Himal H S, Perrault C, Mzabi R
Surgery. 1978 Oct;84(4):448-54.
In a retrospective study of 630 patients with upper gastrointestinal hemorrhage admitted to the Royal Victoria Hospital between 1963 and 1971, the overall mortality was 12.54%. Mortality increased in patients receiving more than 10 units of blood and in patients over 60 years of age. Mortality decreased in patients in whom the site of hemorrhage was known prior to operation. Early surgery for gastric ulcers and conservative therapy for acute gastric erosions reduced mortality. Therefore in 334 patients admitted to the Royal Victoria Hospital between 1973 and 1976 with upper gastrointestinal hemorrhage, an aggressive approach to diagnosis and management was emphasized. There was a significant decrease in patients with duodenal ulcers, acute gastric erosions, and gastric ulcers who received more than 10 units of blood. There was a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant decrease in the number of patients who did not have a diagnosis prior to operation. There was also a significant increase in early surgery for gastric ulcers. This regimen led to a significant decrease in mortality (6.69% vs. 12.54%). This report demonstrates that early diagnosis and management based on the lesion found reduces mortality from upper gastrointestinal hemorrhage.
在一项对1963年至1971年间入住皇家维多利亚医院的630例上消化道出血患者的回顾性研究中，总死亡率为12.54%。接受超过10单位血液的患者以及60岁以上的患者死亡率增加。术前已知出血部位的患者死亡率降低。胃溃疡的早期手术和急性胃黏膜糜烂的保守治疗降低了死亡率。因此，在1973年至1976年间入住皇家维多利亚医院的334例上消化道出血患者中，强调了积极的诊断和治疗方法。接受超过10单位血液的十二指肠溃疡、急性胃黏膜糜烂和胃溃疡患者数量显著减少。用于确定出血来源的内镜检查的使用显著增加，术前未明确诊断的患者数量显著减少。胃溃疡的早期手术也显著增加。这一治疗方案导致死亡率显著降低（6.69%对12.54%）。本报告表明，基于所发现病变的早期诊断和治疗可降低上消化道出血的死亡率。
