A PROSPECTIVE EVALUATION OF THE MANAGEMENT OF BLEEDING PEPTIC-ULCER

被引：6

作者：

JEANS, PL

PADBURY, RTA

TOOULI, J

机构：

[1] Gastrointestinal Surgical & Liver Transplant Unit, Flinders Medical Centre, South Australia, Bedford Park

来源：

AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY | 1991年 / 61卷 / 03期

关键词：

DUODENAL ULCER; GASTRIC ULCER; HEMATEMESIS AND MELENA; STIGMATA OF RECENT HEMORRHAGE;

D O I：

10.1111/j.1445-2197.1991.tb07590.x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly in the elderly. The results of a management policy of early endoscopy and close monitoring of patients were prospectively evaluated to assess whether major stigmata of recent haemorrhage (SRH) helped to identify patients who were likely to rebleed. Early endoscopy allowed the diagnosis of the most likely site of haemorrhage in 94% of the 190 patients. The nature and site of SRH (visible vessel, fresh clot, red or black spot) was recorded. Ninety-three of 167 patients in whom the presence or absence of SRH were recorded, had major SRH (visible vessel, fresh clot) and 51% of these patients rebeled while only 10 of 74 (14%) patients without major SRH rebled. Overall, 80% of those with further haemorrhage had major SRH. Operation was performed on 28% of patients and the main indication for operation was further haemorrhage. Major morbidity in the surgical patients was strongly correlated with vascular instability at the time of further haemorrhage. Significant morbidity occurred in 16 of 28 patients (57%) with vascular instability, compared with only 1 of 18 patients (6%) without vascular instability (P < 0.001). The overall low mortality of 5.3% was attributed to an approach of joint medical and surgical management with early operation for further haemorrhage. Although major SRH identified a group of patients most likely to suffer further haemorrhage, the positive predictive value of major SRH was only 51%.

引用

页码：187 / 193

页数：7

共 17 条

[1]

Foster D.N., Miloszewski K.J.A., Losowsky M.S., Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding, Brit. Med. J., 1, pp. 1173-1177, (1978)

[2]

Griffiths W.J., Neumann D.A., Welsh J.D., The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal haemorrhage, N. Engl.J. Med., 300, pp. 1411-1413, (1979)

[3]

Storey D.W., Brown S.G., Swain C.P., Salmon P.R., Kirkham J.S., Northfield T.C., Endoscopic prediction of recurrent bleeding in peptic ulcers, N. Engl. J. Med., 305, pp. 915-916, (1981)

[4]

Brearley S., Hawker P.C., Morris D.L., Dykes P.W., Keighley M.R.B., Selection of patients for surgery following peptic ulcer haemorrhage, Brit. J. Surg., 74, pp. 893-896, (1987)

[5]

Jones P.F., Johnston S.J., McEwan A.B., Kyle J., Needham C.D., Further haemorrhage after admission to hospital for gastrointestinal haemorrhage, Brit. Med. J., 3, pp. 660-664, (1973)

[6]

Knaus W.A., Zimmerman J.E., Wagner D.P., Draper E.A., Lawrence D.E., APACHE: acute physiology and chronic health evaluation: a physiologically based classification system, Crit. CareMed, 9, pp. 591-597, (1981)

[7]

Knaus W.A., Draper E.A., Wagner D.P., Zimmerman J.E., APACHE II: A severity of disease classification system, Crit. Care Med., 13, pp. 818-829, (1985)

[8]

Knaus W.A., Wagner D.P., Loirat P., Et al., A comparison of intensive care in the USA and France, Lancet, 2, pp. 642-646, (1982)

[9]

Knaus W.A., Wagner D.P., Draper E.A., Relationship between acute physiologic derangement and risk of death, J. Chronic. Dis., 38, pp. 295-300, (1985)

[10]

Bornman P.C., Theodorou N.A., Shuttleworth R.D., Essel H.P., Marks I.N., Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation, Brit. Med. J., 291, pp. 245-247, (1985)

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