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非静脉曲张性上消化道出血。

Non-variceal upper gastrointestinal bleeding.

机构信息

Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, Zaragoza, Spain.

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.

出版信息

Nat Rev Dis Primers. 2018 Apr 19;4:18020. doi: 10.1038/nrdp.2018.20.

Abstract

Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of ∼67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range ∼1-5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.

摘要

非静脉曲张性上消化道出血(NVUGIB)是指发生在食管、胃或近端十二指肠的出血。由幽门螺杆菌感染或使用非甾体抗炎药(NSAIDs)和低剂量阿司匹林(LDA)引起的消化性溃疡是最常见的原因。尽管由于过去 20 年来在预防和管理 NVUGIB 方面取得了相当大的进展,与 NVUGIB 相关的发病率和死亡率有所下降,但它仍然是一个常见的临床问题,2012 年美国每年每 10 万人中有约 67 人发病。NVUGIB 是一种医疗急症,死亡率在 1-5%之间。在复苏和初步评估后,早期(24 小时内)进行诊断和治疗性内镜检查,以及质子泵抑制剂(PPIs)控制胃内 pH 值,是治疗的基础。随着越来越多的接受抗血小板和/或抗凝药物治疗的老年患者,NVUGIB 的临床管理变得复杂,因为需要平衡胃肠道出血事件和不良心血管事件之间的风险。最佳的临床方法包括确定危险因素和预防出血;可用的策略包括在有发生 NVUGIB 风险的患者中持续使用 PPI 或根除幽门螺杆菌。对于需要 NSAIDs 和/或 LDA 且有发生 NVUGIB 风险的患者,应使用 PPI 和/或环氧化酶-2 选择性 NSAIDs 进行治疗。

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