Hospital de Santo André, E.P.E., Rua das Olhalvas-Pousos, Leiria, Portugal.
Eur J Gastroenterol Hepatol. 2011 Apr;23(4):317-22. doi: 10.1097/MEG.0b013e328344ccb5.
Acute lower gastrointestinal bleeding (ALGIB) is a common event, which consumes considerable human and economic resources. Its incidence is expected to rise in the coming years due to an increasing aging population.
Multicentric prospective analysis of patients was carried out with ALGIB in 13 Portuguese hospitals from April 2008 to May 2009, using a protocol designed by the French Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux. Statistical analysis was carried out with SPSS 16.0.
In a total of 371 hemorrhagic events in 364 patients (51.4% men, mean age: 72 years), 28.4% patients showed hemodynamic instability and 54.2% were under single/combined medication with antiaggregants/NSAIDs/heparin/anticoagulants; blood transfusion was administered in 34.8% of patients. Sigmoidoscopy was the first endoscopic procedure performed in 61.3% of patients and rectal enema was the first method of bowel preparation in 67.3% of them. Endoscopic hemostasis was performed in 22.2% of all cases with efficacy ranging from 84.6 to 96.2%. Most frequent diagnoses were ischemic colitis (23.7%), diverticulosis (20.8%), and colorectal malignancies (12.4%). Surgery was needed in 8% of patients, and global mortality rate was 2.2%. Risk factors for poor outcome on multivariate analysis were heparin use before bleeding (hazards ratio: 10.6; 95% confidence interval: 0.94-119.48) and in-hospital bleeding (hazards ratio: 5.6; 95% confidence interval: 1.01-19.70).
ALGIB seems to occur frequently in Portugal with a low mortality rate. Previous heparin use and in-hospital bleeding are associated with worse prognosis. Our management relies on early endoscopic examinations, which are highly available, safe, and accurate. A successful endoscopic therapeutic approach was possible in one fifth of the patients.
急性下消化道出血（ALGIB）是一种常见的病症，耗费了大量的人力和经济资源。由于人口老龄化的加剧，预计未来几年其发病率将会上升。
2008 年 4 月至 2009 年 5 月，13 家葡萄牙医院对 ALGIB 患者进行了多中心前瞻性分析，使用由法国普通医院肝胆病学会制定的方案。采用 SPSS 16.0 进行统计分析。
在 364 名患者的 371 例出血事件中，51.4%为男性，平均年龄为 72 岁，28.4%的患者出现血流动力学不稳定，54.2%的患者服用单一/联合抗血小板药物/非甾体抗炎药/肝素/抗凝药物；34.8%的患者接受输血。直肠镜检查是 61.3%患者的首选内镜检查，直肠灌肠是 67.3%患者的首选肠道准备方法。所有病例中 22.2%进行了内镜止血，有效率为 84.6%至 96.2%。最常见的诊断是缺血性结肠炎（23.7%）、憩室病（20.8%）和结直肠恶性肿瘤（12.4%）。8%的患者需要手术，总死亡率为 2.2%。多因素分析显示，出血前使用肝素（危险比：10.6；95%置信区间：0.94-119.48）和院内出血（危险比：5.6；95%置信区间：1.01-19.70）是预后不良的危险因素。
ALGIB 在葡萄牙似乎很常见，死亡率较低。先前使用肝素和院内出血与预后不良相关。我们的治疗方法依赖于早期的内镜检查，这种方法具有高度的可用性、安全性和准确性。五分之一的患者可以通过内镜治疗成功止血。
