| Background and Objective:Non-variceal upper gastrointestinal bleeding(NVUGIB)is the digestive tract bleeding over flexor ligament in non-variceal disorders,that is a common emergency in the digestive system,and there may cause severe shock,even life-threatening.The scale of Chinese elderly population is large,and the speed of aging is accelerating,which has a great impact on the public,health and other aspects.Because of the body immune dysfunction,decreased ability,combined with multisystem disease,and using a variety of oral bleeding related drugs,the elderly easily suffer from NVUGIB,and the more are acute onset.So the clinical doctors should strengthen awareness of the population risk of NVUGIB,try to do early prevention,diagnosis and treatment.This paper was a retrospective study,which compared the epidemiological characteristics of elderly patients and young patients with NVUGIB etiology,endoscopic examination,blood transfusion strategy,treatment and prognosis.The present study aimed to clear the clinical characteristics of elderly patients with NVUGIB,the optimization of the existing treatment options,improve the prognosis of elderly patients,reduce the rate of rebleeding and mortality.To provide the basis for clinicians to select appropriate assessment tools and improve the accuracy of prediction,this paper also completed Rockall and Blatchford scores of the collected cases,and assessed how full Rockall and Blatchford scores systems can predict clinical outcomes of patients' NVUGIB.Methods:The research objects were selected from January 2013 to December 2015 in NO.1 Hospital of Jilin University,and all were definite diagnosis of NVUGIB(aged?18 years)with gastroscopy.By retrospectively analyzed medical records of patients in hospital,this study completed medical records collection,including basic information(name,gender,age,hospitalization time)etiology,past history,long term and short term medication history,vital signs,clinical symptoms,laboratory examination,clinical diagnosis and treatment(blood transfusion and endoscopy)and prognosis.According to the age,patients were divided into young group(<60 years old)and the elderly group(over 60 years).The two groups were compared the characteristics,comorbidities,medication history,etiology,endoscopic examination,treatment and prognosis.At the same time,the two groups were scored according to the Rockall scoring system and Blatchford scoring system in order to compare the prediction value of different score to the rebleeding and death.Statistical analysis used SPSS 19 statistical software,different indicators used the appropriate test method for testing.All the tests were P<0.05 as the difference,P<0.01 as the significant difference.Results: 1?Case characteristics:The characteristics of the cases were divided into two items: general condition,vital signs and laboratory tests.General condition included gender,age,admission ward and cycle.The morbidity of men and women were difference(P<0.05).And a higher proportion of elderly patients admitted to the ICU(P<0.05).The hospitalization time was longer in the elderly group(P<0.01).Vital signs and laboratory tests included heart rate,blood pressure,hemoglobin and blood urea nitrogen.When compared two groups found that elderly patients with low blood pressure at admission(P<0.05),while others had no obvious difference.2?Etiology of hemorrhage:Peptic ulcer was the primary cause of NVUGIB,compared two groups: the elderly group of acute gastric mucosal lesions and tumors of the digestive tract caused NVUGIB were higher than the young group(P<0.05),while the young group of Mallory Weiss syndrome in NVUGIB was more commen than the elderly group,the difference was statistically significant(P<0.05).3?Combined disease:Hypertension was common in patients with NVUGIB(183/477,38.36%).The elderly patients combined with hypertension,ischemic heart disease,cerebral hemorrhage and diabetes were more than the young group,there was statistically significant difference(P<0.01),and the combination of respiratory system disease,cancer(non-gastrointestinal tumors)were also a high proportion in elderly(P<0.05).In this paper,young group with a history of alcohol accounted for a higher proportion than the older group,which had statistically significant difference(P<0.05),but there was no statistically significant difference with a history of tobacco(P>0.05).4?Medication history:In this study,we presented 4 bleeding related drugs: non steroidal anti-inflammatory drugs(aspirin and other non steroidal anti-inflammatory drugs),clopidogrel,warfarin and hormones.When compared the total number of taking medication,the elderly group was higher than the young group(P<0.01).While the 4 drugs were compared,the number of elderly patients taking NSAIDs were higher than young group with statistical difference(P<0.05).The proportion of patients with acute gastric mucosal lesions caused by aspirin was found to be higher than other drugs,and there was statistically significant difference(P<0.01).5?Clinical symptoms:The patients with melena as the first symptom were more than the number of patient with hematemesis and other symptom(P<0.05),but there was no significant difference among different age groups.6?Endoscopy:In the young group who were completed endoscopy within 24 hours were higher than the elderly group,with significantly statistical difference(P<0.01).7?Blood transfusion strategy:In this study,the patients were grouped into restrictive transfusion group and non restrictive transfusion group on the basis hemoglobin before transfusion.By compared the different blood transfusion groups of mortality and rebleeding rate,we found the mortality was no statistically significant difference between the two groups(P>0.05),but the rebleeding rate was with statistical difference(P<0.05),especially the non restrictive transfusion in the elderly group(P<0.05).8?Surgical treatment:There was no significant difference between the proportion of surgery in elderly group and young group(P>0.05),meanwhile a high proportion of patients underwent surgery due to the tumor(7/14 cases,50%),drug or endoscopic uncontrollable hemorrhage(5/14 cases,35.72%),but with no statistically significant between the two groups(P>0.05).9?Prognosis:In this study,477 patients were followed up for a period of 1 years.In the elderly group,the mortality and rebleeding rate were higher than the young group(P<0.05).When we separately analysed the death related factors in elderly patients,found that the elderly patients who were admission ICU ward,systolic blood pressure <50mm Hg,with two or more complications and rebleeding could significantly increase the mortality.10?Rockall score and Blatchford score:In this study,477 patients underwent complete Rockall score and Blatchford score.According to the Rockall score: the high-risk group mortality and rebleeding rate were significantly higher than that in the low-risk group(P<0.05),as well as elderly patients in high-risk group also had a higher mortality and rebleeding rate than the low-risk group(P<0.05),but in the young group there was no significant difference in mortality and rebleeding rate among three risk group(P>0.05).According to the Blatchford score: the mortality and rebleeding rate in over intermediat-risk group were higher than that in low-risk group(P<0.05),but compared in different age group there showed no significant difference of mortality and rebleeding rate betweent the elderly group and young group in low-risk group(P>0.05).Conclusion:1 ? In elderly NVUGIB patients,the proportion of men was higher than women;peptic ulcer was a common cause as well as tumour and acute gastric mucosal lesions,but mallory-weiss syndrome was less than young patients.2?The proportion of elderly NVUGIB patients with hypertension,ischemic heart disease,cerebral hemorrhage,diabetes,tumor and respiratory diseases was higher than that of young patients.3?The number of elderly NVUGIB patients with long-short term application of bleeding related drugs were more than the young patients,especially non-steroidal anti-inflammatory drugs.And the aspirin often caused acute gastric mucosal lesion.4?In elderly NVUGIB patients,the endoscopic rate within 24 hours was lower.5?In elderly NVUGIB patients,compared with non restrictive transfusion strategies,the use of restrictive transfusion strategies can reduce the rate of rebleeding.6?The Rebleeding and mortality in elderly NVUGIB patients were higher than that in young NVUGIB patients,and the elderly patients who were admission ICU ward,systolic blood pressure <50mm Hg,with two or more complications and rebleeding can significantly increase the mortality.7?The accuracy of Rockall score in NVUGIB elderly patients was higher than Blatchford score. |
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