Analysis Of Relative Factors Of Upper Gastrointestinal Bleeding In Patients With Hepatic Cirrhosis

To a patient with late hepatic cirrhosis,upper gastrointestinalbleeding is one of the most frequent complications.It is so acute andsevere that most patients'death is dued by it. With the developmentof teconology of diagnosis and therapy,people have got newrecognization of etiology and characteristics about it and havegood idea to treat this complication.Objective To analysis the relative factors of Upper gastroin-testinal bleeding in patients with Hepatic cirrhosis and compare thetherapeutic efficacy of Octreotide and hypophysin in treatingesophageal varicose bleeding.Methods A retrospective review of clinical recorders of 385patients with Hepatic cirrhosis during 2000.1～2005.9.Results ⑴ Sex:The male patient was inclined to bleeding(P<0.05,OR=4.43);Drinking: The drinker was inclined to bleeding(P<0.05,OR=6.15);NSAID: A person with a history eating NSAIDwas inclined to bleeding (P<0.05,OR=4.83);Hp:①The patientwith Hp positive was inclined to bleeding(P<0.05,OR=3.20) ②Compared to Hp negative patients, the incidence of different factorsof disease was different from that of Hp positive patients (P<0.05).The incidence of varicose bleeding was no difference betweenthe two sides(P>0.05),The incidence of HU in Hp positive patientswas higher than those in Hp negative(P<0.05), The incidence ofPHG had no defference between the two sides(P>0.05).③Theinfection of Hp had no defference between the group A and B(P>0.05)⑵ During 2003.5～2005.9, The incidence of PHG had a highconstituent ratio compared to the period which was 2001.1～2003.4(P<0.05),but that of varicose bleeding and HU had notchanged obviously(P>0.05).⑶ Different factors of disease oftenoccurred in some age(P<0.05): From twenty to forty,the bleedingcaused by varicose veins always happened (P<0.05);From fortyto sixty,HU always happened(P < 0.05);From sixty toseventy-five,PHG always happened(P < 0.05)(4)The degree ofbleeding had negative correlation with liver function grade(r=-0.376,P<0.05);The degree of bleeding had positive correlationwith the degree of Varicose veins(r=0.341,P<0.05);The degree ofbleeding had positive correlation with the internal diameter ofportal veins(r=0.426,P<0.05);The degree of bleeding hadpositive correlation with the splenic veins (r=0.278,P<0.05).⑸Intreating EGVB, compared to hypophysin , Octreotide was better inthe therapeutic efficacy (P<0.05),and the rate of rebleeding waslower (P<0.05).Moreover,side effect of Octreotide was lower thanthat of hypophysin (P<0.05) .Conclusion ⑴ To a patient with hepatic cirrhosis, the malepatient and the drinker and eating NSAID was inclined tobleeding.To decrease the incidence of upper gastrointestinalbleeding ,the patient with hepatic cirrhosis should avoid drinking andeat NSAID or use the drug to restrain acid and protect gastricmucosa.⑵ The patient with Hp positive was inclined to bleedingand the incidence of HU in Hp positive patients was higher than thatin Hp negative. We should detect the anti Hp-IgG in all patient withhepatic cirrhosis. If we found the infection of Hp, we must eradicateit,which can decrease the incidence of bleeding , especial that ofHU. ⑶ During 2003.5～2005.9, The incidence of PHG had ahigh constituent ratio compared to the period which was 2001.1～2003.4.The reason was relation with the high pressure of Portal veinsand the therapeutics of endoscope. The clinical doctor should raisethe skill of operation and handle the indicatio therapeutics.Wecould give the drug to lower the pressure of Portal,such asβ-receptor blocker and somatostation , orantidiuretin in order toprevent PHG.⑷ From twenty to forty,the bleeding caused byvaricose veins always happened. To a patient with liver cirrhosisduring the period ,if we could not examine with endoscope and findthe reason of bleeding, we could give therapeutics in order to cutdown pressure to control bleeding and decrease the incidence ofdeath.⑸ The degree of bleeding had negative correlation withliver function grade, in the contrary, it have positive correlationwith the degree of varicose veins and the internal diameter of portalveins or the splenic veins. To a patient with hepatic cirrhosis, weshould often detect liver function and examine with endoscope andultrasonic inspection .If we found the liver function was not goodand the degree of varicose vein was increasing,or theinternaldiameter of portal veins and splenic veins was wider thanbefore, the degree of bleeding was bigger than before,thetherapeutics of decreasing the pressure and improving the liverfunction is very important.⑹ Compared to hypophysin, Octreotidewas better in the therapeutic efficacy,moreover,the rate of rebleedingand side effect of Octreotide was lower than that of hypophysin intreating EGVB.