Lower Gastrointestinal Bleding from Acute Hemorhagic Rectal Ulcer in Criticaly Ill Patients

目的：期待獲知於一所大學附設醫院暨醫學中心加護病房內之急重症病患，因急性出血性直腸潰瘍而導致顯著性下消化道出血之臨床表現及影響，以釐清此一特殊疾病於急重症病患之診斷重要性。方法：回朔性分析自2005年1月起至2006年12月止，因病況危急而住進內科加護病房且併發顯著下消化道出血而須緊急進行床邊大腸鏡檢查之病患，計有19名病患診斷爲急性出血性直腸潰瘍。分析此類病患之基本臨床生理數值、臨床危險因子、及預後分析。結果：於此19名病患中，9名爲男性，10名爲女性。平均年齡爲76.3歲（65至90歲）。大多數病患均罹患有嚴重共病症。APACHE Ⅱ分數平均爲19.2(8-28)。大多數之患者爲使用呼吸器治療，多數患者曾接受抗凝血或抗血小板藥物。整體住院中死亡率爲47.3%(9/19)，而僅有一名病患之死亡與出血有關。結論：對於罹患急重症需加護醫療的病患，若發生急性下消化道出血時，急性出血性直腸潰瘍爲常見之出血原因之一，且較其他近端大腸之病因容易被診斷。但其預後不佳，患者常有較高之死亡率及較長加護病房住院日。然而影響病患存活之因素歸因於原有疾病之嚴重度而非單純因下消化道出血。

關鍵字

急性出血性直腸潰瘍；緊急大腸鏡；下消化道出血；重症病患

並列摘要

Purpose: To elucidate the clinical characteristics and impacts of acute hemorrhagic rectal ulcer (AHRU) in critically ill patients during their stay in the ICUs of a university-affiliated hospital. Materials and Methods: From January 2005 to December 2006, medical records of ICU-hospitalized patients acquired a lower GI bleeding that required a colonoscopy done on an emergency basis were reviewed. Nineteen patients with acute hemorrhagic rectal ulcers were enrolled for evaluation. The baseline characteristics, clinical risk factors, and outcomes were analyzed. Results: There were 9 males and 10 females with a median age of 76.3 (range, 65-90) years. The majority of patients had significant life-threatening comorbid diseases. The average APACHE Ⅱ score was 19.2 (range, 8-28). Most of patients received mechanical ventilation (84.2%, 16/19), and more than half had ever used anticoagulant or antiplatelet agents (52.6%, 10/19). Overall in-hospital mortality was 47.3% (9/19). Hemorrhage-related death occurred in only one patient. Conclusions: In conclusion, this study indicated that acute hemorrhagic rectal ulcer was not an uncommon disease causing significant lower GI bleeding in critically ill patients. Patients with AHRU had poorer outcome and longer hospital stay. These life-threatening characteristics were largely attributable to underlying medical conditions but not LGI bleeding itself.

並列關鍵字

acute hemorrhagic rectal ulcer ； early colonoscopy ； lower gastrointestinal hemorrhage ； critically ill

國際替代計量

Lower Gastrointestinal Bleding from Acute Hemorhagic Rectal Ulcer in Criticaly Ill Patients

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