276例急性上消化道大量出血病因分析

目的:分析急性上消化道大量出血的病因及急诊诊断方法,以提高其急诊诊断水平.方法:回顾近十年来收治急性上消化道大量出血患者276例资料,分析急诊诊断方法及结果,并将入院诊断与最后诊断对比.结果:48小时内参与B超检查阳性率50.61%(83/164),胃镜检查阳性率95.24%(100/105),血管造影100%(5/5).入院诊断消化性溃疡、食管胃底静脉曲张破裂、肿瘤、出血性胃炎、贲门黏膜撕裂、血管畸形和Dieulafoy病构成比分别为38.77%、45.65%、8.70%、6.52%、0.36%、0,而最后诊断分别为35.14%、34.78%、21.74%、2.54%、1.45%、4.35%;诊断符合率分别为73.20%、86.46%、20.00%、71.43%、25.00%、0,其中最高是食管胃底静脉曲张破裂,最低是血管畸形和Dieulafoy病.结论:单凭病史作出急性上消化道大量出血的病因诊断可能存在一定误差,非创伤性B超检查有助于病因诊断,急诊胃镜及血管造影检查能作出病因诊断.

Analysis of etiology of 276 cases of massive hemorrhage of acute upper gastrointestinal tract

Objective To analyze the etiology and emergency diagnosis for 276 cases of acute massive hemorrhage of upper gastrointestinal tract(MHAUGIT) and improve its emergency diagnosis. Methods Main emergency diagnosis and results of 276 cases of MHAUGIT were retrospectively analyzed in the past 10 years in our hospital , the preliminary diagnosises were compared with the final ones. Results During 48 hours, the positive rates of B ultrasonography,gastroduodenoscopy and angiography were 50.61%(83/164),95.24%(100/105)and 100%(5/5) respectively. For the preliminary diagnosis, the constituent ratios were 38.77%(peptic ulcer disease),45.65%(cirrhosis of liver),8.70%(tumor),6.52%(hemorrhagic gastritis),0.36%(Mallory-weiss syndrome) and 0(vascular malformation and dieulafoy lesion) respectively, but the final ones were respectively 35.14%,34.78%,21.74%,2.54%,1.45% and 4.35%; the accordance rates of diagnose were respectively 73.20%,86.46%,20.00%,71.43%,25.00% and 0, the highest of them was cirrhosis of liver and the lowest was vascular malformation and dieulafoy lesion. Conclusion The etiogenic diagnosis of MHAUGIT could not only depend on the history of disease. Non-traumatic Bultrasonography helped to etiogenic diagnosis. Emergency gastroscopy or angiography could make a diagnosis etiogenically.