Analysis On The Timing Of Endoscopic Treatment And Diagnosis Of Acute Non-variceal Upper Gastrointestinal Bleeding

Part one: Analysis on the timing of endoscopic treatment and diagnosis of acute non-variceal upper gastrointestinal BleedingObjective:64 patients with acute non-varicose upper gastrointestinal bleeding were treated in the first affiliated hospital of wannan medical college from June 2015 to June 2017.the clinical outcomes of anu gib patients after emergency endoscopy were analyzed and the clinical effects and benefits of emergency endoscopy were discussed to provide reference for clinical treatmentMethodology:A total of 64 inpatients who were admitted to the first affiliated hospital of wannan medical college from June 2015 to June 2017,who met the clinical diagnostic criteria of anu gib and were diagnosed by endoscopy,were enrolled in this study.a complete registration form of anu gib case data was designed and recorded one by one.the data were analyzed by statistical software SPSS 17.0.Results:1.In < 6h gastroscope group,27 cases(96.4 %)had definite etiology,of which iatrogenic injury was the main cause(42.8 %).Only 22 cases(61.1 %)wereidentified in the 6-24 h group,of which iatrogenic injury was the main one(30.5 %).There was significant difference between the two groups(p < 0.05).2.For anu gib patients with Rockall scores less than 5,the average hospital stay was 6.50 1.97 d and 6.00 3.74 d for < 6 h and 6-24 h,respectively,compared with those in < 6 h and 6-24 h,p = 0.588;The mean blood transfusion volume was 761.36466.22 ml and 786.84 486.72 ml,respectively,p = 0.865;The rebleeding rates were8.30 % and 10.50 % p = 0.0643.Emergency endoscopy did not reduce hospitalization days,rebleeding rates,and red blood cell input in patients at high risk of acute nonvascular upper gastrointestinal bleeding(patients with Rockall scores less than 5)within 6 hours.Conclusion:1.Urgent endoscopy within 6 hours can improve the etiological detection rate of anu gib patients.2.Urgent endoscopy in patients with high risk of acute nonvascular upper gastrointestinal bleeding(Rockall score 5 or greater)within 6 hours significantly reduced the number of days in hospital,rebleeding rate,and red blood cell input.3.Urgent endoscopy did not reduce hospitalization days,rebleeding rates,and red blood cell input in patients at high risk of acute nonvascular upper gastrointestinal bleeding(patients with Rockall scores less than 5)within 6 hours.Part two: Meta-analysis of endoscopic diagnosis and treatment timing for acute non-varicose upper gastrointestinal bleedingObjective:The clinical benefit of Urgent endoscopy to patients was systematically evaluated by META analysis.Methodology:The computer retrieval database is Pub Med,CNKI,VIP,CBM,wanfang data.The start and end dates are from the date of construction to December 2017.Search relevant documents manually and search keywords on the internet using Google academic search and Baidu academic search.The Newcastle-ottawa scale(nos)was used to evaluate the quality and classification of literature.data were extracted and entered independently by two reviewers and cross-checked.meta-analysis was performed by revman softwareResults:1.Meta-analysis results showed that there was no significant difference in rebleeding rate between routine group and control group after Urgent endoscopic treatment(or = 0.95,95 % ci: 0.50 ~ 1.80,z = 9.43,p = 0.984),there was no significant difference in surgical rate between routine group and control group after Urgent endoscopic treatment(or = 1.71,95 % ci: 0.80 ~ 3.64,z = 1.12,p = 0.084),and there was no significant difference in mortality rate between routine group and control group after Urgent endoscopic treatment There was no significant difference in blood transfusion volume between the patients in the routine group and the control group after Urgent endoscopic treatment(SMD =-0.17,95 % ci:-0.39 ~ 0.04,z = 2.15,p =0.069)2.Meta-analysis results showed that the rebleeding rate of patients in high-risk group after Urgent endoscopic treatment was significantly different from that in control group(or = 2.24,95 % ci: 1.09 ~ 4.61,z = 2.89,p = 0.023),and the surgical rate of patients in routine group after Urgent endoscopic treatment was significantly different from that in control group(or = 4.32,95 % ci: 1.51 ~ 12.31,z = 4.52,p = 0.00),and the mortality rate of patients in high-risk group after Urgent endoscopic treatment was significantly different from that in control groupConclusion:1.Emergency endoscopy < 6 hours did not increase the clinical benefit of patients with acute non-venous upper gastrointestinal bleeding in the group of patients with relevant clinical score,may be selected into the study with more low-risk population2.for patients with high risk of acute non-venous upper gastrointestinal bleeding(GBS score greater than or equal to 12 patients)within 6 h Urgent endoscopy can significantly reduce the mortality rate,rebleeding rate and blood transfusion...