| Objective:1.Collect the clinical data of patients with acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)in our hospital,and understand the clinical characteristics of ANVUGIB in this region.2.Collect the clinical data of patients with ANVUGIB who were diagnosed as ANVUGIB after admission and were treated with endoscopic hemostasis.According to the rebleeding within 72 hours after successful hemostasis,the patients were divided into early rebleeding group and non bleeding group.The statistical analysis was completed to identify the risk factors of early rebleeding.At the same time,we should improve the level of diagnosis and treatment,make accurate identification and timely treatment for patients with high risk of rebleeding,and ultimately improve the survival rate of high-risk groups of rebleeding.Methods:1.739 patients with ANVUGIB who were admitted to our hospital from October 2017 to October 2019 due to hematemesis,melena and other upper gastrointestinal bleeding symptoms were searched through the inpatient medical record system,and the general information,etiological factors and disease outcomes were collected and analyzed.2.According to the strict inclusion and exclusion criteria,137 patients with ANVUGIB who were diagnosed as ANVUGIB and successfully stopped bleeding immediately after endoscopic hemostasis treatment from October 2017 to October 2019 were included.The medical records(including laboratory examination,endoscopic examination results,etc.)of patients with successful hemostasis immediately after endoscopic treatment were systematically reviewed and collected,The basic information,clinical characteristics,gastroscopy and laboratory examination results of each patient who met the inclusion criteria were registered in detail.According to the rebleeding within 72 hours after successful hemostasis,the patients were divided into early rebleeding group(18 cases)and non bleeding group(119 cases).3.Microsoft Excel was used to establish the survey data table,and the data of the two groups were statistically analyzed.SPSS 21.0 statistical software was used for statistical processing.The count data were expressed by the number of cases and percentage(%),and the measurement data were expressed as mean ± standard deviation(x ± s),The count data were compared by person χ~2 test or continuous correction method,and the measurement data were compared by t test or nonparametric rank sum test.Multivariate logistic regression analysis was carried out to find the independent risk factors of early rebleeding in ANVUGIB patients after treatment.The pre-set P < 0.05 showed that the difference between groups was significant.Results:(1)Clinical features1.Gender and age: a total of 739 patients with ANVUGIB admitted from October 2017 to October 2019 due to hematemesis,melena and other upper gastrointestinal bleeding symptoms were included in the retrospective study,including 561 males(75.91%)and178 females(24.09%).The male to female ratio was 3.15:1,with an average age of51.28 ± 17.72 years and an average length of hospital stay of 9.30 ± 5.93 days.Among them,193 cases were younger than 40 years old(young group),307 cases were 40-60 years old(middle-aged)group,and 239 cases were over 60 years old(old age)group.2.Admission complaints: 47.50% of the patients admitted with melena as the first chief complaint,27.20% with hematemesis as the first chief complaint,24.22% of the patients had hematemesis and melena at the same time,most ANVUGIB patients were admitted to hospital with definite chief complaint of gastrointestinal bleeding.3.Circulation and Hb content: 13.26% patients had hypotension,24.76% patients had tachycardia,10.15% patients had shock index > 1.0,0.95% patients had shock index >1.5.75.78% of the patients had anemia at admission,50.48% had moderate anemia and2.03% had extremely severe anemia(HB < 30 g / L).The proportion of patients with HB< 70 g / L was 27.33%,and 33.02% of the patients received limited blood transfusion during hospitalization.4.Predisposing factors: 53.18% of the patients did not find a definite cause of bleeding before bleeding.21.92% of the patients took aspirin,NSAIDs,glucocorticoids,chemotherapy and molecular targeted drugs to stimulate and damage the gastric mucosa before bleeding,16.10% of the patients suffered from bleeding after drinking,2.84% of the patients ate raw cold food,and took warfarin 2.30%,fatigue 2.17%,emotional excitement 1.49%.After further age grouping,it was found that in the elderly group,the elderly group was more common than the middle-aged group,and the middle-aged group was more common than the young group,while the drinking induced bleeding was the opposite.In addition,the young group was more common than the middle-aged group in diet induced bleeding(P < 0.05).5.Etiology: after the improvement of gastrointestinal endoscopy,peptic ulcer was the most common cause of ANVUGIB(73.34%).Gastrointestinal cancer was the second most common cause(10.83%),and acute gastric mucosal lesions ranked third(9.74%).In addition,iatrogenic upper gastrointestinal bleeding accounted for 1.49% of hospitalized ANVUGIB,including bleeding after ESD / EMR,duodenal papilla after EST and upper gastrointestinal polypectomy.All patients with ANVUGIB were treated with proton pump inhibitors after admission,and some patients were treated with procoagulant drugs.After further age grouping,it was found that acute gastric mucosal lesions,duodenal ulcer and compound ulcer were more common in middle-aged group and young group,gastric ulcer was more common in middle-aged group and elderly group,the incidence of upper gastrointestinal cancer in elderly group was significantly higher than that in middle-aged group and young group(P < 0.05).6.Outcome: in 739 patients with gastrointestinal bleeding,141 patients underwent endoscopic hemostasis,and the endoscopic hemostasis treatment rate was 19.08%.The immediate hemostasis rate was 97.16%.There were 18 cases of rebleeding within 72 hours after endoscopic treatment,and the rebleeding rate of 72 hours was 13.14%.Compared the death rate of patients with recurrent bleeding within 72 hours after endoscopic therapy and those without rebleeding within 72 hours after endoscopic treatment,the mortality of the two groups was statistically significant(P < 0.05).(2)Risk factorsFurther univariate analysis showed that there were no significant differences in gender,admission complaints,first heart rate,first blood pressure,Hb level,PLT level,Pt /APTT prolongation,serum albumin level and blood urea nitrogen level between the two groups(P > 0.10).The factors with P < 0.10 in univariate analysis were included in the binary logistic regression analysis The results showed that there were statistically significant differences between the experimental group(rebleeding group)and the control group(non bleeding group)in four aspects(age > 60y),malignant tumor bleeding,blood transfusion treatment and class IA lesions(P < 0.05),which were independent risk factors for early rebleeding after endoscopic treatment.Conclusion:1.The top three predisposing factors of ANVUGIB in this region were drugs,drinking and eating raw and cold food.Among the patients with ANVUGIB induced by drugs,the elderly group was more common than the middle-aged group,and the middle-aged group was more common than the young group,while the ANVUGIB caused by alcohol drinking was the opposite.In addition,the young group was more common than the middle-aged group in gastrointestinal bleeding caused by dietary incentives.2.The top three causes of ANVUGIB in this region were peptic ulcer,malignant tumor of digestive tract and acute gastric mucosal lesion.The rare causes were Dieulafoy disease,Mallory Weiss syndrome and vascular malformation of upper gastrointestinal tract.Among them,duodenal ulcer,compound ulcer and acute gastric mucosal lesions were more common in young and middle-aged patients,gastric ulcer was more common in middle-aged and elderly patients,the incidence of upper gastrointestinal cancer in elderly group was significantly higher than that in young group and middle-aged group.3.The immediate hemostasis rate of ANVUGIB after endoscopic hemostasis was97.16%,and the rebleeding rate within 72 hours after endoscopic treatment was 13.14%.It is suggested that endoscopic hemostasis via upper gastrointestinal tract has good therapeutic effect,but it is necessary to be alert to rebleeding.4.Patients with rebleeding within 72 hours after initial hemostasis treatment had a higher mortality rate(P < 0.05).Clinicians should pay more frequent and close attention to patients with early rebleeding after successful endoscopic hemostasis during hospitalization,and conduct endoscopic reexamination if necessary.5.Old age(age > 60y),malignant tumor bleeding,blood transfusion therapy,class IA lesions are independent risk factors of early rebleeding after endoscopic treatment.For patients with these risk factors,clinicians should pay more close and frequent attention to detect rebleeding early and improve the prognosis of patients. |
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