非甾体抗炎药相关性上消化道出血的临床特征分析

目的：探讨非甾体抗炎药（NSAIDs）相关性上消化道出血的临床特征。方法：回顾性分析胃和/或十二指肠溃疡、黏膜糜烂导致上消化道出血患者360例患者的临床资料,将出血前7d服用过NSAIDs作为观察组,未服用过NSAIDs作为对照组,分析观察组应用NSAIDs情况;比较两组患者在年龄、消化道症状、血红蛋白（Hb）水平、胃镜表现、预后情况。结果：NSAIDs相关性上消化道出血50例（17.2%）;服用时间平均21.7±19.8d;空腹服药史者35例（70.0%）;按医嘱餐后服药15例（30.0%）;剂量均为常规剂量。与对照组比较观察组年龄大、消化症状少、Hb水平高、住院时间短,病变部位胃部为主,出血方式ForrestⅠ～Ⅱ少;观察组死亡1例低于对照组死亡12例（P〈0.05）。结论：NSAIDs相关性上消化道出血发生率较高,应掌握NSAIDs类药物的适应证和禁忌证,可同时使用胃肠道保护药;选择COX-2阻滞剂;在服药过程中定期检查大便潜血。

Clinical Features of Non steroidal Anti inflammatory Drugs induced Upper Gastrointestinal Bleeding

OBJECTIVE： To investigate the clinical feature of non steroidal anti inflammatory drugs （NSAIDs） associated upper gastrointestinal bleeding. METHODS： A retrospective analysis was performed on the clinical data of 360 patients with upper gastrointestinal bleeding that caused by gastric and / or duodenal ulcers or mucosal erosion, with those who have taken NSAIDs 7 days prior to upper gastrointestinal bleeding as trial group and those who had not taken NSAIDs as control group in order to evaluate the efficacy of NSAIDs. The differences between the two groups in age,gastrointestinal symptoms, hemoglobin （ Hb ） levels, endoscopic features and prognosis were compared. RESULTS： Of the total 360 cases reviewed,50 （17. 2% ） were NSAIDs associated upper gastrointestinal bleeding; the average medication duration of NSAIDs were （21. 7 ± 19. 8 ） days; 35 patients （70. 0% ） had fasting medication history and 15 cases （30. 0% ） took drugs after meals as directed all at a conventional dose. The trial group had older age,less digestive symptoms,higher Hb level,less hospital stay,less incidence of Forrest Ⅰ～Ⅱ bleeding than in the control group,and the stomach lesions were predominant in the trial group. One patient in trial group and 12 in control group died （P〈0. 05）. CONCLUSION： There is high incidence of NSAIDs induced upper gastrointestinal bleeding, therefore, the indications and contraindications of NSAIDs drugs should be mastered and it is advisable to concomitantly use gastrointestinal tract protective drugs and COX 2 inhibitors and have a periodical stool occult blood test during medication.