上消化道出血病因分析及临床预后相关危险因素的研究

发布时间：2018-04-24 00:25

本文选题：UGIB + 死亡率　；参考：《南昌大学》2016年硕士论文

【摘要】：背景:上消化道出血(UGIB)是临床常见急症,虽然最近几年发病率逐渐下降,但其住院死亡率仍保持在7-10%之间。尽管内镜下止血治疗以及辅助药物治疗的发展,死亡率仍相当高以及医疗消耗大,在发达国家每10万人口将近有50-150人发病,这可能与目前人口老龄化、多种合并症、NSAIDs药物以及抗凝药物的使用等相关[1]。患者的临床特点以及病情的严重程度在UGIB中占很重要的作用,其死亡率通常与多器官功能衰竭、心肺功能差、恶性肿瘤相关[2]。因此,早期识别UGIB住院死亡的危险因素、液体复苏以及维持血流动力学稳定、药物治疗以及内镜下止血治疗将改善患者预后。目的:主要分析目前UGIB患者的病因构成、临床特点以及影响住院死亡的危险因素,了解UGIB发病现状,以及在临床上更科学、更有效的评估UGIB的危险因素,为治疗和预防UGIB提供参考依据,以指导临床。方法:1、回顾性收集南昌大学第二附属医院消化内科2011年09月01日至2015年01月31日符合UGIB临床诊断标准的住院患者1272例。2、制定表格,详细记录患者一般情况、既往用药史、临床特点、生化检查、出血相关情况等等。采用构成比统计分析UGIB病因构成以及归纳其临床特征。3、将所有患者根据临床预后情况分为死亡组以及存活组,分别统计病因构成、年龄、性别、吸烟、饮酒、合并症、血压、血生化等指标,对其进行单因素分析,将其中有统计学意义的观察指标纳入多因素Logistic回归分析,根据结果得出影响其死亡的主要危险因素。结果:病因构成分析:1、男性为944例占74.2%,女性为328例占25.8%,男女之比为2.88:1。发病年龄为13-96岁之间,平均年龄为54.95±17.564岁;13-20岁33例(2.6%),20-60岁716例(56.3%),60岁以上者为523例(41.1%)。2、出血原因:其中消化性溃疡共715例(56.2%),胃溃疡共146例(11.5%),十二指肠溃疡共453例(35.6%),复合性溃疡共73例(5.7%),胃肠术后吻合口溃疡共43例(3.4%);静脉曲张破裂出血共236例(18.6%);消化道肿瘤共60例(4.7%);急性胃粘膜病变共43例(3.4%);贲门撕裂综合症共12例(0.9%);血管发育异常共12例(0.9%);食道病变共5例(0.4%);肠道钩虫病5例(0.4%);胆道出血1例;不明原因出血183例(14.4%)。3、各年龄组中消化性溃疡最为多见;evb在40-60岁年龄组最多见,消化道肿瘤以及急性胃粘膜病变在60岁以上年龄组最为多见。预后相关危险因素分析:1、分为死亡组和存活组:死亡组共126例,存活组共1146例,死亡率为9.9%。死亡组中病因构成:消化道肿瘤50例(3.9%)、消化性溃疡38例(3.0%)、静脉曲张破裂出血23例(1.8%)、血管畸形6例(0.47%)。存活组中病因构成相对应为10例、677例、213例、6例。死亡组中合并症前四位为:高血压、糖尿病、冠状动脉粥样硬化、脑血管疾病。2、死亡组与存活组单因素分析:年龄、饮酒、既往出血病史、既往胃切除病史、合并症(高血压、冠状动脉粥样硬化、脑血管疾病、糖尿病、肾功能不全、房颤、合并其他部位肿瘤)、hp感染、阿司匹林的使用、病情严重程度、血压、hb、白蛋白、甘油三酯、胆固醇、肌酐、血糖共15个指标有统计学意义。3、死亡组与存活组二分类logistic回归分析:年龄、合并症(冠状动脉粥样硬化及肾功能不全)、阿司匹林使用、hp感染、既往胃切除病史、血压、hb等7项有统计学意义。可以认为他们是影响ugib死亡的独立危险因素。结论:1、消化性溃疡仍然是ugib的主要原因,其次为evb。而十二指肠溃疡是消化性溃疡中首位病因。2、ugib主要见于男性以及中老年患者,且有多种合并症,以高血压、冠状动脉粥样硬化、糖尿病多见,2种以上合并症患者明显是ugib高危死亡人群。现已成为临床治疗和监护的重点。3、ugib总体死亡率为9.9%,没有显著下降趋势。死亡患者中最常见出血原因是消化道肿瘤,其中以胃癌多见。4、年龄、合并症(冠状动脉粥样硬化及肾功能不全)、阿司匹林使用、hp感染、既往胃切除病史、血压、hb为影响ugib死亡的独立危险因素。
[Abstract]:Background: upper gastrointestinal bleeding (UGIB) is a common clinical emergency. Although the incidence of the disease has gradually declined in recent years, the mortality of the upper gastrointestinal tract remains between 7-10%. Despite the development of endoscopic hemostasis and adjuvant therapy, the mortality rate is still high and medical consumption is large, and nearly 50-150 people in 100 thousand people in developed countries are ill. The clinical characteristics and severity of [1]. patients associated with the current population aging, multiple complications, NSAIDs drugs and the use of anticoagulants are important in UGIB. The mortality rate is usually associated with multiple organ failure, poor cardiopulmonary function, and malignant tumor associated [2]., therefore, the early identification of the death of UGIB in hospital Risk factors, fluid resuscitation, and maintenance of hemodynamic stability, drug therapy and endoscopic hemostasis will improve the patient's prognosis. Objective: to analyze the cause of the UGIB, the clinical features, the risk factors that affect the death of the hospital, the status of the UGIB, and the more scientific and effective evaluation of the UGIB in the clinic. The risk factors provide a reference for the treatment and prevention of UGIB to guide the clinical. Methods: 1, a retrospective collection of 1272 cases of hospitalized patients in the Department of digestive medicine, the Second Affiliated Hospital of Nanchang University, from 01 to 2015 2011 to 2015 01 months, 2015, which were in accordance with the clinical diagnostic criteria of.2, made a form, and recorded the general situation, history of past medication, and clinical characteristics. Biochemical tests, bleeding related conditions and so on. Using the constituent ratio statistical analysis of the UGIB cause and the clinical characteristics of.3, all patients were divided into death group and survival group according to the clinical prognosis, and the cause of disease, age, sex, smoking, alcohol, association, blood pressure and blood biochemistry were analyzed, and the single factor analysis was carried out. The statistically significant observation indexes were included in multiple factor Logistic regression analysis, according to the results, the main risk factors affecting their death were obtained. Results: 1, 944 cases in men were 74.2%, 328 were women, 25.8%, and the age of 2.88:1. was 13-96 years old, and the average age was 54.95 + 17.564 years old; 13-20 33 years old (2.6%), 20-60 years old and 716 cases (56.3%), 523 cases (41.1%).2 over 60 years old, bleeding causes: peptic ulcer in 56.2% (56.2%), gastric ulcer 146 cases (11.5%), duodenal ulcer 453 cases (35.6%), gastroenteric ulcers after gastrointestinal surgery; There were 60 cases (4.7%), 43 cases (3.4%) of acute gastric mucosal lesions, 12 cases of cardia tear syndrome (0.9%), 12 cases of vascular dysplasia (0.9%), 5 cases of esophagus disease (0.4%), 5 cases of intestinal hookworm disease (0.4%), 1 cases of biliary hemorrhage,.3, and EVB in all age groups. The most common group, digestive tract tumor and acute gastric mucosal lesion was the most common in age group over 60 years old. Analysis of risk factors related to prognosis: 1, divided into death group and survival group: the death group was 126 cases, the survival group was 1146 cases, the mortality was 9.9%. death group: 50 cases (3.9%), 38 cases of peptic ulcers (3%), varicose veins. 23 cases of ruptured bleeding (1.8%) and 6 cases of vascular malformation (0.47%). The etiology of survival group should be 10, 677, 213, 6. Hypertension, diabetes, coronary atherosclerosis, cerebrovascular disease.2, death group and survival group single factor analysis: age, drinking, past history of bleeding, past history of gastrectomy, Complications (hypertension, coronary atherosclerosis, cerebrovascular disease, diabetes, renal insufficiency, atrial fibrillation, combined with other parts of tumor), HP infection, aspirin use, severity of the disease, blood pressure, Hb, albumin, triglyceride, cholesterol, creatinine, blood glucose, 15 indicators were statistically significant.3, two classified logistic in the death group and the survival group, logistic Regression analysis: age, complication (coronary atherosclerosis and renal insufficiency), aspirin use, HP infection, past history of gastrectomy, blood pressure, Hb, and other 7 statistical significance. They can be considered as an independent risk factor affecting UGIB death. Conclusion: 1, peptic ulcers are still the main cause of UGIB, followed by evb. and duodenum. Ulcer is the first cause of peptic ulcer.2, and UGIB is mainly found in male and elderly patients, and there are many kinds of complications, with high blood pressure, coronary atherosclerosis, and diabetes. 2 or more complications are obviously the high risk of death in UGIB. It has now become the key.3 for clinical treatment and monitoring, and the overall mortality rate of UGIB is 9.9%. The most common cause of hemorrhage in the patients was digestive tract tumors, including.4, age, age, complication (coronary atherosclerosis and renal insufficiency), aspirin use, HP infection, past history of gastrectomy, blood pressure, and Hb as an independent risk factor for the death of UGIB.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.2

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