Lakhwani M N, Ismail A R, Barras C D, Tan W J
Department of Surgery, Penang Adventist Hospital, Penang.
Med J Malaysia. 2000 Dec;55(4):498-505.
Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit beds and more active participation of multidisciplinary teams in co-ordinating management are among remedial measures advocated. Broader educational preventive strategies should target the causes of UGI bleeding.
尽管在消化性溃疡疾病的内镜检查和药理学治疗方面取得了进展，但在过去四十年中，总体死亡率一直保持在10%。本研究的目的是确定内镜诊断的上消化道（UGI）出血病例的年龄、性别、种族分布、发病率和病因，总结所采取的治疗方法并报告其结果。在吉隆坡医院的两个外科病房对128例UGI出血患者进行了一项前瞻性研究，包括择期和急诊入院患者。研究组包括113名（88.2%）男性和15名（11.7%）女性。平均年龄为51.9岁（范围14至85岁），37.5%（128例患者中的48例）年龄超过60岁。印度种族在所有疾病类别中占比过高。报告的风险因素包括吸烟（50.1%）、饮酒（37.5%）、非甾体抗炎药（NSAIDs）（17.2%）、传统疗法（5.5%）、抗凝剂（2.3%）和类固醇（0.8%）。常见的症状和体征包括黑便（68.8%）、呕血（59.4%）和直肠新鲜出血（33.6%）。UGI出血最常见的原因是十二指肠溃疡（32%）、胃溃疡（29.7%）、糜烂（十二指肠和胃）（21.9%）、食管静脉曲张（10.9%）和恶性肿瘤（3.9%）。90.6%的病例采用非手术治疗UGI出血。62.6%（67/107）的消化性溃疡疾病患者需要输血。约10%的出血性消化性溃疡患者需要手术干预，大多数高危十二指肠和胃溃疡患者采用出血血管缝扎术。消化性溃疡出血疾病的总体死亡率为4.7%。6例患者在就诊后不久死于严重的UGI出血，病因未明。提倡的补救措施包括积极的复苏方案、早期内镜检查、更积极的介入治疗、由更资深的外科医生进行早期手术、增加重症监护病房床位以及多学科团队更积极地参与协调管理。更广泛的教育预防策略应针对UGI出血的病因。
