A Retrospective Clinical Analysis Of 386 Patients With Peptic Ulcer Bleeding

Purpose:To discuss the regularity of Traditional Chinese Medicine ("TCM") Syndrome and Treatment of Peptic Ulcer Bleeding, Unity the TCM Syndrome, and to seek for the best prescription Differential Treatment, so as to provide a reference for the further improvement and optimization of clinical pathways of upper gastrointestinal bleeding.Methods:Collated and retrospectively analyzed the clinical data of 386 patients who met the inclusion criteria and had been admitted to the Guangdong Provincial Hospital (Dade Road General Hospital, Er Sha and Fangcun Branch included) from June 2006 to June 2010. Filled out the observation forms, codes and clinical data entry, SPSS 17.0 application software for statistical analysis. The descriptive analysis method was used to calculate the frequency and composition; the variance and t-test methods were used for measurement data groups; count data groups were analyzed by using the chi-square test and Rank sum test. Bivariate correlation is used for the relationship between the various parameters. Observed the regularity of TCM Syndrome, analyzed the incidence of this disease, and possibility of correlations between this disease and tobacco, alcohol, pepper, and Hp. The 60 patients who met the Dampness-heat Injuring Vascular, Qi and Blood Deficiency Syndrome were also divided into 3 groups, according to the different prescriptions:Treatment Group A (Huanglian Wendan group), Treatment Group B (Shihui group) and Control Group C (no medicine or any other TCM). Observed the effect of the three groups.Result:1. TCM syndrome distribution: By frequency in descending order:Heat Injuring Vascular, Qi and Blood Deficiency Syndrome (39.4%)> Heat Injuring Vascular Syndrome (19.9%)> Failure of Qi to Control Blood Syndrome (17.6%)> Dampness-heat Injuring Vascular, Qi and Blood Deficiency Syndrome(15.5%)>others(4.8%)> Dampness-heat Injuring Vascular Syndrome (2.8%). (Note:other syndromes, a total of 18 cases were including Qi Deficiency and Stasis Syndrome, deficiency-cold of spleen and stomach Syndrome and so on; those syndromes with less than 5 cases respectively are not included in further statistical analysis.)2. Incidence:(1) Seasonal Distribution:Followed by winter (30.4%)> spring (25.5%)> autumn (23.6%)> summer (20.4%);(2) Bleeding Sites:296 cases of DU bleeding (80.4%),29 patients of GU bleeding (7.9%),43 patients Complex Ulcer Bleeding (11.7%);(3) Bleeding Level:A total of 316 patients whose level was mild (85.9%), 45 cases (12.2%) whose level was moderate,7 cases (1.9%) whose level was severe;(4) Endoscopic Staging:A1 for 301 cases (81.8%), A2 for 62 cases (16.8%).Statistical analysis, the TCM Syndrome, ulcers of the bleeding site, bleeding level and endoscopic staging has shown no significant difference through statistical anyalysis (P>0.05).3. Correlation Analysis between indicators:There were 260 patients with Hp Infection (70.7%),113 patients smoked (30.7%),51 patients had drinking habits (13.9%),50 patients addicted to chili (13.6%).Specific results:(1) The correlation between TCM syndrome and indicators:Dampness-heat Syndrome shown a highest smoking rate (54.5%), and the smoking rate of Failure of Qi to Control Blood Syndrome was lowest. (P<0.05); There was no statistical significant correlation between other factors and TCM syndrome. (P>0.05)(2) The correlation between bleeding site:GU bleeding shown the highest smoking rate(55.2%), followed by complex ulcer bleeding (P<0.01). It showed no significant correlation between other factors and bleeding site. (P>0.05)(3) The correlation between bleeding levels:The patients who smoked or drank a lot shown a higher level of bleeding than those who didn't smoke or drink (P<0.01, P<0.05). Those who smoked and drank frequently shown the highest (P<0.01.If they even had the Hp Infection, their bleeding could be more serious, although there was no statistical significance. (P>0.05)(4) The correlation between endoscopic staging:After testing, the influence factors and the staging of endoscopic ulcers showed no significant difference (P>0.05).4. Efficacy Analysis:(1) The overall effect of treatment group A (92.7%) was better than the treatment group B (81.8%) and control group C (75.0%), however, there was no significant difference in overall efficacy between the three groups (P>0.05).(2) Efficacy of symptoms:The overall effect of symptoms in group A (92.7%) was better than group B (90.9%) and group C (87.5%), however, there was no significant difference between the three groups (P>0.05). However, Group A was significantly better than Group B and Group C in the treatment of xerostomia (P<0.01) and Bloating (P<0.05). Of the efficacy of stomach and poor appetite, Group A and Group B were both better than Group C (P<0.05).There were no significant differences in efficacy among the other symptoms (P>0.05)(3) The time of FOB turning negative in Group A and B had no significant meaning (P>0.05). But the time of FOB turning in Group B(7.0±4.6d)was slightly shorter than group A (7.2±3.2d). The difference in average hospitalization days between the two groups had no particular significance either (P>0.05), although for group A (9.8±3.1d) the stay was slightly shorter than for group B (10.7±3.3d).(4) Disease Outcome:The cure rate of group A was 92.7%, significantly better than group B 90.9%, and group C 62.5%. (P<0.01)Conclusion:Peptic Ulcer Bleeding occurrs in winter and spring more frequently, and DU bleeding was more common than the GU & Complex ulser bleeding. Smoking and drinking or having Hp infection will make this disease worse. In Guangdong, the Syndromes of this disease can be divided into 7 types:Heat Injuring Vascular, Qi and Blood Deficiency Syndrome, Heat Injuring Vascular Syndrome, Failure of Qi to Control Blood Syndrome, Dampness-heat Injuring Vascular, Qi and Blood Deficiency Syndrome and Dampness-heat Injuring Vascular Syndrome. By using Huanglian Wendan and Bazhen as differential treatments, the effective rate could reach 92.7%. In addition, these prescriptions could also relieve the symptoms such as xerostomia, bloating, stomachaches and poor appetite, shorten the average days of hospitalization, which were significantly better than Shihui and other prescriptions. However, compared with Shihui, Huanglian Wendan and Bazhen did not show better efficacy in shortening the time of FOB turning negative.