老年人和年轻人之间的胃肠道上部出血差异:非肝硬化患者的出血是否应该被认为是老年综合征?
Francisco Vara-Luiz1,2, Ivo Mendes3,2, Carolina Palma3,2
1Gastroenterology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada 2805-267, Portugal.
Therapeutic advances in gastroenterology
|June 12, 2025
概括
患有上部胃肠道出血 (UGIB) 的老年人面临更高的风险和医疗需求. 这项研究强调了与UGIB年轻人相比,老年患者的特征和结果不同.
科学领域:
- 胃肠病学 胃肠病学
- 老年医学 老年医学
- 内部医学 内部医学
背景情况:
- 上部胃肠道出血 (UGIB) 是一种严重的医疗状况.
- 老年人 (≥65岁) 患UGIB的风险较高,但对于这一群体,具体的管理指导方针仍未得到充分发展.
- 现有的研究往往忽略了老年UGIB患者独特的临床表现和结果.
研究的目的:
- 划分和比较UGIB的流行病学,临床和病因学特征在老年 (≥65岁) 和年轻 (<65岁) 成人患者队列之间.
- 确定影响这些不同年龄组结果和医疗保健资源利用的因素.
- 为制定管理UGIB的年龄特定指南提供信息.
主要方法:
- 一项回顾性多中心队列研究,涉及600名成年患者,他们在6个月内接受了UGIB治疗.
- 患者被分为两组:老年人 (≥65岁) 和年轻人 (<65岁).
- 收集的数据包括人口统计,并发症,药物使用,UGIB病因,风险得分 (格拉斯哥-布拉奇福德,完整的罗卡尔),治疗干预措施和临床结果 (死亡率,住院,ICU入院,再出血).
主要成果:
- 老年人占队列的72.8%,并表现出更高的并发病率和抗血小板/抗凝剂使用率.
- 在老年患者中,非水性UGIB和血管扩张症更为普遍,而水性UGIB在年轻患者中占主导地位.
- 老年患者的格拉斯哥-布拉奇福德和完整罗卡尔得分显著更高,住院时间增加,整体死亡率更高 (15%),许多死亡归因于非出血原因.
- 在不包括肝硬化患者的小组分析中,抗血小板/抗凝剂使用,较高的罗卡尔得分和查尔森并发症指数 (CCI) 等因素独立地与老年人住院死亡率有关.
- 老年患者中较高的CCI与增加对输血的需求,再出血,第二次内镜检查和再住院相关.
结论:
- 患有UGIB的老年人呈现出明显的临床特征,通常与更大的医疗保健资源利用率和较差的结果有关.
- 虽然肝硬化影响年轻患者,但非肝硬化老年人的UGIB可能表现为老年综合征,反映出复杂的多因素风险.
- 这些发现强调,需要为患上上部胃肠道出血的老年患者制定量身定制的治疗策略和指导方针.
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