老年患者与非老年患者急性上消化道出血的临床特征、严重程度及转归：一项前瞻性观察研究

Clinical Profile, Severity and Outcome of Acute Upper Gastrointestinal Bleeding in Elderly Patients Compared to Non-elderly Patients: A Prospective Observational Study.

作者信息

Sourabh Sumit, Sharma Neetu, Sharma Rajesh, Kumar Ramesh, Thakur Surinder, Bodh Vishal, Sharma Brij

机构信息

JR Medicine.

Senior Resident, Physiology.

出版信息

J Assoc Physicians India. 2019 Sep;67(9):30-32.

PMID:31561685

Abstract

AIM

To determine the clinical profile, severity and outcome of acute upper gastrointestinal bleeding (UGIB) in elderly subjects (>60 years) compared to the non elderly ones (<60 years).

METHODS

In a prospective observational study, 380 consecutive adult patients presenting with acute UGIB were enrolled. Patients were divided into two groups: elderly (≥60 years) and non-elderly (<60 years).

RESULTS

Out of 380 patients, 254(66.84%) patients were non-elderly and 126(33.15%) patients were elderly. The proportion of patients with co-morbidity and consumption of non-steroidal anti-inflammatory drugs was higher among elderly patients. The commonest mode of presentation was hematemesis and melena in the both groups, while isolated hematochezia (29% vs. 1.9%, p<0.01) was more common in elderly group. The variceal bleeding was significantly higher among non-elderly group (38.1% vs. 18.2%, p<0.01) and bleeding from gastric or duodenal ulcer was the predominant cause of bleeding among elderly group (65% vs. 43% p<0.01). The proportion of patients with tachycardia (68.2% vs. 20%, p<0.01), postural hypotension (29.3% vs. 14.9%, p<0.01) and blood transfusion requirement of 4 units or more (20.2% vs. 10.1%, p<0.01) was significantly higher among elderly group than in non-elderly group. Despite similar re-bleeding rates, mortality rate was significantly higher in elderly patients compared to the non-elderly patients (10.32% vs. 1.94%, p<0.01).

CONCLUSION

Nearly 33% of the patients with acute UGIB are over 60 years old. The severity of bleeding and mortality rates was higher in elderly in comparison to non-elderly patients.

摘要

目的

确定老年受试者（>60岁）与非老年受试者（<60岁）急性上消化道出血（UGIB）的临床特征、严重程度及预后。

方法

在一项前瞻性观察研究中，纳入了380例连续的急性UGIB成年患者。患者被分为两组：老年组（≥60岁）和非老年组（<60岁）。

结果

380例患者中，254例（66.84%）为非老年患者，126例（33.15%）为老年患者。老年患者中合并症患者及使用非甾体抗炎药的比例更高。两组中最常见的表现方式均为呕血和黑便，而孤立性便血在老年组中更常见（29%对1.9%，p<0.01）。非老年组中静脉曲张出血明显更高（38.1%对18.2%，p<0.01），而老年组中胃或十二指肠溃疡出血是出血的主要原因（65%对43%，p<0.01）。老年组中出现心动过速（68.2%对20%，p<0.01）、体位性低血压（29.3%对14.9%，p<0.01）及需要输注4个或更多单位血液（20.2%对10.1%，p<0.01）的患者比例明显高于非老年组。尽管再出血率相似，但老年患者的死亡率明显高于非老年患者（10.32%对1.94%，p<0.01）。