苏皖地区14岁以下儿童上消化道出血的临床和胃镜特征分析

Analysis of clinical and endoscopic feature in children with upper gastrointestinal bleeding

摘要:

目的   分析苏皖地区14岁以下儿童上消化道出血的临床特征、胃镜下改变、病因及预后。方法    回顾性分析2013年2月-2015年2月该院小儿消化科因上消化道出血住院病例113例，分析其在临床症状、内镜下改变、病因及预后的差异。结果   各组患儿均有呕血或黑便症状，除<1岁患儿组外，其余各组患儿还有上腹痛、头晕乏力及休克征的表现。≥1岁且<3岁患儿组临床表现为呕血合并黑便高于≥3岁且<6岁患儿组（χ2=4.07，P =0.044）和<1岁患儿组（χ2=3.87，P =0.049），但与≥6岁且≤12岁患儿组比较差异无统计学意义（χ2=3.02，P =0.082），其他症状，各组比较差异均无统计学意义。内镜检查显示儿童上消化道出血的病因包括：出血性或糜烂性胃炎、十二指肠球炎及溃疡、返流性或糜烂性食管炎、食管狭窄、胃底食管静脉曲张和贲门黏膜撕裂综合征。除≥6岁且≤12岁患儿组食管狭窄引起的上消化道出血明显低于≥1岁且<3岁患儿组（χ2= 5.64，P =0.018）外，其余各组比较差异均无统计学意义。此外，诱发因素的分析显示，≥1岁且<3岁患儿组误服化学制剂的比例明显高于≥3岁且<6岁患儿组（χ2=4.09，P =0.043），其余各组比较差异无统计学意义。治疗有效率比较，各组无明显差异。结论   苏皖地区14岁以下儿童上消化道出血呈现如下特点：以呕血为首要临床表现；内镜下以糜烂性或出血性胃炎为首要病因；大部分患儿无明显诱因；内镜及药物治愈率较高。

Abstract:

Objective To investigate the clinical and endoscopic features，etiology and prognosis of children with upper gastrointestinal bleeding (UGIB) in Jiangsu and Anhui of China. Methods 113 children with UGIB from Feb. 2013 to Feb. 2015 were studied retrospectively. They were divided into four groups: <1 year old group, ≥1 years old <3 years old group; ≥3 years old <6 years old group, ≥6 years old≤12 years old group. Then study and analyze the clinical and endoscopic features, morbidity, etiology and prognosis among the four groups. Results Children in all groups shown hematemesis or melena symptoms, except infants in the group (< 1 years old), children in the other groups also showed upper abdominal pain, dizziness, weakness, and shock syndrome. The percentage of hematemesis and melena in the group (≥1 year old and <3 years old) was significantly higher than that of the group (≥ 3years old and <6 years old) (χ2=4.07, P = 0.044) and that of the group (< 1 year old) (χ2=3.87, P = 0.049). There was no significant difference among four groups in other symptoms. Endoscopic examination revealed that the cause of upper gastrointestinal bleeding (UGIB) in children included: hemorrhagic or erosive gastritis, duodenal bulb inflammation and ulcer, reflux or erosive esophagitis, esophageal stenosis, esophageal varices, cardiac mucosal tear syndrome. Except the percentage of esophageal stenosis in the group (≥6 year old and <12 years old) was significantly decreased compared with that of children in the group (≥1 year old and <3 years old) (χ2 = 5.64, P = 0.018), There was no significant difference among four group in other endoscopic features. Additionally, predisposing factors analysis showed that the incidence rate caused by accidental chemical agents in the group (≥1 year old and <3 years old) was significantly higher than that of children in the group (≥3 year old and <6 years old) (χ2 = 4.09, P = 0.043). No significant difference was found among four groups in the effective rate of the treatment. Conclusions The features of UGIB in children under the ages of 14 years old in the region of Jiangsu and Anhui showed the following characteristics: Haematemesis was the first clinical manifestation. Erosive or bleeding gastritis was the first reason for UGIB in all patients. Most of the children have no predisposition; The endoscopic and drug cure rate of UGIB in children is high.