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目的:探讨不同危险因素对上消化道大出血(AGMH)患者14天内生存率的影响。方法:以我院急诊科抢救室收治的39例AGMH患者作为观察对象,使用Kaplan-Meier法分析不同因素下的生存情况。结果:观察期内共有10例死亡,首诊日至死亡的区间为2-13天;以上39例患者的生存区间为2-19+天(删失),14天生存率为73%;Kaplan-Meier分析显示:年龄>60岁患者生存期明显短于年龄≤60岁患者(P<0.05),静脉曲张性出血组的生存期明显短于非静脉曲张性出血组(P<0.05),早期内镜检查组患者生存期显著长于晚期内镜检查组(P<0.05),休克组患者生存期显著短于非休克组(P<0.05),出血<3次组患者生存期显著长于出血≥3次组患者(P<0.05),而性别对生存期无明显影响(P>0.05)。结论:首诊后2-13天是AGMH患者死亡的高峰期;年龄>60岁、静脉曲张性大出血、晚期行内镜检查、休克及住院期间出血次数>3次的AGMH患者具有较高的死亡风险,以上对临床决策具有重要指导作用。
Objective: To investigate the effect of different risk factors on the survival rate of patients with upper gastrointestinal hemorrhage (AGMH) within 14 days. Methods: Thirty-nine patients with AGMH admitted to emergency department of our hospital were enrolled in this study. Kaplan-Meier method was used to analyze the survival of different AGMH patients. Results: A total of 10 deaths were observed during the observation period, with a range of 2-13 days between the first diagnosis and death. Survival interval of the above 39 patients was 2-19 days (censored), and the 14-day survival rate was 73%. Kaplan -Meier analysis showed that the survival of patients aged> 60 years was significantly shorter than that of patients ≤ 60 years of age (P <0.05), and the survival of patients with variceal bleeding was significantly shorter than that of patients without varicose bleeding (P <0.05) The survival of patients in endoscopy group was significantly longer than that in advanced endoscopy group (P <0.05), and the survival time in shock group was significantly shorter than that in non-shock group (P <0.05). The survival time of patients in <3 times group was significantly longer than that of hemorrhage≥3 (P <0.05), while gender had no significant effect on survival (P> 0.05). CONCLUSIONS: AGMH patients have a peak mortality rate of 2 to 13 days after the first visit. AGMH patients aged> 60 years, varicose bleeding, late endoscopy, shock, and bleeding> 3 times during hospitalization have a higher death rate Risk, the above has an important guiding role in clinical decision-making.