Clinical Analysis Of 145 Cases Of Cirrhotic Patients With First Upper Gastrointestinal Bleeding

Objective:The clinical data of 145 patients with cirrhosis combined with the first upper gastrointestinal bleeding were retrospectively analyzed,and their clinical characteristics and prognosis related factors were discussed.It will provide data for diagnosis,treatment and prognosis of patients with liver cirrhosis with upper gastrointestinal bleeding in the future.Methods:Based on the analysis of clinical data from September 2013 to September 2017 in First Hospital of Lanzhou University were diagnosed with cirrhosis for first upper gastrointestinal bleeding patients,a total of 145 cases,analyzed of their age,gender,diagnosis time of upper digestive tract bleeding from liver cirrhosis,onset season,bleeding inducement,cause of bleeding,pathogeny of liver cirrhosis,the main way of bleeding,estimation of the amount of bleeding,abdominal symptoms,mind,heart rate,blood pressure,shock index,Child-Pugh classification of liver function,other complication and death,blood routine,blood biochemistry,coagulation function,abdominal ultrasound,electronic gastroscope and treatment.All data were divided into EVB group and NVUGIB group according to the cause of bleeding,and were analyzed by SPSS21 statistical software.Results:1.General information:In this study,69.66%of the patients were male and 30.34%were women,male:female=2.30:1.Age distribution is between 23 and 82 years old,The average age was 55.46±13.12 years.There was no statistically significant difference between the EVB group and the NVUGIB group in sex（P>0.05）,and there was a significant difference in age（P<0.05）.2.Clinical features:In the study,30.34%of the patients were diagnosed with cirrhosis at the first upper gastrointestinal bleeding.The time of diagnosis of liver cirrhosis from the first upper gastrointestinal bleeding was recorded,and the results suggest that 1 to 3 years after diagnosis of liver cirrhosis is the peak of upper gastrointestinal bleeding（27.72%）.The patients were grouped according to the onset season,in winter（35.17%）and spring（28.28%）,the incidence of upper gastrointestinal bleeding was significantly higher than that in summer and autumn.About 72.41%of the patients had no obvious cause of bleeding,and the rest 27.59%had obvious bleeding inducements.There was no significant difference in bleeding inducements between group EVB and group NVUGIB（P>0.05）.The analysis of the causes of liver cirrhosis shows that viral cirrhosis accounts for 67.59%,and viral hepatitis is the main cause of cirrhosis.The difference of bleeding patterns between group EVB and NVUGIB group was compared,and the results showed no significant difference（P>0.05）.The difference of bleeding volume between group EVB and group NVUGIB was analyzed,the results showed that when the amount of bleeding was less than400ml and the amount of bleeding was greater than 1000ml,the difference was statistically significant（P<0.05）.Analysis of the relationship between Child-Pugh classification of liver function and the amount of bleeding in EVB group,the results showed that there was a positive correlation between the Child-Pugh grading and the amount of bleeding（P<0.05）.There was no significant difference in abdominal symptoms between group EVB and group NVUGIB（P>0.05）.3.Analysis of complications and death:There were significant differences in the incidence of complications and death in group EVB and group NVUGIB（P<0.05）.It was found that PLT,TBIL,combined complications and shock index were all risk factors for death（P<0.05）.4.Laboratory examination:The average value of RBC was（3.01±0.80）×10⁹/L,and the decrease was 74.48%;The average value of WBC was（5.98±5.46）×10¹²/L,the decrease was44.14%,and the increase was 12.41%;The average value of PLT was（77.30±47.43）×10⁹/L,and the decrease was 77.93%;The average value of HGB was（91.8±27.6）g/L,and the decrease was75.86%;three cases decreased 28.28%.The average value of TBIL was（44.27±72.78）μmol/L,and the increase was 40%;The average value of ALB was（32.52±5.92）g/L,and the decrease was44.14%;The average value of BUN was（8.71±4.44）mmol/L,and the increase was 53.79%;The average value of CREA was（74.13±33.95）μmol/L,and the increase was 8.97%.The average value of TG was（0.97±0.71）mmol/L,the decrease was 48.97%,and the increase was 38.62%;The average value of TC was（2.52±0.96）mmol/L,the decrease was 88.97%,and the increase was1.38%.The average value of PT is（15.2±4.37）seconds,and the extension is 78.62%.It was found that the number of RBC and HGB in group EVB was lower than that in group NVUGIB,and the prolongation time of PT was much more,and the difference was statistically significant（P<0.05）.5.Accessory examination:It was suggested that 40.85%of the patients combined with a small amount of ascites,9.86%with moderate ascites,and 49.29%with a large amount of ascites.There was no significant difference between group EVB and group NVUGIB in the amount of ascites（P>0.05）.The average internal diameter of the portal vein was（12.98±1.65）mm,37.62%of the patients were widened.There was significant difference between the two groups on the width of the portal vein（P<0.05）.In group EVB,2.59%of patients with mild esophageal varices,14.66%of patients with moderate esophageal varices,79.30%of patients with severe esophageal varices,and 3.45%of patients with simple gastric varices.The red sign accounted for 48.28%of the EVB group.In group NVUGIB,gastric ulcer accounted for 17.24%,duodenal ulcer 17.24%,PHG 41.38%,and erosive hemorrhagic gastritis 24.14%.6.Treatment:57.24%of the patients were treated conservatively,30.34%of the patients were treated under endoscopy,and 12.42%of the patients were treated with TIPS.Conclusion:1.Cirrhosis combined with the first upper gastrointestinal bleeding is mainly in elderly male patients.2.The first peak of upper gastrointestinal bleeding is 1 to 3 years after the diagnosis of cirrhosis.Winter and spring are high risk seasons for upper gastrointestinal bleeding in cirrhosis.3.A small number of patients have a clear cause of bleeding.4.The amount of bleeding in group EVB was larger than that in group NVUGIB,and there was a positive correlation between Child-Pugh classification and the amount of bleeding.5.In the auxiliary examination,the RBC and HGB counts in group EVB were lower than those in group NVUGIB,the extension time of PT was longer,and the diameter of portal vein was wider.6.The incidence of complications and death in group EVB was higher than that in group NVUGIB.7.PLT,TBIL,combined with other complications,systolic blood pressure and shock index were all risk factors for death in patients with cirrhosis combined with the first upper gastrointestinal bleeding.