The Effects Of Gastrointestinal Bleeding And Follow-up Observation After PCI

ObjectiveBy analyzing Coronary heart disease receiving PCI treatment combinedgastrointestinal bleeding fromthe PLA Second Artillery General Hospital of Beijing’sacceptance of clinical data, including gastrointestinal bleeding in patients for theclinical features and prognosis in the analysis, evaluating PCI patients receivedpostoperative hospitalization during the merger gastrointestinal bleeding (GH) theincidence and prognosis factors for gastrointestinal bleeding in hospitalized patients，to explore treatment strategies， to improve the level of treatment basis。MethodsA retrospective analysis of cases, selected from August2010to May2013in thePeople’s Liberation Army General Hospital, Beijing Second Artillery cardiologypatients with coronary artery disease undergoing PCI were2279cases (1062cases ofmale, female1217cases)。 Selected21cases of upper gastrointestinal bleeding inpatients with:①Preoperative analysis of normal blood clotting, platelet count of atleast≥70×109/L, no influence coagulation disorders, such as blood diseases,decompensated cirrhosis, renal failure etc；②No need to take anticoagulant drugswarfarin other diseases, such as valvular disease after valve surgery or atrialfibrillation；③Preoperative no active upper gastrointestinal bleeding or in the nearterm (3months) history of stomach surgery, cerebral hemorrhage historyantithrombotic effects of drug use history；④Six months after PCI in patients withcomplete follow-up。 Exclusion criteria:①Presence of thrombocytopenia withbleeding disorders or other diseases；②Other diseases must take anticoagulant drugs warfarin；③Before surgery patient had a history of gastrointestinal bleeding or inthe near future some drug affects the activity of antithrombotic；④antithromboticactivity can not be followed up for six months on。 Gastrointestinal bleedingdiagnostic criteria:(1)Gastrointestinal bleeding: Upper gastrointestinal bleeding isabove the ligament of Treitz digestive tract。Clinical manifestations often vomiting,melena symptoms and dizziness, pale, heart rate, blood pressure and decreasedperipheral circulatory failure signs。Bleeding capacity5ml, occult blood can bepositive; bleeding capacity50-75ml, may appear black dung; located in the uppergastrointestinal tract exceeds the250-500ml, can be short-term vomiting;400-500ml,there may be systemic symptoms;>1000ml, peripheral circulatory failure may occur,which is the most valuable criteria。Laboratory hemoglobin, red blood cell count andhematocrit decreased, hemoglobin decreased as>50g/L when the promptgastrointestinal bleeding that can lead to acute peripheral circulatory failure, blood lossanemia and azotemia。Exclusion cause gastrointestinal outside: hemoptysis, bleedingmouth nasopharynx, food or drugs (mAb)。(2) Lower gastrointestinal bleeding:The ligament of Treitz following intestinal bleeding called lower gastrointestinalbleeding。Most of lower gastrointestinal bleeding caused by gastrointestinal diseaseitself, a few cases may be localized bleeding systemic disease, it is history andphysical examination is still necessary diagnostic procedures。Generally, the higherthe bleeding site, the darker the color of blood in the stool; the lower the bleeding site,the more color is bright red blood in the stool, or the performance of blood。 Speedand of course also depends on the number of bleeding, such as bleeding fast speed andlarge number of bleeding, blood in the digestive tract to stay a short time, higher evenbleeding site, bright red blood in the stool may。Carefully collect medical history andpositive signs of bleeding to determine the cause of helpful, such as blood dripped afterdefecation and fecal incompatible with those common in mixed hemorrhoids, anal orrectal polyps; moderate amount of blood in the stool more prevalent in the mesentericand portal vein thrombosis formation, acute hemorrhagic necrotizing enterocolitis,ileum colonic diverticulitis and ischemic colitis, and even upper gastrointestinalbleeding lesions can also be expressed as a large stool, to distinguish between the time of diagnosis。Mixed with blood and feces, accompanied by mucus, should considercolon cancer, colon polyps, chronic ulcerative colitis; stool was accompanied by pus-like or bloody mucus and pus, you should consider dysentery, schistosomiasis colon,chronic colon inflammation, colon tuberculosis; severe abdominal pain, blood in thestool, or even shock phenomenon should be considered superior mesenteric veinthrombosis, hemorrhagic necrotizing enterocolitis, ischemic colitis, intussusception,etc.; bloody diarrhea accompanied by abdominal mass, should consider the colon,intussusception。Blood in the stool accompanied by signs of bleeding skin or otherorgans, and they should pay attention to the blood system diseases, acute infectiousdisease, severe liver disease, uremia, vitamin C deficiency disorders suchcircumstances。 Detailed records of patients with general information, including age,sex, history of diabetes, hypertension, myocardial infarction, peptic ulcer, has beentaking aspirin before admission, admission diagnosis of ACS, the use of GP Ⅱ b/Ⅲ a receptor antagonist, multivessel disease, placed DES, after TIMI flow gradeⅢ, emergency PCI, postoperative LMWH。According to the presence or absence of gastrointestinal bleeding patientsadmitted into the combined group, and each group of upper gastrointestinal bleeding inclinical gastrointestinal bleeding unconsolidated group, its endoscopy analyze theincidence of patients with different clinical factors gastrointestinal bleeding,comparative analysis characteristic differences and short-term prognosis, predictors ofgastrointestinal bleeding occurred to discuss the impact。 The clinical data of patientsduring hospitalization major adverse cardiac and cerebrovascular events (MACCE)(death, re-PCI, myocardial infarction, stroke, coronary artery bypass grafting)incidence compared。All data were analyzed application SPSS19.0software, P <0.05considered statistically significant。Results1.Compare groups of gastrointestinal bleeding and nongastrointestinal bleedingclinical data: patient,s age, sex, history of diabetes, peptic ulcer, using GP Ⅱ b/Ⅲa receptor antagonist and admission diagnosis of ACS were statisticallysignificant;and hypertension history, history of myocardial infarction, has been taking aspirin before admission, multivessel disease, into the DES, after TIMI flow gradeⅢ, emergency PCI, postoperative LMWH were no significant。2.PCI eventpostoperative hospitalization was significantly longer in patients with gastrointestinalbleeding, increased mortality during hospitalization, and adverse events duringhospitalization: myocardial infarction, re-PCI, stroke, coronary artery bypass graftingincidence was not statistically significant。Followed up for6months in patients withgastrointestinal bleeding, death, re-PCI, myocardial infarction, stroke, coronaryartery bypass graft surgery was statistically significant, and was higher than in patientswithout gastrointestinal bleeding。3. Logistic regression analysis showed that age, sex,history of diabetes, peptic ulcer, using GP Ⅱ b/Ⅲ a receptor antagonist,admission diagnosis of ACS are independent risk factors for coronary heart diseasein patients with gastrointestinal bleeding after PCI。Conclusion1.Along with age, gender, history of diabetes, peptic ulcer, using PCI patients GPⅡ b/Ⅲ a receptor antagonist, admission diagnosis of ACS and other riskfactors,patient is prone to gastrointestinal bleeding。2.Age、 sex、history of diabetes、peptic ulcer、 using GP Ⅱ b/Ⅲ a receptorantagonist and admission diagnosis of ACS are independent risk factors ofgastrointestinal bleeding occurs during hospitalization。3.PCI postoperative patient with gastrointestinal bleeding events,whosehospitalstay was prolonged,and whose mortality during hospitalization was increasing.PCIpostoperative patient with gastrointestina bleeding events,whose adverse events duringhospitalization (death, re-PCI, myocardial infarction, stroke, coronary artery bypassgrafting) was no difference; followed up for6months in patients with gastrointestinalbleeding were statistically significant。...