急性脑出血继发院内消化道出血的影响因素分析

目的 分析急性脑出血患者院内继发消化道出血的危险因素。方法 回顾性分析首都医科大学附属北京天坛医院神经内科2017年5-12月连续收治的住院急性脑出血患者的临床资料，收集患者人口学信息、血管危险因素、用药史、合并疾病、入院时体格检查和实验室检查、发病时间、出血部位、出血体积等临床数据。根据住院期间患者是否发生消化道出血分为消化道出血组和无消化道出血组，采用多因素logistic回归模型，分析继发消化道出血的独立危险因素。结果 共纳入314例急性脑出血患者，其中16例住院期间继发消化道出血，发生率为5.09%。单因素分析显示，较无消化道出血组，消化道出血组的饮酒比例、入院时NIHSS评分、入院时收缩压、血糖水平均较高，出血体积较大，差异有统计学意义。多因素分析显示，冠心病史（OR 6.63，95%CI1.36～32.34，P =0.019）、饮酒史（OR 6.61，95%CI 1.45～30.22，P =0.015）、入院时高NIHSS评分（OR1.15，95%CI 1.07～1.24，P＜0.001）、入院时收缩压高（OR 1.03，95%CI 1.00～1.05，P =0.021）是脑出血患者继发消化道出血的独立危险因素。结论 入院时收缩压高、NIHSS评分高、有饮酒史和冠心病史的急性脑出血患者住院期间发生消化道出血的风险增高。

Analysis of Risk Factors for Gastrointestinal Bleeding Secondary to Acute Cerebral Hemorrhage

Objective To analyze the risk factors of gastrointestinal bleeding (GB) secondary to acute cerebralhemorrhage.Methods Patients with acute cerebral hemorrhage admitted to the Department of Neurology,Beijing Tiantan Hospital, Capital Medical University from may to December, 2017 were enrolledin this retrospective analysis. The clinical data, including the demographics information, vascularrisk factors, medication history, comorbid diseases, physical examination and laboratory tests, timeof onset, bleeding site, bleeding volume, were collected. According to having in-hospital GB or not,the patients were divided into GB group and no-GB group. A multivariate logistic regression modelwas used to analyze the independent risk factors for GB secondary to acute cerebral hemorrhage.Results A total of 314 patients were included, 16 (5.09%) of whom had secondary GB duringhospitalization. Univariate analysis showed that the proportion of alcohol consumption, the NIHSSscore and systolic blood pressure and blood glucose level at admission were all higher and thebleeding volume was larger in GB group than that in no-GB group. Multivariate analysis showedthat history of coronary heart disease (OR 6.63, 95%CI 1.36-32.34, P =0.019), drinking (OR 6.61,95%CI 1.45-30.22, P =0.015), high admission NIHSS score (OR 1.15, 95%CI 1.07-1.24, P <0.001)and high admission systolic blood pressure (OR 1.03, 95%CI 1.00-1.05, P =0.021) were independent