Hochain P, Merle V, Capet C, Ducrotté P, Michel P, Riachi G, Colin R
Groupe de Recherche sur I'Appareil Digestif, Hôpital Charles-Nicolle, Rouen.
Gastroenterol Clin Biol. 1996;20(8-9):638-44.
The aim of this study was to assess the incidence and the prognosis of upper gastrointestinal hemorrhage in patients aged over 80 years.
Between January and December 1993, among 360 patients admitted for upper gastrointestinal hemorrhage, 63 were older than 80 years (18%). Data were prospectively collected in all patients.
Before admission, 8 experienced a lipothymia and 3 a shock. The median initial hematocrit was 29%. Endoscopy was performed in 59 patients and a cause was determined in 49 (83%). The main cause of bleeding was gastric and duodenal ulcer (n = 26, 53%) and ten of them were graded Forrest < or = IIb. Endoscopy did not contribute in 10 patients and was impossible in 4 because of an hemodynamic failure. Gastrotoxic drugs intake was found in 28 patients: non steroidal anti-inflammatory drugs (n = 14) and aspirin (n = 14). Endoscopic injection therapy was performed in the 10 patients with gastric or duodenal ulcer < or = Forrest IIb and permanent hemostasis was achieved in 8 out of 10. No further bleeding was seen in 53 patients (84%), while bleeding persisted in 4 and rebleeding occurred in 6 (9.5%) (3 duodenal ulcers, 2 gastric carcinomas and 1 esophageal varices bleeding). Only one patient required emergency surgery (rebleeding duodenal ulcer). The overall mortality was 12/63 (19%):50% of the deaths were related to hemorrhagic complications and 50% to concomitant disease. Only one patient among those taking gastrotoxic drug died from bleeding. The risk factors of death from bleeding were: initial shock (P = 0.02), lipothymia before admission (P = 0.02), rebleeding (P < 0.01), persistence of bleeding (P < 10(-4)). Gastrotoxic drugs intake was associated with a favorable prognosis (P < 0.05). The prognosis was not significantly affected by an initial hematocrit < 30% or blood units transfused > or = 4.
People older than 80 years account for a large proportion of upper gastrointestinal bleeding (18%). The more common cause is gastric or duodenal ulcer. Mortality in these patients is high (19%). An initial shock or lipothymia, rebleeding or persistence of bleeding worsens prognosis. Gastrotoxic drugs intake is frequent (44%), but is associated with a good prognosis.
本研究旨在评估80岁以上患者上消化道出血的发生率及预后。
1993年1月至12月期间，在360例因上消化道出血入院的患者中，63例年龄超过80岁（占18%）。对所有患者进行前瞻性数据收集。
入院前，8例发生晕厥，3例出现休克。初始血细胞比容中位数为29%。59例患者接受了内镜检查，49例（83%）明确了病因。出血的主要原因是胃和十二指肠溃疡（n = 26，占53%），其中10例为福里斯特分级≤IIb级。10例患者内镜检查未发现病因，4例因血流动力学衰竭无法进行内镜检查。28例患者服用了致胃损伤药物：非甾体抗炎药（n = 14）和阿司匹林（n = 14）。对10例福里斯特分级≤IIb级的胃或十二指肠溃疡患者进行了内镜注射治疗，10例中有8例实现了永久性止血。53例患者（84%）未再出血，4例出血持续，6例（9.5%）发生再出血（3例十二指肠溃疡、2例胃癌和1例食管静脉曲张出血）。仅1例患者需要急诊手术（十二指肠溃疡再出血）。总死亡率为12/63（19%）：50%的死亡与出血并发症有关，50%与合并疾病有关。服用致胃损伤药物的患者中仅1例死于出血。出血死亡的危险因素为：初始休克（P = 0.02）、入院前晕厥（P = 0.02）、再出血（P < 0.01）、出血持续（P < 10⁻⁴）。服用致胃损伤药物与良好预后相关（P < 0.05）。初始血细胞比容<30%或输注血液单位≥4对预后无显著影响。
80岁以上人群在上消化道出血患者中占很大比例（18%）。最常见的病因是胃或十二指肠溃疡。这些患者的死亡率较高（19%）。初始休克或晕厥、再出血或出血持续会使预后恶化。服用致胃损伤药物很常见（44%），但与良好预后相关。
