Analysis Of TCM Syndrome Types And Risk Assessment In Patients With Acute Upper Gastrointestinal Bleeding

ObjectiveTo explore the clinical symptoms and characteristic of TCM syndrome types in the patients diagnosed with acute non-variceal upper gastrointestinal bleeding,to compare the similarities and differences among different kinds of TCM syndrome in general condition,past-condition,clinical manifestation,laboratory indexes,endoscopy and interventions include transfusion,in ICU,re bleeding,death.Then to find the differences in predictive ability of AIMS65 score and BRS score in blood transfusion,re-bleeding,ICU admission and the forecast effect of death in patients who had an acute non-variceal upper gastrointestinal hemorrhage.MethodsThis research adopts the method of clinical case investigation,the patients diagnosed with acute non-variceal upper gastrointestinal bleeding would be looked at.And to collect admission related clinical data,including general condition(gender、age),past-condition(past-history、evil habits),clinical manifestation(symptom、four diagnostic information of TCM),laboratory indexes,endoscopy results and other related indicators.Than to complete AIMS65 score and BRS score According to the first diagnosis.Using SPSS statistical software to make statistical analysis,compare different TCM syndrome types in general situation,medical history,clinical symptoms,laboratory indexes,whether needs blood transfusion or ICU admission,and whether occurs re-bleeding or death.To explore the differences in predictive ability of AIMS65 score and BRS score in blood transfusion,re-bleeding,ICU admission and the forecast effect of death in patients who had an acute non-variceal upper gastrointestinal hemorrhage.Results1.Among 192 cases included,137 cases were male and 55 cases were female,and the ratio of male patients to female patients was 2.25:1.The mean age was 56.63±18.365 years,and the age of patients was principally divided between 40 and 80 years old.The mean age of syndrome of Qi deficiency and blood loss was older than that of the other three syndromes.Those with a history of peptic ulcer accounted for 43.8%,those with a habit of smoking,intemperance accounted for 34.9%and 28.1%,Those with a habit of smoking and intemperance were all males.2.Among the 192 cases included,The distribution of the four syndromes was:insufficiency of the spleen>stomach heat>liver-fire infringed stomach>qi deficiency and blood loss.Vomiting blood and black stool were the main clinical manifestations,accompanied by common symptoms such as abdominal pain,dizziness,fatigue and weakness,and a few had syncope and cold sweat.Syndrome of spleen deficiency and non-uptake was different from other three groups in hematemesis.There was no statistically significant difference in the distribution of symptoms such as black stool,dizziness,syncope,cold sweat,chest tightness,fatigue and fatigue in the four TCM syndromes(P>0.05).The distribution of symptoms such as hematemesis,hematemesis and black stool,syncope and abdominal pain was statistically significant in four TCM syndromes(P<0.05).There was a significant difference in the occurrence of hematemesis between the spleen deficiency and the other three groups(P<0.05).3.In the included cases,the mean values of RBC,HCT and Hb were different among different TCM syndrome types(P<0.05),and the mean values of RBC,HCT and Hb were liver-fire infringed stomach>insufficiency of the spleen,stomach heat>qi deficiency and blood loss.The difference of ALT value between different TCM syndromes was statistically significant(χ2=12.129,P<0.05).There were no significant differences in AST between different TCM syndromes(χ2=2.798,P>0.05).There were statistically significant differences in Cr and BUN values among different TCM syndromes(P<0.05),and the values of blood and blood detachment syndrome of qi deficiency were higher than those of other three syndromes.4.There was a correlation between TCM syndrome type and ulcer risk(P<0.05),and the number of associations was 0.199,which was statistically significant.But the correlation coefficient is small.It can be considered that the correlation between TCM syndrome type and ulcer risk is low.There was no statistically significant difference between the distribution of ulcer sites and TCM syndromes(P>0.05).5.There were significant differences among different TCM syndromes in terms of whether or not blood was transfused,whether or not they were admitted to ICU,and whether or not they were re-bleeding(P<0.05).There was no statistical significance in death or not(P>0.05).6.There were statistically significant differences in the distribution of AIMS65 score and BRS score among TCM syndromes(P<0.05),among which the score of Qi deficiency and blood loss was significantly greater than that of the other three syndromes.7.In terms of predicting re-bleeding,BRS had better sensitivity than AIMS65,and AIMS65 had better specificity than BRS.In the prediction of blood transfusion,AIMS65 has better sensitivity than BRS,and BRS has better specificity than AIMS65.In terms of forecasting admission to ICU,BRS has better sensitivity and specificity than AIMS65.Conclusion1.ANVUGIB patients caused by peptic ulcer are mainly middle-aged and elderly,and men patients more than women patients;ANVUGIB associated with peptic ulcer is the most likely to occur in people with a history of alcohol and tobacco use and a history of peptic ulcer.2.Most of the ANVUGIB patients caused by peptic ulcer have deficiency syndrome,in which the non-perturbed syndrome of spleen deficiency accounts for more than those with deficiency of qi and blood.3.The symptoms of hematemesis were most likely occurred in insuff iciency of the spleen than the other three groups.and the AIMS65 score and BRS score of these type were higher than the other three syndrome types,and they were more prone to blood transfusion,ICU admission,and re-bleeding.The severity of the condition of patients with qi deficiency and blood loss was more serious than that of the other three groups.4.Compared with AIMS65,BRS has better sensitivity in predicting rebleeding and ICU admission,and better specificity in predicting blood transfusion and ICU admission;AIMS65 is more sensitive than BRS in predicting blood transfusion and more specific in predicting rebleeding.