消化性溃疡合并上消化道出血患者临床分析

发布时间：2018-06-23 03:57

本文选题：消化性溃疡 + 上消化道出血　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:通过大样本的病例数据资料汇总,探讨消化性溃疡合并上消化道出血患者的临床特点,并找出实验室检查与临床症状,收缩压、出血量、出血人数三者间的关系,为进一步提高对该病的认识提供新的参考依据。方法:收集2012年5月至2016年5月在延安医院住院的昆明地区的消化性溃疡合并上消化道出血患者的病例资料。根据患者的性别、年龄、发病因素、首发症状、发生部位、出血量等观察指标制作表格,找出上述观察指标在各个观察项目上的分布特点,并做统计学分析,计算出数据分布是否具有统计学差异。结果:1.该病男性患者有487人,女性患者有159人。2.发病因素(不明原因、饮食、烟酒、药物、手术、劳累)在男女患者各年龄组间的分布差异都有统计学意义(P=0.000,0.000)。3.首发临床症状(呕血黑便、呕血、黑便、上腹痛)在男女患者各年龄组间的分布差异都有统计学意义(P=0.000,0.002)。4.患者RBCmin中最小值为0.89×10~(12)/L,出现在女性20-29岁年龄组;患者WBCmax中最大值为57.05×10~9/L,出现在男性40-49岁组;PLTmin中最小值为22.83×10~9/L,出现在男性80-89岁组;HBmin中最小值为21.44g/L,出现在女性40-49岁组;HCTmin中最小值为8%,出现在男性50-59岁组、女性40-49岁组;BUNmax中最大值为26.12mmol/L,出现在男性80-89岁组。大便隐血试验以阳性最多见,其中以60-69岁年龄组阳性人数最多。各实验室检查指标在男女患者各年龄组间的分布差异都无统计学意义(P0.05)。5.常见发生部位(胃底、胃体、胃窦、胃角、幽门管、十二指肠球部、十二指肠球后、十二指肠降部、食管、吻合口、鞍部、输出袢)在男女患者各年龄组间的分布差异都无统计学意义(P=0.166,0.377)。6.胃镜、组织活检、消化道钡餐、腹部B超、腹部CT、腹部X线、MRCP检查在患者各发生部位间的分布差异有统计学意义(P=0.000)。7.收缩压在患者各出血量组间的分布差异无统计学意义(P=0.731)。有休克病人26人,其中低收缩压组有8人,正常收缩压组有17人,1级高收缩压组有1人。8.治疗方法(药物、内镜)在患者各年龄组间的分布差异无统计学意义(P=0.440)。结论:(1)该病患者男性多于女性,男女比例约为3:1。(2)该病人群的好发年龄为40-79岁的中老年患者。(3)不明原因发病的最多见,药物引起溃疡出血的人数占居第二位。(4)首发临床症状最常见的是黑便,其次是呕血、黑便,再次是上腹痛。(5)该病患者红细胞下降最严重的年龄组为年轻女性组,血红蛋白下降最严重的年龄组为中年女性组。红细胞、血红蛋白的下降程度,女性比男性严重。白细胞升高最严重的年龄组为中年男性组,血小板减少最严重的年龄组为老年男性组。白细胞的升高程度、血小板的减少程度,男性比女性严重。红细胞压积下降最严重的年龄组为中年男性和中年女性组。红细胞压积的下降程度两个年龄组持平。大便隐血试验阳性者居多,约占71%。(6)该病最常见的发生部位是十二指肠球部。(7)患者确诊该病依靠胃镜检查,同时胃镜检查也是最常用的检查之一。腹部B超检查也是最常用的筛查方法。(8)通过数据研究发现,当患者的收缩压从低升至正常时,出血人数呈现升高趋势,与收缩压的变化成正比。当收缩压从正常升至180mm Hg时,出血人数反而呈现出减少的趋势,与收缩压的变化成反比。当患者的收缩压由低压到高压变化时,相应血压区间最多出血人数所对应的出血量呈现减少趋势,与收缩压的变化成反比。出血量从5ml升至1501-2000ml时,这两个区间的出血人数呈现升高趋势;出血量从1501-2000ml升至3500ml时,这两个区间的出血人数呈现下降趋势。通过计算血红蛋白的降低值来估算昆明地区该病患者的出血量主要波动在401-2500ml之间,其中出血人数最多的在1501-2000ml。(9)患者采用的治疗方法主要是药物和内镜,其中内镜治疗以氩气止血和注射止血为主。
[Abstract]:Objective: To investigate the clinical characteristics of peptic ulcer complicated with upper gastrointestinal bleeding, and to find out the relationship between the three cases of laboratory examination and clinical symptoms, systolic pressure, bleeding volume and number of bleeding, and to provide a new reference for further improvement of recognition of the disease. Methods: from May 2012 to 201. In May, 6 years, the data of peptic ulcers in the Kunming area, which were hospitalized in the Yanan hospital, with the patients with upper gastrointestinal bleeding, were made according to the sex, age, pathogenesis, first symptoms, location, and bleeding volume of the patients. The distribution characteristics of the above observation indexes on the observation items were found out, and statistical analysis was made. The statistical difference was calculated. Results: 1. the male patients with the disease were 487, and 159 of the female patients had.2. factors (unexplained reason, diet, tobacco, alcohol, medicine, operation, fatigue) in all age groups of men and women (P=0.000,0.000) the first clinical symptoms of.3. (hematemesis, hematemesis, black, and black) The difference between the age groups of the male and female patients was statistically significant (P=0.000,0.002) the minimum value of RBCmin in.4. patients was 0.89 x 10~ (12) /L, appearing in the 20-29 year old age group of women, and the maximum value of the patients was 57.05 x 10~9/L in the 40-49 year old male group; the minimum value in PLTmin was 22.83 x 10~9/L, appearing in male 80-89. The minimum value of HBmin in HBmin was 21.44g/L, appearing in the female 40-49 year old group; the minimum value in HCTmin was 8%, appearing in the male 50-59 year old group and the female 40-49 year old group; the maximum value in the BUNmax was 26.12mmol/L in the male 80-89 years old group. The most positive of the fecal occult blood test was the 60-69 year old age group. There was no statistically significant difference in the distribution difference between the age groups of men and women (P0.05).5. common sites (gastric fundus, stomach body, gastric antrum, stomach angle, pyloric canal, duodenal bulb, duodenal bulb, duodenal descending, esophagus, anastomosis, saddle, output loop) in both male and female age groups (P=0.166, 0.377).6. gastroscopy, tissue biopsy, barium meal in digestive tract, abdominal B ultrasound, abdominal CT, abdominal X ray, and MRCP examination were statistically significant (P=0.000) in the distribution of.7. systolic blood pressure between the patients' bleeding volume group (P=0.731). There were 8 patients in the low systolic pressure group, and the normal contraction was 8. There were 17 people in the pressure group and 1 people in the 1 class high systolic pressure group. There was no significant difference in the distribution of.8. (medicine and endoscopy) between the age groups of the patients (P=0.440). Conclusion: (1) there are more men than women in this disease, and the proportion of men and women is about 3:1. (2) the good onset age of the patient group is 40-79 years old. (3) the most common occurrence of unexplained causes. The number of people who caused ulcer bleeding was second. (4) the most common symptom was black stool, followed by hematemesis, black stool, and upper abdominal pain. (5) the most serious age group of the patients with the disease was the young female group, the most serious age group of the hemoglobin decreased to the middle age female group. The decline degree of red blood cell and hemoglobin, Women were more severe than men. The age group with the most serious leucocyte increase was the middle age group. The most serious age group of thrombocytopenia was the elderly male group. The degree of leukocyte increase, the degree of platelet reduction, and the severity of the male were more severe than the female. The most serious age groups of the hematocrit were middle-aged men and middle-aged women. The two age groups were flat. The majority of the stool occult blood test was positive, accounting for about 71%. (6) the most common location of the disease was the duodenal sphere. (7) the patients were diagnosed by gastroscopy, and gastroscopy was one of the most commonly used examinations. Abdominal B ultrasonography was also the most commonly used screening method. (8) data research found through data studies, When the systolic blood pressure of the patient rises from low to normal, the number of bleeding shows an upward trend, which is proportional to the change of systolic pressure. When the systolic pressure rises from normal to 180mm Hg, the number of bleeding turns out to decrease, and is inversely proportional to the change of systolic pressure. When the systolic pressure is changed from low pressure to high pressure, the corresponding blood pressure interval is most bleeding. The amount of haemorrhage corresponding to the number showed a decreasing trend, which was inversely proportional to the change in the systolic pressure. When the amount of bleeding increased from 5ml to 1501-2000ml, the number of bleeding in the two intervals showed an upward trend; the number of bleeding in the two intervals showed a decline trend when the amount of bleeding increased from 1501-2000ml to 3500ml. The bleeding volume of the patients in the Ming area was mainly fluctuated between 401-2500ml, and the most bleeding patients in 1501-2000ml. (9) were mainly treated with drugs and endoscopy, and endoscopy was mainly treated with argon gas hemostasis and injection of hemostasis.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573

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