| Objective:To summarize the clinical data of patients with acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)in the inpatient department of our hospital in recent 3 years,and to explore the clinical features,treatment status and prognosis of the disease,so as to provide guidance for future clinical treatment of ANVUGIB.Methods:1.Clinical data collection:1 Basic information: name,gender,age,and contact number;2 Medical history: previous upper gastrointestinal diseases,bleeding,perforation,operation history,etc.,whether accompanied with acute and chronic cardiovascular and cerebrovascular diseases,liver and kidney failure and other basic diseases,whether taken antiplatelet drugs,anticoagulants and other drugs that may cause upper gastrointestinal bleeding;3 General conditions at the time of initial diagnosis: current medical history,systolic blood pressure,pulse and bleeding volume;4 Laboratory tests: routine blood test,six items of coagulation,liver function and kidney function,etc.;5 Treatment or outcome: cause of bleeding,whether surgery replacement or vascular intervention is required,whether the patient dies,and whether there is bleeding again within30 days after treatment.2.Analyze and summarize the clinical characteristics of ANVUGIB,and separately grade the patients using Glasgow-Blatchford and AIMS65 scoring systems and risk stratification(divided into low-risk group and medium-risk group).Then compare the activated partial prothrombin time(APTT),shock index(SI)and disturbance of consciousness of different groups,as well as the differences in clinical characteristics such as drug use history that can cause gastrointestinal bleeding(antiplatelet drugs and anticoagulants),acute and chronic cardiovascular and cerebrovascular diseases,liver and kidney failure,and hematemesis.To explore whether there is statistical significance between two scoring systems in predicting the in-hospital death rate and 30-day rebleeding rate of patients with ANVUGIB.Results:1.Among the 425 patients with ANVUGIB included in this study,87 were female,and 338 were male,with male: female =3.89:1,age from 17 to 92 years old,and average age of 59.8515.67 years old;Nearly half of the patients with ANVUGIB presented with melena,followed by melena with hematemesis,and a small part with hematemesis or vomiting of brown gastric contents.Forty-five cases(10.59%)were accompanied by acute blood loss such as dizziness,palpitations,and cold sweat,and 25 cases(5.88%)had syncope and somnolence.2.Among the 425 patients,239(56.24%)had peptic ulcer,93(21.88%)had gastrointestinal cancer,52(12.24%)had acute gastric mucosal lesion,30(7.06%)had cardiac laceration,and4(0.94%)had Dieulafoy’s disease.Duodenal ulcer accounts for 48.54% of peptic ulcer and has the highest incidence.With the increase of age,the proportion of digestive tract ulcer in ANVUIB decreased gradually(P<0.05),while the proportion of digestive tract tumor increased gradually(P<0.05).3.Among 425 patients,384 cases(90.35%)were treated by internal medicine conservative treatment,13 cases(3.06%)were treated by endoscopic hemostasis,8 cases(1.88%)were treated by vascular embolization,and 20 cases(4.71%)were treated by surgery.There were17 deaths in the hospital,with the mortality rate of 4.0%.There were 26 cases of rebleeding during the 30-day follow-up period,with the rebleeding rate of 6.12%.4.According to the AIMS65 scoring system,the patients were divided into low-risk group and medium-risk group.There was no significant difference in the clinical manifestation of hematemesis between the two groups(P<0.05).Compared with the low-risk group,the activated partial prothrombin time(APTT),shock index(SI),the proportion of patients with conscious disturbance,the proportion of patients with acute and chronic cardiovascular and cerebrovascular diseases,liver and kidney failure and other basic diseases that can cause gastrointestinal bleeding were significantly increased in the middle and high-risk group(P<0.05).5.The patients were divided into low-risk group and medium-risk group according to the GBS scoring system.There was no significant difference in clinical characteristics such as hematemesis,combined consciousness disorder and drug use history(antiplatelet and anticoagulant)that could cause gastrointestinal bleeding between the two groups(P<0.05).Compared with the low-risk group,the activated partial thromboplastin time(APTT)was prolonged,the shock index(SI)was increased,and the proportion of patients with acute and chronic cardiovascular and cerebrovascular diseases,liver and kidney failure and other basic diseases was increased in the medium-and high-risk group(both P<0.05).6.The area under the ROC curve of AIMS65 score in predicting hospital death was 0.77(95% CI: 0.64–0.89),the sensitivity and specificity were 58.82% and 82.84%,respectively.The area under ROC curve of GBS score in predicting hospital death was 0.56(95% CI:0.41–0.72),with the sensitivity of 52.94% and specificity of 59.56%.It indicated that the accuracy of AIMS65 in predicting hospital deaths was good,while that of GBS was low.The clinical value of AIMS65 in predicting hospital deaths was superior to that of GBS and the difference was statistically significant(P<0.05).7.AIMS65 score predicts rebleeding within 30 days with an area under the ROC curve of0.56(95% CI: 0.44–0.68),a sensitivity of 69.23%,and a specificity of 48.37%.The area under the ROC curve of the GBS score in predicting rebleeding within 30 days was 0.58(95% CI: 0.48–0.68),with the sensitivity of 61.54% and specificity of 50.13%.It indicated that the accuracy of the two scores in predicting the rebleeding within 30 days was low,and there was no significant difference between the two scores(P<0.05).Conclusion:1.The incidence rate of ANVUGIB in men is significantly higher than that in women,with peptic ulcer,gastrointestinal tumor,acute gastric mucosal lesion,cardia laceration and Dieulafoy’s disease ranked in the top five.Duodenal ulcer accounts for the highest proportion of peptic ulcer.With the increase of age,the proportion of digestive tract ulcer in ANVUIB decreased gradually(P<0.05),while the proportion of digestive tract tumor increased gradually(P<0.05).2.The treatment of ANVUGIB is mainly conservative in internal medicine.In case of poor effect of internal medicine treatment,we can choose endoscopic hemostasis,interventional embolization and surgical treatment according to the condition.3.The clinical value of 3.AIMS65 in predicting hospital death is superior to that of GBS scoring,with good accuracy,which is worthy of clinical application.Both scores were less accurate in predicting rebleeding within 30 days,and they were equally competent. |
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