埃及某政府医院收治的急性上消化道出血患者的临床转归。
Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt.
机构信息
Department of Medicine, Bolak Eldakror Hospital, Giza, Egypt.
出版信息
Saudi J Gastroenterol. 2012 Jan-Feb;18(1):34-9. doi: 10.4103/1319-3767.91737.
BACKGROUND/AIM: Acute upper gastrointestinal hemorrhage (AUGIH) is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt.
PATIENTS AND METHODS
This was a cross-sectional hospital-based study performed in 1000 patients presenting with AUGIH over a 7-year period between January 2004 and January 2011.
RESULTS
One thousand patients were analyzed. Fifty-four percent were male. Mean age was 52 ± 17 years. Eighty-eight percent were emergency admissions and 12% were inpatients at the time of bleeding. At presentation 68% had major comorbidity and 50% had liver disease. Seven hundred and twenty-four patients (72%) underwent endoscopy. Bleeding varices accounted for 31% of AUGIH and peptic ulcer 28%. Two hundred and thirty-two patients had endoscopically diagnosed bleeding varices or peptic ulcer with a visible vessel or active bleeding. These received endoscopic therapy. Initial hemostasis was achieved in 207 (89%). Thirteen patients (6%) had therapy at a subsequent endoscopy for further bleeding. Surgery was performed on 9 patients (0.9%) with AUGIH. Complications were reported in 70 patients (7%) mainly liver failure (4%). Six hundred and eighty-four patients (68%) were discharged improved, 162 (16%) left hospital without a diagnosis and 4 (0.4%) were referred to another facility. The overall mortality was 15%. Mortality was 24% in patients ≥60 years, 37% among inpatients, and 21% in those who had a major comorbidity. Mortality was 22% in patients who had liver disease and 9% in variceal bleeding.
CONCLUSION
The most common cause of AUGIH was variceal in origin. Endoscopic therapy was successful in most cases. Mortality after AUGIH was particularly high among elderly patients, inpatients, and patients who had a major comorbidity, liver disease, and variceal bleeding.
背景/目的：急性上消化道出血（AUGIH）是一种危及生命的紧急情况，可导致高发病率和死亡率。死亡率在 4%至 14%之间。本研究的目的是确定在埃及一家政府医院收治的 AUGIH 患者的临床转归。
患者和方法
这是一项在 2004 年 1 月至 2011 年 1 月的 7 年期间，对 1000 例出现 AUGIH 的患者进行的横断面医院病例研究。
结果
对 1000 例患者进行了分析。54%为男性。平均年龄为 52±17 岁。88%为急诊入院，12%为出血时的住院患者。就诊时，68%有主要合并症，50%有肝病。724 例（72%）患者接受了内镜检查。出血性静脉曲张占 AUGIH 的 31%，消化性溃疡占 28%。232 例患者内镜诊断为出血性静脉曲张或消化性溃疡，可见血管或活动性出血。这些患者接受了内镜治疗。207 例（89%）患者初始止血成功。13 例（6%）患者因进一步出血在内镜检查后进行了治疗。9 例（0.9%）患者因 AUGIH 行手术治疗。70 例（7%）患者报告有并发症，主要为肝功能衰竭（4%）。684 例（68%）患者病情改善出院，162 例（16%）出院时未明确诊断，4 例（0.4%）转至其他医疗机构。总死亡率为 15%。≥60 岁患者的死亡率为 24%，住院患者为 37%，有主要合并症的患者为 21%。有肝病的患者死亡率为 22%，静脉曲张出血的患者死亡率为 9%。
结论
AUGIH 的最常见原因是静脉曲张。内镜治疗在大多数情况下是成功的。AUGIH 后死亡率在老年患者、住院患者以及有主要合并症、肝病和静脉曲张出血的患者中尤其高。
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