| Objective:Through retrospective analysis of upper gastrointestinal bleeding,(UGIB)in the Affiliated Hospital of Northern Sichuan Medical College from 2014 to 2017,to explore the clinical features and causes of UGIB,summarize its main treatment methods and efficacy,and provide reference for clinical diagnosis and treatment of UGIB.Method:The clinical data of hospitalized patients diagnosed as UGIB from January 2014 to December 2017 in the Department of Gastroenterology,North Sichuan Medical College were collected through electronic medical records and doctor's order system.A total of 906 cases were included according to the inclusion and exclusion criteria.A retrospective study was conducted to investigate the age,gender,predisposing factors,and major clinical features of 906 patients with UGIB.To analyze the etiology of UGIB,the sex and age of the common causes,the characteristics of recurrence,and the occurrence of large hemorrhage in different causes of the digestive tract.To summarize the main treatment methods and the curative effect of UGIB.Result:1.Clinical characteristics:(1)age and gender:906 cases of UGIB patients had the average age of 54.69±15.57 years,and the incidence was mainly the middle-aged and elderly(84.8%).Man:female=3.1:1.The average onset age of females(57.05±14.01)was higher than males(53.93±15.99)(P?0.01).(2)predisposing factors:783 cases of UGIB patients(86.4%)had no induced bleeding,60 cases(6.6%)were bleeding after drinking,51 cases(5.6%)were taking non-steroidal antiinflammatory drugs,12 cases(1.4%)were caused by severe vomiting(non-alcohol).Of the 60 cases of alcohol-induced UGIB,23cases of severe vomiting caused Mallory-weiss Syndrome,18 cases of acute gastric mucosal lesions(AGML),13 cases of duodenal ulcer(DU),6 cases of gastric ulcer(GU).51 cases of UGIB patients who took NSAIDs were 20cases of GU,18 cases of AGML,9 cases of compound ulcer,4 cases of DU.12 cases of UGIB who had severe vomiting after non drinking were all Mallory-weiss Syndrome.(3)symptoms and time for treatment:the main symptoms of the patients were only black stool(47.9%),hematemesis and black stool(22.8%),only hematemesis(16.5%),abdominal pain(6.9%),and other symptoms(5.9%).From the onset to the average time visits,only black stoolwas(5.10±5.09)days,hematemesisandblackstoolwere(2.77±2.78)days,only hematemesis was(1.79±2.83)days,only abdominal pain was(11.59±7.13)days,other symptoms was(12.34±8.58)days.The average time of only black stool patients from the onset to treatment was significantly longer than that of hematemesis and of hematemesis and black stool patients(P<0.01);the average time only abdominal pain or other symptoms of patients from the onset to treatment was longer than the black stool(P<0.01).2.Etiological results:(1)UGIB constitute cause:906 cases of UGIB patients,there were 713 cases(78.7%)of nonvariceal upper gastrointestinal bleeding,193 cases(21.3%)of variceal upper gastrointestinal bleeding.The leading causesofallthecaseswereDU(295 cases,32.6%),esophageal-gastric varices bleeding(EGVB)(193 cases,21.3%),GU(160 cases,17.7%)and gastric cancer(64 cases,7.1%).(2)The age and sex characteristics of four common causes:Among the DU patients,203 cases(68.8%)in the middle-aged group were more than those in the elderly group(92cases,31.2%)(P<0.01).Among the GU patients,151 cases(94.6%)in the middle and old age group were more than those in the young group(9cases,5.6%)(P<0.01).Among the EGVB patients,178 cases(92.2%)in the middle and old age group were more than those in the young group(15cases,7.8%)(P?0.01).Among the gastric cancer,49 cases(76.6%)in the elderly group were more than the young and middle age group(15cases,23.4%)(P<0.01).Four common causes of male patients were more than female(P<0.01).(3)The composition of recurrent cases in common causes of UGIB:109 cases of the patients with peptic ulcer bleeding were recurrent cases,accounting for 24.0%(109/455).77 cases were caused by EGVB recurrence,accounting for 39.9%(77/193),5 cases were caused by gastric cancer recurrence,accounting for 7.8%(5/64).The constituent ratio of EGVB recurrence(39.9%)was higher than that of peptic ulcer(24%)(P<0.01).(4)The occurrence of large hemorrhage of digestive tract in different causes:157 cases(17.3%,157/906)were conformed to large hemorrhage of digestive tract,including 65 cases of EGVB(large bleeding rate 33.7%,65/193),36 cases of GU(22.5%,36/160),33 cases of DU(11.2%,33/295),8cases of gastric cancer(12.5%,8/64),3 cases of AGML(11.1%,3/27),5 cases of Mallory-weiss Syndrome(14.3%,5/35),4 cases of duodenal vascular malformation(66.7%,4/6),2 cases ofduchenne ulcer(100.0%,2/2),1 case of anastomotic ulcer(6.7%,1/15).The large bleeding rate of EGVB was higher than that of GU(x ~2=5.35,P=0.02),DU(x ~2=36.78,P=0.00)and gastric cancer(x ~2=10.60,P=0.00).The large bleeding rate of GU was higher than that of DU(x ~2=10.32,P=0.00).3.Treatment and outcome:(1)713 patients with NVUGIB:NVUGIB were treated with PPI anti acid and hemostasis.The effective rate of drug combined endoscopic therapy in 92 patients with massive hemorrhage was91.5%(54/59)than that of pure drug therapy 72.7%(24/33)(P<0.05).9 cases of simple drug treatment after 72 hours of ineffective patients continued to PPI combined with somatostatin-type drug.The bleeding gradually stopped.5cases of active bleeding after medical treatment combined with endoscopic treatment were treated by interventional embolization,and the success rate of hemostasis was 80.0%(4/5).In 713 patients with NVUGIB,712 cases were discharged and 1 patients died of gastric cancer.(2)193 patients with VUGIB:VUGIB were treated with PPI and somatostatin.Of the 65 patients with acute massive hemorrhage,49 were treated with drug therapy and endoscopic therapy(32 cases of EVL,13 cases of EVL+EVO,4 cases of EVO),3 cases died,and the effective rate was 93.9%(46/49);the 16 cases treated with simple drug therapy,6 cases died,the effective rate was 62.5%(10/16).The effective rate of drug combination endoscopic treatment group was significantly higher than that of the simple drug treatment group(P<0.01).128 cases of VUGIB without acute massive hemorrhage were treated with PPI and somatostatin,all effective,no deaths.Conclusion:1.UGIB is mainly middle-aged and elderly,and male patients are significantly more than female.Most UGIB have no obvious inducements.The main causes are drinking,taking NSAIDs and severe vomiting.The latter often causes Mallory-weiss Syndrome.2.The main symptoms of UGIB are hematemesis and/or black stools.Patients with hematemesis often see a doctor promptly.Other symptoms are often ignored by patients,leading to delayed treatment.3.The main etiologies of UGIB are DU,EGVB,GU and gastric cancer.DU was frequent in young and middle-aged men.EGVB and GU were frequently seen in middle-aged and elderly men.Gastric cancer was frequent in elderly men.4.EGVB is prone to relapse and hemorrhage of upper gastrointestinal tract.5.UGIB treatment is still mainly based on internal medicine.According to the disease,endoscopic therapy or interventional therapy can be applied. |
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