2022 年第 4 期 第 17 卷

重症上消化道出血患者的临床特征及死亡相关危险因素分析 

Analysis of clinical characteristics and risk factors for death in patients with severe upper gastrointestinal bleeding

作者：田浩1熊永红1陶洁1钟振通2左小淑2夏中元1

英文作者：Tian Hao1 Xiong Yonghong1 Tao Jie1 Zhong Zhentong2 Zuo Xiaoshu2 Xia Zhongyuan1

单位：1武汉大学人民医院麻醉科，武汉430060；2武汉大学人民医院重症医学科，武汉430060

英文单位：1Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan 430060 China; 2Department of Critical Care Medicine Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：上消化道出血；临床特征；死亡危险因素

英文关键词：Uppergastrointestinalbleeding;Clinicalfeatures;Riskfactorsfordeath

• 摘要：

• 目的 分析重症上消化道出血（UGIB）患者的临床特征及死亡的危险因素，预测死亡风险，以有效降低UGIB患者的院内病死率。方法 对武汉大学人民医院重症医学科2020年1月至2021年7月收治的118例重症UGIB患者的临床资料进行回顾性分析，依据是否死亡，分为存活组(106例)和死亡组(12例)，并对2组UGIB患者的临床特征及死亡相关危险因素进行对比分析。结果 本研究UGIB院内病死率为10.2%(12/118)。死亡组年龄、饮酒史比例、入院时收缩压<100 mmHg（1 mmHg=0.133 kPa）比例、急性生理学与慢性健康状况评分系统（APACHE）评分、血型为B型者比例大于/高于存活组，差异均有统计学意义(均P<0.05)。在合并症和治疗手段方面，死亡组合并肾脏疾病比例高于存活组，24 h内应用抗菌药物比例低于存活组，同时输注红细胞、输注血浆量也明显高于存活组，差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示，年龄、饮酒史、收缩压<100 mmHg、APACHE评分、合并肾脏疾病、丙氨酸转氨酶（ALT）、血尿素氮、血肌酐、血乳酸是重症UGIB患者院内死亡的独立危险因素(比值比=1.125、6.562、41.418、1.565、13.103、1.005、1.082、1.007、2.154，均P<0.05)。结论 年龄、饮酒史、入院收缩压、APACHE评分、合并肾脏疾病、ALT、血尿素氮、血肌酐、血乳酸等是重症UGIB患者院内死亡的独立危险因素，可对患者院内死亡风险起到一定的预警作用。

• Objective To analyze the clinical characteristics and risk factors for death in patients with severe upper gastrointestinal bleeding(UGIB), so as to predict the risks for death and to effectively reduce the hospital mortality. Methods The clinical data of 118 patients with severe UGIB admitted to Department of Critical Care Medicine, Renmin Hospital of Wuhan University from January 2020 to July 2021 were retrospectively analyzed. They were divided into survival group(106 cases) and death group(12 cases). The clinical characteristics and related risk factors for death of patients with UGIB were compared and analyzed. Results In this study, the hospital mortality of UGIB was 10.2%(12/118). The age, the proportion of drinking history, the proportion of systolic blood pressure <100 mmHg at admission, the score of acute physiology and chronic health evaluation scoring system(APACHE), and the proportion of blood type B in the death group were higher than those in the survival group(all P<0.05). In terms of complications and treatment methods, the proportion of kidney disease in the death group was higher than that in the survival group, the proportion of antibiotics within 24 h was lower than that in the survival group, and the proportion of red blood cells and plasma transfusion was higher than that in the survival group(all P<0.05). Multivariate Logistic regression analysis showed that age, drinking history, systolic blood pressure<100 mmHg, APACHE score, combined with kidney disease, alanine aminotransferase(ALT), blood urea nitrogen, serum creatinine, and serum lactic acid were independent risk factors for hospital death(odds ratio=1.125, 6.562, 41.418, 1.565, 13.103, 1.005, 1.082, 1.007, 2.154, all P<0.05). Conclusion Age, drinking history, systolic blood pressure on admission, APACHE score, combined with kidney disease, ALT, blood urea nitrogen, serum creatinine and serum lactic acid are independent risk factors for hospital death in patients with severe UGIB, which may have a certain early warning effect on the risk of hospital death in patients.