| Background:Acute upper gastrointestinal bleeding(UGIB) is a common clinical emergency.Although the incidence of UGIB has decreased recently, but the hospital mortality remains from 7 to 10%. With the development of hemostatic therapy and endoscopic treatment, the mortality is quite high and also the medical consumption in developed countries.In developed countries there are 50 to 150 cases per 100000 population fall ill.It is associated with currently the aging of the population, multiple comorbidities,NSAIDs and anticoagulant uses. The clinical features and disease severity play an important role in UGIB. Its mortality usually associated with multiple organ failure,poor heart and lung function, malignant tumor.Thus if we identificate risk factors earlier, fluid resuscitation and maintenance of hemodynamic stability, drug therapy and endoscopic hemostasis will improve the prognosis of UGIB.Objective:Mainly analysis UGIB patients with etiology, clinical features and risk factors which influences the prognosis and understand the disease currency.In order to assess the risk factors of UGIB scientificly and effectively.To provide reference basis for the treatment and prevention of UGIB, and guide clinical in the future.Methods:1.Retrospectively collected 1272 UGIB patients from Gastroenterology Department of the Second Affiliated Hospital of Nanchang University,between 2011 to 2015.2.Make a detailed record of the patient's general situation, past medical history,clinical features, biochemical tests and so on. Constituent ratio was used to analysis the causes of UGIB and its clinical characteristics was summarized.3.All patients according to the clinical prognosis were divided into death group and survival group, respectively.I collects indicators as follows:etiology, age, gender,smoking, alcohol consumption, complications, blood pressure and blood biochemicalindex.At last these indicators are conducted with univariate analysis.The statistically significant indicators are placed in the multivariate logistic regression analysis, thus we obtains the main risk factors affecting the prognosis.Result:Etiology analysis:1.The male was in 944 cases,74.2% of the total number of cases, the female was in 328 cases accounting for 25.8%, the ratio of male to female was 2.88:1.The age of patients was between 13 to 96 years old,average age was 54.95 + 17.564 years old,with the 13-20 years old group 33 cases(2.6%), 20-60 years old group 716 cases(56.3%), over the age of 60 accounting for 523 cases(41.1%).2.Etiology of bleeding:peptic ulcer 715 cases(56.2%),gastric ulcer 146 cases(11.5%), duodenal ulcer 453 cases(35.6%),compound ulcer 73 cases(5.7%),43 cases with anastomotic ulcer(3.4%), esophageal varices 236 cases(18.6%),gastric cancer43 cases(3.4%);acute gastric mucosal lesion was 43 cases(3.4%),Mallory-Weiss tear12 cases(0.9%), vascular malformation 12 cases(0.9%),esophageal lesions was 5cases(0.4%),intestinal hookworm 5 cases(0.4%),biliary tract bleeding was1 case,unknown cause 183 cases(14.4%).3.The most cause in patients which age was peptic ulcer,followly esophageal and gastric varices bleeding was the most common in patients aged 40 to 60 years old,over 60 age group with gastric cancer and acute gastric mucosal lesions were the most common.Prognosis associated risk factors:1.All the patients divided into death group and survival group,126 cases in death group and 1146 cases in survival group. the mortality rate was 9.9%. The cause of death group : 50 cases gastric cancer(3.9%),38 cases peptic ulcer(3.0%),esophageal and gastric varices bleeding in 23 cases(1.8%), vascular malformation 6 cases(0.47%). The survival group causes corresponding to were 10 cases, 677 cases, 213 cases, 6 cases. The top four concurrent diseases of death group were:hypertension,,diabetes mellitus, coronary atherosclerosis, cerebrovascular diseases.2.The death group and survival group univariate analysis:age, alcohol consumption, previous history of bleeding, previous gastric resection history,comorbidities(hypertension, coronary atherosclerosis, cerebrovascular diseases,diabetes mellitus, renal failure,auricular fibrillation, merge of the other parts of tumor), Hp infection, aspirin use, the severity of disease, blood pressure, hemoglobin,albumin, triglyceride, cholesterol, blood glucose were 15 indexes which have statistical significance.3. Multivariate logistic regression analysis of Death group and survival group:age, comorbidities(coronary atherosclerosis and renal failure), aspirin use, Hp infection, previous gastric resection history, hemoglobin, blood pressure were 7indexes which have statistically significance. We can think that they are UGIB independent risk factors.Conclusion:1.peptic ulcer is still the main cause of UGIB, followed by esophageal and gastric varices bleeding, and duodenal ulcer is the first cause in the peptic ulcer.2.Upper gastrointestinal hemorrhage mainly in men and older patients, and there are a variety of comorbidities.And hypertension, coronary atherosclerosis,diabetes mellitus are the most common. Patients with two or more comorbidities are obviously UGIB risk of death among population. Nowadays it has become the focus of clinical treatment and care.3.The overall mortality rate of UGIB was 9.9%, there was no significant downward trend, the most common cause of death was gastric cancer, and more common in gastric cancer.4.Age, comorbidities(coronary atherosclerosis and renal failure), aspirin use, Hp infection, previous gastric resection history, hemoglobin, blood pressure are independent risk factors for UGIB to death.Blatchford score cannot very good prediction on the special outcome of upper gastrointestinal hemorrhage. |
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