300例急性上消化道出血患者临床特征及其预后影响因素
|
摘要
目的对300例急性上消化道出血患者的临床特征进行分析,探讨其预后的影响因素,为改善治疗效果和降低病死率提供依据。方法对2017年1月-2018年6月期间我院消化内科收治的300例急性上消化道出血患者进行回顾性分析,总结急性上消化道出血的常见病因及临床特征;通过单因素和多因素分析急性上消化道出血患者的预后相关影响因素。结果本组患者发病的主要病因为十二指肠溃疡(38.33%),其次为胃溃疡(20.33%),其它病因相对较少;临床主要症状为:呕血(52.67%)、黑便(85.67%),少数伴有昏厥、意识障碍等;单因素分析显示:高龄、冠心病史、肝衰及慢性肝病史、阿司匹林应用史、氯吡格雷应用史、入院时血红蛋白水平低、上消化道恶性肿瘤并发出血与治疗后再出血有关(P<0.05);Logistic多因素分析显示:影响上消化道治疗后再出血的危险因素包括上消化道恶性肿瘤并发出血(OR=3.158,95%CI:1.158～8.615,P=0.025)、患有肝衰及慢性肝病史(OR=4.491,95%CI:1.301～15.498,P=0.018)、入院时血红蛋白水平低(OR=2.151,95%CI:1.069～4.331,P=0.032)。结论对急性上消化道出血的常见病因进行针对性治疗,对有相关危险因素的患者重视风险评估,严密监测病情变化,规避风险、选择合适的治疗方案。
Objective To analyze the clinical features of 300 patients with acute upper gastrointestinal Bleeding and to explore the influencing factors for prognosis so as to provide a basis for improving the treatment effects and reducing the mortality.Methods 300 patients with acute upper gastrointestinalBleeding admitted to our Department of Gastroenterology from January 2017 to June 2018 were retrospectively analyzed.The common causes and clinical features of acute upper gastrointestinal Bleeding were summarized.Single factor and multiple factorwere used to analyze the related influencing factors for prognosis ofpatients with acute upper gastrointestinal Bleeding.Results The main cause of this group of patients was due to duodenal ulcer(38.33%),followed by gastric ulcer(20.33%),and other causes were relatively small.The main clinical symptoms werehematemesis(52.67%)and melena(85.67%),and a few patients were accompanied by fainting and disturbance of consciousness.Single factor analysis showedadvanced age,history of coronary heart disease,history of liver failure and chronic liver disease,history of aspirinapplication,history of clopidogrelapplication,low hemoglobin level at admission and upper gastrointestinal malignancy bleeding were associated with re-bleeding after treatment(P<0.05).Logistic multivariate analysis showed that the risk factors for re-bleeding after upper gastrointestinal treatment included upper gastrointestinal malignancy bleeding(OR=3.158,95% CI:1.158～8.615,P=0.025),history of liver failure and chronic liver disease(OR=4.491,95% CI:1.301～15.498,P=0.018)and low hemoglobin level at admission(OR=2.151,95% CI:1.069～4.331,P=0.032).Conclusion Targeted treatment is given for common causes of acute upper gastrointestinal Bleeding,and risk assessment for patients with relevant risk factors should be valued,and it is necessary to strictly monitor disease changes,avoid risk and select appropriate treatment regimens.
Objective To analyze the clinical features of 300 patients with acute upper gastrointestinal Bleeding and to explore the influencing factors for prognosis so as to provide a basis for improving the treatment effects and reducing the mortality.Methods 300 patients with acute upper gastrointestinalBleeding admitted to our Department of Gastroenterology from January 2017 to June 2018 were retrospectively analyzed.The common causes and clinical features of acute upper gastrointestinal Bleeding were summarized.Single factor and multiple factorwere used to analyze the related influencing factors for prognosis ofpatients with acute upper gastrointestinal Bleeding.Results The main cause of this group of patients was due to duodenal ulcer(38.33%),followed by gastric ulcer(20.33%),and other causes were relatively small.The main clinical symptoms werehematemesis(52.67%)and melena(85.67%),and a few patients were accompanied by fainting and disturbance of consciousness.Single factor analysis showedadvanced age,history of coronary heart disease,history of liver failure and chronic liver disease,history of aspirinapplication,history of clopidogrelapplication,low hemoglobin level at admission and upper gastrointestinal malignancy bleeding were associated with re-bleeding after treatment(P<0.05).Logistic multivariate analysis showed that the risk factors for re-bleeding after upper gastrointestinal treatment included upper gastrointestinal malignancy bleeding(OR=3.158,95% CI:1.158～8.615,P=0.025),history of liver failure and chronic liver disease(OR=4.491,95% CI:1.301～15.498,P=0.018)and low hemoglobin level at admission(OR=2.151,95% CI:1.069～4.331,P=0.032).Conclusion Targeted treatment is given for common causes of acute upper gastrointestinal Bleeding,and risk assessment for patients with relevant risk factors should be valued,and it is necessary to strictly monitor disease changes,avoid risk and select appropriate treatment regimens.
引文
[1] 马经琼,朱振新.冷沉淀治疗肝硬化合并消化道出血[J].血栓与止血学,2017,23(3):418-420.
[2] 中国医师协会急诊医师分会.急性上消化道出血急诊诊治流程专家共识[J].中国急救医学,2015,35(10):865-873.
[3] 刘英志,郭权来.内镜治疗急性上消化道出血效果及预后的影响因素分析[J].临床医学工程,2016,23(7):865-866.
[4] 张婧.重庆市江津地区2011-2015年908例上消化道出血患者临床特征分析[J].重庆医学,2017,46(21):2993-2994.
[5] 韩逊.抗血小板聚集药物致消化道出血的临床特点及影响因素[J].血栓与止血学,2016,22(6):651-653.
[6] 王俊仁.内镜治疗急性上消化道出血效果及预后的影响因素探讨[J].中外医学研究,2017,15(13):6-7.
[7] 王小云,吴学琴,汤纳,等.乙肝后肝硬化失代偿期长期抗病毒治疗对上消化道再出血的影响[J].宁夏医科大学学报,2014,36(3):347-348.
[8] 原姗姗,张欣,杨振威,等.急性非静脉曲张性上消化道出血早期预后的影响因素[J].中华消化杂志,2018,38(3):195-197.
[2] 中国医师协会急诊医师分会.急性上消化道出血急诊诊治流程专家共识[J].中国急救医学,2015,35(10):865-873.
[3] 刘英志,郭权来.内镜治疗急性上消化道出血效果及预后的影响因素分析[J].临床医学工程,2016,23(7):865-866.
[4] 张婧.重庆市江津地区2011-2015年908例上消化道出血患者临床特征分析[J].重庆医学,2017,46(21):2993-2994.
[5] 韩逊.抗血小板聚集药物致消化道出血的临床特点及影响因素[J].血栓与止血学,2016,22(6):651-653.
[6] 王俊仁.内镜治疗急性上消化道出血效果及预后的影响因素探讨[J].中外医学研究,2017,15(13):6-7.
[7] 王小云,吴学琴,汤纳,等.乙肝后肝硬化失代偿期长期抗病毒治疗对上消化道再出血的影响[J].宁夏医科大学学报,2014,36(3):347-348.
[8] 原姗姗,张欣,杨振威,等.急性非静脉曲张性上消化道出血早期预后的影响因素[J].中华消化杂志,2018,38(3):195-197.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |