老年人和非老年非静脉曲张性上消化道出血的病因和合并症特征比较

 目的 提高老年人非静脉曲张破裂上消化道出血(non-varicealupper upper gastrointestinal bleeding, NVUGB)的早期识别水平。方法 利用电子病历管理系统检索某医学中心2015-01至2017-01所有以“上胃肠道出血”为出院诊断的病历资料,对符合条件的病例采用回顾性队列研究分析患者的诊断线索、病因及共存病特征。年龄≥60岁为老年组,18～59 岁患者为非老年组,比较分析两组临床资料。结果 呕血、黑便、呕血+黑便及低血容量状态为诊断上胃肠道出血的主要线索,其中老年组呕血比率15.2％(23例)显著低于非老年组23.4％(26例)(P<0.01),而低血容量状态比率10.6％(16例)显著高于非老年组6.0％(7例)(P<0.05)。老年组前三位病因依次是十二指肠溃疡、胃溃疡和上消化道肿瘤,非老年组依次为上消化道肿瘤、十二指肠溃疡和胃溃疡。老年组(134/151)共存病显著多于非老年组(78/112)(P<0.01)。结论 老年人NVUGB的主要危险因素是共存病多和抗血小板治疗,主要病因是十二指肠溃疡、胃溃疡和上消化道肿瘤,早期胃镜检查是明确诊断的关键。

Etiology and comorbidity of non-variceal upper gastrointestinal bleeding in the elderly: a retrospective cohort study

Objective To enhance the ability to early identify non-variceald upper gastrointestinal bleeding (NVUGB) in the elderly.Methods A retrospective cohort study was performed by searching for medical reports on cases diagnosed with "NVUGB" between Jan 2015 and Jan 2017 via an electronic medical records management system.All the patients with NVUGB were divided into the elderly study group(≥60 years old) and control group (aged 18 to 59).The diagnostic clues,etiology,comorbidity and drugs used were compared between two groups.Results The incidence of haematemesis was markedly lower in the elderly group(15.2％) than that in the control group(23.4％,P ＜0.01),but the signs of hypovolemic state occurred more often in the elderly group than in the control group(10.6％ vs 6.0％,P ＜ 0.05).78.8％ of the patients in the elderly group were diagnosed by gastrocopy,and 90.2％ in the control group (P ＜ 0.01).The etiologies among these elderly patients included duodenal and gastric ulcers,and upper gastrointestinal malignancies,while in the control group upper gastrointestinal malignancies were dominating,followed by duodenal and gastric ulcers.Comorbidity (134/151) was more common in the elderly group than in the control group(78/112,P ＜0.01),including cardiovascular diseases and hypertension (P ＜ 0.01).Conclusion The main risk factors of NVUGB in the elderly are the high incidence of comorbidity and antiplatelet therapies.The etiologies are complex,including duodenal and gastric ulcers,and upper gastrointestinal malignancies.Early gastrocopy is the key to positive diagnosis of NVUGB.