1.558~7.112)、有呼吸衰竭(OR=3.405,95%CI:1.61~7.198)和有CIB(OR=3.793,95%CI:1.529~9.414)。而应用鼻胃管(OR=5.209,95%CI:2.820~9.620)、有呼吸衰竭(OR=3.672,95%CI:1.620~8.325)和国际标准化比值>1.5(OR=2.119,95%CI:1.023~4.389)与CIB发生风险增加显著相关,应用质子泵抑制剂进行预防性治疗(Objective To evaluate the differences in risk factors and outcomes of stress ulcer (SU) and clinically important stress-related gastrointestinal bleeding (CIB) between patients from the neurocritical care unit (NCU) and those from the general intensive care unit (GICU).Methods The study included consecutive SU patients admitted to Beijing Friendship Hospital, Capital Medical University, from January 1, 2016, to January 1, 2020. CIB and all-cause death at 30 d were chosen as primary endpoints. The Pearson Chi-square test or Mann-Whitney U test was used to compare the differences of corresponding variables between groups, and multiple logistic regression models were performed to identify the risk factors of each primary endpoint event.Results A total of 261 eligible SU patients (149 from the NCU group and 112 from the GICU group) were enrolled, with 88 (33.7%) women and a median age of 65 years (range 53 to 76). CIB was experienced by 136 SU patients (52.1%), with 68 cases in each group. Compared with the SU patients from the GICU, those from the NCU were older and had a higher proportion of hypertension and previous stroke (all P<0.05), but a lower rate of coronary heart disease, previous peptic ulcer disease, administration of glucocorticoids or the equivalent, hepatic failure, renal failure, respiratory failure, and coagulopathy (all P<0.05). Similarly, the CIB patients from the NCU group had a higher rate of previous stroke, but a lower rate of coronary heart disease, administration of glucocorticoids or the equivalent, renal failure, and coagulopathy, compared with those from the GICU group (all P < 0.05). A significantly lower mortality at 30 d was observed in SU patients from the NCU group than those from the GICU group (16.2% vs 29.7%, χ^(2)=6.748, P=0.009), while there was no significant difference for all-cause death at 30d of CIB patients between the NCU group and the GICU group (30.9% vs 41.8%, P>0.05). Four independent risk factors of all-cause death at 30d, including administration of glucocorticoids

关 键 词：应激性溃疡 消化道出血 预后 并发症 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]