財團法人明日醫學基金會補助專題研究計畫 (成果報告 □期中進度報告

計畫名稱：預測消化性潰瘍出血病人再出血傾向

Predicting the rebleeding tendency in patients with peptic ulcer bleeding.

計畫類別：( 個別型計畫 □ 整合型計畫
執行期間： 2007年 5 月 1 日至 2007年12月 31 日

計畫主持人： 蔡佳珍
共同主持人：
計畫參與人員：

成果報告類型：(精簡報告 □完整報告

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執行單位：台北榮民總醫院內科部

中 華 民 國 97 年 2 月 29 日

Report of project 2007 of Tomorrow Medical Foundation

預測消化性潰瘍出血病人再出血傾向

Predicting the rebleeding tendency in patients with peptic ulcer bleeding.

Abstract

Between Jan. 2007 and Dec 2007, a total of 100 patients with peptic ulcers were enrolled. There were 64 males and 36 females. Age was 56.3 + 12 years (mean + SD). Thirty patients presented in shock state. The classification of bleeding was variceal bleeding: 10, peptic ulcer bleeding: 84, hemangioma: 3, Erosive gastritis 1, gastric cancer: 2. The location of bleeding was esophagus: 15, cardia: 12, gastric body: 30, gastric antrum: 25, duodenum: 18. The stigmata of recent hemorrhage was spurting hemorrhage: 15, oozing hemorrhage: 12, nonbleeding visible vessel: 8, adherent clot: 20, black spots at base: 15, clean base: 20, varices: 10. Conclusions: With one year survey of UGI bleeding, we find that in the VGH, the patients profile is similar to other hospital and reports in the literature. However, the number of patients should be increased in order to assess with Scoring system.

Results:

Between Jan 1 and Dec 31, 2007, a total of 100 patients with UGI bleeding were enrolled. There were 64 males and 36 females. Age was 56.3 + 12 years (mean + SD). Seventy patients presented with tarry stool and 30 patients presented with hematemesis. Thirty patients presented in shock state (systolic pressure less than 100 mmHg) while the endoscopists visited them. The classification of bleeding was variceal bleeding: 10, peptic ulcer bleeding: 84, hemangioma: 3, Erosive gastritis 1, gastric cancer: 2. The location of bleeding was esophagus: 15, cardia: 12, gastric body: 30, gastric antrum: 25, duodenum: 18. The stigmata of recent hemorrhage was spurting hemorrhage: 15, oozing hemorrhage: 12, nonbleeding visible vessel: 8, adherent clot: 20, black spots at base: 15, clean base: 20, varices: 10. There were 40 patients received endoscopic therapy (heat probe: 6, hemoclip: 6, heat probe plus injection14, hemoclip plus injection: 14). After therapy, rebleeding occurred in 8 patients. All these patients received heat probe thermocoagulation, and 7 achieved ultimate hemostasis. One failed patient received surgical intervention.

The total amount of blood transfusion was 1250+ 352 ml (mean + SD). The initial hemoglobin at presentation was 9.6 + 1.2 (mean + SD). The number with co-morbid illness was 78 (78%). The ulcer size was 1.1 + 0.2 cm (mean + SD).

There were 40 patients received endoscopic therapy (heat probe: 6, hemoclip: 6, heat probe plus injection14, hemoclip plus injection: 14). After therapy, rebleeding occurred in 8 patients. All these patients received heat probe thermocoagulation, and 7 achieved ultimate hemostasis. One failed patient received surgical intervention.

In the past two years, we also conducted one plan concerning pariet vs omeprazole p.o. after epinephrine injection over patients with peptic ulcer bleeding (oozing, spurting, nonbleeding visible vessel and adherent blood clots).

There were 156 patients enrolled in this study. Seventy eight patients were enrolled in each group. Age 69.4 vs 67.9 y/o over omeprazole vs pariet groups. Sex ratio was 55/23 vs 58/20 over omeprazole vs pariet groups. Location of bleeding was in the stomach: 42/39, duodenum 32/37 and esophagus 4/2 over omeprazole vs pariet groups.

The stigmata of recent hemorrhage was spurting: 3/1, oozing 28/33, nonbleeding visible vessel 24/18 and adherent clot: 23/26 over omeprazole vs pariet groups. The gastric content was blood in the stomach: 25/20, coffee ground: 33/35 and clear 20/23 over omeprazole vs pariet groups. The number of patients in shock state: 20/16 over omeprazole vs pariet groups.

The number with medical illness was 50/51 over omeprazole vs pariet groups. The mean size of ulcer 1.06 cm/1.12 cm over omeprazole vs pariet groups. The mean hemoglobin was 9.81 vs 10.31 gm/dL over omeprazole vs pariet groups.

The volume of blood transfusion was 1231 vs 1156 ml over omeprazole vs pariet groups (p>0.1). All patients achieved initial hemostasis after injection of epinephrine. A total of 12 patients and 13 patients rebled over omeprazole vs pariet groups (p>0.1). One patient in the omeprazole group and one patient in the pariet group received surgical intervention due to failure of endoscopic injection. The hospital stay was 8.52 vs 8.86 days over omeprazole vs pariet groups (p>0.1). There were one patient and two patients died of unrelated illness over omeprazole vs pariet groups (p>0.1).

Conclusion. With one year survey of UGI bleeding, we find that in the VGH, the patients profile is similar to other hospital and reports in the literature. However, the number of patients should be increased in order to assess with Scoring system.

In patients with peptic ulcer bleeding who received endoscopic injection with epinephrine, pariet and omeprazole have the same preventing rebleeding capability.

Table1. Clinical variables of patients at entry to the study

Omeprazole q12 (n=78)	Pariet bid (n=78)
Age (mean, y)	69.4	67.9
Sex (M/F)	55/23	58/20
Locations of bleeders
Stomach	42	39
Duodenum	32	37
Esophagus	4	2
Endoscopic findings
Spurting	3	1
Oozing	28	33
NBVV	24	18
Clot	23	26
Gastric contents
Blood	25	20
Coffee grounds	33	35
Clear	20	23
No in shock	21	16
No with medical illness	50	51
Mean ulcer size(cm)	1.06	1.12
Mean hemoglobin (g/l)	9.81(9.32~10.48)*	10.31(9.83~10.85)
* Mean (95% confidence interval)

p>0.1 between both groups

Table2. Results of patients receiving endoscopic treatment

OME 40q12 (n=78)	Pariet bid (n=78)
Volume of blood transfusion after therapy	1231 (487-1995)	1156 (489-1569)
No achieving initial hemostasis	78	78
No of rebleeding	12	13
No of surgery	1	1
Stay in hospital (days)	8.52 (7.42 ~ 9.55)	8.86 (7.32 ~ 9.67)
No of deaths	1	2
p>0.1 between both groups.

國科會專題研究計畫成果報告撰寫格式說明

mhuchen_陳美華

2008-10-16

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