上消化道出血的病因及相关因素分析

发布时间：2018-09-11 09:42

【摘要】：目的:回顾性分析2009年至2014年吉林大学第二医院收治的上消化道出血患者的病因构成及其与年龄、性别、季节的关系,观察6年间其变化规律,为更好了解本地区近年来上消化道出血发病现状和病种变迁,加强临床工作中医生对于上消化道出血的了解,以此指导临床医生对上消化道出血病因快速、准确地做出判断及制定合理的临床干预措施,以提高预后,降低病死率,并有利于对患者进行健康教育,降低发病率及复发率。方法:本研究收集吉林大学第二医院2009年1月至2014年12月住院的上消化道出血患者的临床资料,共计2532例,经纳入标准、排除标准进行筛选后,进入本研究的患者共计1510例,统计患者病因、年龄、性别、发病时间、病死率、检查方法等。建立完善的上消化道出血病例资料登记表并逐一记录,整理归纳各变量特征。并分析导致患者上消化道出血的常见病因在6年间的变化规律及其与性别、年龄、季节的关系。所有数据资料均采用SPSS18.0统计软件进行分析处理,样本率的比较采用X2检验,P0.05认为有统计学意义,以P0.01定义为具有显著统计学差异。结果:本研究中:1.本组患者上消化道出血病因前5位依次为十二指肠溃疡、胃溃疡、食管胃底静脉曲张破裂、急性胃黏膜病变、胃癌。2.男性患者多于女性,男性年龄明显小于女性(P0.01),胃溃疡、食管胃底静脉曲张破裂和胃癌患者的男女比例无明显差异(P0.05),而十二指肠溃疡以男性为主(P0.05),急性胃黏膜病变以女性为主(P0.05)。3.特征性临床表现以黑便为主。4.患者住院期间男性因食管胃底静脉曲张破裂的死亡率高于女性(p0.05),差异有统计学意义。5.本研究中糜烂性食管炎发病率呈逐年下降趋势。另外其他原因(如血管性疾病、血液病、尿毒症等)的趋势卡方检验c2=45.749,p=0.0000.05,具有统计学意义,说明其他原因发病率呈逐年上升趋势。6.上消化道出血患者2009至2014年老年组发病比例呈逐年上升的趋势,而青年组发病比例呈逐年下降的趋势。7.十二指肠溃疡的发病率青年组最高,其次为中年组,老年组最低(p0.05);胃溃疡的发病率青年组最低(p0.05);食管胃底静脉曲张破裂的发病率中年组最高(p0.05);胃癌的发病率老年组最高(p0.05)。8.在不同季节中,胃溃疡的发病率春季和冬季要低于夏季和秋季(p0.05);食管胃底静脉曲张破裂的发病率冬季最高(p0.05);急性胃黏膜病变的发病率春季要高于夏季和冬季(p0.05);胃癌的发病率夏季最低(p0.05)。结论:对以长春市吉林大学第二医院为中心的周边区域6年间收治的1510例上消化道出血患者的分析表明:1.主要病因为十二指肠溃疡、胃溃疡、食管静脉曲张破裂、急性胃黏膜病变、胃癌。2.十二指肠溃疡导致上消化道出血者以男性为主,急性胃黏膜病变导致上消化道出血者以以女性为主。3.老年组上消化道出血发病比例呈逐年上升的趋势,最主要出血病因是胃溃疡,青年组发病比例呈逐年下降趋势。4.春季、夏季和冬季均以十二指肠溃疡为最主要出血病因,秋季最主要出血病因为胃溃疡。
[Abstract]:Objective:To retrospectively analyze the etiological components of upper gastrointestinal hemorrhage patients admitted to the Second Hospital of Jilin University from 2009 to 2014 and their relationship with age,sex and season. To understand the causes of upper gastrointestinal hemorrhage, guide clinicians to quickly and accurately determine the causes of upper gastrointestinal hemorrhage and formulate reasonable clinical intervention measures to improve prognosis, reduce mortality, and help patients with health education, reduce the incidence and recurrence rate. The clinical data of 2532 patients with upper gastrointestinal hemorrhage admitted to the hospital in December, 2014 were analyzed. After inclusion criteria and exclusion criteria were selected, 1510 patients were enrolled in the study. The etiology, age, sex, onset time, mortality and examination methods of the patients were analyzed. All data were analyzed by SPSS18.0 statistical software. The sample rate was compared by X2 test, P 0.05 was considered statistically significant, and P 0.01 was defined as having statistical significance. Results: 1. The top five causes of upper gastrointestinal bleeding in this group were duodenal ulcer, gastric ulcer, rupture of esophageal and gastric varices, acute gastric mucosal lesions, gastric cancer. 2. Male patients were more than females, and male patients were significantly younger than females (P 0.01), gastric ulcer, rupture of esophageal and gastric varices and gastric cancer. There was no significant difference between male and female (P 0.05), while duodenal ulcer was predominant in male (P 0.05), and acute gastric mucosal lesion was predominant in female (P 0.05). 3. The characteristic clinical manifestation was mainly black stool. 4. The mortality of male patients with esophagogastric varices rupture was higher than that of female patients during hospitalization (P 0.05). The incidence of middle erosive esophagitis showed a decreasing trend year by year. Other causes (such as vascular diseases, blood diseases, uremia, etc.) trend Chi-square test C2 = 45.749, P = 0.0000.05, statistically significant, indicating that the incidence of other causes showed an increasing trend year by year. 6. Upper gastrointestinal bleeding in 2009 to 2014, the incidence of elderly patients showed a rising trend year by year. The incidence of duodenal ulcer was the highest in the youth group, followed by the middle-aged group, the lowest in the elderly group (p0.05); the incidence of gastric ulcer was the lowest in the youth group (p0.05); the incidence of esophagogastric varices rupture was the highest in the middle-aged group (p0.05); the incidence of gastric cancer was the highest in the elderly group (p0.05); and the incidence of gastric cancer was the highest in the elderly group (p0.05). The incidence of gastric ulcer in spring and winter was lower than that in summer and autumn (p0.05); the incidence of esophagogastric varices rupture in winter was the highest (p0.05); the incidence of acute gastric mucosal lesions in spring was higher than that in summer and winter (p0.05); the incidence of gastric cancer in summer was the lowest (p0.05). Conclusion: Jilin is the largest City for Changchun. Analysis of 1510 patients with upper gastrointestinal bleeding admitted in the peripheral area of the Second Hospital during the past six years showed that: 1. The main causes were duodenal ulcer, gastric ulcer, rupture of esophageal varices, acute gastric mucosal lesions, gastric cancer. 2. Duodenal ulcer caused upper gastrointestinal bleeding was mainly male, acute gastric mucosal lesions caused by disappearance. The incidence of upper gastrointestinal hemorrhage in the elderly group showed an upward trend year by year. The main cause of bleeding was gastric ulcer. The incidence of gastric ulcer in the youth group showed a downward trend year by year. 4. Duodenal ulcer was the main cause of bleeding in spring, summer and winter, and gastric ulcer was the main cause of bleeding in autumn.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.2

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