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目的分析探讨老年人上消化道出血的发病特点,总结诊治经验方法。方法选择67例老年上消化道出血患者均进行胃镜检查,对原因不明的患者进行小肠气钡造影及下消化道钡透或结肠镜检以排除下消化道疾患引起的出血,同时进行出血量及出血形式的记录以及愈后情况的观察。结果老年人上消化道出血的原因以溃疡最多,共26例(38.81%),其次为肿瘤19例(28.36%),食道静脉曲张作为独立因素共5例(7.46%),黏膜炎症(急性胃黏膜病交、慢性胃炎、吻合口炎)8例(11.94%),食管憩室2例(2.99%),胃息肉3例(4.48%),Dieulafoy征1例(1.49%),原因不明3例(4.48%)。经治疗57例患者出血停止,但其中17例于进食后3d内再次出血,再出血率为29.82%,5例经外科手术治愈出院,5例死亡。结论老年人消化道出血病因复杂,仍然以消化性溃疡和肿瘤为主要原因,临床表现不典型,出血持续时间长,病情复杂,临床上不能以症状体征作为依据,应尽早行胃镜检查针对病因系统治疗。
Objective To analyze the incidence of upper gastrointestinal bleeding in the elderly and summarize the experience of diagnosis and treatment. Methods 67 cases of elderly patients with upper gastrointestinal bleeding were examined by gastroscopy, barium in patients with unexplained gastrointestinal barium and lower gastrointestinal barium or colonoscopy to rule out bleeding caused by lower gastrointestinal disorders, while bleeding and Hemorrhagic form of the record and the prognosis of the observation. Results There were 26 cases (38.81%) of upper gastrointestinal bleeding in the elderly, followed by 19 cases (28.36%) of tumors, 5 cases (7.46%) of esophageal varices as independent factors, mucosal inflammation Mucosal disease, chronic gastritis and anastomotic stoma), esophageal diverticulum in 2 cases (2.99%), gastric polyps in 3 cases (4.48%), Dieulafoy sign in 1 case (1.49%) and unexplained cause in 3 cases 4.48%). Fifty-seven patients had hemorrhage stopped, but 17 of them were hemorrhaged again within 3 days after eating. The rate of rebleeding was 29.82%. Five patients were cured by surgery and five died. Conclusions The cause of gastrointestinal bleeding in the elderly is complicated. Peptic ulcer and tumor are still the main causes. The clinical manifestations are not typical. The bleeding duration is long and the condition is complicated. Clinicians should not take the symptoms and signs as the basis. Gastroscopy should be performed as soon as possible for the etiological system treatment.