Acute Nonvariceal Upper Gastrointestinal Bleeding: Literature Review, Routine Of Diagnosis And Treatment

Objective: Acute nonvariceal upper gastrointestinal bleeding is a common and emergercy disease in the internal medicine of digest. The incidence of it was never descent, that seriously affects the people's life and health. The study concluded and summarized the routine of ANVUGIB after reviewing correlative literature. At the same time, through the retrospective study of the epidemiology and routine for diagnosis and treatment from the first affiliated hospital of Guangzhou university of Chinese Medicine in the past five years, we discussed the pathogeny laws, clinical characters and treatment routine of ANVUGIB, and analyzed the rule of the syndrome of blood in Chinese medicine include their difference prognosis, which was hoped to be of help to the development in the period ahead.Methods: The case history information of ANVUGIB inpatients treated in the first affiliated hospital of Guangzhou university of Chinese Medicine from June 1th 2001 to May 31th 2006 was collected for retrospective study. The information included: pathogeny, symptoms, physical signs, result of laboratory examination, drugs and prognosis ect, which was used to have statistical analysis according to their belonging to measurement data or numeration data. Then try to conclude the epidemiology information and classified measures of diagnosis and treatment, and had a pilot study of the standardized precept.Conclusion:1. Edemiology information:In the past 5 years in our hospital The average age of the patient with ANVUGIB is 45.77±17.70 years old, the sex proportion with the male and female is 1: 0.33, the chief season of this disease happened are winter and spring. The main pathogenies were duodenal ulcer, gastric ulcer, gastric mucous membrane inflammation and gastric cancer, Improper diet, use of non-steroidal anti-inflammatory drugs and alcohol abuse were in the front row in the known predisposing factors, that consistent with the domestic epidemiology.2. DiagnosisSyndromes: Dark stools and/or haematemesis, follow the upper gastrointestinal and anaemic syndromes.Physical signs: With no specificity signs, some with bowel sounds active or hyperactive, BP drop, HR rise.Lab examination: HGB drop and BUN rise, 96.5％of the patient can give a final diagnosis by gastroscopy.The patient was classify with the emergency gastroscopy, Rockall scoring, Forrest scoring, age and chief syndrome and then discuss. We found that Rockall scoring with high risk, Forrest scoring with high risk, eld and chief syndrome with haematemesis were the high risk of recurrent bleeding. These factor that emergency gastroscopy, Rockall scoring with low risk, Forrest scoring with low risk and young patient can reduce the time in hospital. The Rockall scoring system combine with the age, blood capacity, Forrest scoring and previous history seen more comprehensive when judge the patient's condition.3. TherapeuticMost of the patients were treat by internal medicine. We emphasize the diet nursing, 135(58.7％) patients were fasting, and all that the chief syndrome with haematemesis were fasting, the average fasting time was 3.10±2.34days. In the medicine use aspect, expanding the blood capacity is the foundation of the supporting treatment; inhibiting acid is the basis in treatment, which PPI(usage 81.3％) use generally, H2RA and SST use less. Hemostyptic was not sure here, but use generally in our hospital(usage 97.4％). Only 2.6％of the patient use endoscopy therapeutic, and 4.8％use surgery therapeutic. 81.3％of the patient took Chinese medicine. We found that recurrent bleeding were lesser happened on the patient who took Chinese medicine than without Chinese medicine (X~2=9.30, P＜0.05=. The TCM syndrome classify with the syndrome of deficiency included syndrome of deficiency of spleen pi (53.9％) and syndrome of qi desertion and blood exhaustion (8.2％), syndrome of excess included syndrome of stomach fire flaring up (27.0 %), syndrome of liver fire invading stomach(10.9%),. The rate of rebleeding with the syndrome of deficiency was higher than the syndrome of excess with significant difference (X~2=5.01, P＜0.05),and the time in hospital of the syndrome of deficiency was longer than the syndrome of excess with significant difference (P＜0.05) .4. Curative effectThe curative effect were satisfying in our hoapital. Nobody dead in our study. 10.4% of patient recurrent bleeding. The average of the time in hospital were 9.42±6.430days.