陳迪青,湯衛(wèi)鋒
(株洲市二醫(yī)院,湖南株洲412000)
老年急性非食管靜脈曲張性上消化道出血的臨床特征分析
陳迪青,湯衛(wèi)鋒
(株洲市二醫(yī)院,湖南株洲412000)
目的探索急性非食管靜脈曲張性上消化道出血老年患者的發(fā)病原因、臨床癥狀及治療情況等特征,以為臨床診治工作提供參考。方法選取140例急性非食管靜脈曲張性上消化道出血患者,按照患者的年齡區(qū)別,其中年齡≥60歲的80例患者作為實(shí)驗(yàn)組,<60歲的60例患者作為對(duì)照組。收集所有患者的臨床資料,對(duì)兩組患者的發(fā)病原因、臨床癥狀及治療情況比較分析。結(jié)果與對(duì)照組患者相比,實(shí)驗(yàn)組患者中因癌癥發(fā)病率(27.50%)明顯較多,實(shí)驗(yàn)組中單純黑便發(fā)生率(87.50%)、低血壓發(fā)生率(25.0%)與NSAIDs服用史(23.75%)明顯較高,實(shí)驗(yàn)組的輸血量(10.62±2.91)mL、再出血發(fā)生率(16.25%)、止血時(shí)間(13.76±5.29)h均明顯較高,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論急性非食管靜脈曲張性上消化道出血老年患者的病情較為危重,治療難度較高,故臨床需加強(qiáng)臨床診斷及有效治療。
老年;急性上消化道出血;臨床特征;發(fā)病原因;治療
隨著社會(huì)人口老齡化進(jìn)程的逐漸加快,老年急性上消化道出血患者的發(fā)病率亦呈逐年增加趨勢(shì)[1-2]。因老年患者的機(jī)體抵抗力與機(jī)體免疫力逐漸降低,故該疾病患者的病情通常比較危重,具有起病急驟、發(fā)病迅猛等特點(diǎn),同時(shí)癥狀通常不夠典型,對(duì)老年患者的身體生命健康造成了嚴(yán)重的威脅[3-4]。為了分析急性上消化道出血老年患者的臨床特征,本研究收集了80例急性非食管靜脈曲張性上消化道出血老年患者,對(duì)其臨床資料進(jìn)行回顧性分析總結(jié)如下。
1.1 臨床資料選取本院消化內(nèi)科2011年1月~2015年12月間收治的140例急性非食管靜脈曲張性上消化道出血患者,納入標(biāo)準(zhǔn):(1)140例患者均經(jīng)電子胃鏡檢查明確診斷;(2)均有黑便、嘔血癥狀;(3)均因食管靜脈曲張引發(fā)上消化道出血;(4)均自愿簽署知情同意書。按照患者的年齡區(qū)別,其中年齡≥60歲的80例患者作為實(shí)驗(yàn)組,其中男49例,女31例;平均年齡(45.39±11.53)歲;<60歲的60例患者作為對(duì)照組,其中男39例,女21例;平均年齡(49.75± 12.14)歲。兩組性別、病情等基線資料比較差異無統(tǒng)計(jì)學(xué)意義,具有可比性。
1.2 方法收集A、B兩組患者的臨床資料,主要包括年齡,性別,有無飲酒史、吸煙史、NSAIDs服用史、阿司匹林服用史,有無肝炎、高血壓、糖尿病、心腦血管疾病等。同時(shí),詳細(xì)觀察兩組的發(fā)病病因、臨床癥狀、實(shí)驗(yàn)室檢查、治療及轉(zhuǎn)歸情況等資料。
1.3 統(tǒng)計(jì)學(xué)方法本研究數(shù)據(jù)詳細(xì)記錄后,納入SPSS 20.0統(tǒng)計(jì)軟件中進(jìn)行分析,計(jì)量資料采用“x±s”表示,組間比較采用t檢驗(yàn);計(jì)數(shù)資料用例數(shù)(n)表示,計(jì)數(shù)資料組間率(%)的比較采用χ2檢驗(yàn)。P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。
2.1 老年急性非食管靜脈曲張性上消化道出血的發(fā)病原因分析兩組患者發(fā)生急性上消化道出血的主要原因均為消化性潰瘍,但兩組組間比較差異無統(tǒng)計(jì)學(xué)意義。實(shí)驗(yàn)組中因癌癥發(fā)病者明顯多于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。實(shí)驗(yàn)組中因急性胃粘膜病變發(fā)病者明顯少于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組中因糞門黏膜撕裂發(fā)病患者的構(gòu)成比比較,差異無統(tǒng)計(jì)學(xué)意義。見表1。
表1 老年急性非食管靜脈曲張性上消化道出血的發(fā)病原因分析(n)Table 1 Analysis of the causes of acute non variceal upper gastrointestinal bleeding in the elderly(n)
2.2 老年急性非食管靜脈曲張性上消化道出血的臨床癥狀分析實(shí)驗(yàn)組發(fā)生嘔血、黑便癥狀的患者構(gòu)成比顯著低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。實(shí)驗(yàn)組單純黑便20、低血壓、NSAIDs服用史分別均明顯多于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組Hp感染率比較,差異無統(tǒng)計(jì)學(xué)意義。見表2。
表2 老年急性非食管靜脈曲張性上消化道出血患者的臨床癥狀分析(n)Table 2 Analysis of clinical symptoms of elderly patients with acute non variceal upper gastrointestinal bleeding(n)
2.3 老年急性非食管靜脈曲張性上消化道出血患者的治療情況分析兩組確診后均行常規(guī)內(nèi)科保守方案治療,治療后實(shí)驗(yàn)組患者的輸血量、再出血發(fā)生率、止血時(shí)間,均顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組的住院時(shí)間對(duì)比,差異無統(tǒng)計(jì)學(xué)意義。見表3。
急性上消化道出血是臨床上一種非常常見的并發(fā)癥,該病的發(fā)病機(jī)制較為復(fù)雜,起病較急,病情兇險(xiǎn),病死率較高[5-6]。老年急性上消化道出血患者常伴有一些了的問題,主要有伴發(fā)疾病較多、藥物使用增加及臨床癥狀不夠典型等,故其臨床診治的難度也相對(duì)較高。因此,為了提高老年急性非食管靜脈曲張性上消化道出血患者的治療效果,確?;颊叩纳踩?,對(duì)該疾病患者的臨床特征進(jìn)行詳細(xì)的分析顯得尤為重要。
表3 老年急性非食管靜脈曲張性上消化道出血患者的治療情況分析(x±s)Table 3 Analysis of the treatment of elderly patients with acute non variceal upper gastrointestinal bleeding(x±s)
本研究中我們選取本院消化內(nèi)科收治的140例急性非食管靜脈曲張性上消化道出血患者作為研究對(duì)象,對(duì)所有患者的發(fā)病原因、臨床癥狀及治療情況進(jìn)行總結(jié)分析,結(jié)果表明消化性潰瘍是引發(fā)急性非食管靜脈曲張性上消化道出血患者的主要發(fā)病原因,且與患者的年齡無明顯相關(guān)性,與相關(guān)研究結(jié)果基本保持一致[7-8]。而在老年急性非食管靜脈曲張性上消化道出血患者中,癌癥是引發(fā)該疾病第2病因,其中又以胃癌、食管賁門癌為主,該病因構(gòu)成率明顯多于中青年患者(P<0.05)??赡苁怯捎诶夏昊颊叩哪挲g較大及消化性潰瘍長(zhǎng)期未得及時(shí)治療而引發(fā)惡性病變?cè)斐蒣6]。在中青年急性非食管靜脈曲張性上消化道出血患者中,急性胃粘膜病變是引發(fā)該疾病第2病因,可能是由于中青年人群的工作壓力較大及生活不規(guī)律等因素所致。此外,老年患者的單純黑便、低血壓等發(fā)生率、NSAIDs服用史均顯著多于中青年患者,老年患者的輸血量、再出血發(fā)生率、止血時(shí)間均顯著高于中青年患者(P<0.05)。因此,臨床上對(duì)急性非食管靜脈曲張性消化道出血老年患者進(jìn)行治療時(shí)需要注意以下幾點(diǎn):(1)及時(shí)的控制患者的出血癥狀,且及時(shí)進(jìn)行針對(duì)性治療,必要時(shí)可行外科手術(shù)治療;(2)針對(duì)基礎(chǔ)疾病進(jìn)行及時(shí)治療,且注意盡快控制病灶,提高患者的生存率;(3)由于老年患者的癥狀通常不夠典型,故臨床醫(yī)師需注意詳細(xì)分析老年患者的出血病因,仔細(xì)甄別,以便及時(shí)進(jìn)行針對(duì)性的治療[9-10]。
綜上所述,急性非食管靜脈曲張性上消化道出血老年患者的病情較為危重,治療難度較高,故臨床需加強(qiáng)臨床診斷及有效治療。
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Analysis of clinical features of elderly with acute non variceal upper gastrointestinal bleeding in the elderly
Chen Di-qing,Tang Wei-feng
(The second hospital of Zhuzhou City,Zhuzhou,Hunan,412000,China)
Objective To explore the cause of disease,clinical symptoms and treatment characteristics of acute non variceal upper gastrointestinal bleeding in elderly patients,and to provide reference for clinical diagnosis and treatment.Methods 140 cases of patients with acute non variceal upper gastrointestinal bleeding and who accepted treatments in hospital of Department of gastroenterology from January,2011 to December,2015 were selected,and according to the age of the patients,80 patients aged 60 years or older patients as the experimental group,60 cases of patients less than 60 years old as the control group.Then,the clinical data of all patients were collected,and the causes of disease,clinical symptoms and treatment condition of two groups of patients were compared and analyzed.Results Compared with the patients in the control group,the incidence of cancer in the experimental group was 27.50%,which was significantly higher,and in the experimental group,the incidence of simple black stools was 87.50%, the incidence of hypotension was 25%,and the history of NSAIDs taking was 23.75%,which was significantly higher.In the experimental group,the blood transfusion volume(10.62±2.91)mL,rebleeding rate(16.25%)and hemostasis time(13.76±5.29)h,which was significantly higher(P<0.05), and the difference was statistically significant.Conclusion The clinical condition of elderly patients with acute non variceal upper gastrointestinal bleeding is more critical,and the treatment is difficult,so it is necessary to strengthen the clinical diagnosis and effective treatment.
Elderly;Acute upper gastrointestinal bleeding;Clinical features;Cause of disease;Treatment
10.3969/j.issn.1009-4393.2017.23.030