Clinical Analysis Of Acute Non-variceal Upper Gastrointestinal Hemorrhage And Evaluation Of Therapeutic Effect Of Endoscopic Therapy

Objective:1.To analyze the clinical data of ANVUGIB patients in recent 6 years,and to understand the characteristics,current situation and change trend of ANVUGIB.Judging the significance of Blatchford risk score system and Rockall risk score system in predicting ANVUGIB rebleeding and death in the near future(within 7 days);2.To analyze the curative effect of ANVUGIB endoscopic therapy.To analyze the risk factors of death after endoscopic therapy and the risk factors of rebleeding in the near future after successful endoscopic hemostasis,and take intervention measures on the risk factors to further improve the prognosis of patients.Methods:1.Clinical data collection:(1)General items: name,sex,age,Telephone number and address;(2)medical history: past medical history(upper gastrointestinal diseases,hemorrhage,perforation,operation history,etc.),combined with basic diseases,and drug administration history that may cause upper gastrointestinal hemorrhage;(3)At first visit: chief complaint and clinical symptoms,blood pressure and pulse,severity of upper gastrointestinal hemorrhage;(4)Laboratory examination: Blood routine,coagulation function,etc.(5)Gastroscopy or treatment: gastroscopy or treatment time,bleeding cause,Forrest classification of peptic ulcer and hemorrhage under gastroscope,endoscopic hemostasis scheme,endoscopic treatment outcome,outcome within 7 days after endoscopic examination/treatment(clinical symptoms,vital signs,changes in circulatory dynamics,complications,rebleeding,need for surgical operation or vascular interventional treatment,death,etc.).2.To analyze and summarize the clinical features of ANVUGIB,and make BRS and RS scores on the subjects to explore its value in predicting rebleeding and death after endoscopic intervention of ANVUGIB.3.To analyze the curative effect of ANVUGIB endoscopic treatment,and explain the correlation between various clinical variables and recent rebleeding after successful endoscopic hemostasis and recent death after endoscopic treatment.Results:1.A total of 2608 ANVUGIB patients were included in this study: 1958 males(75.08%),650 females(24.92%),male: female = 3.01: 1;The average age was 51.99±17.23 years.The clinical manifestations of most ANVUGIB patients are black stool and/or hematemesis,dizziness and fatigue,abdominal discomfort,and a small number of patients have symptoms such as cold sweat or profuse sweating,palpitation,syncope,limb cold dampness,etc.2.The main causes of ANVUGIB are peptic ulcer(1445 cases,57.78%),upper gastrointestinal tumor(629 cases,24.12%),acute upper gastrointestinal mucosal lesion(202 cases,7.75%),Dieulafoy's disease(191 cases,7.32%).ANVUGIB most commonly involves duodenum,followed by stomach,but rarely involves esophagus,pancreas and biliary tract.Duodenal bulb ulcer is the most common type of ANVUGIB caused by peptic ulcer,while gastric tumor is the most common type of upper gastrointestinal tumor.With the increase of age,the incidence of ANVUGIB showed an upward trend(P=0.002),and the proportion of upper gastrointestinal tumor and hemorrhage in ANVUGIB showed a significant upward trend(P=0.001),while the proportion of peptic ulcer and hemorrhage in ANVUGIB showed a significant downward trend(P=0.000).3.Of 2608 ANVUGIB patients,242(9.28%)suffered from rebleeding during the follow-up period(1 week),62(2.38%)died during the follow-up period,of which 57(2.18%)died directly from gastrointestinal hemorrhage.1253 patients received endoscopic hemostasis treatment,of which 1222(97.53%)were successful in endoscopic hemostasis,34(2.71%)were converted to emergency surgery or vascular interventional therapy due to ineffective medical treatment.132 cases(10.80%)suffered from rebleeding within one week after successful endoscopic hemostasis,40 cases(3.19%)died within one week after endoscopic treatment,and 36 cases(2.87% %)were directly related to massive hemorrhage.4.The accuracy of BRS and RS in predicting ANVUGIB's recent rebleeding and death is good,and BRS is better than RS.The higher the score of BRS and RS,the higher the risk of recent rebleeding and death.The value of BRS and RS in predicting recent death is higher than that in predicting recent rebleeding.In addition,for ANVUGIB patients caused by peptic ulcer hemorrhage,with the increase of Forrest grade,the risk of rebleeding and death in the near future gradually decreases.5.Injection hemorrhage,peptic ulcer hemorrhage,drug administration history that may cause upper gastrointestinal hemorrhage in the past,hypotension,tachycardia,severe upper gastrointestinal hemorrhage,common gastroscope intervention,Low hemoglobin and Prolonged APTT are independent risk factors for recent rebleeding after successful endoscopic hemostasis.Tachycardia,Low hemoglobin,Prolonged APTT and recent rebleeding are independent risk factors for recent death after endoscopic treatment.Conclusion:1.The main causes of ANVUGIB are peptic ulcer,upper gastrointestinal tumor,acute upper gastrointestinal mucosal disease and Dieulafoy's disease in turn,of which duodenal bulb ulcer and gastric tumor are the most common.With the increase of age,the incidence of ANVUGIB is on the rise,the proportion of upper gastrointestinal tumor and hemorrhage is on the rise,and the proportion of peptic ulcer and hemorrhage is on the decline.2.The overall recent rebleeding rate of ANVUGIB is 9.28%,the overall mortality rate is 2.38%,and the all-cause mortality is 2.18%.ANVUGIB's endoscopic hemostasis success rate was 97.53%,the recent rebleeding rate after successful endoscopic hemostasis was 10.80%,the mortality rate within one week after endoscopic treatment was 3.19%,and all-cause mortality was 2.87%.3.The value of BRS and RS in predicting recent death is higher than that in predicting recent rebleeding.The accuracy of BRS in predicting recent rebleeding and death of ANVUGIB is better than that of RS.For ANVUGIB patients caused by peptic ulcer hemorrhage,the risk of recent rebleeding and death decreases with the increase of Forrest grade.4.Injection hemorrhage,peptic ulcer hemorrhage,drug administration history,hypotension,tachycardia,severe upper gastrointestinal hemorrhage,common gastroscope intervention,Low hemoglobin and Prolonged APTT are independent risk factors for rebleeding after successful endoscopic hemostasis.Tachycardia,Low hemoglobin,Prolonged APTT and recent rebleeding are independent risk factors for recent death after endoscopic treatment.