【摘要】 目的 探讨脑卒中合并上消化道出血患者的高危因素以及对中枢神经功能恢复的影响。方法 将100例脑卒中患者中51例合并上消化道出血患者设为研究组,49例未合并上消化道出血患者设为对照组,均予以脑卒中常规治疗及康复治疗,同时给予奥美拉唑静脉滴注,观察28 d。统计分析两组患者的高危影响因素,治疗前后采用格拉斯哥昏迷评分量表评估两组中枢神经系统功能状况,统计治疗7 d内多器官功能障碍综合征、肺炎发生率及治疗28 d内病死率。结果 研究组有饮酒史、吸烟史、消化道病史及出血性脑卒中、大面积脑梗死、丘脑出血、重度脑卒中患者的比例均显著高于对照组(P<0.05或0.01)。治疗前两组格拉斯哥昏迷评分量表评分比较差异无统计学意义(P>0.05),治疗28 d后两组评分均较治疗前显著提高,但研究组显著低于对照组(P<0.01);研究组治疗7 d内多器官功能障碍综合征、肺炎发生率及28 d内病死率均显著高于对照组(P<0.05或0.01)。结论 脑卒中合并上消化道出血的危险因素众多,患者治疗后中枢神经系统功能恢复较差,且并发症发生率及病死率较高;针对危险因素予以抑酸及胃黏膜保护剂等对症支持治疗,可有效预防上消化道出血的发生。更多还原

【Abstract】 Objective To investigate the risk factors of cerebral apoplexy complicated with upper gastrointestinal bleeding and the effect on recovery of central nerve function. Methods 51 cases of stroke patients complicated with upper gastrointestinal bleeding were seen as the observation group,49 cases of stroke patients without upper gastrointestinal bleeding were seen as the control group, they were all given conventional therapy, rehabilitation therapy and intravenous drip of omeprazole, patients were observed for 28 d.High risk factors of the two groups were analyzed, central nervous system function condition of the two groups before and after treatment were evaluated by GCS. MODS, pneumonia occurrence rate within 7 d and case fatality rate within 28 d were analyzed. Results Proportion of patients with drinking history,smoking history, digestive disease history, hemorrhagic apoplexy, massive brain infarction, thalamic hemorrhage, severe stroke in the observation group was significantly higher than that of the control group(P<0. 05 or 0. 01). Before treatment, the difference of GCS score between the two groups had no statistic significance(P>0. 05), 28 d after treatment, the scores of the two groups were all significantly increased,but the observation group was significantly lower than the control group(P<0. 01); MODS, pneumonia occurrence rate within 7 d and case fatality rate within 28 d of the observation group were significantly higher than those of the control group(P<0. 05 or 0. 01). Conclusion There are many risk factors of cerebral apoplexy complicated with upper gastrointestinal bleeding, patients have poor recovery of central nervous system function and higher complication incidence and case fatality rate; symptomatic supportive treatment of acid suppression and gastric mucosal protective agents can effectively prevent the occurrence of upper gastrointestinal bleeding.更多还原