老年人急性上消化道出血的并发症

老年人上消化道出血是临床常见急症。本文报道１９８４－１９９３年间收治的６０－９３岁２３７例上消化道出血住院病例，重点讨论老年人上消化出血的特殊并发症。有较常见的心律失常、肺部感染、肝昏迷等，也有较少见的精神异常、心肌梗塞、酮症酸中毒等。指出在治疗老年人上消化道出血时，重视其伴随疾病，积极预防和治疗并发症，是提高疗效、１降低死亡率的重要措施。     

老年人急性上消化道出血165例分析

老年人急性上消化道出血１６５例分析付永庆徐子山江苏省扬州市第四人民医院（２２５００２）老年人急性上消化道出血临床比较常见。本院１９９０～１９９６年间６０岁以上老年人急性上消化道出血住院病人１６５例，现将临床特点分析总结如下。１临床资料１．１年龄与性别...     

老年人急性上消化道出血90例临床分析

急性上消化道出血是内科常见急症之一，病情急，变化快，严重者可危及生命。随着人口老龄化，急性上消化道出血病例逐年增加，由于老年人器官老化，其生理功能、病理生理以及好发疾病和临床表现有着其自身的特点。我院2004年5月至2008年8月共收治老年上消化道出血患者90例，现总结报告如下。     

102例老年人急性上消化道出血病因分析

目的探讨老年人上消化道出血的病因。方法回顾性总结102例老年人急性上消化道出血的病因,与同期住院非老年人上消化道出血患者150例就出血病因进行对比分析。结果老年组患者胃溃疡33例,占32.4%,十二指肠球部溃疡21例,占20.5%;急性胃黏膜病变32例,占31.4%;食管癌及胃癌11例,占10.8%;食管静脉曲张2例,占2.0%;原因不明3例,占2.9%。非老年组患者胃溃疡38例,占25.3%;十二指肠球部溃疡67例,占44.6%;急性胃黏膜病变25例,占16.7%;食管静脉曲张12例,占8.0%;食管癌及胃癌5例,占3.3%;食管贲门黏膜撕裂症2例,占1.3%;胃息肉1例,占0.7%。结论老年人上消化道出血主要病因为消化性溃疡、胃黏膜糜烂、肿瘤。     

老年人上消化道出血临床分析

目的探讨老年人上消化道出血的临床特点。方法对我院同期两年间收治的上消化道出血确诊病例399例,其中老年组(A组60～85岁)149例及非老年组(B组15～59岁)250例的临床资料进行回顾性总结比较分析。结果 A组呕血率、伴随疾病率分别为21.5%、48.3%,与B组相比差异均非常显著(P0.01)。病因方面,不论A组和B组,消化性溃疡仍然是上消化道出血的首要原因,其中A组胃溃疡(GU)与十二指肠溃疡(DU)发病无显著差异(P0.05),而B组DU明显多于GU,差异非常显著(P0.01)。结论老年人上消化道出血呕血发生率高,相关上腹痛、反酸和腹胀症状发生率低,伴随疾病多。     

老年人上消化道出血108例临床分析

我院从1999年10月至2004年4月收治老年人上消化道出血108例，现分析如下。     

108例老年人上消化道出血的临床分析

上消化道出血为老年人常见消化道疾病。本收集了南方医院消化病研究所96至97两年收治的上消化道出血322例，占全院同期上消化道出血病人的63．4％，其中老年108例，占该所上消化道出血病人的33．5％，并与214例中青年为对照，报告如下。     

老年人上消化道出血并发多器官功能衰竭

老年人上消化道出血是临床常见急症 ,随着年龄增长 ,老年人的心、肺、脑、肾等功能均有不同程度的减退 ,故老年患者在出血后更易并发多器官衰竭(ｍｕｌｔｉｐｌｅｏｒｇａｎｆａｉｌｕｒｅ ,ＭＯＦ) ,预后差。本文就中山医院近年来收住的老年人上消化道出血并发ＭＯＦ的病例作一分析 ,以初步探讨其可能的诱因及预防措施。1　资料与方法1.1对象　收集中山医院 1993～ 2 0 0 0年住院的老年人上消化道出血 76 7例 ,其中 30例发生ＭＯＦ ,占3.9% ,男 17例 ,女 13例 ,年龄 6 0～ 92岁 ,平均 70 .9岁。1.2上消化道出血诊断依据　有呕血、黑便并经…     

四种非静脉曲张上消化道出血危险性评分系统的对比分析

目的探讨四种非静脉曲张性上消化道出血的危险性评分系统(Rockall再出血危险积分、Cedars-Sinai Medical Center预后指数、Blatchford入院危险性计分、The Baylor出血积分)对于已确定的非静脉曲张性上消化道出血的病人中再出血情况的预测能力。方法选取2002年-2007年消化内科收治的消化道出血病人753例,以四种危险性评分系统分别评分后,行卡方拟和优度检验检测数据分布的合理性,后计算受试者工作特性曲线(ROC曲线)下面积。结果四种评分系统的ROC曲线下面积分别为:Rockall再出血危险积分0.681(P0.01,95%CI:0.638-0.723),Cedars-Sinai Medical Center预后指数0.685(P0.01,95%CI:0.639-0.731),Blatchford入院危险性计分0.886(P0.01,95%CI:0.857-0.916),The Baylor出血积分0.737(P0.01,95%CI:0.95-0.779)。结论①四种评分系统均对再出血有预测性。②Blatchford入院危险性计分更适用于门诊及急诊。     

Blatchford危险评分系统对老年人急性非静脉曲张上消化道出血的评估价值

目的 探讨Blatchford评分对老年急性非静脉曲张上消化道出血(ANUGIB)患者输血、再出血、干预和死亡的预测价值. 方法 采用Blatchford评分系统对我院270例老年ANUGIB患者进行危险程度分级,与同期311例非老年患者进行对比,应用受试者工作特征(ROC)曲线评估Blatchford评分系统对患者输血、再出血、干预和死亡的预测价值. 结果 老年组输血率显著高于非老年组(39.3％比25.1％,P=0.000);老年组和非老年组再出血率分别为4.1％(11/270)比4.2％(13/311),总干预率为27.0％(73/270)比28.3％(88/311),病死率为2.2％ (6/270)比1.0％(3/311),差异均无统计学意义(P＞0.05).以6分为分界点,Blatchford评分诊断老年和非老年ANUGIB的敏感性分别为94.9％和84.5％;以9分为分界点,特异性分别为73.1％和83.5％.Blatchford评分评估老年和非老年患者ROC曲线下面积(AUC)分别为,输血0.72比0.87,死亡0.74比0.95,Blatchford评分系统对老年和非老年患者输血和死亡均有较好的预测价值(均P＜0.01);再出血0.60比0.70,对非老年组再出血具有较好的预测价值(P=0.015),但对老年组再出血无预测价值;内镜为0.65比0.55,介入0.84比0.65,手术干预0.49比0.66;Blatchford评分系统对老年组进行内镜和介入干预具有较好的预测价值(均P＜0.01),对手术干预无预测价值(P＞0.05);对非老年组手术干预具有较好的预测价值(P＜0.01),对内镜和介入治疗无预测价值(P＞0.05). 结论 Blatchford评分系统对于老年ANUGIB患者输血、内镜/介入干预和死亡具有较好的预测价值,对手术干预和再出血无预测价值;对于老年患者,可将6分作为分界点判断高低危人群.     

Patient-reported outcomes after acute nonvariceal upper gastrointestinal hemorrhage

Abstract

Objective. Nonvariceal acute upper gastrointestinal bleeding (AUGIB) is often associated with significant blood loss and anemia. Both the bleeding episode itself and the subsequent anemia are likely to significantly impact a patient’s health-related quality of life (HRQoL). Treating the anemia is essential to increase the hemoglobin levels. The HRQoL impact has not been investigated. This longitudinal study aimed to determine the relationship between anemia, HRQoL, and fatigue in patients after nonvariceal AUGIB. Materials and methods. A total of 97 patients (51 males and 46 females; mean age 70 years) were followed in a longitudinal study with a 6-month follow-up. All patients had AUGIB and were anemic at inclusion. Anemia, HRQoL (EQ-5D-3L), and fatigue (using the Multidimensional Fatigue Inventory) were assessed at baseline, and at 1, 3, and 6 months. The patients were initially included in an iron supplementation study. Results. The patients’ HRQoL increased and their fatigue levels decreased from baseline to month 3 and month 6. Approximately half of the patients had full health at month 3; similar results were observed in the general population. Three and six months after the bleeding episodes, neither the HRQoL nor fatigue was affected by the anemia. Conclusion. This study did not uncover relationships between anemia and HRQoL or anemia and fatigue after nonvariceal AUGIB.     

老年人急性非食管静脉曲张性上消化道出血的临床特点

目的 分析老年人上消化道出血的临床特点。方法 回顾性总结206例非食管静脉曲张性上消化道出血患者住院病历，其中老年组105例，非老年组101例。详细记录临床、实验室及内镜检查结果。结果 老年组与非老年组上消化道出血的首要原因均为溃疡病，分别为83．8％与84．2％，但老年组胃溃疡患病率(18．1％)明显高于非老年组(5．0％，P＜0．05)；老年组应用阿司匹林／非甾体类抗炎药(NSAID)明显增多，达29．5％，非老年组仅为3.0％(P＜0．05)；与非老年组比较，老年组平均止血时间明显延长，分别为6．9d和5．6d，再出血比例明显增高，分别为6．7％和0；所需平均输血量、需手术者以及需重症监护者均明显高于非老年组。两组患者平均住院时间、转归以及幽门螺杆菌感染情况差异无显著性。结论 老年人上消化道出血临床病情较非老年人重，病程延长，治疗更为复杂。急诊的内镜检查与内镜下止血治疗是安全有效的措施。     

泮托拉唑与奥曲肽治疗上消化道出血的临床分析

目的初步探讨泮托拉唑与奥曲肽单独与联合治疗非静脉曲张性上消化道出血的有效性及安全性。方法选取武汉科技大学附属汉阳医院消化内科2009年12月-2012年12月非静脉曲张性消化道出血153例,随机分为A、B、C组,每组51例,在其他对症治疗的基础上,A组单独给予泮托拉唑,B组单独使用奥曲肽,C组泮托拉唑与奥曲肽联合应用。比较3组患者在持续出血时间、出血量、胃液pH值、血红蛋白、临床疗效及不良反应方面的差异。结果 (1)三组患者持续出血时间、输血量、胃液pH值、血红蛋白比较:与A、B组比较,C组持续出血时间、输血量明显减少,胃液pH值、血红蛋白明显升高,差异均有统计学意义(P0.05)。(2)三组患者临床疗效比较:在显效及总有效率方面,C组均明显高于其他两组,差异均有统计学意义(P0.05)。(3)不良反应比较:三组患者均未发现明显不良反应。结论对于非静脉曲张性消化道出血,泮托拉唑与奥曲肽联合应用能高效快速止血,应在临床开展应用。     

Crohn's disease presenting as acute gastrointestinal hemorrhage

Severe gastrointestinal (GI) hemorrhage is a rare complication of Crohn’s disease (CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.     

3％双氧水喷洒对老年急性上消化道出血病人胃腔视野改善情况

目的 评价3％双氧水对老年急性上消化道出血病人胃腔视野改善情况。方法 2000年3月-2003年12月对228例老年急性上消化道出血进行急诊胃镜检查,64例因胃腔视野不清末发现出血病灶,进入本研究,其中男38例,女26例。先对可疑出血病灶及胃腔照相,再通过活检孔向胃腔喷洒200 ml生理盐水,3分钟后吸尽胃腔液体,照相后换用200ml 3％双氧水喷洒,3分钟后吸尽胃腔液体,再对出血病灶及胃腔照相。由第三位胃镜专家对照片进行视野清晰度评分,同时观察出血部位,出血病灶性质、出血病灶止血情况。结果 喷洒3％双氧水后胃腔视野清晰度评分为2.26±0.23,发现出血部位88％(50／57)、确定出血病灶性质82.46％(47／57),活动性出血停止71.9％(41／57),而喷洒生理盐水后则分别为0.44±0.25、11％(7／64)、7.81％(5／64)、6.25％(4／64),二者相比均有非常显著性差异,P<0.001;42％患者有轻微上腹不适症状。结论 3％双氧水喷洒能改善老年人急性上消化道出血患者胃腔视野清晰状况,提高胃镜诊断率、并有较高的止血率,无明显不良反应,值得临床推广应用。     

老年人上消化道出血134例临床分析

目的探讨老年人上消化道出血及导致死亡的病因。方法回顾性总结分析上消化道出血老年患者１３４例，并与同期非老年患者１２０例比较。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。     

Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence,predictors, and interventions

BACKGROUND Gastrointestinal hemorrhage(GIH) is a common complication with gastrointestinal cancers(GIC). There is no comprehensive research that examines GIH in different types of GIC.AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients(≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.RESULTS Out of a total of 18173885 inpatients, 321622(1.77%) cases had a diagnosis of GIC.Within GIC patients, 30507(9.5%) inpatients had GIH, which was significantly(P 0.001) more than the prevalence of GIH in patients without GIC(3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer(15.7%), liver cancer(13.0%), small bowel cancer(12.7%), esophageal cancer (9.1%), colorectal cancer(9.1%), pancreatic cancer(7.2%), bile duct cancer(6.0%), and gallbladder cancer(5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate(15.6%) than jejunal(11.1%) and ileal cancers(5.7%). Within esophageal cancers, lower third cancers had higher GIH(10.7%) than the middle third(8.0%) or upper third cancers(6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances(Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis(P 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios(OR) = 0.74(0.72-0.77), P 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267(53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42(0.38-0.46), P 0.001].CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor's anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.     

老年心肌梗死伴消化道出血患者临床特点的研究

目的 分析老年急性心肌梗死(AMI)伴消化道出血患者的临床特点及预后.方法 325例确诊为AMI的老年患者分为对照组(304例)、AMI后消化道出血组(14例)和消化道出血后AMI组(7例),分析老年AMI伴消化道出血患者的临床特点和1年心血管死亡和因再发心绞痛、非致死性AMI、心力衰竭和脑卒中而住院的复合终点结果.结果 (1)AMI后消化道出血组的估测肾小球滤过率(eGFR)低于对照组,分别为(61.9±27.3)ml·min-·1.73 m-2与(77.3±27.9)ml·min-1·1.73 m2,差异有统计学意义(P＜0.05),多因素回归分析结果显示,eGFR降低对老年AMI患者发生消化道出血的相对危险为0.980(95％CI为0.960～0.999,P＜0.05);(2)消化道出血后AMI组抗血小板、抗凝治疗的比例和AMI后消化道出血组阿司匹林使用的比例均低于对照组(P均＜0.05),消化道出血后AMI组的血红蛋白低于AMI后消化道出血组,分别为(74±14)g/L与(111±25)g/L,差异有统计学意义(P＜0.01),接受输血治疗的比例高于AMI后消化道出血组,分别为85.7％(6例)与28.6％(4例),差异有统计学意义(P＜0.05);消化道出血后AMI组介入或溶栓治疗的比例显著低于对照组差异有统计学意义(P＜0.01);(3)AMI后消化道出血组的1年心血管死亡和因再发心绞痛、非致死性AMI、心力衰竭和脑卒中而住院的复合终点高于对照组,分别为42.9％(6/14)与17.8％(54/304),差异有统计学意义(P＜0.05).结论 eGFR降低是老年AMI患者发生消化道出血重要的预测因素.老年AMI患者伴发消化道出血常使抗血小板、抗凝和冠状动脉再通治疗困难,且多预后不良.     

内镜下尼龙圈套扎治疗急性非静脉曲张消化道出血

目的探讨内镜下尼龙圈套扎治疗（ENLL）在急性非静脉曲张消化道出血治疗的可行性和有效性。方法选择24h内有活动性非静脉曲张消化道出血患者56例，对出血病灶进行内镜下尼龙圈套扎治疗。结果56例患者巾24例为活动性出血，其中23例即时止血成功（95．9％）。无严重并发症发生。结论ENLL是一种治疗急性非静脉曲张出血的有效方法。