老年上消化道出血的病因与影响预后的因素

目的:探讨老年上消化道出血(UGB)的病因、合并症及其严重程度对预后及治疗费用等的影响。方法:对同期因UGB住院的347例老年患者及545例中青年患者的临床资料进行统计分析。结果:UGB患者中老年女性的发病比率高于中青年组女性,老年组的住院费用、合并症患者及病死率显著高于中青年组;老年组的球溃、复合溃疡发病率、HP感染率低于中青年组;老年组糜烂性胃炎、胃溃疡、胃癌、胰腺癌、各类肿瘤浸润转移致UGB及不明原因的出血高于中青年组;老年组食道癌、肝癌及肝硬化的发病率与中青年组相似;老年死亡组与非死亡组在年龄、性别上无显著差异,老年死亡组住院费用、合并症高于非死亡组;合并休克及严重糖尿病、心、肺、肾疾病的病死率显著增高。结论:老年上消化道出血中胃溃疡、胃癌、其他肿瘤浸润转移以及不明原因出血者、合并症、病死率高于中青年组,老年组占用了更多的医疗资源并以老年死亡组为最;老年死亡组有更多以及更严重的合并症。

The etiologies of upper gastrointestinal bleeding in the elderly patients and the factors influence on prognosis

Objective :To explore the etiologies and complications of upper gastrointestinal bleeding(UGB) in the elderly patients and to investigate the influence of clinical severity on prognosis and medical cost in these patients.Methods: Clinical data of upper gastrointestinal bleeding in patients at a certain period,including 347 cases of elderly patients and 545 cases of patients in the middle age and youth,was statistically analyzed.Results:Elderly female has a higher incidence of UGB than female in the middle age and youth.As compared with the patients in the middle age and youth,the medical cost,complications and the mortality in the elderly were significantly higher.Though the elderly had a lower incidence of duodenal ulcer,complex ulcer and infection rate of helicobacter pylori than the middle-aged and young,more frequent occurrence of gastritis,gastric ulcer,gastric or pancreatic carcinoma,tumor metastasis or infiltration and bleeding of undetermined origin were observed.There was no statistical significance in the frequency of occurrence of esophageal carcinoma,liver cancer and liver cirrhosis between the elder and the middle-aged and young UGB patients.No differences were observed in distribution of age and sex between the elderly patients who survived or not,but the medical costs were much higher in patients who did not survive.A much higher death rate was observed in patients suffering from shock,diabetes and several dysfunction of heart,lung,and kidney. Conclusions: As compared with the middle-aged and young ones,the elderly UGB patients have a more frequent occurrence of gastric ulcer,gastric or pancreatic carcinoma,tumor metastasis or infiltration and bleeding of undetermined origin,a significant higher rate of complication and death,and take up more medical resource.More and much severity complications and even more occupied medical resource are observed in elderly patients who did not survive.