本文選題：消化道出血　切入點(diǎn)：病因　出處：《延安大學(xué)》2017年碩士論文

【摘要】：目的:1.探討陜西地區(qū)急性非靜脈曲張性上消化道出血(acute non variceal upper gastrointestinal bleeding,ANVUGIB)病因構(gòu)成特點(diǎn),加強(qiáng)對(duì)ANVUGIB的了解,指導(dǎo)臨床醫(yī)師對(duì)ANVUGIB做出準(zhǔn)確判斷及合理治療;2.探討最佳內(nèi)鏡檢查時(shí)間,從而指導(dǎo)臨床醫(yī)師對(duì)內(nèi)鏡診治時(shí)間的選擇。方法:回顧式的隨機(jī)選取陜西省人民醫(yī)院2014年1月-2016年12月以不同程度嘔血及或黑便為主訴癥狀的ANVUGIB病例共420例,根據(jù)入組及排除標(biāo)準(zhǔn)共納入351例,其中入組患者均行內(nèi)鏡檢查確診為ANVUGIB,且所有病例均行內(nèi)鏡下止血治療。將所篩選出的351例確診為ANVUGIB病例的各個(gè)病因分別從性別、年齡、季節(jié)、年份等不同角度進(jìn)行分組,分析病因構(gòu)成特點(diǎn);按內(nèi)鏡檢查時(shí)間不同分為3組,即24h以內(nèi),24-48h以及48h以后三組,分別對(duì)病因診斷率、死亡率、住院時(shí)間、住院費(fèi)用進(jìn)行比較;分析影響住院費(fèi)用的因素。結(jié)果:1.對(duì)所納入的病例的病因分析后結(jié)果所示:消化性潰瘍占16.24%,急性胃黏膜病變占13.68%,消化系腫瘤占10.83%,以及食管賁門黏膜撕裂綜合征占6.55%;2.在不同性別中病因構(gòu)成的比較,結(jié)果顯示:男性消化性潰瘍發(fā)病率為85.19%,女性發(fā)病率為14.81%,經(jīng)統(tǒng)計(jì)分析P0.05,差異有統(tǒng)計(jì)學(xué)意義;3.ANVUGIB各個(gè)病因在不同年齡組病因構(gòu)成的比較,經(jīng)分析后結(jié)果顯示:DU(Duodenal ulcer,DU)好發(fā)于青年人及中年人,高于老年人(P0.05);GU(Gastric ulcer,GU)好發(fā)于老年人,高于中年人和青年人(P0.05);急性胃黏膜病變以及腫瘤則多見于老年人,明顯高于中年人和青年人(P0.05)。4.ANVUGIB的不同誘因在不同年齡組比較,結(jié)果顯示:NSAIDs相關(guān)性出血的發(fā)病率老年人大于中年人和青年人(P0.05),因飲酒、勞累、情緒激動(dòng)誘發(fā)出血,中年人和青年人大于老年人(P0.05)。5.急性胃粘膜病變與NSAIDs藥物在近3年發(fā)病率變化的比較,分析后結(jié)果所示:急性胃黏膜病變以及NSAIDs藥物相關(guān)性出血2015年的發(fā)病率高于2014年的發(fā)病率,2016年發(fā)病率超過2015年的發(fā)病率,P0.05,差異有統(tǒng)計(jì)學(xué)意義。6.ANVUGIB各個(gè)病因在不同季節(jié)構(gòu)成的比較,結(jié)果顯示:各個(gè)病因在不同季節(jié)構(gòu)成無明顯差異,P0.05,差異無統(tǒng)計(jì)學(xué)意義。7.不同內(nèi)鏡檢查時(shí)間對(duì)病因診斷率、住院時(shí)間以及住院費(fèi)用均有影響,結(jié)果顯示:24h以內(nèi)內(nèi)鏡檢查組其住院費(fèi)用較24-48h內(nèi)鏡檢查組以及48h以后內(nèi)鏡檢查組少(P0.05),住院時(shí)間短(P0.05),病因診斷率高(P0.05),但3組之間死亡率無明顯差異(P0.05)。8.影響費(fèi)用因素的多元線性回歸分析后結(jié)果顯示:內(nèi)鏡檢查時(shí)間、住院時(shí)間、合并癥與費(fèi)用存在線性關(guān)系,是影響費(fèi)用的因素。結(jié)論:1、ANVUGIB病因中急性胃黏膜病變引起的發(fā)病率較消化道腫瘤增多,這可能與服用NSAIDs藥物有關(guān)。2、病人入院后盡早行內(nèi)鏡檢查可以提高病因診斷率,縮短住院時(shí)間,減少住院費(fèi)用。
[Abstract]:Purpose 1.To investigate the etiological characteristics of acute non variceal upper gastrointestinal bleeding in acute non-varicose upper gastrointestinal bleeding in Shaanxi, to strengthen the understanding of ANVUGIB, and to instruct clinicians to make accurate judgement and reasonable treatment of ANVUGIB.To explore the best time of endoscopy, so as to guide clinicians to choose the time of endoscopic diagnosis and treatment.Methods: a total of 420 cases of ANVUGIB with different degree of hematemesis and or melanosis were selected randomly from January 2014 to December 2016 in Shaanxi Provincial people's Hospital, and 351 cases were included according to the criteria of admission and exclusion.All the patients were diagnosed as ANVUGIBby endoscopy, and all patients were treated with endoscopic hemostasis.The causes of ANVUGIB were divided into three groups according to their sex, age, season, year and so on, and were divided into three groups according to the time of endoscopy.The etiological diagnosis rate, mortality rate, hospital stay time and hospitalization cost were compared among the three groups within 24 h and 24 48 h and after 48 h, respectively, and the factors affecting the hospitalization cost were analyzed.The result is 1: 1.The results of etiological analysis showed that peptic ulcer accounted for 16.24%, acute gastric mucosal lesion 13.68%, digestive system tumor 10.83%, and esophageal and cardiac mucosal tear syndrome 6.5522%.The results showed that the incidence of peptic ulcer was 85.191in males and 14.81in females. The difference was statistically significant (P0.05). 3. The etiological composition of ANVUGIB in different age groups was compared.Compared with the middle aged and young people, the incidence of blood loss in the elderly was higher than that in the middle aged and young people, and the bleeding was induced by drinking, tiredness and emotional agitation, compared with that of the middle aged and young people, and the different inductive factors of ANVUGIB were compared in the different age groups, the results showed that the incidence of blood loss was higher in the elderly than in the middle aged and young people.The middle age and young people are larger than the old people (P 0.05. 5).Comparison of the incidence of acute gastric mucosal lesions with NSAIDs drugs in the past three years.The results showed that the incidence of acute gastric mucosal lesions and NSAIDs drug-related hemorrhage in 2015 was higher than that in 2014, and the incidence rate in 2016 was higher than that in 2015 (P 0.05). The difference was statistically significant.The results showed that there was no significant difference in the composition of each etiology in different seasons (P 0.05), and the difference was not statistically significant.Different time of endoscopy had influence on the rate of etiological diagnosis, length of stay and cost of hospitalization.The results showed that the cost of hospitalization of the group within 24 hours was less than that of the group within 24-48 hours and after 48 hours, the hospitalization time was shorter than that of the group, and the rate of etiological diagnosis was higher than that of the control group. However, there was no significant difference in mortality among the three groups.The results of multivariate linear regression analysis showed that the time of endoscopic examination, the time of hospitalization and the complication had linear relationship with the cost, which were the factors affecting the cost.Conclusion the incidence of acute gastric mucosal lesions in the etiology of the disease is higher than that caused by digestive tract tumor, which may be related to taking NSAIDs drugs. Endoscopic examination can improve the etiological diagnosis rate, shorten the hospitalization time and reduce the cost of hospitalization.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R573.2

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