老年上消化道非静脉曲张性大出血的临床治疗及费效比分析

目的 探讨老年上消化道非静脉曲张大出血的病因、临床特点及疗效与费用.方法 回顾分析近十年来我院急诊科经胃镜或手术证实的上消化道非静脉曲张大出血的老年患者39例完整临床资料,并与同期57例青壮年上消化道非静脉曲张大出血作比较.结果 老年组多以腹胀、排血便、低血压或休克、昏迷及易发展到MODS;出血病因有:消化性溃疡(PUD)占56.4%(22/39),急性胃粘膜病变占20.5%(8/39),上消化道肿瘤占10.3%(4/39),Dieulafoy病占2.6%(1/39),食管溃疡占2.6%(1/39),原因不明占7.7%(3/39);胃镜下止血术疗效确切,止血时间、再出血例数、输血量、手术例数、住院天数和总费用均明显低于内科保守治疗组,老年组与青壮年组比较无显著的统计学意义.结论 老年上消化道非静脉曲张大出血临床表现不典型,易出现严重并发症,死亡率较高;其病因主要为消化性溃疡,其次是急性胃粘膜病变及上消化道肿瘤;胃镜下止血术作用确切有效,安全性高,尤其是在年老体弱、休克状态及不愿手术治疗的患者尤为实用,在基层医院亦可推广.

The Clinical Treatment and Analysis of The Senile Hemorrhage of Upper Digestive Tract Non Variciform

Objective To explore the clause,the clinical effect,characteristic and fee of the hemorrhage of upper digestive tract and non variciform.Methods To review the past ten years,we analyz the 39 clinical statistics about the hemorrhage of upper digestive tract and non variciform which have confirmed by gastroscope in the depart-ment of endocrinology or operations,and at the same time compared with 57 example young adults of.the hemorrhage of upper digestive tract and non variciform.Results The old age group by the distension of the abdomen,the platoon bloody stool,the hypoten-sion or the shock,the stupor and is easy to develop MODS;The hemorrhage cause of disease includes:The PUD accounts for 56.4%(22/39),the acute gastric mucosa patho-logical change accounts for 20.5%(8/39),on the digestive tracttumor accounts for 10.3%(4/39),the Dieulafoy sickness accounts for2.6%(1/39),the esophagus ulcer accounts for 2.6%(1/39),the reason unclearly accounts for 7.7%(3/39);The effect of the stop bleeding under gastroscope is accurate,the time of stop bleeding,the number of bleed again,the quantity of blood transfusion,the number of operations,the time of staying in the hospital and total expense obviously lower than the internal conservative treatment.Comparing with the young adults group,the old age group doesn't have remarkable statistics significance.Conclusions In the old age the digestive tract non-varicosity massive hemorrhage clinical manifestation is untypical,is easy to appear the serious illness complication,the mortality rate is higher;Its cause of disease mainly for the digestion ulcer,next is the acute gastric mucosa,pathological change and on the digestive tract tumor;Under the gastroscope stops bleeding the technique function accurately effective,security high,particularly in the old and weak,the shock condition and the patient who is unwilling to operations,it is very practical and worth promoting in the basic hospital.