Cai Jennifer X, Saltzman John R
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Gastrointest Endosc Clin N Am. 2018 Jul;28(3):261-275. doi: 10.1016/j.giec.2018.02.001. Epub 2018 Apr 17.
Inhospital mortality from nonvariceal upper gastrointestinal bleeding has improved with advances in medical and endoscopy therapy. Initial management includes resuscitation, hemodynamic monitoring, proton pump inhibitor therapy, and restrictive blood transfusion. Risk stratification scores help triage bleeding severity and provide prognosis. Upper endoscopy is recommended within 24 hours of presentation; select patients at lowest risk may be effectively treated as outpatients. Emergent endoscopy within 12 hours does not improve clinical outcomes, including mortality, rebleeding, or need for surgery, despite an increased use of endoscopic treatment. There may be a benefit to emergent endoscopy in patients with evidence of active bleeding.
随着医学和内镜治疗的进展，非静脉曲张性上消化道出血的住院死亡率有所改善。初始治疗包括复苏、血流动力学监测、质子泵抑制剂治疗和限制性输血。风险分层评分有助于对出血严重程度进行分类并提供预后信息。建议在就诊后24小时内进行上消化道内镜检查；选择风险最低的患者可作为门诊患者进行有效治疗。尽管内镜治疗的使用有所增加，但在12小时内进行急诊内镜检查并不能改善临床结局，包括死亡率、再出血或手术需求。对于有活动性出血证据的患者，急诊内镜检查可能有益。
