Golánová J, Hrdlicka L, St'ovícek J, Lochmanová J, Tyburec M, Drábek J, Keil R
Interní klinika 2. lékarské fakulty UK a FN Motol, Praha.
Vnitr Lek. 2004 Apr;50(4):274-7.
Acute upper gastrointestinal tract bleeding is a cause of significant morbidity and mortality and is a reason for urgent endoscopy. Besides an age and associated diseases, prognosis of patients influence also localisation and type of bleeding. The aim of our retrospective analysis was to discover causes of bleeding into upper GI tract and its characteristics over a 4 year period.
A survey of urgent upper GI tract endoscopies in the Clinic of Internal Medicine in Motol in Prague because of an acute GI tract bleeding (hematemesis or melena) was done. Found ulcers were assessed using Forrest classification. Moreover, number and causes of recurrences of bleeding were also assessed.
Within years 1998-2001 an urgent upper GI endoscopy because of bleeding (hematemesis or melena) was done in the Clinic of Internal Medicine in Prague in Motol in 1639 patients of an average age 62.2. 56% were men (average age 59) and 44% were women (average age 65.3). An endoscopy finding without pathology was present in 21.4%. The most frequent sources of bleeding were ulcers in duodenal bulb (20%), stomach ulcers (18.2%), and hemorrhagic gastropathy (16.5%) and varices (10.3%). Results of the Forrest classification in the ulcerative disease of stomach and duodenum were as follows: Forrest Ia 9.5%, Ib 24%, IIa 14.6%, IIb 18.7%, IIc 22.9%, III 10.3%. Recurrent bleeding was identified in 8.4% of patients, thereof bleeding from esophageal varices experienced 2.9% of patients (average age 45.8), bleeding from ulcers in bulbus 2.7% (Forrest Ib, IIa a IIb) of patients of an average age 62.6, and bleeding from ulcers in stomach 2.1% (Forrest Ia, IIa a Ib) of patients of an average age 62.5. Causes of recurrent bleeding were in one case bleeding from Barrett's oesophageal ulcer and in one case bleeding from ulcer in diaphragmatic hernia. Within 48 hours recurrent bleeding appeared in 65% of patients.
Urgent endoscopy in gastrointestinal tract bleeding is an essential part of a complex medical care. It is highly reliable in identifying cause of bleeding, it enables to start treatment immediately and to consider prognosis of a patient.
急性上消化道出血是导致严重发病和死亡的原因，也是紧急内镜检查的指征。除了年龄和相关疾病外，患者的预后还会影响出血的部位和类型。我们进行回顾性分析的目的是找出4年期间上消化道出血的原因及其特点。
对布拉格莫托尔内科诊所因急性胃肠道出血（呕血或黑便）而进行的紧急上消化道内镜检查进行了一项调查。对发现的溃疡采用福里斯特分类法进行评估。此外，还评估了出血复发的次数和原因。
在1998 - 2001年期间，布拉格莫托尔内科诊所对1639例平均年龄为62.2岁的患者进行了因出血（呕血或黑便）而进行的紧急上消化道内镜检查。其中男性占56%（平均年龄59岁），女性占44%（平均年龄65.3岁）。内镜检查未发现病变的占21.4%。最常见的出血来源是十二指肠球部溃疡（20%）、胃溃疡（18.2%）、出血性胃炎（16.5%）和静脉曲张（10.3%）。胃和十二指肠溃疡性疾病的福里斯特分类结果如下：福里斯特Ia级9.5%，Ib级24%，IIa级14.6%，IIb级18.7%，IIc级22.9%，III级10.3%。8.4%的患者出现复发性出血，其中2.9%的患者为食管静脉曲张出血（平均年龄45.8岁），2.7%的患者为十二指肠球部溃疡出血（福里斯特Ib、IIa和IIb级），平均年龄62.6岁，2.1%的患者为胃溃疡出血（福里斯特Ia、IIa和Ib级），平均年龄62.5岁。复发性出血的原因，一例是巴雷特食管溃疡出血，一例是膈疝溃疡出血。65%的患者在48小时内出现复发性出血。
胃肠道出血的紧急内镜检查是综合医疗护理的重要组成部分。它在确定出血原因方面高度可靠，能够立即开始治疗并考虑患者的预后。
