上消化道出血临床特点及死亡风险的初步探讨

发布时间：2018-01-03 08:40

本文关键词：上消化道出血临床特点及死亡风险的初步探讨　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过对1911例上消化道出血(UGIB)病例进行分析,初步总结近五年来UGIB临床特点,并对UGIB的死亡原因以及Rockall评分、Child-Pugh评分对出血风险的预测进行了初步探讨,为提高临床诊治水平提供一定依据。方法:回顾性分析2011年01月至2015年12月苏州大学附属第一医院收治住院患者中UGIB确诊病例共1911例,查阅所有病例的住院病史,收集患者的一般资料、内镜检查结果、诊治过程及预后,将UGIB病例按出血原因分为非静脉曲张性出血(NVUGIB)和食管胃静脉曲张性出血(EGVB)两组,初步分析近5年来UGIB病例特点变化。对本研究中的死亡病例进行分析,初步探讨UGIB的死亡原因,应用Rockall评分及Child-Pugh评分分别对NVUGIB和EGVB病例评分,初步研究两种评分系统的再出血及死亡预测能力。结果:(1)本研究UGIB患者的平均年龄(54.47±17.04)岁,男女发病比例为3.04:1.00,死亡173例,病死率为9.05%。(2)位于前5位的UGIB出血病因依次为:十二指肠球部溃疡、EGVB、胃溃疡、胃癌、急性胃黏膜病变,十二指肠球部溃疡在14-30岁多见,且随着年龄的增长,十二指肠球部溃疡的发生率逐渐下降;EGVB、胃溃疡多发于50-69岁;胃癌多见于60-69岁;急性胃黏膜病变在各年龄段的发生率无明显差异。(3)近五年来,EGVB的比例从26.06%增加至34.84%(P0.001),其中单纯酒精性肝硬化的比例从3.40%增长到7.48%(P0.05),乙型肝炎后肝硬化出血的比例从33.19%增长到42.13%(P0.05)。(4)NVUGIB病例死亡原因中,14例(18.42%)死于出血,62例(81.58%)死于基础疾病的恶化或并发症,恶性肿瘤(27.63%)、肺部疾病(22.37%)、多器官功能衰竭(17.11%)是NVUGIB非出血性死亡的三大原因;EGVB死亡病例中,38例(39.18%)死于出血,59例(60.82%)死于基础疾病的恶化或并发症,肝性脑病(18.56%)、恶性肿瘤(14.43%)、多器官功能衰竭(14.43%)是EGVB非出血性死亡的三大原因。(5)Rockall评分高危组NVUGIB患者死亡及再出血比例均高于中、低危组;Child-Pugh C级EGVB患者死亡及再出血比例显著高于A级和B级。结论:(1)UGIB病因首位仍为消化性溃疡,但EGVB的比例逐年增加,以乙型肝炎后肝硬化和单纯性酒精性肝硬化增加为主。(2)UGIB的死亡原因以基础疾病或并发症为主,因此对于UGIB患者除了治疗出血原因,更应该积极采取措施治疗基础疾病。(3)对于UGIB患者应采取早期评估及危险分层,判断其再出血和死亡风险。
[Abstract]:Objective: to analyze the clinical features of UGIB in 1911 cases of upper gastrointestinal hemorrhage, and to evaluate the causes of death and Rockall score of UGIB. Child-Pugh score was used to predict the risk of hemorrhage. Methods: to improve the level of clinical diagnosis and treatment. From January 2011 to December 2015, 1 911 cases of UGIB were analyzed retrospectively in the first affiliated Hospital of Suzhou University. The hospitalization history of all cases was reviewed and the general data of the patients were collected. The results of endoscopic examination, the course of diagnosis and treatment, and the prognosis were collected. The patients with UGIB were divided into two groups according to the causes of bleeding: non varicose hemorrhage group and esophageal and gastric variceal hemorrhage group. The characteristics of UGIB cases in recent 5 years were analyzed. The death cases in this study were analyzed and the causes of death of UGIB were preliminarily discussed. Rockall and Child-Pugh scores were used to evaluate NVUGIB and EGVB cases respectively. Results the mean age of UGIB patients was 54.47 卤17.04 years old. The incidence ratio of male and female was 3.04: 1.00, 173 cases died, and the mortality was 9.05. The causes of UGIB bleeding in the first five places were: duodenal bulbar ulcer. Gastric ulcer, gastric cancer, acute gastric mucosal lesion, duodenal bulbar ulcer were more common in 14-30 years old, and with the increase of age, the incidence of duodenal ulcer decreased gradually. EGVB, gastric ulcer occurred mostly in 50-69 years old; Gastric cancer was more common in 60-69 years old. There was no significant difference in the incidence of acute gastric mucosal lesions in different age groups (P < 0.05). In the last five years, the proportion of acute gastric mucosal lesions increased from 26.06% to 34.84% (P 0.001). The proportion of pure alcoholic cirrhosis increased from 3.40% to 7.48% (P0.05). The proportion of liver cirrhosis bleeding after hepatitis B increased from 33.19% to 42.13. 14 of the death causes of NVU GIB cases died of hemorrhage. 62 cases (81.58) died of the deterioration or complications of basic diseases, malignant tumor (27.63), lung disease (22.37). Multiple organ failure (MOS 17.11) is one of the three causes of non-hemorrhagic death in NVUGIB. Among the death cases of EGVB, 38 cases (39.18) died of hemorrhage, 59 cases (60.82) died of the deterioration or complication of basic diseases, and 18.56% of hepatic encephalopathy). Malignant tumor 14.43%. Multiple organ failure 14.43) is the three major causes of non-hemorrhagic death in EGVB. The death and rebleeding rates of NVUGIB patients in high risk group are higher than those in middle group. Low risk group; The mortality and rebleeding rates of Child-Pugh C EGVB patients were significantly higher than those of A and B grades. Conclusion the first etiology of Child-Pugh C EGVB is peptic ulcer. However, the proportion of EGVB increased year by year. The main causes of death in patients with hepatitis B cirrhosis and simple alcoholic cirrhosis were basic diseases or complications. Therefore, in addition to the treatment of bleeding causes in patients with UGIB, we should take active measures to treat basic diseases. 3) for patients with UGIB, we should take early assessment and risk stratification. The risk of rebleeding and death was judged.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.2

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