Blood coagulation in patients with ulcerous gastrointestinal hemorrhage]

In 108 patients with ulcerous gastrointestinal hemorrhage, the indices which characterize the coagulative and fibrinolytic systems of the blood were studied. At the moment of admission, in patients with severe blood loss, the moderate manifestations of the disseminated intravascular coagulation, which is the most characteristic in globular volume deficiency of more than 50%, were noted. After the operation, the revealed changes in the system of hemostasis increased. Beginning from the day 5, a tendency for normalization of the indices was noted, however by the moment of discharge of the patients they do not achieve the normal ones.     

Tactics in gastrointestinal hemorrhage under conditions of medical aviation]

Doctors of the medical aviation service were consulted in 774 cases of gastrointestinal bleeding of various genesis in 1985-1989. Chronic gastroduodenal ulcer (peptic ulcer of the anastomosis among others) was the source of the bleeding in 473 (64.88%) patients. In the first period of observation (1985-1986) active surgical tactics was applied in 103 patients with chronic bleeding ulcer. Fifty-one patients (49.5%) underwent operation, with a fatal outcome in 12 cases (23.5%). Active individualized tactics was accepted in the second period (1987-1989). In a group of 370 patients 185 (50%) were operated on, 20 with fatal outcomes (10.8%). Active surgical tactics was individualized by strict comparison of the amount of blood loss and the degree of activity of the bleeding. Clinico-endoscopic and laboratory interpretation of the degree of activity of the bleeding is described and the expediency of indicating this criterion along with the amount of blood loss in establishing the diagnosis in a patient with bleeding from the ulcer is pointed out.     

Ways of improving the results in treating patients with acute gastrointestinal hemorrhage of peptic ulcer etiology

The results of treatment of 1837 patients with gastric and duodenal ulcers, complicated by bleeding are presented. Emergency surgical interventions were performed in 468 patients, 92 (19.7%) died, early elective operations--in 416 patients, 13 (3.1%) died, conservative treatment was performed in 953 patients, 55 (5.8%) died. In 1274 patients, the actively expectant tactics was used, in 563--surgical tactics based on endoscopic characteristics of the source of bleeding and degree of the severity of blood loss. The use of this tactics permitted to reduce lethality after emergency operations from 27.7 to 9.6%, in patients treated conservatively--from 7.5 to 0.8%, to increase operative activity from 44.6 to 56.1%.     

Lipid peroxidation and lysosomal enzyme activity in patients with acute gastrointestinal hemorrhage of peptic ulcer etiology

In examination of 51 patient with acute gastrointestinal bleeding of ulcer etiology, the activity of lysosomal enzymes, peroxide oxidation of lipids were increased, the activity of antioxidant system was decreased. This can lead to inhibition of proliferative processes, stipulating the severity of blood loss, course of the postoperative period, the incidence of postoperative complications, and lethality.     

生长抑素在腹部外科术后并发应激性溃疡大出血中的应用

目的　探讨生长抑素在治疗腹部外科术后患者并发应激性溃疡大出血中的作用。方法　对 48例在腹部外科术后并发应激性溃疡大出血患者按时间先后分为对照组 (n =2 0 )及生长抑素治疗组 (n =2 8)。对照组以采用雷尼替丁静脉推注为主要治疗手段 ,治疗组采用雷尼替丁静脉推注加生长抑素持续静脉点滴为主。观察两组患者出血停止例数、再次手术次数、手术死亡率。结果　治疗组的出血停止例数较对照组多 (P <0 .0 5) ,再次手术次数、手术死亡率均较对照组减少 (P <0 .0 5)。结论　生长抑素能明显减少患者的出血量 ,减少再次手术次数 ,降低手术死亡率。     

Intensive therapy of patients surgically treated in acute gastrointestinal hemorrhage of peptic ulcer etiology

The emergency operations were performed in 6,506 patients for acute hemorrhage in gastric and duodenal ulcer. A method for the complex corrigative intensive therapy is presented. The use of combined parenteral and enteral nutrition facilitates a care of the patients, favours the prophylaxis of complications. Because of incomplete rehabilitation by the moment of patient's discharge from the hospital, it is necessary to continue the corrigative therapy directed at liquidation of the globular volume deficiency, correction of disproteinemia, normalization of the indices of central hemodynamics and metabolic processes in the organs and tissues.     

Evaluation of gastrointestinal hemorrhage in patients with neurofibromatosis

Over a 3-year period, two patients with neurofibromatosis were referred to our medical center for evaluation of repeated episodes of melena. Upper endoscopy was unrevealing in each case, as was colonoscopy. Arteriography during active hemorrhage was helpful in localizing the source of bleeding in one patient but not in the other. The source of bleeding in each patient was obvious at surgical exploration. Large neurofibromas protruded from the seorsal surface of a short region of jejunum in both cases and an additional segment of ileum in one case. Hemorrhage had occurred as a result of erosion of mucosa stretched over these tumors. Local resection of the involved segments produced long-term control of the hemorrhage. Since these tumors were grossly visible on the serosal surface of the involved intestinal segments, laparoscopic evaluation could have been used to hasten diagnosis in each case.     

Diagnosis and treatment of gastrointestinal hemorrhage]

The article analyses the results of treatment of 4,430 patients with gastrointestinal bleeding in the last four decades. Two periods, from 1950 to 1969 and from 1970 to 1990, are compared from the standpoint of change of the disease structure, the methods of diagnosis and hemostasis. The number of hemorrhages of ulcer genesis reduced from 80 to 40.3%. Changes in the pattern of the disease is associated with improved diagnostic methods and recognition of pathological processes which were previously inaccessible to radiological examination, such as the Mallory-Weiss syndrome, acute ulcerations of the mucosa. The age composition remains relatively stable. Just like in the previous years, each third patient is over 6.0 years of age. Despite introduction of new methods of treatment, such as endoscopic arrest of bleeding, enteral feeding, a new method for management of penetrating ulcers and others, the mortality rate reduced only from 4.5% (1950-1969) to 3.4% (1970-1990). It is noted, however, that fatal outcomes in the last years prevail among patients aged 65-70 or older.     

消化性溃疡合并上消化道出血影响因素分析

目的探讨消化性溃疡合并上消化道出血的影响因素。方法收集笔者所在医院315例消化性溃疡合并上消化道出血患者为研究组;同期门诊选取656例消化性溃疡无上消化道出血并发症的患者为对照组。再根据研究组中HP阳性者根除HP后随访2年,观察上消化道再出血情况。所有入选患者均统计幽门螺杆菌检测结果、NSAIDs服用、性别、年龄、饮酒史、血小板计数等情况。结果 NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）;年龄对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.01）;合用不同种类NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）。结论 NSAIDs增加消化性溃疡合并上消化道出血的风险;年龄与消化性溃疡合并上消化道出血相关,大于60岁的老龄消化性溃疡患者更易合并上消化道出血;合用不同种类NSAIDs较单用NSAIDs者消化性溃疡更易合并上消化道出血。