急性非静脉曲张上消化道出血病因、诱因及内镜下治疗时机与方法分析

发布时间：2018-05-21 03:31

  本文选题：急性非静脉曲张上消化道出血 + 病因　； 参考：《吉林大学》2014年硕士论文

【摘要】：目的： 1.回顾性分析2004年—2014年就诊于吉林大学中日联谊医院急性非静脉曲张上消化道出血患者病因及诱因的构成、年龄差异和10年间变化规律，为更好的了解本地区近年来急性非静脉曲张上消化道出血（ANVUGIB）病因及诱因的特点和变迁,提供循证医学证据。 2.比较不同内镜治疗方法及内镜检查时机，旨在根据不同病情选择最佳内镜下治疗方法，并探讨内镜检查时机对内镜下出血征象病灶检出率的影响，为临床治疗提供参考依据。 方法： 收集2004年1月至2014年1月就诊于吉林大学中日联谊医院，符合ANVUGIB临床诊断标准且经内镜检查明确病因的共2306例住院患者病历资料，设计完善的ANVUGIB病例资料登记表并逐一记录，应用统计学软件SPSS17.0进行分析。 结果： 1.老年组、中年组、青年组均以消化性溃疡为主因，老年组以胃溃疡为主（36.6%），中、青年组以十二指肠溃疡为主，且老年组癌症（11%）及吻合口溃疡（8.0%）所占病因比例高于青年组。 2.老年组主要诱因为非甾体类抗炎药（43.8%），显著高于中年组（12.3%）及青年组（6.5%），P＜0.01，差异具有统计学意义；而中年组及青年组的主要诱因均为饮酒和劳累情绪激动，其比例也明显高于老年组（P＜0.01，差异具有统计学意义)。 3.10年间消化性溃疡病因比例逐渐下降，急性胃黏膜病变及上消化道肿瘤比例呈升高趋势。 4.10年间非甾体抗炎药所占诱因比例逐年显著递增，其已成为急性非静脉曲张性上消化道出血越来越重要的诱因， 5.≤48h组，内镜下有出血征象者占急诊胃镜检查的37．8％，显著高于48h组（23．2％)，P＜0.01，差异有统计学意义。 6.对于Rockall评分高危的患者，联合治疗更有效（92.5%），P＜0.05，差异有统计学意义。 7.对于直径2cm的病变，联合治疗更有效（91.1%），P＜0.05，差异有统计学意义,对于直径小于0.5cm病变，钛夹是主要治疗方法。 8.钛夹治疗对于ForrestⅠa级（89.7%）及Ⅱa级（96.6%）病变是有效的主要治疗方法。 结论： 1.消化性溃疡是急性非静脉曲张上消化道出血最常见的病因，其次为急性胃黏膜病变和上消化系统肿瘤，其他常见病因依次为食管贲门黏膜撕裂综合征、Deulafoy病、反流性食管炎等。 2.急性非静脉曲张上消化道出血病因中，老年组以胃溃疡为主，中、青年组以十二指肠溃疡为主，并且老年组肿瘤所占病因比例高于青年组。 3.10年间，，溃疡病所占病因比例逐年递减，而急性胃黏膜病变近年来上升趋势明显。 4.10年间，非甾体类抗炎药所占诱因比例逐年递增。 5.48小时内的急诊胃镜更易发现出血病灶。 6.对于Rockall评分高危的患者，联合治疗更有效。 7.对于直径大于2cm的病变，联合治疗更有效。对于直径小于0.5cm病变，钛夹是主要治疗方法。 8.钛夹治疗对于ForrestⅠa级及Ⅱa级病变更有效。
[Abstract]:Objective: 1. From 2004 to 2014, the etiology and inducement of acute non-varicose upper digestive tract hemorrhage in Sino-Japanese Lianyi Hospital of Jilin University were analyzed retrospectively. In order to better understand the etiology and etiology of ANVUGIBB in recent years, the evidence of evidence-based medicine was provided. 2. The purpose of this study was to select the best endoscopic therapy according to different conditions, and to explore the influence of endoscopy time on the detection rate of endoscopy hemorrhage lesions, and to provide reference for clinical treatment. Methods: From January 2004 to January 2014, a total of 2306 inpatients who met the clinical diagnostic criteria of ANVUGIB and confirmed the etiology of ANVUGIB were collected. The complete registration form of ANVUGIB cases was designed and recorded one by one. Statistical software SPSS17.0 was used to analyze. Results: 1. Peptic ulcer was the main cause in the aged group, middle age group and young group, gastric ulcer was the main cause, and duodenal ulcer was the main cause in the young group, and the proportion of cancer and anastomotic ulcer in the old group was higher than that in the young group. 2. The main inducement of the aged group was 43.8% of the non-steroidal anti-inflammatory drug, which was significantly higher than that of the middle-aged group (12.3%) and the young group (6.5% P < 0.01), the difference was statistically significant, while the main inducement of the middle-aged group and the young group were drinking and exerting emotion. The ratio was also significantly higher than that in the elderly group (P < 0.01), and the difference was statistically significant. 3. During the past 10 years, the proportion of the causes of peptic ulcer decreased gradually, and the proportion of acute gastric mucosal lesions and upper digestive tract tumors increased. 4.The proportion of inducement caused by non-steroidal anti-inflammatory drugs increased year by year, and it has become more and more important inducement of acute non-varicose upper gastrointestinal bleeding. 5. In the group of 鈮

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