本文選題：消化性潰瘍 + 上消化道出血　； 參考：《云南中醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過大樣本的病例數(shù)據(jù)資料匯總,探討消化性潰瘍合并上消化道出血患者的臨床特點,并找出實驗室檢查與臨床癥狀,收縮壓、出血量、出血人數(shù)三者間的關(guān)系,為進一步提高對該病的認(rèn)識提供新的參考依據(jù)。方法:收集2012年5月至2016年5月在延安醫(yī)院住院的昆明地區(qū)的消化性潰瘍合并上消化道出血患者的病例資料。根據(jù)患者的性別、年齡、發(fā)病因素、首發(fā)癥狀、發(fā)生部位、出血量等觀察指標(biāo)制作表格,找出上述觀察指標(biāo)在各個觀察項目上的分布特點,并做統(tǒng)計學(xué)分析,計算出數(shù)據(jù)分布是否具有統(tǒng)計學(xué)差異。結(jié)果:1.該病男性患者有487人,女性患者有159人。2.發(fā)病因素(不明原因、飲食、煙酒、藥物、手術(shù)、勞累)在男女患者各年齡組間的分布差異都有統(tǒng)計學(xué)意義(P=0.000,0.000)。3.首發(fā)臨床癥狀(嘔血黑便、嘔血、黑便、上腹痛)在男女患者各年齡組間的分布差異都有統(tǒng)計學(xué)意義(P=0.000,0.002)。4.患者RBCmin中最小值為0.89×10~(12)/L,出現(xiàn)在女性20-29歲年齡組;患者WBCmax中最大值為57.05×10~9/L,出現(xiàn)在男性40-49歲組;PLTmin中最小值為22.83×10~9/L,出現(xiàn)在男性80-89歲組;HBmin中最小值為21.44g/L,出現(xiàn)在女性40-49歲組;HCTmin中最小值為8%,出現(xiàn)在男性50-59歲組、女性40-49歲組;BUNmax中最大值為26.12mmol/L,出現(xiàn)在男性80-89歲組。大便隱血試驗以陽性最多見,其中以60-69歲年齡組陽性人數(shù)最多。各實驗室檢查指標(biāo)在男女患者各年齡組間的分布差異都無統(tǒng)計學(xué)意義(P0.05)。5.常見發(fā)生部位(胃底、胃體、胃竇、胃角、幽門管、十二指腸球部、十二指腸球后、十二指腸降部、食管、吻合口、鞍部、輸出袢)在男女患者各年齡組間的分布差異都無統(tǒng)計學(xué)意義(P=0.166,0.377)。6.胃鏡、組織活檢、消化道鋇餐、腹部B超、腹部CT、腹部X線、MRCP檢查在患者各發(fā)生部位間的分布差異有統(tǒng)計學(xué)意義(P=0.000)。7.收縮壓在患者各出血量組間的分布差異無統(tǒng)計學(xué)意義(P=0.731)。有休克病人26人,其中低收縮壓組有8人,正常收縮壓組有17人,1級高收縮壓組有1人。8.治療方法(藥物、內(nèi)鏡)在患者各年齡組間的分布差異無統(tǒng)計學(xué)意義(P=0.440)。結(jié)論:(1)該病患者男性多于女性,男女比例約為3:1。(2)該病人群的好發(fā)年齡為40-79歲的中老年患者。(3)不明原因發(fā)病的最多見,藥物引起潰瘍出血的人數(shù)占居第二位。(4)首發(fā)臨床癥狀最常見的是黑便,其次是嘔血、黑便,再次是上腹痛。(5)該病患者紅細(xì)胞下降最嚴(yán)重的年齡組為年輕女性組,血紅蛋白下降最嚴(yán)重的年齡組為中年女性組。紅細(xì)胞、血紅蛋白的下降程度,女性比男性嚴(yán)重。白細(xì)胞升高最嚴(yán)重的年齡組為中年男性組,血小板減少最嚴(yán)重的年齡組為老年男性組。白細(xì)胞的升高程度、血小板的減少程度,男性比女性嚴(yán)重。紅細(xì)胞壓積下降最嚴(yán)重的年齡組為中年男性和中年女性組。紅細(xì)胞壓積的下降程度兩個年齡組持平。大便隱血試驗陽性者居多,約占71%。(6)該病最常見的發(fā)生部位是十二指腸球部。(7)患者確診該病依靠胃鏡檢查,同時胃鏡檢查也是最常用的檢查之一。腹部B超檢查也是最常用的篩查方法。(8)通過數(shù)據(jù)研究發(fā)現(xiàn),當(dāng)患者的收縮壓從低升至正常時,出血人數(shù)呈現(xiàn)升高趨勢,與收縮壓的變化成正比。當(dāng)收縮壓從正常升至180mm Hg時,出血人數(shù)反而呈現(xiàn)出減少的趨勢,與收縮壓的變化成反比。當(dāng)患者的收縮壓由低壓到高壓變化時,相應(yīng)血壓區(qū)間最多出血人數(shù)所對應(yīng)的出血量呈現(xiàn)減少趨勢,與收縮壓的變化成反比。出血量從5ml升至1501-2000ml時,這兩個區(qū)間的出血人數(shù)呈現(xiàn)升高趨勢;出血量從1501-2000ml升至3500ml時,這兩個區(qū)間的出血人數(shù)呈現(xiàn)下降趨勢。通過計算血紅蛋白的降低值來估算昆明地區(qū)該病患者的出血量主要波動在401-2500ml之間,其中出血人數(shù)最多的在1501-2000ml。(9)患者采用的治療方法主要是藥物和內(nèi)鏡,其中內(nèi)鏡治療以氬氣止血和注射止血為主。
[Abstract]:Objective: To investigate the clinical characteristics of peptic ulcer complicated with upper gastrointestinal bleeding, and to find out the relationship between the three cases of laboratory examination and clinical symptoms, systolic pressure, bleeding volume and number of bleeding, and to provide a new reference for further improvement of recognition of the disease. Methods: from May 2012 to 201. In May, 6 years, the data of peptic ulcers in the Kunming area, which were hospitalized in the Yanan hospital, with the patients with upper gastrointestinal bleeding, were made according to the sex, age, pathogenesis, first symptoms, location, and bleeding volume of the patients. The distribution characteristics of the above observation indexes on the observation items were found out, and statistical analysis was made. The statistical difference was calculated. Results: 1. the male patients with the disease were 487, and 159 of the female patients had.2. factors (unexplained reason, diet, tobacco, alcohol, medicine, operation, fatigue) in all age groups of men and women (P=0.000,0.000) the first clinical symptoms of.3. (hematemesis, hematemesis, black, and black) The difference between the age groups of the male and female patients was statistically significant (P=0.000,0.002) the minimum value of RBCmin in.4. patients was 0.89 x 10~ (12) /L, appearing in the 20-29 year old age group of women, and the maximum value of the patients was 57.05 x 10~9/L in the 40-49 year old male group; the minimum value in PLTmin was 22.83 x 10~9/L, appearing in male 80-89. The minimum value of HBmin in HBmin was 21.44g/L, appearing in the female 40-49 year old group; the minimum value in HCTmin was 8%, appearing in the male 50-59 year old group and the female 40-49 year old group; the maximum value in the BUNmax was 26.12mmol/L in the male 80-89 years old group. The most positive of the fecal occult blood test was the 60-69 year old age group. There was no statistically significant difference in the distribution difference between the age groups of men and women (P0.05).5. common sites (gastric fundus, stomach body, gastric antrum, stomach angle, pyloric canal, duodenal bulb, duodenal bulb, duodenal descending, esophagus, anastomosis, saddle, output loop) in both male and female age groups (P=0.166, 0.377).6. gastroscopy, tissue biopsy, barium meal in digestive tract, abdominal B ultrasound, abdominal CT, abdominal X ray, and MRCP examination were statistically significant (P=0.000) in the distribution of.7. systolic blood pressure between the patients' bleeding volume group (P=0.731). There were 8 patients in the low systolic pressure group, and the normal contraction was 8. There were 17 people in the pressure group and 1 people in the 1 class high systolic pressure group. There was no significant difference in the distribution of.8. (medicine and endoscopy) between the age groups of the patients (P=0.440). Conclusion: (1) there are more men than women in this disease, and the proportion of men and women is about 3:1. (2) the good onset age of the patient group is 40-79 years old. (3) the most common occurrence of unexplained causes. The number of people who caused ulcer bleeding was second. (4) the most common symptom was black stool, followed by hematemesis, black stool, and upper abdominal pain. (5) the most serious age group of the patients with the disease was the young female group, the most serious age group of the hemoglobin decreased to the middle age female group. The decline degree of red blood cell and hemoglobin, Women were more severe than men. The age group with the most serious leucocyte increase was the middle age group. The most serious age group of thrombocytopenia was the elderly male group. The degree of leukocyte increase, the degree of platelet reduction, and the severity of the male were more severe than the female. The most serious age groups of the hematocrit were middle-aged men and middle-aged women. The two age groups were flat. The majority of the stool occult blood test was positive, accounting for about 71%. (6) the most common location of the disease was the duodenal sphere. (7) the patients were diagnosed by gastroscopy, and gastroscopy was one of the most commonly used examinations. Abdominal B ultrasonography was also the most commonly used screening method. (8) data research found through data studies, When the systolic blood pressure of the patient rises from low to normal, the number of bleeding shows an upward trend, which is proportional to the change of systolic pressure. When the systolic pressure rises from normal to 180mm Hg, the number of bleeding turns out to decrease, and is inversely proportional to the change of systolic pressure. When the systolic pressure is changed from low pressure to high pressure, the corresponding blood pressure interval is most bleeding. The amount of haemorrhage corresponding to the number showed a decreasing trend, which was inversely proportional to the change in the systolic pressure. When the amount of bleeding increased from 5ml to 1501-2000ml, the number of bleeding in the two intervals showed an upward trend; the number of bleeding in the two intervals showed a decline trend when the amount of bleeding increased from 1501-2000ml to 3500ml. The bleeding volume of the patients in the Ming area was mainly fluctuated between 401-2500ml, and the most bleeding patients in 1501-2000ml. (9) were mainly treated with drugs and endoscopy, and endoscopy was mainly treated with argon gas hemostasis and injection of hemostasis.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R573

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