Jayaprakash Anthoor, McGrath Christine, McCullagh Emily, Smith Frank, Angelini Gianni, Probert Christopher
Department of Gastroenterology, Bristol Royal Infirmary, UK.
Eur J Gastroenterol Hepatol. 2004 Feb;16(2):191-4. doi: 10.1097/00042737-200402000-00011.
To compare the frequency and outcome of upper gastrointestinal haemorrhage (UGH) patients who had undergone cardiac surgery with a control group of vascular surgery patients.
Patients who had undergone cardiac or vascular surgery from January 1999 to December 2000 were identified from departmental records. The inclusion criteria used were haematemesis and/or melaena in the post-operative period.
Only 20 of the 2274 (0.9%) cardiac operations were complicated by UGH compared to eight of 708 (1.1%) vascular operations. Among those with UGH, 90% of the cardiac and 43% of the vascular patients were taking aspirin, warfarin or both. The mean interval between surgery and the UGH was 9.6 days (range 1-30) for the cardiac and 6 days (range 0-15) for the vascular patients. Duodenal and gastric ulcers were the most common cause of UGH (60%) in the cardiac group. Despite endoscopic intervention, more than one third of ulcer associated haemorrhages required surgical over-sewing, but none of the patients who had surgery died. The overall mortality on the cardiac surgery patients who experienced UGH was 15%, significantly higher than the 2.3% for the whole cardiac surgery group during the study period (P = 0.00075, OR = 8, 95% confidence interval 2.3-28). However, even this mortality is less than that of general inpatients who suffer UGH (33%).
Cardiac and vascular surgical patients have similar low post-operative rate of UGH. Post-operative UGH is associated with increased mortality after primary surgery. Early surgical intervention appears to be life saving in those patients who are too ill to compensate for the haemodynamic disturbance of untreated UGH.
比较接受心脏手术的上消化道出血（UGH）患者与血管外科手术患者对照组的出血频率和结局。
从科室记录中确定1999年1月至2000年12月期间接受心脏或血管手术的患者。纳入标准为术后出现呕血和/或黑便。
2274例心脏手术中仅有20例（0.9%）并发UGH，而708例血管手术中有8例（1.1%）并发UGH。在发生UGH的患者中，90%的心脏手术患者和43%的血管手术患者正在服用阿司匹林、华法林或两者都服用。心脏手术患者手术与UGH之间的平均间隔为9.6天（范围1 - 30天），血管手术患者为6天（范围0 - 15天）。十二指肠和胃溃疡是心脏手术组UGH最常见的原因（60%）。尽管进行了内镜干预，但超过三分之一的溃疡相关性出血需要手术缝合，但接受手术的患者均未死亡。经历UGH的心脏手术患者的总体死亡率为15%，显著高于研究期间整个心脏手术组的2.3%（P = 0.00075，OR = 8，95%置信区间2.3 - 28）。然而，即使是这个死亡率也低于一般UGH住院患者的死亡率（33%）。
心脏和血管外科手术患者术后UGH发生率相似。术后UGH与初次手术后死亡率增加相关。对于病情过重无法代偿未治疗UGH的血流动力学紊乱的患者，早期手术干预似乎可挽救生命。
