Intensive Care in Ulcerative Gastroduodenal Hemorrhages
https://doi.org/10.15360/1813-9779-2008-4-9
Abstract
Objective: to retrospectively evaluate the efficiency of using an algorithm of intensive medical therapy for ulcerative gastroduodenal hemorrhage (UGDH). This algorithm combines earlier initiation of intensive care, identification of groups at increased risk for poor outcomes of hemorrhage, endoscopic treatment, and the present-day antisecretory treatment regimens using proton pump inhibitors (PPI). Subjects and methods. The authors analyzed 108 cases of intensive therapy for UGDH at two emergency care hospitals in 2005—2006, including 57 patients from intensive care units (ICU) who received antisecretory therapy with parenteral ^-histamine blockers and 51 patients who took par-enteral PPI. The Rockall scale was used to predict the outcome of treatment and to determine needs for intensive care. The formed groups were similar in age, gender, the pattern, frequency, and nature of comorbidity, the sources and severity of hemorrhage, and the level of blood loss on admission. Results. The rates of recurrent hemorrhages and deaths were significantly higher among high-risk patients having a Rockall Score of 5 or more. As compared ^-histamine blockers, the use of PPI showed a reliable and clinical significant (39.3%) reduction in the rate of recurrences in high-risk patients. The frequency of emergency operations for a relapse reduced by 18.1%, the duration of ICU treatment and the mean length of hospital stay decreased by 23.7 hours and 2.5 days, respectively. Red blood cell transfusion volume showed a 25% reduction per dose. Overall mortality, a need for surgery, and the length of hospital stay remained unchanged. Conclusion. The study has provided evidence for the predictive value of the Rockall scale in determining a relapse and a fatal case in patients with UGDH and demonstrated the higher efficiency of prevention of recurrent hemorrhage during ICU treatment with PPI versus ^-histamine blockers. Key words: ulcerative gastro-duodenal hemorrhage, Rockall scale, proton pump inhibitors.
References
1. Laine L., Peterson W. L.
2. Lau J. Y. W., Chung S.Quadrennial review. Management of upper gastrointestinal hemorrhage. J. Gastroenterol. Hepatol. 2000; 15: G8—G1
3. Rockall T. A., Logan R. F. A., Devlin H. B. et al.Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ 1995; 311: 222—226.
4. Van Leerdam M. E., Vreeburg E. M., Rauws E. A.J. et al.Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am. J. Gastroenterol. 2003; 98 (7): 1494—1499.
5. Barkun A. N., Bardou M., Marshall J. K.Nonvariceal upper GI bleeding consensus conference group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann. Intern. Med. 2003; 139: 843—857.
6. Шапкин Ю. Г., Чалык Ю. В., Капралов С. В., Матвеева Е. Н.Прогнозирование рецидива язвенного кровотечения. Хирургия 2002; 11: 32—33.
7. Sanders D. S., Carter M. J., Goodchap R. J. et al.Prospective validation of the Rockall risk scoring system for upper GI haemorrhage in subgroups of patients with varices and peptic ulcers. Am. J. Gastroenterol. 2002; 97 (3); 630—635.
8. Huang C. S., Lichtenstein D. R.Nonvariceal upper gastrointestinal bleeding. Gastroenterol. Clin. N. Am. 2003; 32: 1053—107
9. Oh D. S., Pisegna J. R.Management of upper gastrointestinal bleeding. Clin. Farm. Pract. 2004; 6 (3): 631—645.
10. Гостищев В. К., Евсеев М. А.Рецидив острых гастродуоденальных язвенных кровотечений. Хирургия 2003; 7: 43—49.
11. Гостищев В. К., Евсеев М. А.Патогенез рецидива острых гастродуо-денальных язвенных кровотечений. Хирургия 2004; 5: 46—51.
12. Rockall T. A., Logan R. F. A., Devlin H. B., Northfield T. C.Selection of patients for early discharge or outpatient care after acute upper gastrointestinal hemorrhage. Lancet 1996; 347: 1138—1140.
13. Blatchford O., Murray W. R., Blatchford M.A risk score to predict need for treatment for upper-gastrointestinal hemorrhage. Lancet 2000; 356: 1318—1321.
14. Guglielmi A., Ruzzenente A., Sandri M. et al.Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy 2002; 34: 778—786.
15. Vreeburg E. M., Terwee C. B., Snel P. et al.Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999; 44: 331—335.
16. Голуб И. Е., Кузнецов С. М., Нетесин Е. С.Диагностика и оценка степени тяжести больных с кровотечениями. Вестн. Интенс. терапии 2003; 4: 12—
17. Lang T.Twenty statistical errors even you can find in biomedical research articles. Croatian Medical J. 2004; 45 (4): 361—370.
18. Шорох Г. П., Жуковский И. М., Климович В. В. и соавт.Современные принципы хирургической тактики при гастродуоденальных язвенных кровотечениях. В кн.: Шорох Г.П. (ред.) Декабрьские чтения по неотложной хирургии. 2. Гастродуоденальные кровотечения язвенной этиологии. Минск: Промпечать; 1997. 7—24.
19. Mischinger H. J., Gerwenka H., Marsoner H. J. et al.Gastroduodenal ulcer bleeding. Eur. Surg. 2002; 34: 220—224.
20. Григорьев С. Г., Корытцев В. К.Хирургическая тактика при язвенных дуоденальных кровотечениях. Хирургия 1999; 6: 12—15.
21. Fallah M. A., Prakash C., Edmundowicz S.Acute gastrointestinal bleeding. Med. Clin. North. Am. 2000; 84 (5): 1183—1208.
22. Khuroo M. S., Farahat K. L. C., Kavegi I. E.Treatment with proton pump inhibitiors in acute non-variceal upper gastrointestinal bleeding: A meta-analysis. J. Gastroenterology and Hepatology 2005; 20: 11—25.
23. Andriulli A., Cordiano C., Lombardo F. et al.Proton-pump inhibitiors and outcome of endoscopic hemostasis in bleeding peptic ulcers: A Series of meta-analyses. Am. J. Gastroenterol. 2005; 100: 207—219.
24. Bardou M., Toubouti Y., Benhaberou-Brun D. et al.Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding. Aliment. Pharmacol. Ther. 2005; 21: 677—686.
25. Гостищев В. К., Евсеев М. А.Антисекреторная терапия как составляющая часть консервативного гемостаза при острых гастродуоде-нальных язвенных кровотечениях. Хирургия 2005; 8: 52—57.
26. Cyristensen P. B., Albertsen K. E. P., Jensen P.Renal failure after omepra-sole. Lancet 1993; 341: 55.
27. Schonhofer P. S.Ocular damage associated with proton pump inhibitors. BMJ 1997; 314: 1805.
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For citations:
Nedashkovsky E.V., Spiridonov S.V., Ivanova V.G. Intensive Care in Ulcerative Gastroduodenal Hemorrhages. General Reanimatology. 2008;4(4):9. (In Russ.) https://doi.org/10.15360/1813-9779-2008-4-9
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