【摘要】 目的:探索急性冠脉综合征(ACS)患者发生胃肠出血的主要危险因素。方法:回顾性分析我院2003年～2011年诊断为ACS的3 642例患者的临床资料,根据是否发生胃肠道出血分为胃肠道出血组(90例)和无胃肠道出血组(3 552例),比较两组临床资料,并分析其胃肠出血的危险因素。结果:胃肠出血者死亡率较无胃肠出血者明显升高(33.7%比4.6%,P<0.001)。与无胃肠出血者比较,胃肠出血组年龄明显偏高[(62.4±13.5)岁比(68.2±12.3)岁],女性患者较多(41.8%比57.8%),胃肠疾病史、心脏停搏、肾功能不全、PCI术、心力衰竭、糖尿病、高血压病、合用替罗非班比率明显升高(P<0.05～0.01),肌钙蛋白T峰值明显升高[(82±146)ng/ml比(139±168)ng/ml,P<0.01]。多元Logistic回归分析显示,胃肠道出血的危险因素为:年龄,女性,胃肠疾病史,肌钙蛋白T峰值,心脏停搏,肾功能不全,PCI术,心力衰竭(OR=1.01～3.18,P均<0.01)。结论:ACS患者发生胃肠出血的主要危险因素是:年龄>65岁,女性,PCI术,心脏停搏,肾功能不全,胃肠疾病史,肌钙蛋白T峰值,心力衰竭。ACS患者合并胃肠出血的患者住院死亡率明显增加,需要重视其预防和治疗。更多还原

【Abstract】 Objective:To investigate main risk factors of gastrointestinal bleeding(GB) in patients with acute coronary syndrome(ACS).Methods:Clinical data of 3 642 patients diagnosed as ACS in our hospital from 2003 to 2011 were retrospectively analyzed.According to GB or not,patients were divided into GB group(n=90) and no-GB group(n=3552),clinical data were compared between two groups and risk factors of GB were analyzed.Results:Compared with no-GB group,there were significant increase in mortality rate(4.6% vs.33.7%,P<0.001),age [(62.4±13.5) years vs.(68.2±12.3) years],percentages of female(41.8% vs.57.8%),patients with gastrointestinal disease history,cardiac arrest,renal dysfunction,PCI,heart failure,diabetes mellitus,hypertension,combined use of tirofiban and troponin T peak level [(82±146) ng/ml vs.(139±168) ng/ml](P<0.05~0.01) in GB group.Multiple Logistic regression analysis indicated that risk factors of GB were age,female,gastrointestinal disease history,troponin T peak,cardiac arrest,renal dysfunction,PCI and heart failure(OR=1.01~3.18,P<0.01 all).Conclusion:Main risk factors of GB in ACS patients are age >65 years,female,PCI,cardiac arrest,renal dysfunction,gastrointestinal disease history,troponin T peak and heart failure.In-hospital mortality rate significantly increases in ACS patients with GB,therefore need to pay attention to prevention and treatment for improving prognosis.更多还原