目的:探索急性冠脉综合征(ACS)患者发生胃肠出血的主要危险因素.方法:回顾性分析我院2003年～2011年诊断为ACS的3 642例患者的临床资料,根据是否发生胃肠道出血分为胃肠道出血组(90例)和无胃肠道出血组(3 552例),比较两组临床资料,并分析其胃肠出血的危险因素.结果:胃肠出血者死亡率较无胃肠出血者明显升高(33.7％比4.6％,P＜0.001).与无胃肠出血者比较,胃肠出血组年龄明显偏高[(62.4±13.5)岁比(68.2±12.3)岁],女性患者较多(41.8％比57.8％),胃肠疾病史、心脏停搏、肾功能不全、PCI术、心力衰竭、糖尿病、高血压病、合用替罗非班比率明显升高(P＜0.05～0.01),肌钙蛋白T峰值明显升高[(82±146) ng/ml比(139±168)ng/ml,P＜0.01].多元Logistic回归分析显示,胃肠道出血的危险因素为:年龄,女性,胃肠疾病史,肌钙蛋白T峰值,心脏停搏,肾功能不全,PCI术,心力衰竭(OR=1.01～3.18,P均＜0.01).结论:ACS患者发生胃肠出血的主要危险因素是:年龄＞65岁,女性,PCI术,心脏停搏,肾功能不全,胃肠疾病史,肌钙蛋白T峰值,心力衰竭.ACS患者合并胃肠出血的患者住院死亡率明显增加,需要重视其预防和治疗.%Objective: To investigate main risk factors of gastrointestinal bleeding (GB) in patients with acute coronary syndrome (ACS). Methods: Clinical data of 3 642 patients diagnosed as ACS in our hospital from 2003 to 2011 were retrospectively analyzed. According to GB or not, patients were divided into GB group (n = 90) and no-GB group (n = 3552), clinical data were compared between two groups and risk factors of GB were analyzed. Results: Compared with no-GB group, there were significant increase in mortality rate (4. 6% vs. 33. 7%, P<0. 001), age [ (62. 4 ± 13. 5) years vs. (68. 2 ± 12. 3) years], percentages of female (41. 8% vs. 57. 8%), patients with gastrointestinal disease history, cardiac arrest, renal dysfunction, PCI, heart failure, diabetes mellitus, hypertension, combined use of tirofiban and troponin T peak level [ (82 ± 146) ng/ml vs. (139 ± 168) ng/ml] (P<0. 05~0.01) in GB group. Multiple Logistic regression analysis indicated that risk factors of GB were age, female, gastrointestinal disease history, troponin T peak, cardiac arrest, renal dysfunction, PCI and heart failure (OR= 1. 01~3. 18, P<0. 01 all). Conclusion: Main risk factors of GB in ACS patients are age >65 years, female, PCI, cardiac arrest, renal dysfunction, gastrointestinal disease history, troponin T peak and heart failure. In-hospital mortality rate significantly increases in ACS patients with GB, therefore need to pay attention to prevention and treatment for improving prognosis.
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