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目的观察急性白血病合并消化道出血的临床表现并探讨其防治措施。方法回顾性分析急性白血病并发消化道出血患者36例,对出血原因进行分析。结果 36例中13例(36.1%)合并消化系统基础疾病;28例(77.8%)血小板﹤20×109/L;30例(83.3%)有应用化疗药物史且化疗期间有恶心、呕吐症状;20例(55.6%)有应用大量糖皮质激素史;16例(44.4%)存在凝血功能异常;6例(16.7%)高白细胞瘀滞。经积极治疗消化道出血后,4例(11.1%)患者死亡,32例患者出血持续时间6~15d,中位时间8d。结论急性白血病合并消化道出血的危险因素有胃肠道基础疾病、血小板减少、凝血功能异常、化疗药物及糖皮质激素应用等,临床上应采取积极措施制酸止血,以降低死亡率。
Objective To observe the clinical manifestations of acute leukemia combined with gastrointestinal bleeding and explore its prevention and treatment. Methods Retrospective analysis of 36 cases of acute leukemia patients with gastrointestinal bleeding, the cause of bleeding were analyzed. Results Thirty-six patients (36.1%) had underlying diseases of digestive system. Twenty-eight patients (77.8%) had thrombocytopenia less than 20 × 109 / L and 30 patients (83.3%) had history of chemotherapy drugs and nausea and vomiting during chemotherapy. Twenty patients (55.6%) had a history of massive glucocorticoid use; coagulation abnormalities were present in 16 patients (44.4%); and 6 patients (16.7%) had high blood leukocyte stasis. After active treatment of gastrointestinal bleeding, 4 patients (11.1%) died, 32 patients with the duration of bleeding 6 ~ 15d, the median time 8d. Conclusions The risk factors of acute leukemia complicated with gastrointestinal bleeding are gastrointestinal diseases, thrombocytopenia, abnormal coagulation function, chemotherapeutic drugs and glucocorticoid application. Active measures should be taken to stop acidosis in order to reduce the mortality rate.