本文選題：急性非靜脈曲張上消化道出血 + 病因�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 1.回顧性分析2004年—2014年就診于吉林大學(xué)中日聯(lián)誼醫(yī)院急性非靜脈曲張上消化道出血患者病因及誘因的構(gòu)成、年齡差異和10年間變化規(guī)律，為更好的了解本地區(qū)近年來(lái)急性非靜脈曲張上消化道出血（ANVUGIB）病因及誘因的特點(diǎn)和變遷,提供循證醫(yī)學(xué)證據(jù)。 2.比較不同內(nèi)鏡治療方法及內(nèi)鏡檢查時(shí)機(jī)，旨在根據(jù)不同病情選擇最佳內(nèi)鏡下治療方法，并探討內(nèi)鏡檢查時(shí)機(jī)對(duì)內(nèi)鏡下出血征象病灶檢出率的影響，為臨床治療提供參考依據(jù)。 方法： 收集2004年1月至2014年1月就診于吉林大學(xué)中日聯(lián)誼醫(yī)院，符合ANVUGIB臨床診斷標(biāo)準(zhǔn)且經(jīng)內(nèi)鏡檢查明確病因的共2306例住院患者病歷資料，設(shè)計(jì)完善的ANVUGIB病例資料登記表并逐一記錄，應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS17.0進(jìn)行分析。 結(jié)果： 1.老年組、中年組、青年組均以消化性潰瘍?yōu)橹饕�，老年組以胃潰瘍?yōu)橹鳎?6.6%），中、青年組以十二指腸潰瘍?yōu)橹�，且老年組癌癥（11%）及吻合口潰瘍（8.0%）所占病因比例高于青年組。 2.老年組主要誘因?yàn)榉晴摅w類抗炎藥（43.8%），顯著高于中年組（12.3%）及青年組（6.5%），P＜0.01，差異具有統(tǒng)計(jì)學(xué)意義；而中年組及青年組的主要誘因均為飲酒和勞累情緒激動(dòng)，其比例也明顯高于老年組（P＜0.01，差異具有統(tǒng)計(jì)學(xué)意義)。 3.10年間消化性潰瘍病因比例逐漸下降，急性胃黏膜病變及上消化道腫瘤比例呈升高趨勢(shì)。 4.10年間非甾體抗炎藥所占誘因比例逐年顯著遞增，其已成為急性非靜脈曲張性上消化道出血越來(lái)越重要的誘因， 5.≤48h組，內(nèi)鏡下有出血征象者占急診胃鏡檢查的37．8％，顯著高于48h組（23．2％)，P＜0.01，差異有統(tǒng)計(jì)學(xué)意義。 6.對(duì)于Rockall評(píng)分高危的患者，聯(lián)合治療更有效（92.5%），P＜0.05，差異有統(tǒng)計(jì)學(xué)意義。 7.對(duì)于直徑2cm的病變，聯(lián)合治療更有效（91.1%），P＜0.05，差異有統(tǒng)計(jì)學(xué)意義,對(duì)于直徑小于0.5cm病變，鈦夾是主要治療方法。 8.鈦夾治療對(duì)于ForrestⅠa級(jí)（89.7%）及Ⅱa級(jí)（96.6%）病變是有效的主要治療方法。 結(jié)論： 1.消化性潰瘍是急性非靜脈曲張上消化道出血最常見的病因，其次為急性胃黏膜病變和上消化系統(tǒng)腫瘤，其他常見病因依次為食管賁門黏膜撕裂綜合征、Deulafoy病、反流性食管炎等。 2.急性非靜脈曲張上消化道出血病因中，老年組以胃潰瘍?yōu)橹�，中、青年組以十二指腸潰瘍?yōu)橹�，并且老年組腫瘤所占病因比例高于青年組。 3.10年間，，潰瘍病所占病因比例逐年遞減，而急性胃黏膜病變近年來(lái)上升趨勢(shì)明顯。 4.10年間，非甾體類抗炎藥所占誘因比例逐年遞增。 5.48小時(shí)內(nèi)的急診胃鏡更易發(fā)現(xiàn)出血病灶。 6.對(duì)于Rockall評(píng)分高危的患者，聯(lián)合治療更有效。 7.對(duì)于直徑大于2cm的病變，聯(lián)合治療更有效。對(duì)于直徑小于0.5cm病變，鈦夾是主要治療方法。 8.鈦夾治療對(duì)于ForrestⅠa級(jí)及Ⅱa級(jí)病變更有效。
[Abstract]:Objective: 1. From 2004 to 2014, the etiology and inducement of acute non-varicose upper digestive tract hemorrhage in Sino-Japanese Lianyi Hospital of Jilin University were analyzed retrospectively. In order to better understand the etiology and etiology of ANVUGIBB in recent years, the evidence of evidence-based medicine was provided. 2. The purpose of this study was to select the best endoscopic therapy according to different conditions, and to explore the influence of endoscopy time on the detection rate of endoscopy hemorrhage lesions, and to provide reference for clinical treatment. Methods: From January 2004 to January 2014, a total of 2306 inpatients who met the clinical diagnostic criteria of ANVUGIB and confirmed the etiology of ANVUGIB were collected. The complete registration form of ANVUGIB cases was designed and recorded one by one. Statistical software SPSS17.0 was used to analyze. Results: 1. Peptic ulcer was the main cause in the aged group, middle age group and young group, gastric ulcer was the main cause, and duodenal ulcer was the main cause in the young group, and the proportion of cancer and anastomotic ulcer in the old group was higher than that in the young group. 2. The main inducement of the aged group was 43.8% of the non-steroidal anti-inflammatory drug, which was significantly higher than that of the middle-aged group (12.3%) and the young group (6.5% P < 0.01), the difference was statistically significant, while the main inducement of the middle-aged group and the young group were drinking and exerting emotion. The ratio was also significantly higher than that in the elderly group (P < 0.01), and the difference was statistically significant. 3. During the past 10 years, the proportion of the causes of peptic ulcer decreased gradually, and the proportion of acute gastric mucosal lesions and upper digestive tract tumors increased. 4.The proportion of inducement caused by non-steroidal anti-inflammatory drugs increased year by year, and it has become more and more important inducement of acute non-varicose upper gastrointestinal bleeding. 5. In the group of 鈮

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