134例老年上消化道出血的临床诊治分析

目的:观察分析老年人上消化道出血的发病因素、临床表现及诊治特征,籍以提高对本症的重视和诊治水平。方法:收集本院近10年来上消化道出血患者共254例(其中老年患者134例,并与同期非老年患者120例比较),分类归纳这些病例的原发疾病、出血诱发因素、伴随疾病、临床及生化特征和治疗转归。结果:老年人上消化道出血病因中主要为酸相关疾病(十二指肠溃疡、胃溃疡、胃炎、十二指肠炎、食管炎)71例,占73.9%;胃癌14例,占14.5%。发生低血压或休克,老年组18例,非老年组8例(P<0.05)。使用阿司匹林或非甾体类抗炎药物,老年组28例,显著高于非老年组(7例,P<0.01)。老年组死亡18例,病死率为13.4%,其中15例因全身慢性疾病恶化和出血后并发症死亡;非老年组死亡6例,病死率为5.0%(P<0.01)。结论:酸相关疾病是老年人上消化道出血的主要病因,其次为胃癌。全身慢性疾病恶化和出血后并发症是影响老年人上消化道出血预后的重要因素,特别是肺部感染、心脑血管疾病是主要的死亡原因。老年上消化道出血,不论从诱发因素、病因、伴发疾病谱、临床、实验室检查及诊治过程均有别于非老年组,值得临床重视,因病施治。

134 Cases of Elderly Upper Gastrointestinal Bleeding in the Clinical Analysis

Objective Observation of the elderly the incidence of upper gastrointestinal bleeding factors,clinical manifestations,diagnosis and treatment characteristics,which will raise the importance of this disease and diagnosis and treatment.Methods Hospital nearly 10 to upper gastrointestinal bleeding in patients with a total of 254 cases(of which elderly patients with 134 cases and with the same period in non-elderly patients 120 cases compared),the classification into these cases of primary disease,hemorrhage-induced factors,accompanied by diseases,clinical and biochemical characteristics and treatment outcome.Results Of the elderly upper gastrointestinal bleeding is the main cause of acid-related diseases(duodenal ulcer,gastric ulcer,gastritis,duodenitis,esophagitis) 71 cases,accounting for 73.9 percent;gastric cancer 14 cases,accounting for 14.5 percent.In hypotension or shock,old age group 18 cases,non-elderly group eight cases(P<0.05).Use of aspirin or non-steroidal anti-inflammatory drugs,old age group 28 cases,significantly higher than the non-elderly group(n = 7,P<0.01).The elderly group killed 18 cases,mortality was 13.4%,of which 15 cases due to systemic chronic illness worsened after bleeding complications and death;non-elderly group killed six cases,mortality was 5.0%(P<0.01).Conclusion Acid-related diseases in the elderly is a major cause of gastrointestinal bleeding,followed by gastric cancer.Chronic diseases and general deterioration of bleeding complications affecting the elderly upper gastrointestinal bleeding prognosis of important factors,especially lung infection,cardiovascular and cerebrovascular diseases are the main cause of death.Older upper gastrointestinal bleeding,both from the induced factors,etiology,associated with disease spectrum,clinical and laboratory examinations,diagnosis and treatment process are different from the non-elderly group,worthy of attention,illness and treatment.