急诊消化道出血的临床特征与诊治分析

目的 探讨三级医院急诊科消化道出血(GIB)的病因构成、诊治特点及预后.方法 收集2006年1-12月北京协和医院急诊科收治的168例消化道出血患者的一般资料、临床症状、实验室检查、治疗及病情变迁.结果 (1)一般资料:男:女=1.75:1(107:61),年龄13～87(56.5 4±17.8)岁.患病高峰年龄60～69岁,老年人GIB发病率明显高于青、中年组(52.4%比19.6%和52.4%比28.0%,P值均为0.000).(2)服用非甾体消炎药(NSAIDs)者急性胃黏膜病变发生率(18.5%)明显高于不服者(0.7%),P=0.000.(3)86.9%(146/168)的GIB患者伴随贫血,以中度为主.(4)急诊胃镜确诊率(89.4%)明显高于非急诊胃镜确诊率(58.5%),P=0.000.急诊肠镜与非急诊者确诊率的差异无统计学意义(20.0%比57.9%,P=o.315).(5)消化性溃疡出血的止血成功率(86.0%)明显高于其他病因引起的出血(40.7%),P=0.000;GIB急诊手术治疗率为1.8%.结论 三级医院GIB患者以高龄男性为多见;服用NSAIDs是上消化道出血的重要原因之一;急诊胃镜检查有助于上消化道出血的诊断,急诊结肠镜对下消化道出血诊断意义不明显.

The clinical characteristics of etiologies, diagnoses and treatment of emergency gastrointestinal hemorrhage

Objective To investigate the causes, clinical features, treatment and prognosis of gastrointestinal bleeding (GIB) patients in emergency department.Methods To analyze prospectively the clinical data of 168 GIB patients admitted to the emergency department of Peking Union Medical College Hospital during 2006.1-2006.12.Results (1) General data; male: female = 1.75:1 ( 107: 61) , mean age 13-87(56.5 ±17.8) years with a peak in 60-69 years.The percentage of old patients was significantly higher than that of young and middle age ( 52.4% vs 19.6% and 28.0% , P = 0.000 ).( 2 ) The incidence of acute gastric mucosal lesion in patients taking non-steroidal antiinflammatory drugs ( NSAIDs) ( 18.5% ) was significantly higher than that in patients not taking( 0.7% , P = 0.000 ).( 3 ) 86.9% ( 146/168 ) of the patients had anemia.(4) More patients who took emergency gastroscopy could be diagnosed than those patients who did not (89.4% vs 58.5% , P =0.000), while no significant difference could be seen between patients who took emergency enteroscopy and patients who had non-emergency gastroscopy (20.0% vs 57.9% , P =0.315).(5)The hemostatic ratio in GIB patients due to peptic ulcer was obviously higher than that in GIB patients due to other causes (86.0% vs 40.7% ,P =0.000).The rate of emergency operation for GIB patients was 1.8%.Conclusions Most of the GIB patients admitted to tertiary general hospitals are elderly males.NSAIDs administration is one of the most important causes of upper GIB.Upper GIB patients should have gastroscopy as soon as possible, while emergency coloscopy is of little significance in cases with lower gastrointestinal hemorrhage.