急性非静脉曲张性上消化道出血病因及内镜时间选择的研究

发布时间：2018-04-09 20:50

本文选题：消化道出血　切入点：病因　出处：《延安大学》2017年硕士论文

【摘要】：目的:1.探讨陕西地区急性非静脉曲张性上消化道出血(acute non variceal upper gastrointestinal bleeding,ANVUGIB)病因构成特点,加强对ANVUGIB的了解,指导临床医师对ANVUGIB做出准确判断及合理治疗;2.探讨最佳内镜检查时间,从而指导临床医师对内镜诊治时间的选择。方法:回顾式的随机选取陕西省人民医院2014年1月-2016年12月以不同程度呕血及或黑便为主诉症状的ANVUGIB病例共420例,根据入组及排除标准共纳入351例,其中入组患者均行内镜检查确诊为ANVUGIB,且所有病例均行内镜下止血治疗。将所筛选出的351例确诊为ANVUGIB病例的各个病因分别从性别、年龄、季节、年份等不同角度进行分组,分析病因构成特点;按内镜检查时间不同分为3组,即24h以内,24-48h以及48h以后三组,分别对病因诊断率、死亡率、住院时间、住院费用进行比较;分析影响住院费用的因素。结果:1.对所纳入的病例的病因分析后结果所示:消化性溃疡占16.24%,急性胃黏膜病变占13.68%,消化系肿瘤占10.83%,以及食管贲门黏膜撕裂综合征占6.55%;2.在不同性别中病因构成的比较,结果显示:男性消化性溃疡发病率为85.19%,女性发病率为14.81%,经统计分析P0.05,差异有统计学意义;3.ANVUGIB各个病因在不同年龄组病因构成的比较,经分析后结果显示:DU(Duodenal ulcer,DU)好发于青年人及中年人,高于老年人(P0.05);GU(Gastric ulcer,GU)好发于老年人,高于中年人和青年人(P0.05);急性胃黏膜病变以及肿瘤则多见于老年人,明显高于中年人和青年人(P0.05)。4.ANVUGIB的不同诱因在不同年龄组比较,结果显示:NSAIDs相关性出血的发病率老年人大于中年人和青年人(P0.05),因饮酒、劳累、情绪激动诱发出血,中年人和青年人大于老年人(P0.05)。5.急性胃粘膜病变与NSAIDs药物在近3年发病率变化的比较,分析后结果所示:急性胃黏膜病变以及NSAIDs药物相关性出血2015年的发病率高于2014年的发病率,2016年发病率超过2015年的发病率,P0.05,差异有统计学意义。6.ANVUGIB各个病因在不同季节构成的比较,结果显示:各个病因在不同季节构成无明显差异,P0.05,差异无统计学意义。7.不同内镜检查时间对病因诊断率、住院时间以及住院费用均有影响,结果显示:24h以内内镜检查组其住院费用较24-48h内镜检查组以及48h以后内镜检查组少(P0.05),住院时间短(P0.05),病因诊断率高(P0.05),但3组之间死亡率无明显差异(P0.05)。8.影响费用因素的多元线性回归分析后结果显示:内镜检查时间、住院时间、合并症与费用存在线性关系,是影响费用的因素。结论:1、ANVUGIB病因中急性胃黏膜病变引起的发病率较消化道肿瘤增多,这可能与服用NSAIDs药物有关。2、病人入院后尽早行内镜检查可以提高病因诊断率,缩短住院时间,减少住院费用。
[Abstract]:Purpose 1.To investigate the etiological characteristics of acute non variceal upper gastrointestinal bleeding in acute non-varicose upper gastrointestinal bleeding in Shaanxi, to strengthen the understanding of ANVUGIB, and to instruct clinicians to make accurate judgement and reasonable treatment of ANVUGIB.To explore the best time of endoscopy, so as to guide clinicians to choose the time of endoscopic diagnosis and treatment.Methods: a total of 420 cases of ANVUGIB with different degree of hematemesis and or melanosis were selected randomly from January 2014 to December 2016 in Shaanxi Provincial people's Hospital, and 351 cases were included according to the criteria of admission and exclusion.All the patients were diagnosed as ANVUGIBby endoscopy, and all patients were treated with endoscopic hemostasis.The causes of ANVUGIB were divided into three groups according to their sex, age, season, year and so on, and were divided into three groups according to the time of endoscopy.The etiological diagnosis rate, mortality rate, hospital stay time and hospitalization cost were compared among the three groups within 24 h and 24 48 h and after 48 h, respectively, and the factors affecting the hospitalization cost were analyzed.The result is 1: 1.The results of etiological analysis showed that peptic ulcer accounted for 16.24%, acute gastric mucosal lesion 13.68%, digestive system tumor 10.83%, and esophageal and cardiac mucosal tear syndrome 6.5522%.The results showed that the incidence of peptic ulcer was 85.191in males and 14.81in females. The difference was statistically significant (P0.05). 3. The etiological composition of ANVUGIB in different age groups was compared.Compared with the middle aged and young people, the incidence of blood loss in the elderly was higher than that in the middle aged and young people, and the bleeding was induced by drinking, tiredness and emotional agitation, compared with that of the middle aged and young people, and the different inductive factors of ANVUGIB were compared in the different age groups, the results showed that the incidence of blood loss was higher in the elderly than in the middle aged and young people.The middle age and young people are larger than the old people (P 0.05. 5).Comparison of the incidence of acute gastric mucosal lesions with NSAIDs drugs in the past three years.The results showed that the incidence of acute gastric mucosal lesions and NSAIDs drug-related hemorrhage in 2015 was higher than that in 2014, and the incidence rate in 2016 was higher than that in 2015 (P 0.05). The difference was statistically significant.The results showed that there was no significant difference in the composition of each etiology in different seasons (P 0.05), and the difference was not statistically significant.Different time of endoscopy had influence on the rate of etiological diagnosis, length of stay and cost of hospitalization.The results showed that the cost of hospitalization of the group within 24 hours was less than that of the group within 24-48 hours and after 48 hours, the hospitalization time was shorter than that of the group, and the rate of etiological diagnosis was higher than that of the control group. However, there was no significant difference in mortality among the three groups.The results of multivariate linear regression analysis showed that the time of endoscopic examination, the time of hospitalization and the complication had linear relationship with the cost, which were the factors affecting the cost.Conclusion the incidence of acute gastric mucosal lesions in the etiology of the disease is higher than that caused by digestive tract tumor, which may be related to taking NSAIDs drugs. Endoscopic examination can improve the etiological diagnosis rate, shorten the hospitalization time and reduce the cost of hospitalization.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.2

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