Clinical Analysis Of 1520 Upper Gastrointestinal Bleeding Cases And Research Of Risk Assessment After Non-variceal Upper Gastrointestinal Bleeding

Objective 1.Through investigate the demography datas,bleeding causes and clinical characteristic of upper gastrointestinal bleeding (UGIB) cases in the last 6 years,to understand the current situation of UGIB morbility and the entity of transition.To deepen clinician's recognization of UGIB.2.Analysis the risk factors of re-bleeding and death after non-variceal upper gastrointestinal bleeding (NVUGIB).To investigate the prediction ability and applicability of Rockall and Blatchford risk score systems about NVUGIB in re-bleeding and death.Providing basis in choosing suit NVUGIB score system for clinician in our country and elevating accuratissime of prognosis.Methods 1.Retrospective studyed 1520 UGIB inpatients who coincided clinical diagnosis between 2004 and 2009 at the department of gastroenterology,the first affiliated hospital of anhui medical university.Registration form of the medical record was instituted,clinical information and examine results were protocoled indetail and arranged.2.Prospective collected 256 NVUGIB inpatients between January and December in 2009 at the department of gastroenterology.Rejecting 61 cases which were incomplete infromarion and noendoscopy,195 cases were bringed into study.Registration form was institued,clinical information was protocoled indetail.According to Rockall and Blatchford score systems,patients were calculated score and stratified risk(lower risk group,mid risk group and high risk group).Patients'prognosis of re-bleeding and death after 30-day were followed.The correlation between clinical variables and re-bleeding and death was studyed.Checking and comparing Rockall and Blatchford score systems in prognosing re-bleeding and death.Results 1. Clinical Analysis of 1520 Upper Gastrointestinal Bleeding Cases The ratio of male to female patients was 3.4:1 in this datas. The mean age was 52.8 years (14-102years).114 cases (7.5%) were turned to surgical treatment.38 cases (2.5%) were death,including 52.6% succumbed to massive hemorrhage of gastrointestinal tract,47.4% succumbed to other disease.The mean death age was 66 years.The first five causes were peptic ulcer,gastroesophageal varices,gastric cancer,Mallory-Weiss tear and acute gastric mucosal lesion.The incidence of older patients (older than 60 years) had a tendency of increasing (31.1%,31.9%,32.4%,42.7%,38.1%,50.5%),gastric cancer was the most important cause (21.6%). 2.Research of Risk Assessment after Non-variceal Upper Gastrointestinal Bleeding The number of NVUGIB patients was 195,including 44 cases (22.6%) had combination medication and 66 cases (28.7%) had comorbidity.Mortality,comorbidities and taking aspirin were higher in elderly patients than in younger patients (P<0.05).Drug treatment was 190 cases,endoscopy hemostasis was 3 cases,emergency operation was 2 cases. Followed up 30 days after discharged and the mortality was 6.7%,including 69.2% succumbed to other disease.The re-bleeding rate was 5.6%,duodenal ulcer accounted for 72.7% in re-bleeding causes.Eld,combination,volume of bleed,hematemesis and heart rate over 100bpm were all clinical risk factors in death (P<0.05).The finding of stigmata of recent hemorrhage within 24 hours endoscopy was higer than over 24 hours (P<0.01).The mortality was increaseing as Rockall and Blatchford score increased.Rockall score (4.38±2.22) of death group was higer than survival group (2.69±1.45) ( P=0.018).There were no statistically signifiant between re-bleeding and no re-bleeding group of Rockall and Blatchford score.The AUC of Rockall score system in predicting was 0.742 (P=0.004) for the risk of death and 0.469 (P=0.101) for re-bleeding risk.Rockall score was positively correlated with length of hospital stay(r=0.77,P<0.05).The AUC of Blatchford score system were less than 0.70 in both of predicting death and re-bleeding risk.Conclusion 1.The morbility of esophagus-fundus variceal bleeding is increasing,while acute gastric mucosal lesion is decreasing.As age older,the morbility of duodenal ulcer decrease,gastric ulcer and cancer increase.The proprotion of old patinets become more and more.Old patients who have comorbidity are hige risk in death.2. Eld, combination, volume of bleed,hematemesis and heart rate over 100bpm are all clinical risk factors in death.Rockall score system in NVUGIB death prognosis is well,but bad in re-bleeding.This study recommend to use Rockall score system as eatimate instrument in NVUGIB death risk.Blatchford score system can not be used in inpatients'prognosis.