人工关节置换术后并发应激性溃疡大出血(附2例报告及文献复习)

目的：探讨人工关节置换术后并发应激性溃疡大出血的预防及治疗经验。方法：1997年9月－2001年9月行人工关节置换术589例，对术后出现应激性溃疡大出血的2例临床资料进行回顾性分析并复习相关文献。结果：本组患者合并有高血压，长期服用激素和非甾体类消炎药物（NSAIDs)，1例患者抗凝治疗，人工关节置换术后并发应激性溃疡大出血的发生率为0．34％，临床表现为排柏油样大便，呕血、低血容量休克、贫血，急诊胃镜显示胃十二指肠粘膜糜烂，弥散性出血，结论：人工关节置换术后并发应激性溃疡大出血是一种严重的并发症，治疗在于有效控制出血，补充血容量，同时注意对重要脏器的保护，非手术治疗无效时，应外科手术治疗。对长期服用容易引起胃粘膜损害药物的患者，围手术期应使用抑制胃酸分泌的药物，预防应激性溃疡的发生。

Stress Ulcer with Bleeding in Postoperation of Total Joint Replacement:Report of 2 Patients and Review Related Documents

Objective:To study the experiences of prevention and treatment in stress ulcer with bleeding in postoperation of total joint replacement.Methods:From Sep.1997 to Sep,2001,589 paitents underwent total joint replacement.Among them,stress ulcer with bleeding occured in 2 patients after operation.Their clinical informations and related documents were retrospectively reviewed.Res ults: The patients suffered hypertension,and treated with non steroidal anti inflammatory drugs(NSAIDs)and corticosteroids to relieve the pain of joints in a long term.One case with anti coagulants therapy during the perioperative period.The rate of stress ulcer with bleeding in the postoperation of total joint replacement was 0.34%.There were tarry stool,hematemesis,hypovolemic shock and anemia among them.Conclusions:Stress ulcer with bleeding was a severe complications in postoperation of total joint replacement.The treatment of stress ulcer with bleeding should be controlled actively bleeding,support the stability of blood pressure,and prevent progressive organ failure.The surgical intervention should be performed after the failure of conservative treatment.Acid suppressants should be used to the patients who have taken drugs for a long time which ease damage gastric mucosa during perioperative period.