Laursen Stig Borbjerg, Jørgensen Henrik Stig, Schaffalitzky de Muckadell Ove B
Department of Gastroenterology S, Odense University Hospital, Odense C, Denmark.
Dan Med J. 2012 Jul;59(7):C4473.
A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the Danish Society of Gastroenterology and Hepatology September 4, 2011.
Recommendations emphasize the importance of early and efficient resuscitation. Endoscopy should generally be performed within 24 hours, reducing operation rate, rebleeding rate and duration of in-patient stay. When serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective in achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended as it decreases both rebleeding rate and mortality in patients with high-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) again as soon as cardiovascular risks outweigh gastrointestinal risks. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75mg ASA and PPI should be preferred to monotherapy with clopidogrel in patients needing anti-platelet therapy on the basis of indications other than coronary stents.
一个由丹麦专家组成的多学科小组制定了关于胃十二指肠溃疡出血管理的本指南。数据来源包括截至2011年3月发表的研究。已对证据质量和推荐强度进行了分级。该指南于2011年9月4日获得丹麦胃肠病学和肝病学会批准。
推荐强调早期和有效复苏的重要性。内镜检查一般应在24小时内进行，可降低手术率、再出血率和住院时间。当怀疑有严重溃疡出血且胃抽吸物中发现血液时，12小时内进行内镜检查将使出院更快且输血需求减少。对于高危病变仍需进行内镜止血。夹子、热凝和肾上腺素注射在实现内镜止血方面有效。不推荐单纯使用肾上腺素注射进行内镜治疗。推荐在内镜止血成功后静脉给予高剂量质子泵抑制剂（PPI）治疗72小时，因为这可降低高危征象患者的再出血率和死亡率。虽然部分患者在内镜检查后可迅速出院，但高危患者在内镜止血后应住院至少3天。需要二级心血管预防的消化性溃疡出血患者，一旦心血管风险超过胃肠道风险，应尽快重新开始服用阿司匹林（ASA）。需要继续使用ASA或非甾体抗炎药治疗的患者，应采用标准剂量的PPI进行预防性治疗。对于因除冠状动脉支架外的其他适应证需要抗血小板治疗的患者，75mg ASA与PPI联合应用应优于氯吡格雷单药治疗。
