Wilcox C M, Alexander L N, Cotsonis G
Department of Medicine (Division of Digestive Diseases), Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Gastroenterol. 1997 Feb;92(2):231-5.
Although hematochezia is well recognized to occur in patients with upper GI hemorrhage (UGIH), its prevalence, clinical presentation, causes, and outcome in these patients are not well defined.
Consecutive patients evaluated for UGIH by the gastroenterology service at a large inner city hospital from August 1, 1990, through September 31, 1994, were prospectively identified. Vital signs and stool color were recorded on admission to the emergency department. Endoscopy was performed in all patients, usually within 48 h of admission. The cause of bleeding was determined by endoscopy, surgery, or autopsy.
Over the 50-month study period, 727 patients with UGIH meeting the inclusion criteria were evaluated, with 104 (14%) presenting with hematochezia (18 with bright red blood and 86 with maroon blood). The most common causes of bleeding were duodenal ulcer (44%) and gastric ulcer (20%). In comparison with patients with melena (N = 441), patients with hematochezia were older (55 vs 50 yr, p < 0.01) and more likely to present with duodenal ulcer bleeding (43 vs 25%, p < 0.01); no differences in vital signs, including prevalence of shock, or admission Hb concentration were found. However, transfusion requirements (5.4 vs 4.0 units, p = 0.01), need for surgery (11.7 vs 5.7%, p = 0.03), and mortality (13.6 vs 7.5%, p = 0.05) were significantly higher in patients with hematochezia than in those with melena, suggesting more severe bleeding and a worse outcome.
Hematochezia is common in patients with UGIH, and the presenting features are similar to those of patients with melena. Duodenal ulcer is the most common cause of bleeding associated with hematochezia. Patients with UGIH and hematochezia seem to have a worse prognosis.
尽管便血在上消化道出血（UGIH）患者中较为常见，但其患病率、临床表现、病因及预后在这些患者中尚不明确。
前瞻性确定了1990年8月1日至1994年9月31日期间在一家大型市中心医院接受胃肠病科评估的连续UGIH患者。在急诊科入院时记录生命体征和大便颜色。所有患者均接受内镜检查，通常在入院后48小时内进行。出血原因通过内镜检查、手术或尸检确定。
在50个月的研究期间，评估了727例符合纳入标准的UGIH患者，其中104例（14%）出现便血（18例为鲜红色血液，86例为暗红色血液）。最常见的出血原因是十二指肠溃疡（44%）和胃溃疡（20%）。与黑便患者（N = 441）相比，便血患者年龄更大（55岁对50岁，p < 0.01），更有可能出现十二指肠溃疡出血（43%对25%，p < 0.01）；在生命体征方面，包括休克患病率或入院时血红蛋白浓度均未发现差异。然而，便血患者的输血需求量（5.4单位对4.0单位，p = 0.01）、手术需求（11.7%对5.7%，p = 0.03）和死亡率（13.6%对7.5%，p = 0.05）显著高于黑便患者，提示出血更严重，预后更差。
便血在UGIH患者中很常见，其表现特征与黑便患者相似。十二指肠溃疡是与便血相关的最常见出血原因。UGIH合并便血的患者预后似乎更差。
