Sereda S, Lamont I, Hunt P
Med J Aust. 1977 Mar 12;1(11):362-6.
This report is of the results of management in a haematemesis and melaena unit at Prince Henry's Hospital, Melbourne. The unit was established in October, 1972, in response to unpublished data for the decades 1950 to 1959 and 1960 to 1969, which showed a mortality of about 15%. In the 39 months to December, 1975, 513 patients were received into a semi-intensive care setting. The unit staff consisted of a group of four surgeons and four physicians working a weekly roster. Primary care and liaison were the responsibility of the gastroenterology registrar. The basic diagnostic measure taken was the routine early use of fibreoptic duodenoscopy. The unit was set up with an agreed policy of management of the common causes of haematemesis and melaena, and data were prospectively recorded in a form suitable for computer analysis in every case. Of the 513 admissions, 378 were of males and 135 were of females. Forty-five patients died, giving an overall admission mortality of 8-8. There were 143 admissions for bleeding duodenal ulceration, 102 for acute peptic ulceration, 47 for chronic gastriculceration, 43 for oesophageal varices, 33 for Mallory-Weiss syndrome and 45 for less common causes of upper gastrintestinal bleeding. In 100 cases the source of bleeding was not discovered. Of the 143 patients admitted for chronic duodenal ulcer, either patients died, giving a mortality of 5-6%; 72 patients underwent operation, with an operative mortality of 9-7%. Of the 47 admitted with bleeding gastric ulcer, nine died (19-1%), while 26 came to operation; the operative mortality was 26-9%. There were 102 admissions for acute peptic ulceration, with an overall mortality of 11-7% (12 patients); 16 patients came to operation, with an operative mortality of 43-7%. Eleven deaths occurred in the 43 patients admitted for bleeding oesophageal varices (25-6%), with 10 patients coming to operation; the operative mortality was 30-0%. An age of greater than 50 years and shock on admission were the most significant factors for poor prognosis in this group of patients.
本报告介绍了墨尔本亨利王子医院上消化道出血与黑便治疗单元的治疗结果。该单元于1972年10月设立，这是根据1950年至1959年以及1960年至1969年未发表的数据设立的，这些数据显示死亡率约为15%。在截至1975年12月的39个月里，513名患者被收治进入半强化护理病房。该单元的工作人员包括一组四名外科医生和四名内科医生，他们按周排班。初级护理和联络工作由胃肠病学住院医师负责。采取的基本诊断措施是常规早期使用纤维十二指肠镜检查。该单元依据一项商定的上消化道出血与黑便常见病因治疗政策设立，并且对每一个病例的数据都进行前瞻性记录，记录形式适合计算机分析。在513例入院患者中，男性378例，女性135例。45例患者死亡，总体入院死亡率为8.8%。因十二指肠溃疡出血入院143例，急性消化性溃疡102例，慢性胃溃疡47例，食管静脉曲张43例，马洛里-魏斯综合征33例，上消化道出血其他少见病因45例。100例患者未发现出血源。在143例因慢性十二指肠溃疡入院的患者中，有患者死亡，死亡率为5.6%；72例患者接受手术，手术死亡率为9.7%。在47例因胃溃疡出血入院的患者中，9例死亡（19.1%），26例接受手术；手术死亡率为26.9%。急性消化性溃疡入院102例，总体死亡率为11.7%（12例患者）；16例患者接受手术，手术死亡率为43.7%。43例因食管静脉曲张出血入院的患者中有11例死亡（25.6%），10例患者接受手术；手术死亡率为30.0%。在这组患者中，年龄大于50岁和入院时休克是预后不良的最显著因素。
