Analysis Of Risk Factors For Perforated Peptic Ulcer And General Management Strategy

PurposeRetrospectively analyze the clinical data of patients with peptic ulcer and acute perforation,discuss the risk factors of acute perforated and sepsis in patients with peptic ulcer,and make recommendations for general medical management to reduce the incidence and death of acute piercing ulcer perforation rate.MethodCollected case data of patients with peptic ulcer hospitalized in the People's Hospital of Shaanxi Province from January 1,2017 to August 31,2019.The in-pati ent departments include emergency medicine,emergency surgery,gastroenterology,intensive care,and general surgery.Case inform-ation includes the patient's name,age,gender,past history,personal history,history of H.pylori infection,laboratory test data,etc.(1)According to the diagnosis of perforation at discharge,it was divi-ded into two groups,with acute perforation as the case group(PPU group)and without perforation as the control group(PU group).(2)The patients with acute perforation were divided into two groups according to the presence or absence of sepsis,the case group(S group)with sepsis,and the control group(NS group)without sepsis.The clinical data was analyzed by SPSS 23.0 software.For measure ment data,the t-test is used for comparison between groups that conform t-o the normal distribution;the Mann-Whitney U test is used for comparison between non-normally distributed measurement data.For counting data,chi-square test was used for inter-group analysis.It is considered that P<0.05 has statistical significance.Result1 Searched for 325 cases of patients diagnosed with the keyword"peptic ulcer"on discharge,64 cases were excluded according to the inclusion and exclusion criteria,and finally 261 cases were included in the study.2 Analysis of risk factors for acute perforation:PPU group:93 males(73.8%)and 33 females(26.2%),with a male to female sex ratio of 2.81.Aged 16-85(56.17±18.19)years old,there were 8 deaths.PU group:103 males(76.3%)and 32 fe-males(23.7%)with a sex ratio of 3.22.Aged 17-87(49.50±16.78)years old,the re were 0 deaths.3 Single factor analysis of combined acute perforation:single factor analysis:age,treatment outcome,vital signs at admission[body temperature,pulse,respiratio n,blood pressure(systolic pressure,diastolic pressure),mean arterial pressure],adm ission symptoms(abdominal pain,melena,Acid reflux,hematemesis,fever),history of ulcers,number of ulcers/perforations,laboratory tests(WBC,N;DBil;PA,A LB;CRE,Cys-C;PT-INR,Fg,DD;Na~+,K~+),past There is a significant difference in the history of stroke(P<0.05)4 Combined with multi-factor analysis of acute perforation:there were signific ant differences in respiration,blood pressure(systolic pressure,diastolic pressure)a nd mean arterial pressure(P<0.05),but no significant difference in body temperatur e and pulse(P>0.05).5 Analysis of risk factors for acute perforation combined with sepsis:Group S:16 males(53.3%)and 14 females(46.7%),with a sex ratio of 1.14.Age 19-85(64.97±16.06)years old.The average hospital stay was 11.88(3.75)days.There wer e 8 deaths(26.7%)at the end of treatment.NS group:77 males(80.2%)and 19 females(19.8%)with a male to female ratio of 4.05.Age 16-84(53.42±18.03)ye ars old.The average hospital stay was 17.13(11.25)days,and 0 deaths occurred.6 Single factor analysis of acute perforation with sepsis:age,gender,average hospital stay,vital signs at admission[breathing,blood pressure(systolic pressure,di astolic pressure),mean arterial pressure],admission symptoms(abdominal pain,fever,State of consciousness),History of ulcers,past medical history(diabetes,cardiovas cular,stroke history),smoking history,perforation site and perforation diameter,delayed treatment time,HB,liver f-unction(TBil,DBil,PA,ALB),renal function(CRE,Cys-C),coagulate-on function(PT-INR,Fg,DD),K~+,qSOFA score at admission,SOF A score at admission,concomitant symptoms(hypoproteinemia,anemia)are significa ntly different(P<0.05).7 Multi-factor analysis of acute perforation with sepsis:age,fever and qSOFA scores at hospital admission were significantly different(P<0.05).Conclusion1 Patients with peptic ulcer had acute severe abdominal pain,shortness of bre-ath,and rapid pulse when they were admitted to the hospital.A previous history of stroke is a risk factor for acute perforation.2 Old age and fever are classified as risk factors for sepsis in patients with acute perforation.A qSOFA score on admission can help identify sepsis early.3 The increase in delayed treatment time for patients with acute perforation is proportional to the incidence of sepsis and mortality.4 Respiratory frequency and blood pressure are more sensitive to the early id-entification of sepsis in patients with acute perforation.5 General practitioners should carry out long-term management of patients with peptic ulcer to reduce the occurrence of acute perforation.