| Objectives:The etiological composition of upper gastrointestinal bleeding and its relationship with sex,age and season were analyzed.The clinical characteristics of upper gastrointestinal bleeding caused by NSAIDs and other drugs were studied.The clinical efficacy of PPI or PPI combined with somatostatin in the treatment of patients with non-variceal bleeding was compared.On the one hand,it provides evidence-based medical evidence for clinical diagnosis and treatment of upper gastrointestinal bleeding.On the other hand,it can guide clinicians to quickly formulate relevant interventions for patients,so as to reduce the mortality of patients,improve the prognosis of patients,and also play a role in health education for patients.Methods:From February 2013 to February 2017,128 patients with upper gastrointestinal bleeding were hospitalized in our hospital.After screening according to the selection criteria and exclusion criteria,720 patients were selected as the research objects.The clinical data of these patients were retrospectively analyzed to calculate the age,sex,cause of disease,time of onset and final mortality rate of patients.According to the statistical results,the correlation between the etiology of the upper gastrointestinal hemorrhage in patients with hemorrhage ant the factors of their sex,age and season was analyzed.The characteristics of upper gastrointestinal bleeding caused by NSAIDs,warfarin and clopidogrel and the effects of these drugs on upper gastrointestinal bleeding were also discussed.In addition,according to different drug treatment schemes,631 patients with non-variceal hemorrhage in 720 patients were divided into observation group and control group.Patients in the observation group were treated with PPI combined with somatostatin,and patients in the control group were treated with PPI alone.The clinical efficacy of the two groups of patients was compared and the difference of Blatchford scores was identified.Results:(1)According to the statistics of the causes of the disease,the top five causes were duodenal ulcer(DU),gastric ulcer(GU),esophageal varices rupture(EGVB),acute gastric mucosal lesion(AGML)and gastric cancer(GC).During hospitalization,the proportion of male patients who died of esophageal and gastric varices rupture was higher than that of female patients(P < 0.05).(2)In addition to the top five main causes,erosive esophagitis,vascular diseases and other causes are not uncommon.The incidence of erosive esophagitis shows a downward trend(P < 0.05),while the incidence of vascular diseases,anastomotic ulcer and other causes has no significant change(P > 0.05).(3)There was no difference between the main causes of upper gastrointestinal bleeding and gender(P > 0.05).The majority of patients with bleeding caused by duodenal ulcer were males,while the majority of patients with bleeding caused by acute gastric mucosal lesions were females(P < 0.05).There was no significant difference between males and females in the proportion of patients with bleeding caused by gastric cancer,gastric ulcer,esophagastric varices rupture(P > 0.05).(4)In terms of age,except for acute gastric mucosal lesions,there were significant differences between the other four etiologies and age(P < 0.05).The incidence of duodenal ulcer was the highest and that of gastric ulcer was the lowest in the youth group(P < 0.05).The incidence of gastric cancer was the highest and that of duodenal ulcer was the lowest in the elderly group(P < 0.05).There was no significant difference in the incidence of acute gastric mucosal lesions among the three groups(P > 0.05).(5)Seasonally,there was no significant difference in the incidence of duodenal ulcer and gastric cancer in the four seasons(P > 0.05),but there were significant differences in the incidence of gastric ulcer,esophageal varices and acute gastric mucosal lesions in the four seasons(P < 0.05).The incidence of gastric ulcer was the lowest in spring,which was significantly different from that in summer,autumn and winter(P < 0.05).The incidence of esophagogastric varices rupture was the highest in winter,which was significantly different from that in spring,summer and autumn(P < 0.05).The incidence of acute gastric mucosal lesions was the highest in spring,which was different from that in autumn and winter(P <0.05).(6)Gastric ulcer was the main cause of upper gastrointestinal bleeding caused by NSAIDs,warfarin and clopidogrel,followed by acute gastric mucosal lesions,with statistical significance(P < 0.05).The results of gastroscopy showed that the nature of lesions in the observation group was erosive lesions,and the incidence of multiple,positive Hp infection and lesions located in the stomach was high(P < 0.05).(7)The proportion of common inducements of different etiologies was different,and the proportion of drinking inducements in the elderly group was significantly lower than that in the young and middle-aged group(P < 0.05).Drug-induced elderly group was significantly higher than that of young and middle-aged group(P < 0.05).(8)For NVUGIB patients,PPI combined with somatostatin was better than PPI alone(P < 0.05).The proportion of patients with Blatchford score of 0 after treatment in both groups showed a significant upward trend(P < 0.05);the proportion of patients with Blatchford score of 0 in PPI combined somatostatin treatment group increased more than those in PPI alone treatment group(P < 0.05).Conclusion and Significance:According to the retrospective analysis of the clinical data of 720 patients with upper gastrointestinal hemorrhage,The main causes of upper gastrointestinal bleeding are: DU,GU,EGVB,AGML and GC.The other common causes are: erosive esophagitis,vascular disease,anastomotic ulcer,etc.The causes of bleeding are different in different age groups.There are obvious differences in sex ratio,bleeding inducement and mortality.The incidence of the main causes is different in different seasons.The main causes of UGIB caused by NSAIDs are gastric ulcer and acute gastric mucosal lesion,and gastric ulcer is more common.The clinical efficacy of PPI combined with somatostatin in the treatment of non-variceal hemorrhage is better than that of PPI alone.On the basis of the above-mentioned etiological components and related factors,we formulate an appropriate,timely and effective diagnosis and treatment plan for these patients according to the age,inducement and season of onset.Early gastroscopy and definite diagnosis should be done to improve the therapeutic effect.At the same time,we should strengthen the propaganda and education of prevention and treatment of upper gastrointestinal bleeding to reduce the incidence of upper gastrointestinal bleeding. |
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