消化性溃疡并出血预后因素分析

目的;寻找影响消化性溃疡并出血的预后的各项因素,以指导临床个体化治疗方案的选择。方法：设年龄、吸烟、饮酒、腹痛程度、发病时间、首次出血年龄、出血来源、出血部位、出血方式、出血量（血色素）、休克、内镜表现、伴随疾病数、伴随疾病严重性、服药（NSAIDs)史、治疗手段（药物、内镜、手术）为可能影响预后的因素;设治愈,再出血、急症手术、死亡为转归结果;对588例消化性溃疡并出血的患者进行Logistic逐步回归分析。结果：出血部位位于胃底、内镜下有活动性出血表现及内镜介入止血治疗与再出血有显著性关系;内镜下有活动性出血表现及内镜介入止血治疗与急性手术有显著性关系;高龄、休克、有严重伴随疾病、内镜下有活动性出血表现与死亡有显著性关系。结论：高龄、有休克表现、胃底出血以及内镜下有活动性出血表现、有严重的伴随疾病是消化性溃疡出血的高危因素,对此类病人,尽早内镜治疗和手术治疗可改善预后,减少再出血,减低手术率和死亡率。

Analysis of prognostic factors in peptic ulcer bleeding

Aim To estimate the prognostic factors in peptic ulcer bleeding.Methods To suppose age,smoking,drinking,degree of abdominal pain,course of peptic ulcer,age of the first time of bleeding,source of bleeding,location of bleeding,kind of bleeding,quantity of bleeding(Hb),severity and number of associated illnesses,using of NSAID s history,shock,expression under endoscopy and procedures of treatment as prognostic factors in peptic ulcer.To suppose healing,rebleeding,surgery and death as the outcome of peptic ulcer bleeding.588 patients with peptic ulcer bleeding were analysed with logistic analysis.Results There were significant relations between location of bleeding,expression under endoscopy,procedure of treatment and rebleeding.There were significant relations between expression under endoscopy,procedure of treatment and emergency surgery.While the mortality,there are significant relations between age,experience under endoscopy,shock,severity of associated disease and death.Conclusions Advanced age,shock,location of bleeding,severity of associated disease,active bleeding ulcer under endoscope and ulcer with vessels or clots were highly risk factors of peptic ulcer bleeding.These patients should be treated with endoscopy or surgery as early as possible.