ABSTRACT
An experience of treatment of 133 patients with severe bums was analyzed. Bleedings from the upper parts of the gastrointestinal tract were diagnosed in 16 patients in different terms since their admission to the hospital. At the moment of carrying out of the endoscopic research all bleedings were considered as taking place. Statistically significant risk factors of the development of gastroduodenal bleedings were considered to be an alcoholic intoxication at the moment of injury and insufficient fluid therapy during the pre-admission stage and young age of the patients. The antisecretory therapy showed that the detection of risk factors in question should be regarded as an indication to the reinforced regime of preventive measures for gastroduodenal injuries.
Subject(s)
Burns , Famotidine/administration & dosage , Gastrointestinal Hemorrhage , Proton Pump Inhibitors/administration & dosage , Shock, Traumatic , Anti-Ulcer Agents/administration & dosage , Burns/complications , Burns/physiopathology , Duodenum/blood supply , Duodenum/physiopathology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/physiopathology , Gastrointestinal Hemorrhage/prevention & control , Humans , Outcome and Process Assessment, Health Care , Prognosis , Risk Assessment , Risk Factors , Shock, Traumatic/etiology , Shock, Traumatic/physiopathology , Splanchnic Circulation , Stomach/blood supply , Stomach/physiopathology , Trauma Severity IndicesSubject(s)
General Surgery/history , Anniversaries and Special Events , History, 20th Century , Humans , USSRSubject(s)
Antifibrinolytic Agents/administration & dosage , Duodenal Ulcer , Peptic Ulcer Hemorrhage/drug therapy , Stomach Ulcer , Tranexamic Acid/administration & dosage , Aged , Dose-Response Relationship, Drug , Endoscopy, Gastrointestinal , Female , Follow-Up Studies , Hemoglobins/metabolism , Humans , Injections, Intravenous , Male , Middle Aged , Peptic Ulcer Hemorrhage/blood , Peptic Ulcer Hemorrhage/diagnosis , Retrospective Studies , Treatment OutcomeABSTRACT
Results of realization of the protocols of organization of the medico-diagnostic care to patients with bleedings from chronic gastric and duodenal ulcers since 2002 have been analyzed. A simplified scale of the assessment of severity of ulcerous bleedings (UB) at admission including 8 criteria is proposed. Protocols of medical strategy for "severe UB" under conditions of the resuscitation unit are discussed. The principles of rendering the medico-diagnostic care for UB allowed stabilization of total lethality among these patients at the level of 3.4-3.7% at operative activity 27%. The possibility to improve results of the treatment of this pathology in future is associated by the authors with the available and high quality elements of conservative treatment.
Subject(s)
Clinical Protocols , Diagnostic Services/organization & administration , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/surgery , Peptic Ulcer/diagnosis , Peptic Ulcer/surgery , Practice Patterns, Physicians'/organization & administration , HumansABSTRACT
On the basis of the study of 2388 patients with chronic gastric and duodenal ulcers complicated by acute bleeding, the most disputable organizational and tactical issues of ulcer bleeding (UB) treatment are discussed. It is reasonable to divide surgery for UB into urgent, delayed and elective. Indications for different surgeries in UB and basic surgical principles are discussed. Severe blood loss is the main factor of general lethality. Combined conservative therapy must provide correction of posthemorrhagic tissue hypoxia, functional disorders, hemostatic disturbances and immunosuppression. Artificial transmitters of oxygen and infusion of antihypoxants are promising in management of UB. Antisecretory drugs are a necessary component of conservative treatment in UB. Therapeutic endoscopy is important in the treatment of acute UB, but it is not alternative to surgical hemostasis. It may be regarded as a method of temporary hemostasis before delayed for more than 2 hours operation or as a method of final hemostasis in combined conservative treatment, first of all in patients of "surgical risk" group.
Subject(s)
Peptic Ulcer Hemorrhage/surgery , Blood Chemical Analysis , Emergency Treatment/methods , Humans , Peptic Ulcer Hemorrhage/mortality , Postoperative Complications/mortality , Time FactorsSubject(s)
Stomach Neoplasms/diagnosis , Stomach Ulcer/diagnosis , Antigens, Tumor-Associated, Carbohydrate/blood , Biomarkers, Tumor/blood , CA-19-9 Antigen/blood , Carcinoembryonic Antigen/blood , Chronic Disease , Diagnosis, Differential , Humans , Stomach Neoplasms/immunology , Stomach Neoplasms/pathology , Stomach Ulcer/immunology , UlcerABSTRACT
The data presented show that along with acid-peptic aggression an important role in pathogenesis of stress ulceration in the stomach and duodenum belongs to energy and immune deficiency which makes the correction of these alterations necessary. The timely and valuable conservative therapy including histamine H2-receptor blocking agents in addition to antacids and endoscopic electrocoagulation in case of profuse bleeding from stress ulcers allows to obtain hemostasis and healing of the ulcers more than in 90% of cases. When choosing the surgical method of treatment the preference should be given to atraumatic organ-preserving operations.
