Baradarian Robin, Ramdhaney Susan, Chapalamadugu Rajeev, Skoczylas Leor, Wang Karen, Rivilis Svetlana, Remus Kristin, Mayer Ira, Iswara Kadirawel, Tenner Scott
Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
Am J Gastroenterol. 2004 Apr;99(4):619-22. doi: 10.1111/j.1572-0241.2004.04073.x.
Despite advances in diagnostic and therapeutic endoscopy, the mortality of patients with upper gastrointestinal bleeding (UGIB) has remained relatively constant. Inadequate early resuscitation is believed to be a major factor in the persistently high mortality rate in patients with UGIB. In order to evaluate the role of intensive resuscitation in the outcome of patients with UGIB, we conducted the following prospective study.
A consecutive series of patients with UGIB complicated by hemodynamic instability related to bleeding were enrolled in the study. An initial cohort of patients (Observation Group) was followed by a team of physicians to collect data. After recording demographic information, the time interval between presentation with UGIB and the correction of hemodynamic instability, hematocrit (HCT), and coagulopathy was prospectively recorded. Medical treatment, endoscopic intervention, and subsequent outcome were also prospectively recorded. A subsequent cohort of patients (Intensive Resuscitation Group) was then prospectively followed and similar demographic and outcome data were collected. However, in this cohort, the physicians involved in collecting the data also provided guidance to the health care team managing the patients. The goal for this group of patients was to allow a more rapid correction of hemodynamic instability, HCT, coagulopathy, and medical/endoscopic intervention.
Seventy-two patients were included in the study, 36 males, 36 females, mean age 70 yr (range 21-94). Thirty-six patients were followed in the Observational Group, and 36 in the Intensive Resuscitation Group. There were no significant differences with regard to age, gender, number and type of comorbid diseases, history of prior gastrointestinal bleeding, or etiology of bleeding between the two groups. Patients treated in the Intensive Resuscitation Group had a significant decrease in the time interval from admission to the stabilization of hemodynamics and the correction of HCT. There were no significant differences in the time interval from admission to endoscopic intervention, length-of-stay (LOS), or the number of units of blood given. Fewer patients in the Intensive Resuscitation Group suffered myocardial infarction (p= 0.04). Mortality was lower in the Intensive Resuscitation Group (one death) compared to the Observational Group (four deaths), (p= 0.04).
Early intensive resuscitation of patients with upper gastrointestinal bleeding significantly decreases mortality. Physicians involved in the care of patients with UGIB should focus on early and rapid correction of hemodynamics, HCT, and underlying coagulopathy.
尽管诊断性和治疗性内镜检查取得了进展，但上消化道出血（UGIB）患者的死亡率仍相对稳定。早期复苏不充分被认为是UGIB患者死亡率持续居高不下的主要因素。为了评估强化复苏在UGIB患者预后中的作用，我们进行了以下前瞻性研究。
连续纳入一系列因出血导致血流动力学不稳定的UGIB患者。一组初始患者（观察组）由一组医生随访以收集数据。记录人口统计学信息后，前瞻性记录UGIB出现至血流动力学不稳定纠正、血细胞比容（HCT）及凝血功能障碍纠正之间的时间间隔。还前瞻性记录医疗治疗、内镜干预及后续结局。随后一组患者（强化复苏组）进行前瞻性随访并收集类似的人口统计学和结局数据。然而，在该组中，参与收集数据的医生也为管理患者的医疗团队提供指导。该组患者的目标是使血流动力学不稳定、HCT、凝血功能障碍及医疗/内镜干预得到更快纠正。
72例患者纳入研究，男性36例，女性36例，平均年龄70岁（范围21 - 94岁）。观察组36例患者，强化复苏组36例患者。两组在年龄、性别、合并疾病的数量和类型、既往胃肠道出血史或出血病因方面无显著差异。强化复苏组患者从入院到血流动力学稳定及HCT纠正的时间间隔显著缩短。从入院到内镜干预的时间间隔、住院时间（LOS）或输血单位数量无显著差异。强化复苏组发生心肌梗死的患者较少（p = 0.04）。强化复苏组死亡率（1例死亡）低于观察组（4例死亡），（p = 0.04）。
上消化道出血患者早期强化复苏可显著降低死亡率。参与UGIB患者护理的医生应注重早期快速纠正血流动力学、HCT及潜在的凝血功能障碍。
