Turkiye Klinikleri Journal of Gastroenterohepatology

İnatçı ve Tekrarlayan Üst Gastrointestinal Sistem Kanamalı Hastalarda Klinik Risk Faktörleri
THE RISK FACTORS IN PERSISTENT AND RECURRENT UPPER GASTROINTESTINAL TRACT BLEEDING PATIENTS
Mehmet DEMİR*, Fatih DEDE*, Mehmet ARHAN**, Burçin BUDAKOĞLU***, Enver ÜNVER*, Erdal ESKİOĞLU*
* Ankara Numune Eğitim ve Araştırma Hastanesi 2. Dahiliye Servisi**, Türkiye Yüksek ihtisas Hastanesi Gastroenteroloji Servisi***, Ankara Numune Eğitim ve Araştırma Hastanesi 5. Dahiliye Servisi, ANKARA
Turkiye Klinikleri J Gastroenterohepatol. 2003;14(2):86-92
Article Language: TR
Full Text
ÖZET
 Amaç: Üst gastrointestinal sistem (GİS) kanamaları önemli mortalite nedenlerinden birisidir. Üst GİS kanaması olan hastaların % 80inde kanama kendiliğinden durmaktayken, %20sinde devam etmekte veya tekrarlamaktadır. Üst GİS kanamalarında mortalite %10 düzeylerindeyken, inatçı ve tekrarlayan kanamalarda bu oran %30-40lara kadar yükselmektedir. Amacımız üst GİS kanamalı hastalarda inatçı ve tekrarlayan üst GİS kanamasını tanımlayacak klinik risk faktörlerini belirlemekti.Materyal ve Metod: Çalışmaya Şubat-Haziran 2001 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi acil polikliniğine başvuran ve üst GİS kanaması tanısı ile acil dahiliye servisine yatırılan 107si erkek, 50si kadın 157 hasta dahil edildi. Hastalarda 9 değişik klinik parametre değerlendirildi.Bulgular: Hastaların 25 (%15,92)inde eşlik eden başka bir aktif hastalık, 14 (%8,9) hastada da ileri derecede karaciğer hastalığı mevcuttu. 106 (%67,51) hastada NSAI ilaç kullanım hikayesi mevcuttu. Başvuru anında 23 (%14,64) hastada hipovolemiye bağlı hipotansiyon vardı. Acil polikliniğe başvuru sırasındaki kanama bulguları: yalnız hematemez 18 (%11.47), yalnız melana 65 (%41,40) ve hematemezle birlikte melana 70 (%44,58) olarak saptandı. Hastaların 4(%2,55)ünde başvuru sırasında hematemez veya melena yoktu. 37 (%23,56) hastada inatçı ve tekrarlayan kanama oldu. Genel mortalite oranı % 5,09, inatçı ve tekrarlayan kanamalarda mortalite %16,2 olarak tespit edildi. Sonuç: Erkek cinsiyet ve başvuru semptomu olarak hematemez varlığının, inatçı ve tekrarlayan kanama açısından birbirinden bağımsız klinik risk faktörleri olduğu saptandı

Anahtar Kelimeler: İnatçı ve tekrarlayan üst GİS kanamaları, Klinik risk faktörleri
ABSTRACT
 Background: Upper gastrointestinal tract bleeding is an important cause of mortality.In 80% of patients bleeding is self-limited while persistent and recurrent in the remaining 20%. Although the mortality rate is 10% in upper gastrointestinal tract bleedings, this rate exceeds to 30%-40% in persistent and recurrent cases. The aim of the study was to determine the risk factors for persistent and recurrent bleeding in patients with upper gastrointestinal tract bleeding.Materials and Methods: 157 patients (107 male, 50 female) that applied to the Ankara Numune Hospital emergency unit and diagnosed as upper GİS bleeding between February-June 2001 were recruited in this study. 9 clinical parameters were considered.Results: 25 patients (15,92%) had an accompanying active disease and 14 patients (8,9%) had serious liver disease. 106 patients (67,51%) had a positive medical history for previous NSAID medication.At the time hospitalization, 23 (14,64%) patients had hypotension as a consequence of hypovolemia. The presentation of bleeding was hematemesis in 18 patients(%11,47), melena in 65 patients (41,40%), both hematemesis and melena in 70 patients (44,58%). 4(2,55%) of the patients had no hematemesis or melena on hospital admission. In 37(23,56%) patients persistant and recurrent bleeding was observed. The general mortality rate was 5,09%, persistent and recurrent bleeding mortality rate was 16,2%. Conclusion: Male gender and hematemesis as an initial symptom were found as independent clinical risk factors for persistent and recurrent upper gastrointestinal tract bleeding.

Keywords: Persistent and recurrent upper gastrointestinal tract bleeding, Clinical risk factors

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30.03.2014

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