老年急性非静脉曲张性上消化道出血临床特点分析

目的总结分析急性非静脉曲张性上消化道出血≥75岁老年患者的临床特点,以便进一步了解该类患者的特殊性,为更好的临床诊治提供参考。方法回顾性分析165例于2006～2007年收住消化内科的非静脉曲张性上消化道出血患者的临床病历资料,其中老年组（≥75岁）96例,非老年组（〈60岁）59例,详细记录其临床表现、实验室检查、内镜下表现及伴随的其他系统疾病,并进行对比和分类分析。结果老年组与非老年组急性非静脉曲张性上消化道出血的首要原因均为溃疡病,老年组胃溃疡发病率（20.8%）高于非老年组（8.5%）（P〈0.05）,而非老年组十二指肠球部溃疡（57.6%）及复合性溃疡（15.3%）发病率高于老年组（39.6%及5.2%）（P〈0.05）,老年组急性糜烂出血性胃炎发病率（13.5%）明显高于非老年组（3.4%）（P〈0.05）,老年组有上腹痛和（或）上腹部压痛者（49%）低于非老年组（66.1%）（P〈0.05）。与非老年组比较,老年组伴随的其他系统疾病明显增高（P〈0.01）;应用阿司匹林/非甾体类抗炎药（NSAIDs）明显增多（P〈0.01）;血尿素氮数值明显增高（P〈0.01）;住院时间明显延长（P〈0.05）。2组幽门螺杆菌感染情况比较无显著性差异（P〉0.05）。结论≥75岁老年患者非静脉曲张性上消化道出血病情较非老年组重,住院时间长,治疗也较为复杂。对于老年组急诊内镜下诊治可以明确诊断,并可同时进行镜下止血治疗。

Clinical characteristics of acute nonvariceal upper gastrointestinal bleeding in elderly patients

Objective To investigate and analyze the clinical characteristics of acute nonvariceal upper gastrointestinal bleeding in elderly patients in order to provide reference for diagnosis and treatment.Methods The clinical data of 165 patients with acute nonvariceal upper gastrointestinal bleeding were retrospectively analyzed.The patients were divided into two groups: elderly group with 96 cases and non-elderly group with 59 cases.The clinical features,the results of laboratory examination and endoscope and the complicated diseases were recorded,then the results were compared and analyzed.Results Ulcer was the main reason for acute nonvariceal upper gastrointestinal bleeding in elderly or non-elderly patients.The incidence rates of gastric ulcer and upper abdominal pain with or without tenderness were higher in elderly group than those in non-elderly group(P<0.05).The incidence rates of bulbar duodenal ulcer,combined ulcers and erosive hemorrhagic gastritis were lower in elderly group than those in non-elderly group(P<0.05).Compared with non-elderly group,elderly group showed more other diseases,higher level of blood urea nitrogen and longer length of stay,and used more non-steroidal anti-inflammatory drugs(P<0.05).Helicobacter pylori infection showed no difference between elderly and non-elderly group.Conclusions Acute nonvariceal upper gastrointestinal bleeding could be more serious in elderly patients with a longer length stay and complex treatment.Endoscope could be used to diagnose and treat acute nonvariceal upper gastrointestinal bleeding.